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Core Cariology Curriculum Framework in Spanish for Latin American dental schools: development and consensus

Abstract

The aim of this study was to develop and achieve consensus on a cariology teaching framework for dental schools in Latin American Spanish-speaking countries. The Delphi process, with a ≥8 0% pre-defined participants’ agreement, included three phases and a Coordinating Group. During the Preparation phase three panels of experts were selected and invited to participate: a) Regional academic/professional Dental Associations (Associations-Panel): n = 12; b) Regional Dental Schools (Dental-Schools-Panel): existing dental schools (n = 263) from the 19 Spanish-speaking regional countries; c) International academic/professional associations Peer Experts (Peer-Panel): n = 4. Based on consensus documents from Europe, Colombia, the Caribbean, USA, Chile and Spain, and updated scientific evidence, the Coordinating Group developed a baseline framework proposal of domains, main competencies (MC) and specific competencies (SC). The Consultation-Agreement and Consensus phases included three rounds of questionnaires with a step-wise sharing of the MC updated version of the consensus framework with the Dental-Schools-Panel and including SC with the Associations-Panel. Diverse communication strategies were used ( e.g ., independent google-form questionnaires and workshops). Consensus was reached after an on-site Associations-Panel workshop and secret voting, followed by an online meeting with the Peers-Panel. A total of 127 academic/professional institutions participated (Associations-Panel: 11, 91.6%; Dental-Schools-Panel: 112, 42.6%, all countries; Peers-Panel: 4, 100%). The baseline Cariology teaching framework of 5 domains, 10 MC and 92 SC underwent modifications after agreements for a final consensus framework consisting of 5 domains, 10 MC and 85 SC. A Core Cariology curriculum framework in Spanish for Latin American Dental Schools was successfully developed and agreed upon with regional dental academic and professional institutions.

Education, Dental; Dental Caries; Curriculum; Competency-Based Education

Introduction

Dental caries was defined in 2021 as ‘a biofilm-mediated, diet modulated, multifactorial, non-communicable, dynamic disease resulting in net mineral loss of dental hard tissues’, in the international cariology terminology consensus report by ORCA (European Organisation for Caries Research) and CRG IADR (Cariology Research Group of IADR). 11.Machiulskiene V, Campus G, Carvalho JC, Dige I, Ekstrand KR, Jablonski-Momeni A, et al. Terminology of dental caries and dental caries management: Consensus Report of a Workshop Organized by ORCA and Cariology Research Group of IADR. Caries Res. 2020;54(1):7-14. https://doi.org/10.1159/000503309
https://doi.org/10.1159/000503309...
Despite the shift that the understanding of dental caries has undergone over the course of decades, 22.Fejerskov O. Changing paradigms in concepts on dental caries: consequences for oral health care. Caries Res. 2004;38(3):182-91. https://doi.org/10.1159/000077753
https://doi.org/10.1159/000077753...

3.Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, et al. Dental caries. Nat Rev Dis Primers. 2017 May;3(1):17030. https://doi.org/10.1038/nrdp.2017.30
https://doi.org/10.1038/nrdp.2017.30...
- 44.Pitts NB, Twetman S, Fisher J, Marsh PD. Understanding dental caries as a non-communicable disease. Br Dent J. 2021 Dec;231(12):749-53. https://doi.org/10.1038/s41415-021-3775-4
https://doi.org/10.1038/s41415-021-3775-...
and notwithstanding the available evidence-based, best-practice and cost-effective measures, untreated caries in permanent dentition continues to be the most common health condition that occurs in primary teeth in over 40% of children and it is associated with health inequalities. 55.Peres MA, Macpherson LM, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: a global public health challenge. Lancet. 2019 Jul;394(10194):249-60. https://doi.org/10.1016/S0140-6736 (19)31146-8
https://doi.org/10.1016/S0140-6736 (19)3...

6.Bernabe E, Marcenes W, Hernandez CR, Bailey J, Abreu LG, Alipour V, et al.; GBD 2017 Oral Disorders Collaborators. GBD 2017 Oral Disorders Collaborators. Global, regional, and national levels and trends in burden of oral conditions from 1990 to 2017: a systematic analysis for the global burden of disease 2017 study. J Dent Res. 2020 Apr;99(4):362-73. https://doi.org/10.1177/0022034520908533
https://doi.org/10.1177/0022034520908533...

7.Sabbah W, Tsakos G, Chandola T, Sheiham A, Watt RG. Social gradients in oral and general health. J Dent Res. 2007 Oct;86(10):992-6. https://doi.org/10.1177/154405910708601014
https://doi.org/10.1177/1544059107086010...
- 88.Wen PY, Chen MX, Zhong YJ, Dong QQ, Wong HM. Global Burden and Inequality of Dental Caries, 1990 to 2019. J Dent Res. 2022 Apr;101(4):392-9. https://doi.org/10.1177/00220345211056247
https://doi.org/10.1177/0022034521105624...

To change this global health scenario ‘oral health has finally been included in the global agenda’. 99.Eaton K, Yusuf H, Vassallo P. Editorial: The WHO Global Oral Health Action Plan 2023-2030. Community Dent Health. 2023 May;40(2):68-9. https://doi.org/10.1922/CDH_Jun23Editorial02
https://doi.org/10.1922/CDH_Jun23Editori...
By reducing the prevalence of oral disease and promoting well-being through the course of life, and recognizing dental caries as a non-communicable disease, public health actions have been taken by the World Health Organization (WHO) and the World Dental Federation (FDI) to ensure progress towards universal health coverage for oral health by 2030. 1010.World Health Organization. WHO Draft Global Oral Health Action Plan (2023-2030). 2023 [cited 2023 Sep 17]. Available from: https://cdn.who.int/media/docs/default-source/ncds/mnd/oral-health/eb152-draft-global-oral-health-action-plan-2023-2030-en.pdf?sfvrsn=2f348123_19&download=true
https://cdn.who.int/media/docs/default-s...
, 1111.FDI World Dental Federation. Access to oral health through primary health care. 2023 [cited 2023 Sep 17]. Available from: https://www.fdiworlddental.org/sites/default/files/2023-05/FDI%20Access%20to%20Oral%20Health%20Care%20White%20Paper.pdf
https://www.fdiworlddental.org/sites/def...
In parallel, a taskforce from the Alliance for a Cavity-Free Future (ACFF) delivered in 2021 a consensus of policy recommendations ‘towards a more progressive and holistic long-term, patient-centered, tooth-preserving preventive care system, to reduce the incidence of dental cavities and to secure improvements in both oral and general health’. 1212.Pitts NB, Mayne C. A global consensus for achieving a dental cavity-free future. JDR Clin Trans Res. 2021;6(3):264-7. https://doi.org/10.1177/23800844211020298
https://doi.org/10.1177/2380084421102029...
Its first policy recommendation involves curriculum related changes. Simultaneously, experts from Latin America and the Caribbean, gathered together with support from the Latin American Oral Health Association (LAOHA) 1313.Latin American Oral Health Association. Sobre nós: quem somos. São Paulo; 2023 [cited 2023 Sep 17]. Available from: https://laoha.org/sobre-nos/
https://laoha.org/sobre-nos/...
and reported on a regional review of caries-related epidemiology, quality of life, risk factors, prevention and management. 1414.Sampaio FC, Malheiros Z, Benítez C, Stewart B, Bönecker M. Dental caries in Latin American and Caribbean countries: urgent need for a regional consensus. Braz Oral Res. 2021 May;35 suppl 1:e057. https://doi.org/10.1590/1807-3107bor-2021.vol35.0057
https://doi.org/10.1590/1807-3107bor-202...

