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1 Attitudes and Awareness of Final-Year Predoctoral Dental and Medical Students to Medical Problems in Dentistry Yehuda Gill, D.M.D., M.Sc.; Crispian Scully, C.B.E., M.D., Ph.D., M.D.S., M.R.C.S., F.D.S.R.C.P.S., F.D.S.R.C.S., F.F.D.R.C.S.I., F.D.S.R.C.S.E., F.R.C.Path., F.Med.Sci., D.Sc. Abstract: An increasing proportion of the population is medically compromised. Dental and medical staff need to communicate and cooperate to afford these patients the best possible health care. In this study, the attitude towards and awareness of medical problems were examined in final-year predoctoral (undergraduate) dental and in final-year medical students. The results revealed that most dental students felt their knowledge of and training in medical problems in dentistry to be moderate to good. In contrast, most medical students thought both their knowledge and training in medical problems in dentistry to be only poor to moderate. rated the importance of medical problems in dentistry higher than did medical students. Dr. Gill, who lives in Haifa, Israel and was formerly with the University of Witwatersrand, Johannesburg, South Africa, is now with the Eastman Dental Institute for Oral Health Care Sciences and International Centres for Excellence in Dentistry, WHO Collaborating Centre for Disability, Culture and Oral Health, University College London, University of London; and Prof. Scully is with the Eastman Dental Institute for Oral Health Care Sciences and International Centres for Excellence in Dentistry, WHO Collaborating Centre for Disability, Culture and Oral Health, University College London, University of London. Direct correspondence and requests for reprints to Prof. Crispian Scully, Eastman Dental Institute for Oral Health Care Sciences and International Centres for Excellence in Dentistry, University College London, University of London, 256 Gray s Inn Road, London WC1X 8LD, Great Britain; phone; fax; c.scully@eastman.ucl.ac.uk. See also ucl.ac.uk/staff/cscully.html. Key words: dental education, medical education, medical, oral, medical complications Submitted for publication 3/27/6; accepted 6/15/6 An increasing number of patients have medical problems that might necessitate modifications in oral health care. For example, demographic predictions of the age distribution of the U.S. population indicate that, by the year 22, 2 percent will be over the age of sixty-five, with a considerable increase in a number of diseases, including cancers. 1 Increasing numbers of younger patients also present with medical problems, both as a result of the appearance of new diseases such as HIV disease and because of control of many chronic illnesses that previously would have claimed their victims at an earlier age. Elderly patients and others suffering from cardiovascular diseases such as ischaemic heart disease and hypertension, those with transplants, and those with cancer or HIV infection are therefore increasingly encountered in dental practice. 2 Patients presenting with medical problems in dentistry may require special management and treatment planning, 2,3 and there is increasing need for a team approach involving both dental and medical practitioners as well as professions complementary to dentistry and medicine. For these health care professionals to be in a position to communicate adequately about relevant medical problems, appropriate knowledge of oral health care and potential interactions with medical conditions is essential. The purpose of this study was to examine the attitude and awareness of final-year dental and medical undergraduate students towards medical problems in dentistry. Materials and Method One hundred and fifty-seven university predoctoral (undergraduate) clinical students were surveyed; seventy were final-year dental students and eighty-seven were final-year medical students of the University of Witwatersrand, Johannesburg, South Africa. All were presented with a questionnaire covering three areas: 1) knowledge of medical problems in dentistry; 2) undergraduate training in medical problems in dentistry; and 3) importance of medical problems in dentistry. Students were asked to grade their knowledge of medical problems as excellent, good, moderate, or poor; undergraduate training as excellent, good, moderate, or poor; and importance September 26 Journal of Dental Education 991

2 as very, reasonably, of little, or very little importance. An area for other unsolicited responses was included. The questionnaires were collected in person by one of the authors (YG) after one hour. Results All 157 questionnaires were completed, an excellent response. In the category of knowledge of medical problems in dentistry, nearly 63 percent of dental students graded their knowledge as moderate, 37 percent as good, and none of them graded their knowledge as either poor or excellent. Seventy-seven percent of medical students graded their knowledge as poor, 22 percent as moderate, and only 1 percent as good, but none graded their knowledge as excellent. (See Figure 1 and Table 1.) In the category of undergraduate training, nearly 49 percent of the dental students graded their undergraduate training in this topic as good, 33 percent as moderate, 14 percent as excellent, and 4 percent as poor. About 9 percent of the medical students graded their undergraduate training in medical problems relevant to dentistry as poor, while 9 percent graded it as moderate. None of the medical students graded their undergraduate training in this topic to be good or excellent. (See Figure 2 and Table 1.) In the category of importance of medical problems in dentistry, most dental students (67 percent) graded medical problems in dentistry as very important and 33 percent as reasonably important, while none of them graded the importance as little or very little. Over percent of the medical students graded the importance as reasonably important, 42 percent as very important, and 7 percent as of little importance. None of the medical students graded the importance of medical problems in dentistry as of very little importance. (See Figure 3 and Table 1.) Table 1. Medical and dental predoctoral students knowledge, training, and perceived importance of medical problems in dentistry (% respondents) Knowledge Training Importance Medical Dental Medical Dental Medical Dental Poor/Low Moderate Good Excellent/High poor m oderate good excellent Figure 1. Students perception of their knowledge of medical problems in dentistry 992 Journal of Dental Education Volume, Number 9

