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More Than Meets The Teeth

Unlock the secrets of dental health with Prof Toh Chooi Gait. Delve into comprehensive insights, innovative approaches, and transformative care that go beyond the surface.

As the field of dentistry advances with new technology and equipment enabling ever more complicated procedures, so too must the education of dental students. Prof Toh Chooi Gait, IMU’s Professor of Restorative Dentistry at the International Medical University (IMU), Kuala Lumpur, talks about how dental education has grown over the years.

Did you know that dentistry has its roots in barber shops? In the old days, a visit to the barber meant that you could get a myriad of self-care services – have your hair cut, clean out your ears, and check your teeth. This was where the field of dentistry evolved from and it’s no accident that the chairs at both establishments share similarities – from hydraulics to adjust heights and mechanics to recline customers…and patients.

Dentistry has of course come a long way since then. “The early dentists learned through apprenticeship. In Malaysia, there was no formal education until the 1950s when we started to formulate laws for dental education,” says Prof Toh. There were no local institutes of higher learning that offered dentistry then but today there are 13 universities that offer the course around the country.

That’s why you need five years to study dentistry – it’s much more than just 32 teeth.

says Prof Toh.

A WIDE SCOPE OF STUDY

Much has changed over the decades and thanks to advances in materials and tools, the dentist is not such a scary place to visit. These changes have also had a big impact on how and what students learn in dental schools. For example, Prof Toh recalls that when she was a student, training was centred around precision – when preparing cavities, fillings, and indirect cast restorations you had to be precise to the micron. Cavities prepared need sharp line angles and completed fillings need to be polished to a shiny and smooth surface. “At that time, we still used amalgam, and amalgam didn’t stick to teeth so well. The new materials used today have micro retention properties so the old principles of cavity preparation and the techniques of making sure things stay in place are no longer as relevant,” she says.

Today, dental students learn a lot more about diseases and how to manage them. Although tooth decay and gum disease are still the main diseases they deal with, dentists also deal with other diseases from cysts to cancer. According to Prof Toh, dentists used to be the first to diagnose conditions such as AIDS and tuberculosis because these would present as lesions in the mouth or jaws before they showed up in other areas of the body.

AN EDUCATOR’S ROLE

The role of the dentist in the community has also evolved over the years. Instead of just learning to treat, students now learn to take on the role of educator. “It’s about teaching people to maintain their teeth for life. Our aim is for every person to have at least 20 teeth to see them through life,” Prof Toh says, explaining that with this number of teeth, you would still be able to eat properly and therefore maintain good nutrition as we age. “There are fewer cases of tooth extraction today compared to when I was studying,” says Prof Toh.

Students are also trained to go beyond just regurgitating the same dental health information and oral hygiene instructions to every patient. Prof Toh feels it is important that students are taught to personalise their approach according to the patient’s particular situation. “This is what we call person-centred care. We look at you as a person within your environment, such as factors of family and work life. We teach students to appreciate people’s circumstances and personalise their instructions and make it doable for the patient,” says Prof Toh. For example, she says, when treating the homeless, the issue might not be about awareness of oral hygiene, but the lack of access to the basic needs – a toothbrush, toothpaste and clean water.

Prof Toh cites a former tagline of the IMU dental clinic – to transform lives through oral wellness. “It’s about the relationship established with a patient so that you care for them as a whole. I always tell students, that in the future, I predict every person will have a personal dentist and a personal doctor to keep them healthy,” she says. In her vision, dentists will play a big part in maintaining overall health and prevention of diseases rather than be there only when there is a problem.

CHANGES IN DELIVERING EDUCATION

One of the big changes that Prof Toh initiated when she started the School of Dentistry at the IMU was the cessation of the schedule of requirements for her students. The schedule is a list and quantity of procedures and treatments that a student needs to have done during their studies. According to Prof Toh, while the schedule ensures that a student has adequate practice with different treatment procedures and techniques, it ends up taking the focus away from the patient. The tendency is for students to see patients as a means to fulfil their quota and they are not keen to take on cases that don’t help them to achieve this and abandon cases after they had their quota fulfilled. “It doesn’t make it person-centric,” she says.