15.Paiva SM, Abreu-Placeres N, Camacho ME, Frias AC, Tello G, Perazzo MF, et al. Dental caries experience and its impact on quality of life in Latin American and Caribbean countries. Braz Oral Res. 2021 May;35 suppl 1:e052. https://doi.org/10.1590/1807-3107bor-2021.vol35.0052
https://doi.org/10.1590/1807-3107bor-202...

16.Martignon S, Roncalli AG, Alvarez E, Aránguiz V, Feldens CA, Buzalaf MA. Risk factors for dental caries in Latin American and Caribbean countries. Braz Oral Res. 2021 May;35 suppl 1:e053. https://doi.org/10.1590/1807-3107bor-2021.vol35.0053
https://doi.org/10.1590/1807-3107bor-202...

17.Ricomini Filho AP, Chávez BA, Giacaman RA, Frazão P, Cury JA. Community interventions and strategies for caries control in Latin American and Caribbean countries. Braz Oral Res. 2021 May;35 suppl 1:e054. https://doi.org/10.1590/1807-3107bor-2021.vol35.0054
https://doi.org/10.1590/1807-3107bor-202...
- 1818.Pozos-Guillén A, Molina G, Soviero V, Arthur RA, Chavarria-Bolaños D, Acevedo AM. Management of dental caries lesions in Latin American and Caribbean countries. Braz Oral Res. 2021 May;35 suppl 1:e055. https://doi.org/10.1590/1807-3107bor-2021.vol35.0055
https://doi.org/10.1590/1807-3107bor-202...
From the latter, a general recommendation towards a stakeholders’ regional oral health agenda was derived. 1919.Sampaio FC, Bönecker M, Paiva SM, Martignon S, Ricomini Filho AP, Pozos-Guillen A, et al. Dental caries prevalence, prospects, and challenges for Latin America and Caribbean countries: a summary and final recommendations from a Regional Consensus. Braz Oral Res. 2021 May;35 suppl 1:e056. https://doi.org/10.1590/1807-3107bor-2021.vol35.0056
https://doi.org/10.1590/1807-3107bor-202...
This included three Call-to-action initiatives that were defined during the LAOHA online regional symposium- related, held the 14 th of October 2021: 2020.Cariology. Braz Oral Res. 2021 [cited 2023 Sep 17];35 Suppl 1. Available from: https://laoha.org/ebooks/BOR-v35_ebook-en.pdf
https://laoha.org/ebooks/BOR-v35_ebook-e...
Fluoride use and sugar reduction policies in Latin America (1), 2121.Paiva SM, Prado IM, Perazzo MF, Guarnizo-Herreño CC, Acevedo AM, Castillo JL, et al. Situational diagnosis of policies in Latin American and Caribbean countries for the use of fluoride and reduction of sugar consumption. Braz Oral Res. 2023;37(suppl):e121. and working on regional-level consensus documents for cariology teaching among dental schools for Spanish-speaking Latin American countries (2) and for Brazil (3). 2222.Sampaio FC, Bönecker M, Paiva SM, Arthur RA, Cohen-Carneiro F, Ditterich R, et al. Consensus for teaching dental caries in the Portuguese Language at Brazilian dental schools. Braz Oral Res. 2023;37(suppl):e120. This paper focuses on the second Call to action.

Transformation of the cariology curriculum has been driven by the need to translate the caries paradigm shift into education and the practice, to move away from the curative approach shown in cariology teaching surveys in dental schools worldwide ( e.g ., in Japan, 2323.Fukushima M, Iwaku M, Mjör IA. Cariology in Japanese dental schools. Int Dent J. 2004 Oct;54(5):269-72. https://doi.org/10.1111/j.1875-595X.2004.tb00292.x
https://doi.org/10.1111/j.1875-595X.2004...
Europe, 2424.Schulte AG, Buchalla W, Huysmans MC, Amaechi BT, Sampaio F, Vougiouklakis G, et al. A survey on education in cariology for undergraduate den- tal students in Europe. Eur J Dent Educ. 2011;15 Suppl 1:3-8. https://doi.org/10.1111/j.1600-0579.2011.00708.x
https://doi.org/10.1111/j.1600-0579.2011...
Latin America, 2525.Martignon S, Gomez J, Tellez M, Ruiz JA, Marin LM, Rangel MC. Current cariology education in dental schools in Spanish-speaking Latin American countries. J Dent Educ. 2013 Oct;77(10):1330-7. https://doi.org/10.1002/j.0022-0337.2013.77.10.tb05607.x
https://doi.org/10.1002/j.0022-0337.2013...
Brazil, 2626.Sampaio FC, Rodrigues JA, Bönecker M, Groisman S. Reflection on the teaching of cariology in Brazil. Braz Oral Res. 2013;27(3):195-6. https://doi.org/10.1590/S1806-83242013000300001
https://doi.org/10.1590/S1806-8324201300...
, 2727.Ferreira-Nóbilo NP, Rosário de Sousa ML, Cury JA. Cariology in curriculum of Brazilian dental schools. Braz Dent J. 2014;25(4):265-70. https://doi.org/10.1590/0103-6440201300149
https://doi.org/10.1590/0103-64402013001...
Chile, 2828.Díaz-Yokens M, González S, Giacaman RA, Araya-Bustos F, Moncada G, Martignon S. Cariology Curriculum in Chilean Universities. Rev Clín Periodoncia Implantol Rehabil Oral. 2018;11(2):98-101. https://doi.org/10.4067/S0719-01072018000200098
https://doi.org/10.4067/S0719-0107201800...
Canada, 2929.Tikhonova S, Girard F, Fontana M. Cariology education in Canadian dental schools: where are we? Where do we need to go? J Dent Educ. 2018 Jan;82(1):39-46. https://doi.org/10.21815/JDE.018.006
https://doi.org/10.21815/JDE.018.006...
Australia with New Zeland 3030.Raphael SL, Foster Page LA, Hopcraft MS, Dennison PJ, Widmer RP, Evans RW. A survey of cariology teaching in Australia and New Zealand. BMC Med Educ. 2018 Apr;18(1):75. https://doi.org/10.1186/s12909-018-1176-4
https://doi.org/10.1186/s12909-018-1176-...
and Asian and Arabian countries 3131.Splieth CH, Abudrya MH, Anandakrishna L, Cheng L, Al-Khalifa KS, Kim BI, et al. Teaching Cariology in Asia and Arabia. Caries Res. 2022;56(2):109-15. https://doi.org/10.1159/000524168
https://doi.org/10.1159/000524168...
), towards a curricula where caries is considered a preventable disease that can be controlled through a patient-centered, risk-based caries management, with a focus on health outcomes to maintain oral health and preserve tooth structure in the long-term. 3232.Martignon S, Pitts NB, Goffin G, Mazevet M, Douglas GV, Newton JT, et al. CariesCare practice guide: consensus on evidence into practice. Br Dent J. 2019 Sep;227(5):353-62. https://doi.org/10.1038/s41415-019-0678-8
https://doi.org/10.1038/s41415-019-0678-...