3 Discussion In this questionnaire study, with a 1 percent response, the attitude towards and awareness of medical problems were examined in final-year dental and medical students. The results revealed that most dental students reported that they felt their knowledge of and training in medical problems in dentistry were moderate to good. In contrast, most medical students thought both their knowledge and training in medical problems in dentistry were only poor to moderate. rated the importance of medical problems in dentistry higher than did medical students. The present study revealed that whilst most final-year dental students stated they were aware of the importance of medical problems in dentistry and felt their undergraduate training in medical problems in dentistry to be good, many lacked confidence and assessed their knowledge to be only moderate. In contrast, medical students from the same university felt that both their undergraduate training and poor m oderate good excellent Figure 2. Students perception of their undergraduate training in medical problems relevant to dentistry problem s 2 1 m inim al im portant Figure 3. Students perception of the importance of medical problems September 26 Journal of Dental Education 993

4 knowledge of medical problems in dentistry were poor. Of course, such a global questioning without identifying specific disease examples might elicit a different response, and this is not to say that these attitudes or the level of awareness persist into the graduate years, but there is no evidence to suggest there are changes. Medical problems in dentistry may be viewed from two perspectives. First, the management of medically compromised patients may require modified dental treatment. Those with ischaemic heart disease, especially if there is angina pectoris or myocardial infarction, and others with valvular lesions may, for example, require special management. Bleeding disorders such as haemophilia or anticoagulant therapy are other examples of conditions that may dictate that dental treatment be modified. Patients suffering from infectious diseases such as viral hepatitis or HIV disease, as well as cancer patients, are further examples. 2-4 Second, there may be oral manifestations that are the first presentation of systemic diseases: for example, some haematological, gastrointestinal, rheumatological, infective, and dermatological diseases may present with mouth ulcers. 5 All need preventive care, and many will need dental treatment at some stage. These patients commonly seek treatment from general dental practitioners. 6 The increasing burden of patients with medical problems has been recognized by the increasing emphasis given to medical problems in dentistry in predoctoral (undergraduate) and postdoctoral (postgraduate) education and training programs and in the literature 2-4 and emergence of societies, 7,8 journals, 9,1 literature, and specialties specifically related to special care dentistry Dentists are continuously urged to cooperate with the patient s medical practitioner. The results of this study give rise to concern that both the medical practitioner and, to some extent, the dental practitioner may not be able to give medical problems in dentistry adequate consideration. The available evidence indicates that few medical students or doctors in the UK receive any training in oral disease, and few medical texts contain much data about the mouth. 39 Indeed, in one UK study, only eleven of the twenty-one medical schools that responded about the teaching of oral pathology/medicine in their medical curricula suggested they had any coverage of the area, and the authors of that report concluded that doctors and medical students are inadequately educated about oral diseases. Conclusions The results of this small study revealed that most dental students felt their knowledge of and training in medical problems in dentistry to be moderate to good. In contrast, most medical students thought both their knowledge and training in medical problems in dentistry were only poor to moderate. Dental students rated the importance of medical problems in dentistry higher than did medical students. Further studies that examine the objective knowledge of these two groups are needed. It is also incumbent upon both dental and medical practitioners to keep their knowledge updated. REFERENCES 1. Balducci L. Epidemiology of cancer and aging. J Oncol Manag 25;14(2): Scully C, Cawson RA. Medical problems in dentistry, 5th ed. Edinburgh: Elsevier, Little JW, Falace DA, Miller CS, Rhodus NL. Dental management of the medically compromised patient, 6th ed. St. Louis: C.V. Mosby Co., Davies R, Bedi R, Scully C. ABC of oral health 9: oral health care for patients with special needs. Br Med J 2;321(7259): Scully C, Flint S, Porter SR, Moos K. Oral and maxillofacial diseases, 3rd ed. London: Taylor and Francis, Goss AN. The dental management of medically compromised patients. Int Dent J 1984;34(4): At: Accessed: March At: Accessed: March At: Accessed: March At: Accessed: March Nunn J, ed. Disability and oral care. London: FDI World Dental Press, Chapple JR, Nunn JH. The oral health of children with clefts of the lip, palate, or both. Cleft Palate Craniofac J 21;38(5): Fiske J, Boyle C. Epilepsy and oral care. Dent Update 22;29(4): Fiske J, Griffiths J, Jamieson R, Manger D, British Society for Disability and Oral Health Working Group. Guidelines for oral health care for long-stay patients and residents. Gerodontology 2;17(1): Fiske J, Griffiths J, Thompson S. Multiple sclerosis and oral care. Dent Update 22;29(6): Fiske J, Hyland K. Parkinson s disease and oral care. Dent Update 2;27(2): Fiske J, Lloyd HA. Dental needs of residents and carers in elderly peoples homes and carers attitudes to oral health. Eur J Prosthodont Restor Dent 1992;1(2): Journal of Dental Education Volume, Number 9

