Number 2

Volume 2

June 1993

INTRODUCTION

Restorative and Prosthetic Dental

Education: Changes, Challenges,
and Opportunities
HE PRACTICE OF dentistry has dramaticall)

changed over the past decade, and one prediction 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 prosthetic 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 employed 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 prosthetic 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 prevalence 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 restorative 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 prostheses 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 dental practice. The list of new procedures and materials
includes bonded restorations and prostheses, laminate veneers, castable glasses, new procelain and
resin inlay-onlay systems, and visible-light polymerized materials. Perhaps most significantly for prosthetic dentistry, the use of dental implants has
increased dramatically in the past few years. National 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

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 education, will be altcrcd. The dental curriculum must
continue to provide students with significant clinical
experience and an appreciation for thc clinical application 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 procedures 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 opportunities to reassess the dental curriculum to assure that it
reflects the restorative and prosthetic services provided 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 education programs that enable dental clinicians to acquire new knowledge and develop new skills to cope
with future practice changes.
Certainly, the restorative and prosthetic education of prcdoctoral and postdoctoral students and

Richurd R. kYmh,Jr
~

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, operative dentistry, fixed prosthodontics, removable prosthodontics, 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