Association for Dental Education in Europe

Learning together to improve oral health and quality of life

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Dentistry and Society

In addition to treating individual patients, a Dentist must be able to focus on promoting health, monitoring interventions and implementing effective strategies of care at community and population levels.

This necessarily involves understanding population demography and health trends, engaging with health policy and promoting health.

A Dentist must also understand population demography and health trends, in the context of the healthcare system, or systems, within which they work.

Recognising that most of dentistry is provided in a primary dental care setting, where Dentists practise as members of teams in healthcare systems, it is vitally important that Dentists:

  • take account of the wider context within which they practise
  • integrate effectively with society
  • advocate for general and oral health, and system change

The undergraduate curriculum should reflect the importance of these principles and provide students with the opportunity to engage outside of dental settings. To understand populations and their health, new graduates must understand demographic changes and trends in oral/general health and society, which have major implications for their future patient base and care provision. Additionally, it is important to be aware of wider contextual influences: social, political, economic and environmental and their influence on populations and the health workforce. Dentists must be capable of promoting the general and oral health of their community, and that of the wider population.

This population health aspect of the dental undergraduate curriculum is often labelled “Community Dental Health,” “Dental Public Health” or “Preventive Dentistry.” This may, in turn, be delivered by a range of dental specialties such as (but not exclusively) Restorative Dentistry, Special Care Dentistry, Periodontics, Endodontics, Prosthodontics, Gerodontology, Paediatric Dentistry, Oral Medicine, Oral Surgery and Orthodontics.

Five competences have been identified by the GED that a graduating european dentsits must demonstrate.

4.1 Dental Public Health

Dental public health is concerned with the strategic aspects of dentistry at individual, community and population levels. It has been defined as “the science and art of preventing oral disease, promoting oral health and the quality of life through the organised efforts and informed choices of society; organisations, public and private; communities and individuals” (Gallagher 2005).

Four learning outcomes have been identified in this competence by the GED.

4.1.1 Dental public health

Dental Public Health and discuss its implications for dental practice

4.1.2 Public health strategies

Describe effective public health strategies

4.1.3 Recognised public health problems

Discuss oral and systemic diseases, and their associated risk factors, which are recognised public health problems

4.1.4 Advocate for oral and general health

Advocate for oral and general health with patients and the community including policy leaders

4.2 Health Promotion and Disease Prevention

Health promotion not only addresses diseases and behaviours which take a common risk factor approach (Sheiham and Watt 2000) but also seeks to take into consideration the wider social determinants of health and, in doing so, uncovers the fundamental causes (Phelan et al. 2010). This recognises that health follows a social gradient, and better health often arises as a result of increased socio‐economic position (Graham 2007). Dental professionals should therefore be conscious that promoting oral health means identifying the contexts in which people live their lives, taking into account the health promotion action areas recommended by the World Health Organisation (WHO 1997). Addressing social inequalities in health means that interventions should be appropriate to reduce the gradient (Marmot 2010, Marmot and Bell 2011). The opportunity for students to participate in community oral health projects, either during their formal programme or as part of an elective study period, is therefore highly recommended.  Eight learning outcomes have been identified that the graduating european dentist must demonstrate. 

4.2.1 Concepts and definitions

Describe concepts and definitions of general and oral health

4.2.2 Social determinants of health

Discuss the social determinants of health (and health inequalities)

4.2.3 the importance of context

Appraise the importance of context, when applying the evidence base for health promotion

4.2.4 Behaviour change

Evaluate the importance and limitations of behaviour change at population level

4.2.5 Professional advocacy

Appraise the importance of professional advocacy for population health in achieving change

4.2.6 Inter-professional approaches

Describe and implement interprofessional approaches to disease prevention and promotion, including the training of non‐dental health care providers

4.2.7 Common risk factor approach

Discuss and advocate for a common risk factor approach in promoting health

4.2.8 Health promotion approaches

Discuss approaches to health promotion and disease prevention which address inequalities in health

4.3 Population demography, health and disease

The graduate Dentist must have knowledge of the global burden of oral disease (Marcenes et al. 2013), population demographic, social, health, and oral health trends; and consider the implications for oral diseases and conditions and the practice of dentistry. Wider European and global perspectives will be important given Dentist and patient movement. The tools for assessing and monitoring oral health needs should be understood and the implications of findings.

The graduating european denist must demonstrate seven learning outcomes in this competence.

4.3.1 Demographics

Describe demographic trends and discuss their implications

4.3.2 Epidemiological tools and indicators

Describe the process of assessing population oral health needs including the use of epidemiological tools and indicators

4.3.3 Current trends

Discuss the trends of oral diseases

4.3.4 National and global trends

Discuss national and global oral health trends and their implications

4.3.5 Political, social and economic trends

Discuss political, social and economic trends and their implications for health

4.3.6 Inequalities

Debate inequalities in health and oral health

4.3.7 Common risk factors

Discuss and promote the association of oral health with general health and quality of life, including common risk factors for disease

4.4 Healthcare systems

It is important to gain insight into public and private healthcare systems, the policies governing systems at national and European levels and how healthcare systems serve the population, particularly vulnerable groups.

Knowledge of national policies and those advocated by the World Health Organisation and the United Nations will be particularly important resources, including concepts of universal health coverage (World Health Organisation 2013, World Health Organisation 2016), human resources for health (World Health Organisation 2016) and the integration of oral health with wider general health assessment, to meet sustainable development goals.

Additionally, it will be important to explore how health systems are orientating towards prevention and managing risk, as well as defined disease, and examining patient experience and outcomes with an emerging emphasis on “value‐based healthcare”; this considers how treatments are distributed across a population, how effectively treatments meet the needs of the population, and individual patients.

The graduating European dentist must demonstrate seven learning outcomes have been achieved.

4.4.1 Equity of access

the organisation and delivery of oral health care in relation to equity (public and private) of access, quality and outcomes

4.4.2 Evidence based population healthcare

Discuss evidence‐based population healthcare interventions

4.4.3 Oral health policy

Describe known oral health, and wider health, policies

4.4.4 General mechanism

Describe the general mechanisms of delivering health care

4.4.5 Remuneration and payments systems

Describe various remuneration and payment systems and debate their merits

4.4.6 Changes in health services

Discuss examples of changes in health services at local and national levels in support of health

4.4.7 Career choices

Describe available career choices and training opportunities

4.5 Planing for health and oral health

Just as Dentists plan care for individual patients, students should have the chance to explore strategic planning for the health of populations. This should draw on theory and the evidence base for community and population interventions. They should have the opportunity to consider different populations and the needs of different patient groups.  Four learning outcomes have been identified witin this competence.

4.5.1 Public health interventions

Provide examples of effective public health interventions

4.5.2 Strategies for using the team

Discuss strategies to best use dental (and wider health care) teams for oral health

4.4.3 Future research informing oral health promotion

Discuss future research needed to inform oral health promotion, disease prevention and the delivery of dental care

4.4.4 Co production of care

Discuss principles of coproduction of care with local communities

© ADEE 2019

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