5 18. Fiske J, Shafik HH. Down s syndrome and oral care. Dent Update 21;28(3): Fiske J. Dental care for elderly people with a handicap. Dent Update 1992;19(7): Fiske J. Diabetes mellitus and oral care. Dent Update 24;31(4):19-6, Kaye PL, Fiske J, Bower EJ, Newton JT, Fenlon M. Views and experiences of parents and siblings of adults with Down syndrome regarding oral healthcare: a qualitative and quantitative study. Br Dent J 25;198(9): Lee AP, Boyle CA, Savidge GF, Fiske J. Effectiveness in controlling haemorrhage after dental scaling in people with haemophilia by using tranexamic acid mouthwash. Br Dent J 25;198(1): Narang A, Maguire A, Nunn JH, Bush A. Oral health and related factors in cystic fibrosis and other chronic respiratory disorders. Arch Dis Child 23;88(8): Newton JT, Fiske J, Foote O, Frances C, Loh IM, Radford DR. Preliminary study of the impact of loss of part of the face and its prosthetic restoration. J Prosthet Dent 1999;82(5): Nunn JH, Gordon PH, Carmichael CL. Dental disease and current treatment needs in a group of physically handicapped children. Community Dent Health 1993;1(4): Nunn JH, Sharp J, Lambert HJ, Plant ND, Coulthard MG. Oral health in children with renal disease. Pediatr Nephrol 2;14(1-11): Oliver CH, Nunn JH. The accessibility of dental treatment to adults with physical disabilities in northeast England. Spec Care Dentist 1996;16(5): Porter SR, Scully C. Oral healthcare for those with HIV and other special needs. Northwood: Science Reviews, Schembri A, Fiske J. The implications of visual impairment in an elderly population in recognizing oral disease and maintaining oral health. Spec Care Dentist 21;21(6): Scully C, Diz Dios P, Kumar D. Special care dentistry: handbook of oral health care. Edinburgh and London: Elsevier Churchill Livingstone, Scully C, Kumar N. Dentistry for those requiring special care. Prim Dent Care 23;1(1): Scully C. Special problems. In: Manning J, ed. General dental practice. Kluwer Publications, 1981:(A)5.9-1 to Scully C. Special problems. In: Beard D, Bennett MR, eds. General dental practice. Kluwer Publications, 1987:(A)5.9-1 to Scully C, Diz Dios P, Shotts R. Oral health care in patients with the most important medically compromising conditions; 2. congenital coagulation disorders. CPD Dentistry 24;5: Scully C, Diz Dios P, Shotts R. Oral health care in patients with the most important medically compromising conditions; 3. anticoagulated patients. CPD Dentistry 24;5: Scully C, Diz Dios P, Shotts R. Oral health care in patients with the most important medically compromising conditions; 4. patients with cardiovascular disease. CPD Dentistry 24;5: Scully C, Diz Dios P, Shotts R. Oral health care in patients with the most important medically compromising conditions; 1. platelet disorders. CPD Dentistry 24;5: Shaw MJ, Kumar ND, Duggal M, Fiske J, Lewis DA, Kinsella T, et al. Oral management of patients following oncology treatment: literature review. Br J Oral Maxillofac Surg 2;38(5): McCann PJ, Sweeney MP, Gibson J, Bagg J. Training in oral disease, diagnosis and treatment for medical students and doctors in the United Kingdom. Br J Oral Maxillofac Surg 25;43(1):61-4. September 26 Journal of Dental Education 995

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