The importance of some dental knowledge by members of the medical profession has been widely acknowledged (1–5). The requirement of knowledge of medicine by members of the dental profession is answered by an extensive study of human disease, and an examination has long been part of the undergraduate dental course. However, with some exceptions (1–3), the inclusion of dental subjects in the curriculum for medical students has been limited or neglected (1–5).
Whilst the skill in treating medical and dental disease rests with the professions and specialisations, it is important to realise that there is no absolute anatomical boundary between medicine and dentistry, equally in the recognition of the signs of disease and the knowledge of when to treat and when to refer. Further, a basic knowledge of dentistry by medical practitioners, as much as a basic knowledge of medicine by dentists, increases the respect and improves communication between the professions.
The value of knowledge of oral and dental disease by medical practitioners is illustrated by a survey of patients attending a hospital dental department in the United Kingdom (6). The patients were shown a list of orofacial symptoms and asked whether they would be more likely to visit their physician or their dentist. Beginning with toothache, all the conditions listed were related to the orofacial region. A dentist might consider it appropriate that the patient should consult a member of his profession. However, many of the patients questioned felt it more appropriate to consult their physician and even considered that the physician was better trained in diagnosing such conditions as a swelling under the tongue or white patches on the inside of the cheek. In this way, physicians might expect to frequently encounter patients who present orofacial symptoms. Without appropriate teaching as medical students, they may be otherwise unprepared.
The teaching of dentistry to medical students has been shown to vary greatly between medical schools in the same country as well as between different countries (5, 7). A comprehensive survey of dentistry taught in medical schools in North America showed the considerable variation in United States and Canadian Medical Schools in teaching and local arrangements (5). Oral and dental diseases were most commonly taught as a component of other courses, but in a minority of schools, there was a structured course in dentistry. In the least minority, there was apparently no dental teaching, and no perceived need, although in the vast majority of schools, the teaching of dental topics was perceived to be important.
The presence of a formal association between medical and dental schools was shown to facilitate dental teaching to the medical students, but the overwhelming barrier to a more extensive course was curriculum time. Areas of common interest to dentistry and medicine are cited in an earlier article with the recommendation that medical schools without a dental school affiliation should establish a source for this important teaching and patient care (8).
A recent survey of the teaching of oral and maxillofacial surgery (OMFS) circulated a questionnaire to all medical schools in the United Kingdom (7). All schools that responded offered some teaching of OMFS in lectures or workshops, although in a few, this was only one lecture in the entire medical course. The opportunity for a clinical placement for a period of elective study also existed at a number of schools; however, few students had taken advantage of this. The survey did not consider teaching in any other speciality of dentistry except OMFS in the medical course.
Teachings in adjacent regions to the mouth in the medical course (i.e. ear, nose and throat) may overlap into the oral cavity and general medicine to include signs and symptoms of medical diseases that are manifested in the oral cavity. But the exclusion of all teaching on dental and oral diseases to medical students is hard to justify.
Although probably in all developed countries a central organisation regulates the medical profession and sets standards for professionalism and teaching, the unevenness of the inclusion of dentistry in the medical curriculum detracts from the full place of dentistry as a branch of medicine (9). Only in Poland, are we aware of a mandatory requirement as the result of a government directive (10) which requires that there should be a minimum of 15 h programmed teaching of dentistry to medical students across all eleven medical institutes in that country.
For the past 5 years, the authors of this paper have had responsibility for teaching dentistry in the English language to students on the Medical Course for Foreigners at the Jagiellonian University Medical College, Faculty of Medicine, School of Medicine in Krakow. Two courses are offered by the University: a 6-year undergraduate course in medicine and a shorter 4-year course for students who are already graduated in another discipline. All teaching on the course for foreigners is in English, and students may be from any part of the world. Teaching of dentistry to medical students occurs in the fourth year of the 6-year course and in the third year of the 4-year medical course. Medical courses for Polish nationals in the Polish language at the same University in Krakow include the same requirement for teaching in dentistry. The authors do not presently participate in the Polish language courses for medical students.
We have constructed a well-balanced course in accordance with the Directive of the Polish Ministry of Science and Education 2007 (10). This document defines the minimum dental education requirements for medical students, the objectives of the course and competencies expected of graduates after completion of their studies. The official syllabus directs attention to diseases of the teeth, periodontium and oral mucous membrane, changes in the oral mucosa associated with systemic diseases, systemic manifestations of oral disease, and to understanding the impact that medical treatment might have on the mouth and teeth. After completing the course, students should possess the skill to diagnose dental and oral health and systemic symptoms of dental illness and should know where to refer the patient.
On this basis, our course comprises an introductory seminar, including tooth development and basic dental anatomy, followed by seminars in Orthodontics, Oral Surgery, Oral Medicine, and Restorative Dentistry including Cariology, Endodontics, Prosthodontics and Periodontics. Following the last seminar, there is a short test or examination.
Beginning with the systematic examination of the mouth, we expect to teach the students to recognise the more common oral mucosal conditions, and particularly those that may be precancerous or cancerous and distinguish them from the benign.
In 2011, we are planning for the first time to introduce a clinical element with instruction and practicals in the systematic examination of the mouth, particularly using the mouth mirror or a wooden blade to retract the tongue to examine the depth of the lingual sulcus and floor of the mouth where some of the most significant lesions are known to occur.
Only by learning to examine the entire mouth and recognising the normal appearance and texture of the tissues will the students be able to recognise the abnormal. Further, to understand, it is always acceptable and without hesitation to refer a patient with an unrecognised lesion to a specialist without blame or criticism if the condition or lesion proves to be entirely benign. In the same way, students of dentistry are taught to recognise signs of systemic disease of which the patient may be unaware and make the appropriate referral.
The medical students are interested and appreciative, but the 15 h allocated for the course have been lately compressed into 3 days which is exhausting for the students and the lecturers alike. We believe that such an intensive short period of teaching is a challenge to the students to retain to the end of their medical studies.
At the beginning of each course we have been giving in Krakow, the medical students may have a little more knowledge of dentistry than their own experience of visiting the dentist. Questions asked by the students in the seminars often begin with symptoms they may be presently suffering or have suffered themselves, such as discomfort from an erupting third molar, mottling of the enamel of their incisors or dysfunction of the temporomandibular joint, to quote some recent examples.
There are eleven undergraduate medical schools in Poland of which ten are part of universities also with an undergraduate dental school. All eleven schools teach a medical course in English in addition to the course in Polish, and all are required to follow the directive for the teaching of dentistry to medical students. Although our own experience is exclusively in the English language course in one city in Poland, we assume that the same difficulties may apply to the Polish language courses in this as much as in the Medical Academies in some other cites in Poland. We can, however, report the agreement of the University authorities in Krakow that in future, the dental course for medical students should be in the final year of studies when it will be more relevant and better remembered to the completion of the students’ studies.
Our appeal is to anyone reading this paper with any influence that they will join with us in raising the profile of dentistry in the medical course and the knowledge and appreciation of dentistry amongst the medical profession as a whole. The authors of this paper would welcome any contact with other teachers of dentistry to medical students. There is further scope for a forum of present teachers to share their experience with each other and to support medical schools where dentistry assumes a low priority in the curriculum.