Volume 2 Number 2 June 1993

INTRODUCTION

Restorative and Prosthetic Dental Education: Changes, Challenges,

and Opportunities HE PRACTICE OF dentistry has dramaticall) T changed over the past decade, and one predic-

tion seems safe: more changes can be expected in the future. Several items that relate to knowledge of current and future dental health needs are worthy of consideration when planning restorative and pros- thetic education programs for the dental clinicians of the 21st century.

Older Americans (ages 65 and older) comprise the fastest growing segment of the US population. It is projected that when the baby boom generation enters this stage of life in the 21st century, the over-65 age group will constitute more than one third of the total population.' Since the 1960s, the increased use of dental services by the 65-and-older age group has far surpassed the increase in dental visits in all other reported age group^.^ If past predictors of utilization of dental services remain equally applicable in the future, the demand for dental services will continue to increase with the next generation of older adults.

Just as the demographics of the population are changing, the demographics of dental disease are changing. There has been a gradual decrease in thr number of edentulous people over the past three decades. Edentulism will continue to decline despite the aging of the population. However, according to a National Institute of Dental Research survey of oral health, those over 65 years of age with teeth havc lost an average of more than 10 of 28 teeth, and em- ployed dentate persons from 55 to 64 years of age have lost an average of 9 of 28 teeth? Therefore, millions of individuals without complete dentitions will require integrated fixed and removable pros- thetic procedures well into the 21st century. .4-

though significant reductions in dental caries have been documented in several western nations, the epidemiology of root caries has shown that preva- lence increases with age, number of teeth, and number of gingival recessions.& Furthermore, the impact of increased cervical abrasion-erosion has not been considered because of limited data. Another area becoming increasingly imporant in the restor- ative and prosthetic treatment of older indiTiduals is the replacement of existing restorations. One survey recently indicated that more than 50% of the income presently generated through restorative procedures is the direct result of replacement of restorations in patients older than 40.? Similar high rates of prosthe- ses replacement were also noted in the areas of fixed and removable prosthetic procedures.

New restorative and prosthetic procedures and inaterials are continually being introduced into den- tal practice. The list of new procedures and materials includes bonded restorations and prostheses, lami- nate veneers, castable glasses, new procelain and resin inlay-onlay systems, and visible-light polymer- ized materials. Perhaps most significantly for pros- thetic dentistry, the use of dental implants has increased dramatically in the past few years. Na- tional estimates showed that the number of implants placed each year rose between 1986 and 1990. In this period, there was a 73% increase in the number of implants placed.6 Improved laboratory and clinical research is essential if dentistry is to ensure that rest0ratii.e and prosthetic procedures and materials are selected on a truly scientific basis.

It is apparent that restorative and prosthetic education programs for the 21st century must face the challenge of continually reassessing curricular

Journal ofProsthodontics,, Vol2, N o 2 (June),, 1993:jp 73-74 73

74 Introductzon 0 Richurd R. kYmh, ~ Jr

adequacy in training dental clinicians to meet the needs of a society with changing health needs and desires. As the demographics of dental disease and the population change, the requiremenls and scopc of dental practice, and correspondingly dental educa- tion, will be altcrcd. The dental curriculum must continue to provide students with significant clinical experience and an appreciation for thc clinical appli- cation of scientifically developed procedures and materials. It will be necessary for dental education to effectively address geriatric dentistry, integration of fixed and rcmovable prosthodontics, restoration of teeth that have been previously rcstored, new proce- dures and materials, imlant prosthodontics, as wcll as the ongoing issues of infection control and dental laboratory procedures.

Fortunately, associated with the reassessmcnt of restorative and prosthetic education programs will be opportunities. Among these will he the opportuni- ties to reassess the dental curriculum to assure that it reflects the restorative and prosthetic services pro- vided by the dental profession; identify clinical and laboratory competencies that should be eliminated from or addcd to the curriculum; identify the best use of available curricular time; and establish educa- tion programs that enable dental clinicians to ac- quire new knowledge and develop new skills to cope with future practice changes.

Certainly, the restorative and prosthetic educa- tion of prcdoctoral and postdoctoral students and

continuing education of dental clinicians will pro1,ide challenges to dental educators for years to come. Perhaps the most important challcngc will be to take advantage of the opportunity to address the new complexities involved in teaching the concepts of restorativc and prosthetic dentistry. More emphasis uill be needed toward biomatcrials, occlusion, opera- tive dentistry, fixed prosthodontics, removable prosth- odontics, and implant prosthodontics, so that future dental clinicians will have the knowledge and skills to meet the dental health needs in the 21st century.

Richard R. Seal$, Jr, DDS. MEd, ilLS Section Editor

REFERENCES 1. Page R: Periodontal disease in the elderly: A critical evaluation

of current information. Gerodontology 1981;3:63-70 2. Waldman HB: The dental profession and the elderly: A

Iavorable opportunity. Spec Care Dentist 1984;1:9-12 3. Oral IIealth of United Statcs Adults, Thc National Hcalth

Sumey of Oral IIealth in United States Eniploycd Adults and Seniors. US Department of Health and Human Services 1987, NIH publication 87-2868

1. Douglass C W , Gammon MD: The futurc need for dental trratmcnt in Canada. J Can Dcnt Assoc 1985;51:583-590

5. Meskin LII, Dillenberg J, Heft M W , et al: Economic impact of dental service utilization by older adults. J Am Dent Assoc 1990; 120:665-668

6. Stillman N, Douglas CW: The developing market for dental implants. .JL4rn Dent Assuc 1993;124:51-j6