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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 16  |  Issue : 3  |  Page : 288-293

Influence of early clinical exposure for undergraduate students on self-perception of different aspects of geriatric dental care: Pilot study between two colleges from Japan and India


1 Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
2 Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College, Tokyo, Japan

Date of Submission17-Dec-2015
Date of Acceptance08-Apr-2016
Date of Web Publication18-Jul-2016

Correspondence Address:
Pravinkumar G Patil
Division of Clinical Dentistry, School of Dentistry, International Medical University, Jalan Jalil Perkasa 19, Kuala Lumpur 57000
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-4052.186402

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  Abstract 

Objective: The objective of this study is to identify the influence of early clinical exposure for undergraduate students on self-perception of different aspects of geriatric dental care. Materials and Methods: We have selected two different colleges from Japan and India, namely, Tokyo Dental College (TDC), Tokyo, and Government Dental College (GDC), Nagpur, respectively. The GDC students exposed to patients in a 3rd year and TDC in the 5th year of course. Survey of 74 undergraduate students GDC and 95 of TDC was conducted. The questionnaire was developed based on to the 50 points undergraduate curriculum by European College of Gerodontology. The questionnaire categorized into four parts; Part I (15 questions) on aging and medicine, Part II (15 questions) on communication skills, Part III (15 questions) on diagnosis/treatment, and Part IV (5 questions) on need of more training in Gerodontology. Their own-perception on self-knowledge and competency was scored on 4 level scale as 3, 2, 1, and 0 for response yes, rather yes, rather no, and no, respectively. Average scores were calculated and presented. Results: The differences of the opinions as per students' perception level were found to be slightly more affirmative in GDC students (1.9 for the 4th year and 2 for the 5th year) than TDC students (1.1 for 5th grade and 1.5 for 6th grade). Both clinical and didactic hours should be increased in curriculum according to the TDC (89%) and GDC (79%) students. Separate gerodontology subject is suggested from TDC (76%) to GDC (81%) students. Conclusion: Average scores about own-perception of knowledge and competency about aging, medicine, and communication skills were almost same in both GDC and TDC students. With early clinical exposure, GDC students appear have better self-perception regarding the different aspects of the geriatric dental care including subject knowledge, communications, diagnosis, and treatment planning than TDC students with late clinical exposure.

Keywords: Aging, dental education, geriatric dental care, gerodontology


How to cite this article:
Patil PG, Ueda T, Sakurai K. Influence of early clinical exposure for undergraduate students on self-perception of different aspects of geriatric dental care: Pilot study between two colleges from Japan and India. J Indian Prosthodont Soc 2016;16:288-93

How to cite this URL:
Patil PG, Ueda T, Sakurai K. Influence of early clinical exposure for undergraduate students on self-perception of different aspects of geriatric dental care: Pilot study between two colleges from Japan and India. J Indian Prosthodont Soc [serial online] 2016 [cited 2020 Jan 29];16:288-93. Available from: http://www.j-ips.org/text.asp?2016/16/3/288/186402


  Introduction Top


Aging is associated with disabilities, compromised general health and quality of life. Oral health is an essential component in general health.[1] Geriatric dentistry is a science pertaining to the multidisciplinary and multidimensional approach to the management of the oral health problems of the elderly. Awareness and knowledge would facilitate the setting up of separate health care units for the elderly along with oral health care clinics and involvement of multidisciplinary teams, mobile oral health services, domiciliary services in the urban and rural areas, and provision of systematic oral health care.[2] Anehosur and Nadiger (2012) studied the attitude toward the elderly population in 98 5th year students and concluded that there is a need to change the perspective of the students toward elderly by the inclusion of geriatric dentistry in the dental curriculum.[3] Komabayashi et al. studied the pattern of didactic, practical, and clinical activities taught in India as well as in Japan and found out that there is a considerable difference between two countries.[4] India and Japan are two countries with fastest growing geriatric populations.[3] In absolute size of the aged population, the India ranks 4th (population 77 million).[5] The average life expectancy at birth increased from 50.5 years for males and 49.0 years for females in 1970–1975 to 61.8 years for the males and 64.1 years for females in 1999–2001; it is expected to reach 69.8 years for males and 72.3 years for females by 2021–2025.[6],[7] In the West, geriatric dentistry is a subject that is spread across the dental undergraduate curriculum and pertains to every aspect of oral health needs of the young old (65–74 years); old (75–84 years), and the oldest old (85 + years). Careful consideration of all coexisting medical problems before initiating treatment is a cardinal rule in geriatric care.[8],[9] Shah described that gerodontology is not structured as an independent specialty at postgraduate level, and the undergraduate curriculum does not have any significant component about the subject in India.[5] The lack of training results in poor understanding of special needs of older adults. Even in Japan, there is no such official training program exist in the undergraduate curriculum.[5] Oral care guidelines designed to assist elderly should consider not only prevention and treatment modalities but also the means of implementing such therapies in varying settings and utilizing the whole dental team.[10] Any preparation toward the provision of oral health care should not be limited to treatment alone but more importantly focus on empowering this elderly community with information and education programs.[11] Increasing numbers of older people and decreasing rates of edentulism highlight the importance of dental education that focuses on oral health and aging. Exposure of students to didactic and clinical setting appears to be a critical element toward positive knowledge and attitude of the elderly.[12]

