A curriculum for primary care dentistry

This paper is a discussion of curricular planning with respect to primary care dentistry. It is meant to be anticipatory, although the proposals contained are transitional and evolutionary rather than abrupt. It is intended to be suggestive rather than authoritarian and exemplary rather than definitive. Many of the recommendations and suggestions are already operative in dental education, albeit in limited or experimental form. An overview of both the content and the process of a primary care dental curriculum is presented, and several specific recommendations for curricular change are submitted. Among the more salient recommendations are (1) changing the admissions process to attract to dentistry those most qualified for primary care; (2) moving the basic sciences into the predental curriculum during the initial phase in the development of primary care dentistry; (3) substantially increasing the amount of behavioral science in the dental curriculum; (4) placing curricular emphasis initially on diagnosis and expanding the competence of the primary care dentist in endodontics, periodontics, pedodontics, orthodontics, and prevention; (5) initiating student group practice as the vehicle for patient care; (6) including intradisciplinary and interdisciplinary training as integral components of primary care curricula; (7) extending the curriculum; (8) establishing general practice or primary care residencies either as an intracurricular experience or as a postdoctoral requirement; (9) reorganizing dental school clinics and clinical training to reflect primary care curricular goals; (10) making more rational use of existing auxiliaries, the eventual goal being auxiliaries who perform most of the routine functions; and (11) ultimately integrating dentistry into medicine so that the future primary care practitioner receives both medical and dental training. It is obvious that the extent to which any of these recommendations will be implemented depends on a great deal more than what happens within a dental school. There are many putative countervailing forces which can make implementation difficult; on the other side of the ledger, these same forces might be propitious. As an illustration, the staggering financial constraints imposed on the dental schools can cause us to throw up our hands in despair or can impel us to look carefully at what we are doing, ask why we are doing it, and by building on what is sound and discarding the antiquated and irrelevant, reassemble our curricula to meet public need better than we have been doing...