CARIOLOGY TEACHING IN LATIN AMERICAIN LATIN AMERICA

(LA)(LA)FOP

The ‘University’ Critical View

JAIME A CURY

JCury@fop unicamp brJCury@fop.unicamp.br

PIRACICABA DENTAL SCHOOLUNIVERSITY OF CAMPINAS

1. Cariology: Why are we still studying caries?. Concepts about Cariology: What has been used to be? What should be?

2. What, How Cariology has been taught in LA?

3. Dichotomies on Cariology TeachingTh h i d t l d t t d i l f k- The archaic dental departments and curriculum framework

4. How Cariology should be taught?gy g5. Dichotomy between Cariology teaching and

practicespractices6. Teaching Cariology and Changing Paradigmsg gy g g g

7. Conclusions

..a new idea or concept ‘does not..a new idea or concept does not

triumph by convincing the opponents p y g pp

and make them see the light, but rather g ,

because its opponents eventually die, pp y

and a new generation grows up that is

familiar with it’

1940Max Planck, 1940

Cariology = The study of dental cariesgy

• What has been studied?• What has been studied?

- The disease?- Its causes?Its causes?- The diagnostic?

Th ti ?- The prevention?oror- The treatments?

1986-2008 Textbooks evolution

1986“In recent years it has been become evident that dental caries can only beIn recent years it has been become evident that dental caries can only be prevented, if the dental profession has a thorough knowledge of the Biological variables influencing the disease pattern”

Thylstrup & Fejerskov. Textbook of Cariology

1994“Cariology is the discipline within stomatology which deals with the complexCariology is the discipline within stomatology which deals with the complexinterplay between the oral fluids and the microbial deposits in relation to subsequent change in the dental hard tissues.” “It is not merely a theoretical and academic exercise but it is central in any“It is not merely a theoretical and academic exercise, but it is central in any

attempt to Manage dental caries that be at community level orindividuals in the dental office ”individuals in the dental office.

Thylstrup & Fejerskov. Textbook of Clinical Cariologyy p j gy

2003“We hope that the scientific evidence and experience presented in the bookWe hope that the scientific evidence and experience presented in the book enable the reader to perform evidence-based dental care within the field of Cariology and Restorative Dentistry”

Fejerskov & Kidd. Dental caries: The disease and its clinical management

2008“It is our hope that that this book prepare the reader to become a lessp p p

dogmatic and more knowledgeable Health Professional who strives

to Control dental caries in the most cost-effective way”to Control dental caries in the most cost-effective way

Fejerskov & Kidd. Dental caries: The disease and its clinical management. 2 d d2nd ed.

in conclusion: Cariology studies the..in conclusion: Cariology studies thebiological factors of dental caries! ...

..Cariology should be the study of dental i dicaries as a disease...

1. The causes: Which is or are?Bacteria infectious disease?- Bacteria infectious disease?

- A bacteria transmittable disease?

- A biofilm (plaque) disease?

- A biofilm sugar-dependent disease?

Lack of fluoride?- Lack of fluoride?

- A multifactorial, complex disease?

- A biosocial disease?

Dental caries as a disease...

2 The diagnosis: How?2- The diagnosis: How?- Tactil instrument?

- Visual?

- VisuTactil (“Sharp eyes & blond explorer”)?

Electronical instruments (lasers etc)?- Electronical instruments (lasers, etc)?

- Social Instruments (Who is sick?)

. The 36? The individual or the society?

Dental caries as a disease...

3 The prevention3- The prevention- Which level?

. Community Health? Individual?

- Using what?

Fluoride?. Fluoride?

. Vaccine?

. Sugar restriction?

. Biofilm control?

Dental caries as a disease...

4 The treatment: How?4- The treatment: How?- Operatively (Invasive)? p y ( )

. How much? (Mini-Invasive, µInvasive..?) --

- Not Invasive

Controlling biofilm?. Controlling biofilm?

. Using Fluoride?

2- WHAT, HOW CARIOLOGY HAS BEEN TAUGHT IN LATAUGHT IN LA

No data about LA 1 publication about NA- No data about LA, 1 publication about NAClark & Mjor. Current teaching of Cariology in North AmericaD t l S h l O D t 2001 26 412 8Dental Schools. Oper Dent 2001;26:412-8

• 66% repondents from 65 Dental Schools• 66% repondents from 65 Dental Schools• Marked variations in the teaching• Cariology was not promoted as predicted 20 years agogy p p y g• Programs lack of details and depth• Only 3 schools had a separate department or discipline ofC i lCariology

“The fact that Cariology is not a recognized specialty in gy g p yNorth America may also contribute to the lack of

attention in this area”

2- WHAT, HOW CARIOLOGY HAS BEEN TAUGHT IN LATAUGHT IN LA

- In LA there are ~ 300 dental schools and myIn LA there are 300 dental schools and myfirst view doing an internet search is:

M t f th h h i f k f d t t• Most of them have an archaic framework of departments ordisciplines

• With very few exceptions, teaching of Cariology is not integrated,the subject is taught by several disciplinesj g y p

“In Brazil there are 23 dental specilties and Cariology is t i d b t th 2 i lti d linot a recognized one but there are 2 specialties dealing

with dental caries, Operative Dentistry and Dentistica”

...I presume..