Currently, students are provided with sufficient experience with patients who come in for varied treatments without the students having a number in mind. In this way, students are encouraged to treat patients as a whole – seeing to all their patients’ needs rather than only what is on the list of requirements. The interactions are tracked, and patients then get to evaluate the students on their professionalism.
In this way, the school can measure and evaluate students as a whole, and not just on specific technical dental skills.

“It’s about outcome- and competency-based education – it’s not just providing a license to practise but training the person holistically to be a responsible professional,”

says Prof Toh.

A FACILITATIVE AND REFLECTIVE PRACTICE

According to Prof Toh, today’s education also needs to develop students who think creatively by being less instructive and more facilitative. One of the ways this has been achieved is through challenge-based learning – where students go into a community, identify its challenges, find solutions, implement and evaluate the results of the solutions. “It is not about assessing how successful the solutions are but rather training them to think. When they implement, evaluate, and reiterate their solutions, it trains their minds to see things in different ways,” says Prof Toh. This prepares students to tackle challenges and ultimately prepares them for work.

As part of resetting students’ mindsets, reflective learning sessions have also been implemented. At the end of each clinical session, students have small group reflections with the clinical supervisor where they get to discuss what has gone well, what they were not happy about and what they could do better. “Learning is one thing, but reflecting on what you have done gives you more confidence and helps you remember. It’s powerful,” says Prof Toh, adding that graduates have later come back to her saying that they continue to practise this at their workplace.

TECH-ING IT FURTHER

Of course, the use of technology has changed many things in education, and in dentistry, one of the advancements is that students get to practise on virtual patients. With the help of AI, simulators and haptic technology, students can even select the type of patient and what problems they have and get a feel of procedures in a simulated environment. This has proven helpful in engaging young students, as Prof Toh remarks, “Young students enjoy tech.”

The advances and changes in education though depend on each country and what their needs are. For example, in Japan, undergraduates are not allowed to treat real patients. They can only use simulators while they are in university, and this means that simulators have evolved in leaps and bounds there. “They have very lifelike robots that can talk and give feedback and even express pain!” says Prof Toh.

Technology also means that information is easily accessible on our phones and other devices, and therefore remembering theory and information is not as crucial for the dental student. Rather, it is knowing where to get the information, adapting it to the patient and relating it to the patient that is important. “They need to know how to personalise care,” says Prof Toh.

COMMUNICATION IS THE KEY

What would be the key skill then for today’s dental student? “Communication,” says Prof Toh. “What used to be considered soft skills are now considered essential skills,” she says. Students need to know how to empower their patients to take charge and maintain, not just their teeth but their health. To do this, they need interpersonal and communication skills to be relevant to patients, to motivate them to adopt healthier lifestyles and to build trust with their patients. “This is one thing that technology, such as AI or the robot, cannot replace,” she says.

LEARNING NEVER STOPS

Today’s education landscape is a far cry from what it used to be. Today, students can take charge of their learning and create personalised learning plans. “We are not here to hold your hand all the time. We want to equip you with skills to be successful,” Prof Toh says. To allow person-centred learning, students are allocated a mentor who helps them evaluate the progress of the development of their competencies, identify gaps and then strategise their learning. This may mean taking on e-learning modules or seeking help from a subject matter expert or more time working on simulators.

However, there is one thing that will never change in education and that is the integral nature of continuous learning. Research and new discoveries continually break new ground and no one can predict how things will evolve. It is imperative that students, after graduating and throughout their years of practice, continue to learn and keep up with current knowledge, trends and techniques.

“We cannot prepare a student to know everything that they need to know for their professional life. The learning never stops”

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