Dental Education at the Crossroads Challenges and Change (1995) / Chapter Skim
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2 Evolution of Dental Education
2 Evolution of Dental Education
Pages 35-58
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From page 35... ...
The question of who should assess dental practice and education and in what fashion-has provoked controversy for more than a century. The following brief account of the evolution of dental education provides context for the rest of this report.
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From page 36... ...
1905 National Board of Dental Examiners published percentage of graduates of schools who failed licensing examinations 1906 First dental hygienist trained 1906 First public school-based dental assessment funded in Rochester, New York 1909 Dental Educational Council of America established by national organizations of dental examiners, dental faculties, and dental practitioners 1910 Novocaine introduced in the United States 1910 Publication of Abraham Flexner's report on medical education 1910 Graduation from high school established as prerequisite for dental school .
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From page 37... ...
. Organlzatlons 1923 American Dental Hygiene Association established 1924 University of California Dental School funded by Carnegie Foundation and NRC for study of pyorrhea 1925 NRC appointed committee to investigate mottled teeth 1926 Publication of William Gies' report on dental education 1931 Link between fluoride and mottled teeth established, potential for caries protection reinforced 1931 NRC dental advisory committee recommended creation of dental research bureau 1933 First national written board examinations administered 1941 Dental school accreditation standards published by ADA council 1944 Dental problems identified as major reason for rejecting recruits during World War II 1945 First controlled water fluoridation projects initiated by PHS in Grand Rapids, Michigan to test effect on decay 1948 National Institute of Dental Research {NIDR)
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From page 38... ...
129-201) routinely discussed oral health problems and advised pharmacological and mechanical strategies for managing and sometimes preventing pain, tooth decay, tooth loosening, bad breath, gum swelling, and abscesses.
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From page 39... ...
FORMAL EDUCATION: EARLY DEVELOPMENTS A SLOW START Formal or institutional dental education began in the United States in 1840 when the state of Maryland chartered the Baltimore College of Dental Surgery, possibly after the medical department of the University of Maryland refused a request that it include dental education in its curricuTum.2 3 Regardless of its origins, Interestingly, in his 1910 report on medical education, Abraham Flexner refers to this institution as the "so-called medical department of the so-called University of Maryland," one that established early in the nineteenth century the "harmful precedent" of proprietary institutions that "were not a branch
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From page 40... ...
Some groups viewed the establishment of independent schools as more practical on grounds that medical schools would be unwilling to supply the requisite physical space and expensive equipment, to support the greater technical or mechanical training needed by dentists, or to maintain truly collegial relationships with dental faculty (Sissman, 1971~. Nonetheless, when the medical community sought out dentists, the latter could be skeptical and even hostile.
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From page 41... ...
In 1860, the newly organized American Dental Association (ADAl5 charged one of its committees with preparing an annual report on the state of dental education {McCluggage, 1959~. This activity provided a forum for collective discussion and debate about dental education when the initial efforts of dental schools to organize an association dissolved amidst disputes about criteria for granting degrees, in particular, unearned degrees.
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From page 42... ...
to the disgrace of the profession and to the dishonor of dental education. Many of the dental schools that were chartered since 1884 have been .
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From page 43... ...
The report reflected and reinforced several themes or innovations in medical education including the mobilization against proprietary medical schools; the rationalization of the relationship between universities and professional schools; the creation of higher standards for medical school admissions and for better-qualified, full-time faculty; and the movement toward education grounded in scientific research and thinking.6 6Flexner's promotion of full-time research-oriented medical faculty was attacked by many respected physicians. For example, William Osler foresaw "the evolution throughout the country of a set of clinical prigs, the boundary of whose horizon would be the laboratory .
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From page 44... ...
TABLE 2.2 Conclusions of the Gies Report on Dental Education, 1926 1. In universities, dentistry, an independent division of health service and, in effect, the oral specialty of the healing art, should receive the quality of consideration and support now deservedly accorded to medicine.
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From page 45... ...
A liberal preprofessional education stimulates the spirit of inquiry and scientific thinking and helps prepare dental students to be the intellectual peers and colleagues of medical students. Better predental education would allow transfer of some courses from the predoctoral to the predental level and encourage better teaching of the basic sciences at the predoctoral level.