The educational goal of gerodontology is to raise awareness of barriers to care and to prepare dental students, in terms of knowledge, attitudes, ethics, and skills to provide appropriate oral health care for the older adults. Part of the problem is related to the limited training of undergraduate dental students in all the factors relevant to the oral care of the elderly. Modifications are required in the dental undergraduate and postgraduate curricula to provide appropriate knowledge, attitudes, and skills. The survey was planned with the preparation of the questionnaire to know students' own-perception about their knowledge and competency in various curriculum components of gerodontology. The representative dental schools Government Dental College (GDC) and Tokyo Dental College (TDC) from India and Japan were selected, respectively, for a pilot project. We hypothesize that the early clinical exposure may influence the student's self-perception of different aspects of geriatric dental care including subject knowledge, communication skill with geriatric patients, and diagnosis and treatment planning.


  Materials and Methods Top


Our unique 50 questions validated and based on 50 point-undergraduate curriculum guidelines in gerodontology by the European College of Gerodontology.[13] Questions were considered 4 parts as 15 for knowledge, 15 for communications, 15 for treatment, and 5 for lectures. Subsequently, the questions are scattered in the questionnaire to indicate the competency, knowledge or familiarity of the question. (1) Be competent (C) at means: The student should have a sound theoretical knowledge and understanding of the subject together with an adequate clinical experience to be able to resolve clinical problems encountered, independently, or without assistance. (2) Have knowledge (K) of means: Students should have a sound theoretical knowledge of the subject, but need only to have limited clinical/practical experience. (3) Be familiar (F) with means: Students should have a basic understanding of the subject, but need not have direct clinical experience or be expected to carry out procedures independently.[14]

Investigation was by a questionnaire and unsigned method. Their knowledge and competency were scored as follows: 3 points for the response “yes,” 2 points for “rather yes,” 1 point for “rather no,” and 0 point for “no.” Total 52 5th grade students (just before clinical training in hospital) and 44 6th grade students (just after clinical training in hospital) of TDC were selected [Table 1]. From GDC, 36 students of the 4th year and 38 students from Internship (5th year) were selected to responds for the questionnaire [Table 1]. All 100% of the students enrolled to the survey have given filled up the survey form.
Table 1: Distribution of the students participated in the survey

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  Results Top


Average scores were calculated for all the students in, GDC Nagpur and TDC [Table 2]. Data were presented in the average score of each question from each grade/year students from GDC and TDC. The comparison of average values is described in the [Graph 1 [Additional file 1]]. It was found that, for the questions from the part I and Part II categories, both college students had given the similar responses as per their own-perception in knowledge and competency. The difference of the opinions as per students' perception level was found to be slightly more affirmative in GDC students (1.9 for the 4th year, 2 for the 5th year) than TDC students (1.1 for 5th grade, 1.5 for 6th grade). The part III questions are principally competency related questions covering the syllabus related to the diagnosis, treatment planning, therapy, and prevention. Both clinical and didactic hours should be increased in curriculum according to the TDC (89%) and GDC (79%) students. Separate gerodontology subject is suggested from TDC (76%) and GDC (81%) students.
Table 2: Average score of student responses for each question

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  Discussion Top


The average scores about knowledge were almost same before and after clinical training in TDC. On the other hand, the average scores about communication skill, diagnosis, planning, etc., after clinical training were higher than it before clinical training. Therefore, it was thought that students acquired the competency of gerodontology during clinical training, and the importance of clinical training in the competency education of gerodontology became clear anew in this study. Compare to students in TDC, average scores in many parts were high in GDR's students. Although the elderly ratio of India is 7.7% now, it will be 11% in 2020. Advance of rapid aging like Japan is expected. Since it is under such a situation, the consciousness to GDC students' gerodontology is considered to be a high thing. On the other hand, Japan is under much higher elderly ratio. However, TDC students have same or lower interest in gerodontology compare to GDC. The necessity for the illuminative education about the importance of gerodontology to students is suggested in this study.