The European Core Curriculum in Cariology started the process in 2010 with the support from ORCA and the Association of Dental Education in Europe (ADEE). 3333.Schulte AG, Pitts NB, Huysmans MC, Splieth C, Buchalla W. European Core Curriculum in cariology for undergraduate dental students. Eur J Dent Educ. 2011 Nov;15(s1 Suppl 1):9-17. https://doi.org/10.1111/j.1600-0579.2011.00694.x
https://doi.org/10.1111/j.1600-0579.2011...
Since then, adapted consensuses have been agreed upon by dental schools on a national-basis, such as in Colombia, with the Colombian Association of Dental Schools (ACFO, as per its Spanish acronym) and the Alliance for a Cavity Free Future (ACFF) 3434.Martignon S, Marín LM, Pitts N, Jácome-Liévano S. Consensus on domains, formation objectives and contents in cariology for undergraduate dental students in Colombia. Eur J Dent Educ. 2014 Nov;18(4):222-33. https://doi.org/10.1111/eje.12091
https://doi.org/10.1111/eje.12091...
and in the USA, with the American Dental Education Association. 3535.Fontana M, Guzmán-Armstrong S, Schenkel AB, Allen KL, Featherstone J, Goolsby S, et al. Development of a Core Curriculum Framework in Cariology for U.S. Dental Schools. J Dent Educ. 2016 Jun;80(6):705-20. https://doi.org/10.1002/j.0022-0337.2016.80.6.tb06133.x
https://doi.org/10.1002/j.0022-0337.2016...
Other Spanish-speaking countries such as Chile, the Caribbean countries and Spain have followed. 3636.Giacamán RA, Aranguiz V, Botelho J, Bustos I, Cabello R, Candiales Y, et al. Development of a competency-based curriculum in cariology for undergraduate dental students in Chile. Rev Clín Periodoncia Implantol Rehabil Oral. 2018;11(1):58-68. https://doi.org/10.4067/S0719-01072018000100058
https://doi.org/10.4067/S0719-0107201800...

37.Abreu-Placeres N, Grau-Grullón P, Naidu R, García-Godoy F, Newton JT, Ekstrand KR, et al. Cariology consensus for undergraduates at dental schools in the Caribbean region. Eur J Dent Educ. 2021 Nov;25(4):717-32. https://doi.org/10.1111/eje.12651
https://doi.org/10.1111/eje.12651...
- 3838.Cortés-Martinicorena FJ, Ceballos L, Martínez-Pérez E, Hernández-Juyol M, Schulte AG, Almerich-Silla JM; Spanish Curriculum of Cariology Expert Group. Spanish curriculum in cariology for undergraduate dental students: proceedings and consensus. Eur J Dent Educ. 2022 May;26(2):317-28. https://doi.org/10.1111/eje.12706
https://doi.org/10.1111/eje.12706...
All documents follow the European core structure 3333.Schulte AG, Pitts NB, Huysmans MC, Splieth C, Buchalla W. European Core Curriculum in cariology for undergraduate dental students. Eur J Dent Educ. 2011 Nov;15(s1 Suppl 1):9-17. https://doi.org/10.1111/j.1600-0579.2011.00694.x
https://doi.org/10.1111/j.1600-0579.2011...
and include five to six caries-driven domains related to knowledge base, assessment, synthesis, diagnosis and care - both at the individual level of caries risk and at the tooth-surface level of caries lesions, and by evidence-based cariology in clinical and public health practice. 3333.Schulte AG, Pitts NB, Huysmans MC, Splieth C, Buchalla W. European Core Curriculum in cariology for undergraduate dental students. Eur J Dent Educ. 2011 Nov;15(s1 Suppl 1):9-17. https://doi.org/10.1111/j.1600-0579.2011.00694.x
https://doi.org/10.1111/j.1600-0579.2011...

The aim of this study was to develop and achieve consensus on a competency-based core cariology curriculum framework for use in dental schools in Latin American Spanish-speaking countries.

Methodology

This paper reports the process used to develop and achieve the cariology teaching consensus framework for dental schools in Latin American Spanish-speaking countries based on the previously mentioned frameworks, 3333.Schulte AG, Pitts NB, Huysmans MC, Splieth C, Buchalla W. European Core Curriculum in cariology for undergraduate dental students. Eur J Dent Educ. 2011 Nov;15(s1 Suppl 1):9-17. https://doi.org/10.1111/j.1600-0579.2011.00694.x
https://doi.org/10.1111/j.1600-0579.2011...

34.Martignon S, Marín LM, Pitts N, Jácome-Liévano S. Consensus on domains, formation objectives and contents in cariology for undergraduate dental students in Colombia. Eur J Dent Educ. 2014 Nov;18(4):222-33. https://doi.org/10.1111/eje.12091
https://doi.org/10.1111/eje.12091...

35.Fontana M, Guzmán-Armstrong S, Schenkel AB, Allen KL, Featherstone J, Goolsby S, et al. Development of a Core Curriculum Framework in Cariology for U.S. Dental Schools. J Dent Educ. 2016 Jun;80(6):705-20. https://doi.org/10.1002/j.0022-0337.2016.80.6.tb06133.x
https://doi.org/10.1002/j.0022-0337.2016...

