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Volume 3 Issue 5
S
upporting
Y
our
P
ractice
Key policies and clinical guidelines related to infant and
toddler oral health appear to be present in curricula.
Other concepts related to infant oral health, such as the
use of fluoride toothpastes and varnishes, infant feeding
practices and caries diagnosis, are also taught. Most
programs recommend fluoridated toothpaste for infants
and toddlers (dentistry 80%, dental hygiene 65.2%). Nearly all
respondents said that their program discusses professional
recommendations for a first dental visit and were aware
of CDA’s position statement on early childhood caries.
2
All
respondents indicated that their curriculum teaches students
about the relationship between bottle feeding and oral
health, and the majority reported teaching students about
breastfeeding and oral health.
Prenatal Oral Health Curriculum
Respondents noted that in most dentistry and dental
hygiene programs, prenatal oral health is a component
of the curriculum. Time is designated in the curriculum
of 40% of dentistry and 69.6% of hygiene programs for
teaching prenatal oral health. Educating students about the
relation between periodontal disease during pregnancy
and premature birth and low birthweight was commonly
reported (dentistry 70%, dental hygiene 95.7%). Most
respondents also reported that their program informs
students about the role of prenatal nutrition in infant oral
health. All mentioned teaching about bacterial transmission
from mother to infant.
Discussion
A search of the Commission on Dental Accreditation
of Canada’s (CDAC) accreditation requirements for a
graduating dentistry student found none specifically
addressing infant oral health. CDAC requires that Doctor
of Dental Surgery and Doctor of Dental Medicine program
graduates “be competent in the management of the oral
health care of the child, adolescent, adult and geriatric
patient.”
15
The document does not identify management
of infant oral health as a separate requirement, although
its inclusion is implied. Similarly, there is no mention of
specific requirements relating to infant oral health for a
graduating dental hygiene student; these graduates must
be “competent to manage health promotion and oral health
care for a range of clients within the life cycle, including
children, adolescents, adults, and seniors.”
16
Because dental
development and progression of dental disease during
childhood vary greatly from birth to adolescence, the lack of
specific inclusion of the infant and toddler age groups may
lead to their omission from curricula.
So how best can we assist educators to prepare dental
professionals to care for pregnant women and young
children? Based on our findings, we propose that curricula
consider didactic, clinical domain and system-wide changes.
Didactic Teaching
The amount of didactic teaching in prenatal and infant oral
health reported by dentistry (70% and 100%, respectively)
and dental hygiene (82.6% and 100%, respectively) programs
is encouraging. Although responding dental hygiene
programs reported more time dedicated to didactic teaching
in infant and toddler oral health than dentistry schools, 44%
of them do not recommend a first visit by 12 months of age.
This suggests the need for re-acquaintance with current
clinical practice guidelines. A survey of Manitoba dentists
found that only 58% were aware of the recommendation
for a first dental visit,
6
but this proportion appears to have
increased following a health promotion campaign by the
profession (Free First Visit program).
7,21
It was reported that
a First Dental Visit campaign by the British Columbia Dental
Association (BCDA) that included hands-on workshops and
an online learning tool has also led to increased numbers of
dentists welcoming infants and toddlers to their offices.
With limited human resources for education,
23,24
innovative
ways to disseminate knowledge about current guidelines
on prenatal and infant oral health could be helpful. Time
could be better devoted to promoting clinical experiences
in this area, a barrier noted by educators in our study.
Development of standardized curricula using innovative
web-based teaching methods, similar to that developed by
BCDA, may provide students with a foundational level of
knowledge.
25
Evidence suggests that web-based delivery
can produce learning outcomes equal to face-to-face
education.
26
Clinical Experience
Our study found that, although many programs teach
about the timing of a first visit, less than a third offer
hands-on experiences in performing assessments. This
lack of clinical experience increases the possibility that
students will not engage in these activities following
graduation.
24,27
Unfortunately, most of the hands-on clinical
experience that students receive is with children 4 years of
age and over.
24,27
A recent Cochrane review found that combining interactive
and didactic formats is a more effective approach than either
alone.
28
Specific to dental education in early childhood,
evidence suggests that comfort is a significant predictor
of general dentists’ stage of readiness
to deliver preventive oral health services
to this cohort. Strategies to promote
comfort and self-efficacy through clinical
experiences during dental education
have been shown to improve knowledge
Based on our findings, we propose that curricula
consider didactic, clinical domain and system-
wide changes.