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From page 46... ...
By 1926 when Gies's criticism of these schools was published, only three proprietary dental schools remained.7 Also, as already mentioned, the economic realities of bringing proprietary schools up to standards implied by state licensing laws or defined by the Council on Medical Education had a major effect. In Paul Starr's characterization, "these changing economic realities, rather than the [FIexner]
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From page 47... ...
{An initiative in the 1970s to revive the three-year concept was also relatively unsuccessful, as described later in this chapter.J Gies's conclusion that predoctoral education should emphasize general practice and avoid early specialization remains largely in place today, and predental educational requirements at most dental schools have become more or less equivalent to those for medical schools. Gies's support for hospital internships and a broad array of graduate specialty programs also had some influence.
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From page 48... ...
The various objectives behind the drive for professionalization in general and educational standards in particular are sources of both tension and harmony between the practice and the education communities. The National Association of Dental Examiners jNADEl, organized in 1883, put pressure on the dental schools to improve standards for accepting students and granting degrees, and it criticized the weakness of the major association of dental educators, the National Association of Dental Faculties iNADFl.8 The latter organization, which was created in 1884, took most of the propri ~Unless otherwise indicated, this discussion relies primarily on McCluggage, 1959.
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From page 49... ...
tA high school diploma was not required for dental school admission until 1916 tWard, 1972~.) Echoing the split between institutional and preceptor models of dental education in the late nineteenth century, the American Dental Association {then called the National Dental Association)
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From page 50... ...
Initially, the battle over uniform standards focused on the development of a uniform written national examination that dealt with knowledge of the basic sciences and certain clinical matters. The National Board of Dental Examiners was created in 1928 amidst intense controversy over the initiation and control of such a uniform examination.9 It administered the first nationwide written examinations in 1933 and 1934, but by 1958, only 32 states accepted the national examination certificates as a full or partial substitute for a state written examination {Damiano et al., 1992~.
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207~. Like early dental education, early dental research, at least In its applied aspects, was troubled by disputes about commercialism.
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Even though the 1941 standards of the ADA's Council on Dental Education {created in 19381 required that dental schools conduct research, only 21 of the 40 dental schools even applied for the new funds. SINCE 1 948 With the creation of the National Institute for Dental Research in 1948, the federal government initiated a focused albeit still modest effort to promote research in oral health problems.
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From page 53... ...
· The NIDR contracted with the ADA in 1964 for an information center to collect and make available dental research data that could be used in designing and developing research and training programs. · In 1974, the National Research Service Award Act created a separate congressional authorization for research training, after the Nixon administration had impounded all NIH training funds and proposed elimination of all federally supported research training (IOM, 19904)
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From page 54... ...
As discussed further in Chapter 3, these data are still limited in important respects. In light of their generally limited involvement in research at midcentury, it is not surprising that dental schools figure little in the most important oral health research of that period, that is, investigation of the oral health effects of fluoride {Rosebury, 1955, reprinted in Oriand, 1992; McNeil, 1957; McClure, 1970; Harris,
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From page 55... ...
From time to time, for example, controversy has focused on dental school clinics as a source of competition for practitioners and a form of "corporate dental practice," akin to the prepaid group practices that provoked the opposition of physicians from their earliest days. When the dean of the dental school at Columbia University proposed early in this century to offer dental services "at a moderate charge to persons in moderate circumstances," rather than only low-cost preventive and medical services, he was strongly criticized {Oriand, 1992, p.
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When the Medicare program was established in 1965, it excluded dental services and that exclusion remains in place. Although required to cover some services for children, most state Medicaid programs pay relatively little for dental care, especially for adults (OTA, 1990~.
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One early response came in the Health Professions Educational Assistance Act of 1963 tP.L. 88-1291, which provided for construction and expansion grants to schools and for loans to students.
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SUMMARY The twentieth century opened for dental education with an abundance of proprietary schools, a trade not fully transformed into a profession, and a primitive regulatory structure. The population was beset by serious dental disease, resigned to tooth loss, and limited in the treatments available to it.
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