36.Giacamán RA, Aranguiz V, Botelho J, Bustos I, Cabello R, Candiales Y, et al. Development of a competency-based curriculum in cariology for undergraduate dental students in Chile. Rev Clín Periodoncia Implantol Rehabil Oral. 2018;11(1):58-68. https://doi.org/10.4067/S0719-01072018000100058
https://doi.org/10.4067/S0719-0107201800...

37.Abreu-Placeres N, Grau-Grullón P, Naidu R, García-Godoy F, Newton JT, Ekstrand KR, et al. Cariology consensus for undergraduates at dental schools in the Caribbean region. Eur J Dent Educ. 2021 Nov;25(4):717-32. https://doi.org/10.1111/eje.12651
https://doi.org/10.1111/eje.12651...
- 3838.Cortés-Martinicorena FJ, Ceballos L, Martínez-Pérez E, Hernández-Juyol M, Schulte AG, Almerich-Silla JM; Spanish Curriculum of Cariology Expert Group. Spanish curriculum in cariology for undergraduate dental students: proceedings and consensus. Eur J Dent Educ. 2022 May;26(2):317-28. https://doi.org/10.1111/eje.12706
https://doi.org/10.1111/eje.12706...
on best evidence and taking into consideration the regional context. The original language of the framework is Spanish, applicable to Latin America, and its structure follows that of the European Core Curriculum, 3333.Schulte AG, Pitts NB, Huysmans MC, Splieth C, Buchalla W. European Core Curriculum in cariology for undergraduate dental students. Eur J Dent Educ. 2011 Nov;15(s1 Suppl 1):9-17. https://doi.org/10.1111/j.1600-0579.2011.00694.x
https://doi.org/10.1111/j.1600-0579.2011...
in five Domains, each encompassing a minimum of one Main Competency (MC) supported by Specific Competencies (SC) with different levels of learning, as defined by Cowpe et al. ( Table 1 ). 3939.Cowpe J, Plasschaert A, Harzer W, Vinkka-Puhakka H, Walmsley AD. Profile and competences for the graduating European dentist: update 2009. Eur J Dent Educ. 2010 Nov;14(4):193-202. https://doi.org/10.1111/j.1600-0579.2009.00609.x
https://doi.org/10.1111/j.1600-0579.2009...
These, in a general way, are intended to cover the basic and fundamental aspects of cariology training, for use by educators, dental schools and countries, subject to national or internal adaptations.

Table 1
Definitions of competencies and their levels of development (modified from Cowpe et al.). 3939.Cowpe J, Plasschaert A, Harzer W, Vinkka-Puhakka H, Walmsley AD. Profile and competences for the graduating European dentist: update 2009. Eur J Dent Educ. 2010 Nov;14(4):193-202. https://doi.org/10.1111/j.1600-0579.2009.00609.x
https://doi.org/10.1111/j.1600-0579.2009...

Prior to the development and consensus of cariology, a survey and a hybrid workshop were held in November 2021 during the annual meeting of OFEDO-UDUAL (Organization of Dental Schools - Union of Latin American Universities). A total of n=121 (46%) deans participated, agreeing on a general curative approach within dental schools, and 91% manifested the will to participate in the development and consensus of a cariology curriculum framework for the region.

In order to conduct a thorough process of regional inclusivity and agreement, the Delphi process was used to establish the MC and SC to be considered, by using the nominal group method favored by consensus. 4040.Sourani A, Sohail M. The Delphi method: review and use in construction management research. Int J Constr Educ Res. 2015;11(1):54-76. https://doi.org/10.1080/15578771.2014.917132
https://doi.org/10.1080/15578771.2014.91...
The process included three phases and was previously discussed and agreed upon by the LAOHA Cariology Core group. An agreement percentage of ≥ 80% among participants was preset.

Preparation phase

Three panels and a coordinating group were selected: a panel inviting experts representing 12 regional academic and professional dental associations (Associations-Panel); a panel composed of representatives of the n = 263 dental schools in all Spanish-speaking Latin American 19 countries who accepted to participate (Dental Schools-Panel); a panel of expert peer reviewers willing to represent four international academic and professional associations (Peers-Panel), and a Coordinating Group of five experts and collaborators from UNICA (Caries Research Unit) at Universidad El Bosque. The Coordinating Group took into consideration the comparison of previous frameworks 3333.Schulte AG, Pitts NB, Huysmans MC, Splieth C, Buchalla W. European Core Curriculum in cariology for undergraduate dental students. Eur J Dent Educ. 2011 Nov;15(s1 Suppl 1):9-17. https://doi.org/10.1111/j.1600-0579.2011.00694.x
https://doi.org/10.1111/j.1600-0579.2011...

34.Martignon S, Marín LM, Pitts N, Jácome-Liévano S. Consensus on domains, formation objectives and contents in cariology for undergraduate dental students in Colombia. Eur J Dent Educ. 2014 Nov;18(4):222-33. https://doi.org/10.1111/eje.12091
https://doi.org/10.1111/eje.12091...

35.Fontana M, Guzmán-Armstrong S, Schenkel AB, Allen KL, Featherstone J, Goolsby S, et al. Development of a Core Curriculum Framework in Cariology for U.S. Dental Schools. J Dent Educ. 2016 Jun;80(6):705-20. https://doi.org/10.1002/j.0022-0337.2016.80.6.tb06133.x
https://doi.org/10.1002/j.0022-0337.2016...

36.Giacamán RA, Aranguiz V, Botelho J, Bustos I, Cabello R, Candiales Y, et al. Development of a competency-based curriculum in cariology for undergraduate dental students in Chile. Rev Clín Periodoncia Implantol Rehabil Oral. 2018;11(1):58-68. https://doi.org/10.4067/S0719-01072018000100058
https://doi.org/10.4067/S0719-0107201800...

37.Abreu-Placeres N, Grau-Grullón P, Naidu R, García-Godoy F, Newton JT, Ekstrand KR, et al. Cariology consensus for undergraduates at dental schools in the Caribbean region. Eur J Dent Educ. 2021 Nov;25(4):717-32. https://doi.org/10.1111/eje.12651
https://doi.org/10.1111/eje.12651...
- 3838.Cortés-Martinicorena FJ, Ceballos L, Martínez-Pérez E, Hernández-Juyol M, Schulte AG, Almerich-Silla JM; Spanish Curriculum of Cariology Expert Group. Spanish curriculum in cariology for undergraduate dental students: proceedings and consensus. Eur J Dent Educ. 2022 May;26(2):317-28. https://doi.org/10.1111/eje.12706
https://doi.org/10.1111/eje.12706...
and updated scientific evidence, and produced a baseline framework proposal (Framework 1 st version) by adapting the original five domains, the MC and their supporting SC.

