Background:Oral Health (OH) is an important topic and area of medicine that all physicians should understand and that has become a more pressing issue in the last decade. OH is clearly tied to overall health and a number of systemic diseases, such as diabetes, immune disorders and infectious diseases, are known to have oral manifestations. Likewise, a number of oral diseases have systemic manifestations. (Migliorati, 2007). Oral disease and oral health issues affect all ages from infancy through adulthood. Childhood caries affect up to 25% of children in the U.S. and can lead to a lifetime of other oral health issues (Vargas, 2006).

Given these known issues, the Association of American Medical Colleges (AAMC) published Report IX: Contemporary Issues in Medicine: Oral Health Education for Medical and Dental Students in 2008, which challenged medical schools to revise their curricula to include oral health education. The report outlined the necessary changes to a school’s curriculum to provide students with adequate OH training. This report was in response to the 2000 Surgeon General’s Oral Health in America Report and the 2003 A National Call to Action to Promote Oral Health which helped to make the medical and dental communities aware of the fact that they should be trained to provide adequate oral health care.

In addition, the USMLE Step 2CK and Step 3 exams include oral health topics, also making it evident that medical students should be learning oral health subjects during their training. There are some existing oral health curricula, such as the Academy of Pediatrics (AAP) modules on pediatric oral health and care and the Society of Teachers in Family Medicine’s (STFM) Smiles for Life comprehensive oral health curriculum, of which some schools are taking advantage. However, it is unclear to what extent medical schools have actually integrated oral health topics into their curricula to adequate train their students.

Objective:The objective of our survey was to determine the extent to which U.S. allopathic and osteopathic schools are including oral health in their curricula. We specifically were interested in finding out how much time is dedicated to oral health and which topics are being covered, as well as finding out if schools who have not implemented OH are aware of the current guidelines. We also wanted to determine what the level of interest for developing stronger OH curricula is at the schools with no or little OH curriculum.

Methods:Via web search and phone contacts, the ‘Dean of Education’ at all U.S. allopathic and osteopathic schools was identified. A 22-question survey was constructed to elicit demographic information about the school and information about its oral health curriculum (e.g., hours of oral health education, topics covered, and student evaluations about oral health). Other questions included: awareness of USMLE topics in oral health, the existence of the AAMC’s report encouraging OH curriculum development, awareness of existing oral health curriculum, current use of existing curriculum and plans to develop or expand curriculum at their institution. The survey was put into SurveyMonkey format to be sent to schools via e-mail.

The survey was pilot tested with 10 New England schools to gauge implementation issues, response rates and ease of completing the 15-minute survey. Once revisions were made for clarity, the survey was emailed to the remaining 154 Deans of Education (at 126 allopathic and 28 osteopathic schools) with an email explaining the purpose of the study. One week prior to the distribution of the survey link, an email announcing the upcoming survey was sent to all schools. We sent a reminder email to non-respondents (with the survey link) every 2 weeks for a total of 3 reminders. A final phone call was made to each non-responding school to encourage participation.

Descriptive univariate analyses were done using SPSS statistical software. This data was then assessed using chi-square tests and t-tests to examine relationships with school size, school location and the presence of an established affiliation with either a dental school or dental residency using an alpha of .05 to denote statistical significance.

Results:A total of 88 schools replied to the survey out of the 154 schools contacted (response rate: 57.1%). Of the 88 schools, 72 Allopathic schools and 13 Osteopathic schools replied; the remaining 3 were unknown. All regions of the country were represented with slightly higher responses from the Midwest region (29.6%) and lower responses from the Western region (12.5%). Response rates increased with increasing class size; the majority (55.7%) of respondents being from schools with more than 150 students. Most of the responding schools did not have an affiliated dental school (70.5%) nor a dental residency (62.5%). Finally, most schools offered either 1-2 hours (28.4%) or 3-4 hours (30.7%) of oral health curriculum over a student’s four years; one in 10 schools (10.2%) offered no oral health curriculum hours.

An analysis of the relationship between demographic information and the number of current hours of oral health curriculum (less than 5 hours or greater than 5 hours) found that hours of curriculum was statistically significantly related to matriculating class size (p=.022). Schools with greater than 150 students were more likely to offer 5 or more hours of oral health curriculum than small or mid-size schools. School location and having a dental residency and/or school were not found to be statistically significantly related to number of hours of oral health curriculum (p=.728 and p=.271, respectively).

Awareness of oral health questions on the USMLE board exams and/or the AAMC Report on Oral Health Education was also not associated with curriculum volume. In schools with an OH curriculum, topics being covered ranged from 10.0% teaching hands-on skills training to 81.7% covering oral cancers. Only 29.9% reported evaluating students around OH topics.

Conclusions:Few medical and osteopathic schools are currently providing more than 4 hours of oral health curriculum. Only large school size seems to have a positive association with more oral health curriculum. Fewer still are conducting rigorous evaluations of such education. Being aware of the AAMC Report on oral health education or that the USMLE has test questions on oral health, or being affiliated with a dental school or residency did not have a positive effect on the quantity of oral health curriculum. Future educational efforts should utilize these results to create a strategy aimed at promoting an awareness of oral health education requirements, training materials and potential oral health educational champions.

Presented as part of the Senior Scholars Program at the University of Massachusetts Medical School, May 3, 2010.