Ed i to r ia l

Gerodontology – the case for education

As many contributors and readers of this Journal

are aware, very significant demographic changes

have taken place and continue to do so at a rapid

rate. Not so long ago the subject of gerontology, let

alone gerodontology, was a minority area, which

was of only peripheral interest to the majority of

health care providers. Generally old age with all the

various impacts on activity, socialising and diet was

regarded as a process which was accepted as an

inevitable restriction on daily life. One of the most

profound was the loss of the natural dentition and

their replacement with often inadequate prostheses

leading to a limitation of mastication and therefore

the choice of food. Although the number of

edentulous individuals has fallen dramatically over

the last 30 years, the percentage of this group

having problems with speaking, eating and drink-

ing has remained the same. However, the subject

area of gerodontology had its enthusiasts; among

them people involved with the setting up and

development of this Journal as a forum for

research, exchange of clinical techniques and pro-

cedures and the development of partnerships. Also

part of this process is the education of the profes-

sion and hopefully those that come into contact

with elderly people. One of the best times to

inculcate this understanding is during the educa-

tional process.

In the UK, education in gerodontology now

forms a key passage in the General Dental

Council’s framework for undergraduate dental

education, The First Five Years (2002) and I am

sure this would be replicated in other countries.

They state that ‘the student should be aware of

the presentation of dental and oral diseases and

disorders in elderly people, and the range of

psychological and social factors involved in such

situations… be able to distinguish between nor-

mal and abnormal consequences of ageing’. They

also state that the individual ‘should be able to

formulate management strategies for the dental

care of elderly people, and participate with

members of the dental team in implementing

them’. One very important point is also made

which is almost lost within the text but has much

wider implications than just within a dental

curriculum; ‘…learn to avoid stereotyping elderly

people’. It could be suggested that this maxim

should be applied to society at large.

However, it would appear that this educational

process is very variable, even in countries with a

high proportion of older people in their popula-

tions. In some countries, dental schools have a high

prevalence of departments specially devoted to

geriatric or special care dentistry, whereas others do

not. A study of undergraduate teaching in gero-

dontology in dental schools in three European

countries, reported in this issue, indicated large

differences. These ranged from well-established

courses with clearly defined outcomes to very little

being readily identified in the curriculum. A sur-

prising outcome was the view of some dental deans

who did not want the little that was already

included to be increased. Also, hands-on teaching

in nursing homes was rare although it could be

suggested that this would present the undergra-

duate with an insight into the potential difficulties

and limitations of home-based dental care.

An approach which is being taken by the

Association for Dental Education in Europe (ADEE)

is to harmonise the dental curricula across Euro-

pean countries by developing the criteria for the

profile and competencies for the new European

dentist. The Commission of the European Com-

munities has adopted a directive of the European

Parliament and of the Council on the recognition of

professional qualities. Part of this document states

that ‘member states must ensure that the training

given to dental practitioners equips them with the

skills needed for prevention, diagnosis and treat-

ment relating to anomalies and illnesses of the

teeth, mouth, jaws and associated tissues’. The

ADEE document has been out to consultation to

European Dental Schools so that the major com-

petencies of professionalism, knowledge base,

information handling and critical thinking, diag-

nosis and treatment planning, establishing and

maintaining oral health, and health promotion can

be clearly defined with their supporting compe-

tencies. It is anticipated that this document will be

adopted as a framework at the meeting of ADEE

taking place in September and will form a con-

sensus on the future direction of dental education

in order to improve the oral health care systems for

our patients.

In approaching the education of the older per-

son, it has been reported that participating in

activities that stimulate the mind can have a pos-

itive effect on the mental processes and may offer

some protection against senile dementia. These can

be as diverse as crossword puzzles, chess and ball-

room dancing. It has been suggested that learning

� 2004 The Gerodontology Association, Gerodontology 2004; 21: 121–122 121

to speak a second language can not only broaden

the mind but also goes some way to offsetting the

decline of the brain. Research from Canada, where

11 percent of the population speak two languages,

has shown that these individuals have faster reac-

tion times and are less easily distracted while

completing mental agility tasks than those who

only speak a single language, this being signifi-

cantly greater in the older age group. The other

area which is key to the improved quality of life is

to be able to educate the older person and their

carers in preventive oral health. In Japan, a study is

looking at how a telecare system can address some

of these issues by providing a tutorial programme.

This includes information on oral homecare, edu-

cation on oral and general health care and

enhancement of life skills related to exercise and

interpersonal communication. Initial results in this

issue provide a number of interesting ideas as to

how this concept might be utilised.

The clear message that is coming from all of this

is the need for an integrated approach to meet the

aspirations of future oral health care professionals

as well as the needs of this particular group of

patients.

To borrow the phrase of a well-known Prime

Minister: Education, education, education!

James P. Newton

Editor

� 2004 The Gerodontology Association, Gerodontology 2004; 21: 121–122

122 Editorial