Consultation and agreement phase.

This corresponded to a series of three rounds of questionnaire conducted to stabilize opinions. Although anonymity among participants’ answers was maintained, later discussion was invited for achieving agreement. The coordinating group was in charge of controlling the feedback and updating the frameworks at each stage. In all rounds, each participant was asked to independently assess each item from the pedagogical and cariology perspective and define whether the MC or SC should or should not be included. A negative answer had to be supported by evidence and in case of a positive answer, conceptual and/or wording modifications could be proposed for both types of competencies, as well as changes in the level of development of learning for specific competencies.

The first round was conducted from February to April 2022, by sharing the baseline framework with the AP in two consecutive time intervals. It started with the 10 MC (including the five domains) and then continued with the SC. Each time, the document was shared via a Google Forms platform questionnaire (Google Inc., Menlo Park, United States of America) and this was followed by an online workshop that allowed for ‘round table’ discussions of controversial items until an agreement was achieved. Based on the agreements the CG produced a Framework 2 nd version.

The second round was conducted by sharing the adapted 10 MC with the Dental Schools’ panel via a Google Forms platform questionnaire. Up to three reminders were sent to the representatives and deans of dental schools who accepted to participate (May - August 2022). Answers went through discussion within the CG, who then produced a Framework 3 rd version.

Consensus phase

The third and last round was conducted with the Associations’ panel in a workshop held in Universidad El Bosque during September 2022. At this stage, the MC and SC were read out and the only available answering options were ‘agree’ or ‘agree with modifications’; a secret voting was conducted with an electronic program (Turning Point interactive software, Ingesonic®). After the first voting, thorough “round table” discussions of items were held as and when required, either due to a lower-than-80% agreement or to different opinions about wording/concepts, and after their adaptation, agreement was confirmed by secretly voting for a second time. Subsequently, the Coordinating Group adapted the Framework 4 th version, circulate it with the peer reviewers’ panel and held an online meeting with them for final agreements and recommendations about the document (October 2022). This resulted in the Framework 5 th version and final cariology teaching consensus Framework for dental schools in Latin American Spanish-speaking countries.

Results

A total of 127 academic/professional institutions participated (Supplementary Table 2 ). These were distributed in n = 11 from the AP (91.6%) (ALOP -the Latin American Association of Pediatric Dentistry did not accept to participate); 112 dental schools (42.6%) from all (100%) Spanish-speaking countries in the DSP (see Table 3 for proportion of DS participation by country) and one additional English-speaking country DS from Trinidad and Tobago, and four associations in the EP (100%).

Table 2
Academic/professional participating Institutions.

Table 3
Core cariology curriculum framework for dental schools in Latin American Spanish-speaking countries.

The baseline Framework 1 st version included five Domains, 10 MC and 92 SC. The overall MC and SC agreement results after the first round (AP) corresponded to (mean; range): Full agreement (88%; 83–100%); Agreement with modifications (11%; 0–16%) and Disagreement (2%; 0–4%). After analysis of answers and modifications proposals, the CG derived a Framework 2 nd version of 10 MC and 86 SC, applying wording modifications of Domains 1, 3 and 4, and content and wording modifications of seven and nine SC, respectively. Corresponding MC agreement results after the second round (DSP) disclosed: 92%; 87–96%; 8%; 4–13% and 0%, respectively. Wording adaptations were made in 29 MC for the Framework 3 rd version. The third and on-site round (AP) reported high agreement results (mean; range) for MC (97%; 89–100%) and SC (99%; 89–100%). After discussions it was agreed to merge two SC of Domain 5 into one; to make content modifications in 18 SC, changing the learning level of one SC, making changes in the wording in three MC and 50 SC. Resulting Framework 4 th version included five Domains, 10 MC and 85 SC. The suggestions from the PP were discussed and agreed, resulting in content modification of two MC and four SC, changing learning level in two SC, and changes in wording in Domains 3 and 4, 10 MC and two SC, for a final Cariology Core Curriculum Framework for Dental Schools in Latin American Spanish-speaking countries of five Domains, 10 MC and 85 SC. Figure shows the Cariology Framework general structure with Domain titles and respective number of MC and SC, illustrating the inter-relationship between domains. Table 3 shows the complete Cariology Framework.

Figure
General characteristics of the core cariology curriculum framework for dental schools in Latin American Spanish-speaking countries.

Adapted from Schulte et al. 2222.Sampaio FC, Bönecker M, Paiva SM, Arthur RA, Cohen-Carneiro F, Ditterich R, et al. Consensus for teaching dental caries in the Portuguese Language at Brazilian dental schools. Braz Oral Res. 2023;37(suppl):e120.


A series of high-relevance general considerations were considered throughout the consensus process as common to all domains and competencies. These included:

  1. Aspects of social determination; life cycles/life courses, with their particularities and differences, including their outcomes; emerging evidence; health promotion in a general context, including oral health; working in the context of the WHO and FDI 2030 emerging goals. 1010.World Health Organization. WHO Draft Global Oral Health Action Plan (2023-2030). 2023 [cited 2023 Sep 17]. Available from: https://cdn.who.int/media/docs/default-source/ncds/mnd/oral-health/eb152-draft-global-oral-health-action-plan-2023-2030-en.pdf?sfvrsn=2f348123_19&download=true
    https://cdn.who.int/media/docs/default-s...
    , 1111.FDI World Dental Federation. Access to oral health through primary health care. 2023 [cited 2023 Sep 17]. Available from: https://www.fdiworlddental.org/sites/default/files/2023-05/FDI%20Access%20to%20Oral%20Health%20Care%20White%20Paper.pdf
    https://www.fdiworlddental.org/sites/def...

  2. In addition, the following considerations apply to clinical domains: Obtaining informed assent and/or consent; working with other members of the dental and health care team; critically evaluating new scientific and technological developments and how to integrate them into their clinical activities; as regards to the term dental caries, this includes its classifications according to coronal/root location, if it is primary or secondary (associated with restorations and sealants - CARS), and in the primary (early childhood caries) or permanent dentition; other disorders of dental hard tissues ( e.g ., erosive tooth wear - associated with erosion, abrasion, attrition, abfraction, and developmental defects of the enamel, including but not limited to dental fluorosis, molar- incisor hypomineralization-MIH, hypomineralized second primary molar -HSPM, hypoplasia) are considered as part of the cariology teaching. 3333.Schulte AG, Pitts NB, Huysmans MC, Splieth C, Buchalla W. European Core Curriculum in cariology for undergraduate dental students. Eur J Dent Educ. 2011 Nov;15(s1 Suppl 1):9-17. https://doi.org/10.1111/j.1600-0579.2011.00694.x
    https://doi.org/10.1111/j.1600-0579.2011...