3- DICHOTOMIES ON CARIOLOGY TEACHING A i LA i th i l (R t ti• Are we in LA in the surgical (Restorative

Dentistry) age?

BasicClinical

RestorativePreventiveBasic Restorative

DentistryDentistry

Doctor ofDental Surgery

DICHOTOMY BETWEEN RESTORATIVE DENTISTRY & PREVENTIVE DENTISTRY

g y

PREVENTIVE DENTISTRY a) One discipline is responsible for the invasive treatment and

the other for the preventionb) Prevention is not part of the treatment of caries, it is a

phylosophy!

3- DICHOTOMIES ON CARIOLOGY TEACHING A i LA i th bi l i l (C i l ) ?• Are we in LA in the biological (Cariology) age?

Basic ClinicalRestorative

PreventiveCariology Restorative

DentistryDentistry

DDSCariologist

DICHOTOMY BETWEEN RESTORATIVE DENTISTRY & PREVENTIVE DENTISTRY & CARIOLOGYPREVENTIVE DENTISTRY & CARIOLOGY

a) Cariologist does researchb) DDS tib) DDS practices

3- DICHOTOMIES ON CARIOLOGY TEACHING A i LA i th i l (“ f ”) ?• Are we in LA in the social (“causes of causes”) age?

Basic ClinicalRestorative

CommunityD ti tCariology Restorative

DentistryDentistry

DDSCariologist HealthProfessional

DICHOTOMY BETWEEN RESTORATIVE DENTISTRY & PREVENTIVE DENTISTRY & CARIOLOGY & SOCIAL DENTISTRYPREVENTIVE DENTISTRY & CARIOLOGY & SOCIAL DENTISTRY

a) DDS treats cariesb) C i l i t d h b t ib) Cariologist does research about cariesc) Dental Health Professional discuss caries

4- How Cariology Should be Taught

Basic ClinicalRestorative

CommunityCariology Restorative

DentistryDentistry

Dental Doctor?

The teaching of Cariology should be done on the best understanding ofThe teaching of Cariology should be done on the best understanding of what is known about the etiology and pathogenesis of dental caries so that diagnosis, prevention and control of lesion progression, as well as

d i i b t h d h t f t ti t t t bdecisions about when and how to perform restorative treatments, can be made based on comprehensive knowledge of the disease and its

different manifestationsF&K 2003

5- Dichotomy between Cariology teaching and practicepractice

P i d t l C i lPeriodontology vs. Cariology

Periodontology Cariology• It was born in 1965 1980?It was born in 1965 1980?• Disease of one (?) cause “Complex”• It is a discipline not yet• It is a discipline not yet • It has identity Biological!

T hi & P i S li• Teaching & Practice Split• Dental Specialty Noty• Periodontics ?

6- Teaching Cariology and Changing ParadigmsDental Caries Management in the XXI CenturyDental Caries Management in the XXI Century

1- Is dental caries an infectious disease?2- Is dental caries a transmittable disease?3 H fl id k i t l?3- How fluoride works on caries control?

4- Is dental caries a biosocial disease?

Nyvad et al. Cariology in the 21st Century – State of the art and future perspectives. CariesRes 38 (3), 2004Fejerskov, O. Changing paradigms in concepts on dental caries: Consequences for OralHealth Care. Caries Res 2004;38(3):182-191

6- Conclusions

The achievements by Cariology have not yet

translated either to the clinic practice or at

community level because the different actors are

t l i t th ith l i th lnot playing together with one only aim, the oral

health care!health care!

Will it change? When? How?

6- Conclusions

1- ..most of traditional Professors of RestorativeWhen?

Dentistry and Preventive Dentistry retire? and...2 Al h t f l i C i l i t2- Also, when most of revolucionary Cariologistsretire? but...3- Have we a new generation that understandsand advocates the need for new strategies in theand advocates the need for new strategies in themanagement of dental caries?

“Although it is very difficult teach new home ways to an oldAlthough it is very difficult teach new home ways to an olddonkey, it is never too late to mend!”

Cury JA, 2009

6- ConclusionsHow?

I hope that this conference hold in the mostI hope that this conference hold in the most

beautiful city (marvelous!) of the world has a

simple solution ...

Dental caries is a biofilm-sugar dependent disease

SugargLoaf

Rio de Janeiro, RJ, Brasil

“Caries Free” 12-year old children y

(%)

Th kTh k !!!!!!ThankThank youyou !!!!!!

40FluorideFluoride10

1990 20031990 2003

Piracicaba, SP, BrazilJCury@fop.unicamp.br