It has been reported that the attitude of dental students toward elderly patients is more or less neutral when the regular dental curriculum is followed. It was felt that the curriculum needed to be developed to try to modify students' attitude from neutral to positive, to enhance health care delivery.[15] Without adequate training and personal experience of growing old, young graduates may not be able to understand the physical, socio-economic, and psychological problems of the elderly and the complexities involved in treatment planning for patients with multiple chronic diseases and medication. It is emphasized that geriatric dentistry should be included in each of the preclinical, paraclinical, and clinical subjects at the undergraduate level. Graduate students should be encouraged to treat elderly patients in clinics under supervision using a multidisciplinary approach. The knowledge and skills required for oral health care of elderly may improve the attitude to treat them more carefully and tenderly. As compare to pediatric dentistry, the geriatric dentistry in not so well-developed throughout the world. Since the ratio of the percentage of the elderly to that of the pediatric population is approximately 7:35, there are more number of specialty clinics and postgraduation specialty courses in pediatric dentistry. However, looking at the geriatric population and their special need there are quite a few geriatric care centers or specialty courses. Currently, in some countries, there are no such official postgraduate courses available. Hence, we need to depend upon the undergraduate dental students to take care of these people. The nature of undergraduate dental training courses to treat elderly population is different in different countries. We selected two dental collages from two different countries India and Japan to where the geriatric population proportion is relatively more. The magnitude of the dental requirements for the elderly can be gauged from the fact that, i.e., the pediatric population is 5 times the elderly population. These patients are healthy and have their parents to look after them, whereas there are no oral health care centers catering to the special needs of the elderly. In spite of these demographic pointers indicative of the future volume of geriatric oral health care needs, there is no specialist in this field and as yet, no formal training on this subject has been introduced in the dental curriculum.


  Conclusion Top


Average scores about own-perception of knowledge and competency about aging, medicine, and communication skills were almost same in both GDC and TDC students. With early clinical exposure, GDC students appear have better self-perception regarding the different aspects of the geriatric dental care including subject knowledge, communications, diagnosis, and treatment planning than TDC students with late clinical exposure.

Acknowledgment

This study was conducted during author PGP's 'International Scientific Exchange Program between Indian Prosthodontic Society (IPS) and Japanese Prosthodontic Society (JPS) 2010.' The author thanks Dr. V. Rangarajan (IPS), Dr. Kazuyoshi Baba (JPS) and Dr. Masahiro Yamada, Japan.

Conference presentation

This study was presented in 39th Indian Prosthodontic Society Conference, Dubai, UAE in December 2011.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century – The approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31 Suppl 1:3-23.  Back to cited text no. 1
    
2.
Talwar M, Chawla HS. Geriatric dentistry: Is rethinking still required to begin undergraduate education? Indian J Dent Res 2008;19:175-7.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Anehosur GV, Nadiger RK. Evaluation of understanding levels of Indian dental students' knowledge and perceptions regarding older adults. Gerodontology 2012;29:e1215-21.  Back to cited text no. 3
    
4.
Komabayashi T, Raghuraman K, Raghuraman R, Toda S, Kawamura M, Levine SM, et al. Dental education in India and Japan: Implications for U.S. dental programs for foreign-trained dentists. J Dent Educ 2005;69:461-9.  Back to cited text no. 4
    
5.
Shah N. Need for gerodontology education in India. Gerodontology 2005;22:104-5.  Back to cited text no. 5
    
6.
Registrar General, India, Report and Tables on Age, Series-I, India, C-14, C-14 SC and C14 ST. Vol. I. Census of India 2001: New Delhi; 2004.  Back to cited text no. 6
    
7.
Registrar General, India, Population Projections for India and States 2002-2006: Report of the Technical Group on Population Projection Constituted by the National Commission on Population: New Delhi; 2006.  Back to cited text no. 7
    
8.
Nitschke I, Müller F, Ilgner A, Reiber T. Undergraduate teaching in gerodontology in Austria, Switzerland and Germany. Gerodontology 2004;21:123-9.  Back to cited text no. 8
    
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Kalk W, de Baat C, Meeuwissen JH. Is there a need for gerodontology? Int Dent J 1992;42:209-16.  Back to cited text no. 9
    
10.
Bharti R, Chandra A, Tikku AP, Arya D, Gupta R. Oral care needs, barriers and challenges among elderly in India. J Indian Prosthodont Soc 2015;15:17-22.  Back to cited text no. 10
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Deogade SC, Vinay S, Naidu S. Dental prosthetic status and prosthetic needs of institutionalised elderly population in oldage homes of Jabalpur city, Madhya Pradesh, India. J Indian Prosthodont Soc 2013;13:587-92.  Back to cited text no. 11
    
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Fabiano JA, Waldrop DP, Nochajski TH, Davis EL, Goldberg LJ. Understanding dental students' knowledge and perceptions of older people: Toward a new model of geriatric dental education. J Dent Educ 2005;69:419-33.  Back to cited text no. 12
    
13.
Kossioni A, Vanobbergen J, Newton J, Müller F, Heath R. European College of Gerodontology: Undergraduate curriculum guidelines in gerodontology. Gerodontology 2009;26:165-71.  Back to cited text no. 13
    
14.
General Dental Council. The First Five Years. A Framework for Undergraduate Dental Education. 2nd ed. London: General Dental Council; 2002.  Back to cited text no. 14
    
15.
Eyison J, Mann J, Holtzman JM, Mersel A. A comparative study of the attitude of dental students towards the elderly. Eur J Prosthodont Restor Dent 1992;1:87-90.  Back to cited text no. 15
    



 
 
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