    34.Martignon S, Marín LM, Pitts N, Jácome-Liévano S. Consensus on domains, formation objectives and contents in cariology for undergraduate dental students in Colombia. Eur J Dent Educ. 2014 Nov;18(4):222-33. https://doi.org/10.1111/eje.12091
    https://doi.org/10.1111/eje.12091...

    35.Fontana M, Guzmán-Armstrong S, Schenkel AB, Allen KL, Featherstone J, Goolsby S, et al. Development of a Core Curriculum Framework in Cariology for U.S. Dental Schools. J Dent Educ. 2016 Jun;80(6):705-20. https://doi.org/10.1002/j.0022-0337.2016.80.6.tb06133.x
    https://doi.org/10.1002/j.0022-0337.2016...

    36.Giacamán RA, Aranguiz V, Botelho J, Bustos I, Cabello R, Candiales Y, et al. Development of a competency-based curriculum in cariology for undergraduate dental students in Chile. Rev Clín Periodoncia Implantol Rehabil Oral. 2018;11(1):58-68. https://doi.org/10.4067/S0719-01072018000100058
    https://doi.org/10.4067/S0719-0107201800...

    37.Abreu-Placeres N, Grau-Grullón P, Naidu R, García-Godoy F, Newton JT, Ekstrand KR, et al. Cariology consensus for undergraduates at dental schools in the Caribbean region. Eur J Dent Educ. 2021 Nov;25(4):717-32. https://doi.org/10.1111/eje.12651
    https://doi.org/10.1111/eje.12651...
    - 3838.Cortés-Martinicorena FJ, Ceballos L, Martínez-Pérez E, Hernández-Juyol M, Schulte AG, Almerich-Silla JM; Spanish Curriculum of Cariology Expert Group. Spanish curriculum in cariology for undergraduate dental students: proceedings and consensus. Eur J Dent Educ. 2022 May;26(2):317-28. https://doi.org/10.1111/eje.12706
    https://doi.org/10.1111/eje.12706...

  3. This consensus is of cariology and should be integrated with other clinical and systemic conditions related to oral health (such as periodontal disease, other dental, occlusal, articular conditions).

  4. It should be noted that each of the competencies (core and specific) should exist in the context of ‘what for’ and considering ‘how it will be measured’.

  5. Terms used are in agreement with the dental caries terminology consensus report. 11.Machiulskiene V, Campus G, Carvalho JC, Dige I, Ekstrand KR, Jablonski-Momeni A, et al. Terminology of dental caries and dental caries management: Consensus Report of a Workshop Organized by ORCA and Cariology Research Group of IADR. Caries Res. 2020;54(1):7-14. https://doi.org/10.1159/000503309
    https://doi.org/10.1159/000503309...

Discussion

This paper presents the process of development and consensus of the Core Cariology Curriculum Framework in Spanish for Latin American Dental Schools. This framework is based on European Core Cariology Curriculum 3333.Schulte AG, Pitts NB, Huysmans MC, Splieth C, Buchalla W. European Core Curriculum in cariology for undergraduate dental students. Eur J Dent Educ. 2011 Nov;15(s1 Suppl 1):9-17. https://doi.org/10.1111/j.1600-0579.2011.00694.x
https://doi.org/10.1111/j.1600-0579.2011...
and those derived from it, 3434.Martignon S, Marín LM, Pitts N, Jácome-Liévano S. Consensus on domains, formation objectives and contents in cariology for undergraduate dental students in Colombia. Eur J Dent Educ. 2014 Nov;18(4):222-33. https://doi.org/10.1111/eje.12091
https://doi.org/10.1111/eje.12091...

35.Fontana M, Guzmán-Armstrong S, Schenkel AB, Allen KL, Featherstone J, Goolsby S, et al. Development of a Core Curriculum Framework in Cariology for U.S. Dental Schools. J Dent Educ. 2016 Jun;80(6):705-20. https://doi.org/10.1002/j.0022-0337.2016.80.6.tb06133.x
https://doi.org/10.1002/j.0022-0337.2016...

36.Giacamán RA, Aranguiz V, Botelho J, Bustos I, Cabello R, Candiales Y, et al. Development of a competency-based curriculum in cariology for undergraduate dental students in Chile. Rev Clín Periodoncia Implantol Rehabil Oral. 2018;11(1):58-68. https://doi.org/10.4067/S0719-01072018000100058
https://doi.org/10.4067/S0719-0107201800...

37.Abreu-Placeres N, Grau-Grullón P, Naidu R, García-Godoy F, Newton JT, Ekstrand KR, et al. Cariology consensus for undergraduates at dental schools in the Caribbean region. Eur J Dent Educ. 2021 Nov;25(4):717-32. https://doi.org/10.1111/eje.12651
https://doi.org/10.1111/eje.12651...
- 3838.Cortés-Martinicorena FJ, Ceballos L, Martínez-Pérez E, Hernández-Juyol M, Schulte AG, Almerich-Silla JM; Spanish Curriculum of Cariology Expert Group. Spanish curriculum in cariology for undergraduate dental students: proceedings and consensus. Eur J Dent Educ. 2022 May;26(2):317-28. https://doi.org/10.1111/eje.12706
https://doi.org/10.1111/eje.12706...
and it takes into consideration the aspects of variability in education and context in the 19 Spanish-speaking Latin American countries. The development of this framework recognizes and respects the ‘university autonomy’ according to the Latin American Project of Convergence in Education (PLACEO, as per its Spanish acronym) seeking to offer “developing directives as model for the educational institutions, as well as the government and academic authorities, to make the modifications required to allow for adaptation of the existing educational systems in Dentistry, and would thus make it possible to achieve the standards of education of Dentists that our communities need ”. 4141.Alonso MS, Antoniazzi JH. Libro del proyecto Latino-Americano de Convergencia en Educación Odontológica (PLACEO). São Paulo: Artes Médicas; 2010. The comprehensive focus assumed for the domains and main competencies favored the approach of learning results of dentistry programs, as an explicit description of “ what a student should know, understand, and be capable of performing, as the learning result ”. 4242.Bingham J. Guide to developing learning outcomes. Sheffield: Sheffield Hallam University; 1999. The resulting cariology curriculum framework had previously undergone regional and up-to-date adaptations related to content and wording, and it corresponded to a valuable dental education guideline in cariology within the region. After adapting the framework to local education systems, it is expected that its 10 Main Competencies will be followed, supported by the Specific Competencies. This framework offers precise parameters regarding cariology teaching and counts on being sufficiently flexible to allow for an independent implementation in each dental school. 3535.Fontana M, Guzmán-Armstrong S, Schenkel AB, Allen KL, Featherstone J, Goolsby S, et al. Development of a Core Curriculum Framework in Cariology for U.S. Dental Schools. J Dent Educ. 2016 Jun;80(6):705-20. https://doi.org/10.1002/j.0022-0337.2016.80.6.tb06133.x
https://doi.org/10.1002/j.0022-0337.2016...

The implementation of this cariology teaching framework poses a challenge to dental schools, in terms of infrastructure, budget, and curriculum components, including expected learning outcomes that reflect on the students’ grading. Moreover, as Fontana et al. pointed out, 3535.Fontana M, Guzmán-Armstrong S, Schenkel AB, Allen KL, Featherstone J, Goolsby S, et al. Development of a Core Curriculum Framework in Cariology for U.S. Dental Schools. J Dent Educ. 2016 Jun;80(6):705-20. https://doi.org/10.1002/j.0022-0337.2016.80.6.tb06133.x
https://doi.org/10.1002/j.0022-0337.2016...
it requires educators’ capability of teaching students to think critically and solve problems based on best available evidence. As an example of lack of evidence translated into clinical practice, we cite that in dental clinics, the requirements relative to evaluation have shown that they were traditionally focused on developing the ability to eliminate carious tissue completely, without considering a tooth-preserving appraoch. 4343.Innes NP, Frencken JE, Schwendicke F. Don’t know, can’t do, won’t change: barriers to moving knowledge to action in managing the carious lesion. J Dent Res. 2016 May;95(5):485-6. https://doi.org/10.1177/0022034516638512
https://doi.org/10.1177/0022034516638512...
In general, surveys on cariology teaching through-out the world have shown that the curative approach continues to be followed. 2323.Fukushima M, Iwaku M, Mjör IA. Cariology in Japanese dental schools. Int Dent J. 2004 Oct;54(5):269-72. https://doi.org/10.1111/j.1875-595X.2004.tb00292.x
https://doi.org/10.1111/j.1875-595X.2004...

24.Schulte AG, Buchalla W, Huysmans MC, Amaechi BT, Sampaio F, Vougiouklakis G, et al. A survey on education in cariology for undergraduate den- tal students in Europe. Eur J Dent Educ. 2011;15 Suppl 1:3-8. https://doi.org/10.1111/j.1600-0579.2011.00708.x
https://doi.org/10.1111/j.1600-0579.2011...

25.Martignon S, Gomez J, Tellez M, Ruiz JA, Marin LM, Rangel MC. Current cariology education in dental schools in Spanish-speaking Latin American countries. J Dent Educ. 2013 Oct;77(10):1330-7. https://doi.org/10.1002/j.0022-0337.2013.77.10.tb05607.x
https://doi.org/10.1002/j.0022-0337.2013...

26.Sampaio FC, Rodrigues JA, Bönecker M, Groisman S. Reflection on the teaching of cariology in Brazil. Braz Oral Res. 2013;27(3):195-6. https://doi.org/10.1590/S1806-83242013000300001
https://doi.org/10.1590/S1806-8324201300...

27.Ferreira-Nóbilo NP, Rosário de Sousa ML, Cury JA. Cariology in curriculum of Brazilian dental schools. Braz Dent J. 2014;25(4):265-70. https://doi.org/10.1590/0103-6440201300149
https://doi.org/10.1590/0103-64402013001...

28.Díaz-Yokens M, González S, Giacaman RA, Araya-Bustos F, Moncada G, Martignon S. Cariology Curriculum in Chilean Universities. Rev Clín Periodoncia Implantol Rehabil Oral. 2018;11(2):98-101. https://doi.org/10.4067/S0719-01072018000200098
https://doi.org/10.4067/S0719-0107201800...

29.Tikhonova S, Girard F, Fontana M. Cariology education in Canadian dental schools: where are we? Where do we need to go? J Dent Educ. 2018 Jan;82(1):39-46. https://doi.org/10.21815/JDE.018.006
https://doi.org/10.21815/JDE.018.006...

30.Raphael SL, Foster Page LA, Hopcraft MS, Dennison PJ, Widmer RP, Evans RW. A survey of cariology teaching in Australia and New Zealand. BMC Med Educ. 2018 Apr;18(1):75. https://doi.org/10.1186/s12909-018-1176-4
https://doi.org/10.1186/s12909-018-1176-...
- 3131.Splieth CH, Abudrya MH, Anandakrishna L, Cheng L, Al-Khalifa KS, Kim BI, et al. Teaching Cariology in Asia and Arabia. Caries Res. 2022;56(2):109-15. https://doi.org/10.1159/000524168
https://doi.org/10.1159/000524168...

Considering that the future challenge is to translate the evidence (and guidelines, e.g . , this framework) into practice in order to render its real relevance, 4444.Elouafkaoui P, Bonetti D, Clarkson J, Stirling D, Young L, Cassie H. Is further intervention required to translate caries prevention and management recommendations into practice? Br Dent J. 2015 Jan;218(1):E1. https://doi.org/10.1038/sj.bdj.2014.1141
https://doi.org/10.1038/sj.bdj.2014.1141...
work with implementation science 4545.Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health. 2011 Jan;38(1):4-23. https://doi.org/10.1007/s10488-010-0327-7
https://doi.org/10.1007/s10488-010-0327-...
and support from the COM-B (capability, opportunity, motivation behavior model) 4646.Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012 Apr;7(7):37. https://doi.org/10.1186/1748-5908-7-37
https://doi.org/10.1186/1748-5908-7-37...
is on the way to start elucidating these aspects. For the moment this will occur on a small scale in eight Latin American Spanish-speaking dental schools. A survey (with COM-B) describing how dental students, educators and practitioners diagnose and manage caries in Colombia, after an overall moderate exposure of over 10 years to the ICCMS system (International Caries Classification and Management System), indicated that students perform many related up-to-date clinical behaviors with increasingly more significant frequency than educators and practitioners do. 4747.Pitts NB, Banerjee A, Mazevet ME, Goffin G, Martignon S. From ‘ICDAS’ to ‘CariesCare International’: the 20-year journey building international consensus to take caries evidence into clinical practice. Br Dent J. 2021 Dec;231(12):769-74. https://doi.org/10.1038/s41415-021-3732-2
https://doi.org/10.1038/s41415-021-3732-...
The study also reported that best clinical practices would more frequently translate into best clinical practices relative to diagnosis of risk and caries lesions, if resources ( e.g ., time, oral health recording software) were increased. Moreover, caries management would also improve if the capability of the professionals and students related to these activities were also enhanced.

A limitation of this study was the low participation of dental schools in the area (42.6%). Although direct contact was made with OFEDO-UDUAL, and all 19 Spanish-speaking countries participated, there was a regional lack of an updated Latin American Spanish-speaking dental schools’ directory. This could have occurred for many reasons, included the rapid and increasing number of dental schools in the region. For example, many of them have not yet become members of OFEDO-UDUAL and there were difficulties with online access; thus many showed no apparent interest in participating. Nevertheless, we now have a more updated directory that will enable us to offer future opportunities to participate in regional initiatives. This will be kept in the LAOHA repository and will be available by formal request.

The process of development and reaching consensus to achieve this framework was robust by implementing the Delphi methodology 4040.Sourani A, Sohail M. The Delphi method: review and use in construction management research. Int J Constr Educ Res. 2015;11(1):54-76. https://doi.org/10.1080/15578771.2014.917132
https://doi.org/10.1080/15578771.2014.91...
that was thoroughly and successfully followed. In the process. the academy was highly represented, evident by an important participation of dental schools - including all Spanish-speaking countries, and the participation of representatives of academic and professional associations that work closely with dental caries management and education.

There is increasing relevance of the implementation and adoption of this cariology teaching Framework by the academic community, given its contribution to the quality of education of future dentists, with the performance of evidence-based best clinical practices, in the context of the right to health, assuming ethical and social responsibility. Other aspects that will influence its implementation include the development of an oral health record that allows for registration of these updated aspects of cariology, in addition to being linked to a standardized software; 4747.Pitts NB, Banerjee A, Mazevet ME, Goffin G, Martignon S. From ‘ICDAS’ to ‘CariesCare International’: the 20-year journey building international consensus to take caries evidence into clinical practice. Br Dent J. 2021 Dec;231(12):769-74. https://doi.org/10.1038/s41415-021-3732-2
https://doi.org/10.1038/s41415-021-3732-...
training and calibrating educators; 3535.Fontana M, Guzmán-Armstrong S, Schenkel AB, Allen KL, Featherstone J, Goolsby S, et al. Development of a Core Curriculum Framework in Cariology for U.S. Dental Schools. J Dent Educ. 2016 Jun;80(6):705-20. https://doi.org/10.1002/j.0022-0337.2016.80.6.tb06133.x
https://doi.org/10.1002/j.0022-0337.2016...
the shift of national health systems and health providers to payment systems focused on health outcomes 4848.Vernazza CR, Pitts NB, Mayne C, Mazevet ME. Dental Policy Lab 1: towards a cavity-free future. Br Dent J. 2021 Dec;231(12):754-8. https://doi.org/10.1038/s41415-021-3723-3
https://doi.org/10.1038/s41415-021-3723-...
as well as shifting public and industry behavior to demonstrate the value of a cavity-free world. 4646.Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012 Apr;7(7):37. https://doi.org/10.1186/1748-5908-7-37
https://doi.org/10.1186/1748-5908-7-37...
Furthermore, the current relevance of caries as a non-communicable disease, 44.Pitts NB, Twetman S, Fisher J, Marsh PD. Understanding dental caries as a non-communicable disease. Br Dent J. 2021 Dec;231(12):749-53. https://doi.org/10.1038/s41415-021-3775-4
https://doi.org/10.1038/s41415-021-3775-...
that has not only provided the opportunity of the disease being included in the WHO and FDI agendas. 1010.World Health Organization. WHO Draft Global Oral Health Action Plan (2023-2030). 2023 [cited 2023 Sep 17]. Available from: https://cdn.who.int/media/docs/default-source/ncds/mnd/oral-health/eb152-draft-global-oral-health-action-plan-2023-2030-en.pdf?sfvrsn=2f348123_19&download=true
https://cdn.who.int/media/docs/default-s...

11.FDI World Dental Federation. Access to oral health through primary health care. 2023 [cited 2023 Sep 17]. Available from: https://www.fdiworlddental.org/sites/default/files/2023-05/FDI%20Access%20to%20Oral%20Health%20Care%20White%20Paper.pdf
https://www.fdiworlddental.org/sites/def...
- 1212.Pitts NB, Mayne C. A global consensus for achieving a dental cavity-free future. JDR Clin Trans Res. 2021;6(3):264-7. https://doi.org/10.1177/23800844211020298
https://doi.org/10.1177/2380084421102029...
Altogether, these aspects might influence the education area to recognize dental caries and cariology teaching at the same level and receiving emphasis equal to that laid on periodontal disease. 4949.Chong GT. The yawning gap: waiting for cariology to germinate whilst periodontology is fruiting. Eur J Dent Educ. 2023 May;27(2):296-303. https://doi.org/10.1111/eje.12803
https://doi.org/10.1111/eje.12803...

Conclusion

A Core Curriculum Framework in Cariology for Dental Schools in Latin American Spanish-speaking countries was successfully developed and agreed upon with regional dental academic and professional institutions.

Acknowledgements

This study was funded by LAOHA, Colgate-Palmolive, and Universidad El Bosque contributed. The authors are grateful for the contribution of all institutions and representatives that took part in formulating this framework, including the panel of expert peers: Luis F Castillo (President of IAPD), Margherita Fontana (AAC Board member; ORCA President), Paulo Melo (FDI Council), Ruth Santamaría (ORCA Education Platform).

References

  • 1
    Machiulskiene V, Campus G, Carvalho JC, Dige I, Ekstrand KR, Jablonski-Momeni A, et al. Terminology of dental caries and dental caries management: Consensus Report of a Workshop Organized by ORCA and Cariology Research Group of IADR. Caries Res. 2020;54(1):7-14. https://doi.org/10.1159/000503309
    » https://doi.org/10.1159/000503309
  • 2
    Fejerskov O. Changing paradigms in concepts on dental caries: consequences for oral health care. Caries Res. 2004;38(3):182-91. https://doi.org/10.1159/000077753
    » https://doi.org/10.1159/000077753
  • 3
    Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, et al. Dental caries. Nat Rev Dis Primers. 2017 May;3(1):17030. https://doi.org/10.1038/nrdp.2017.30
    » https://doi.org/10.1038/nrdp.2017.30
  • 4
    Pitts NB, Twetman S, Fisher J, Marsh PD. Understanding dental caries as a non-communicable disease. Br Dent J. 2021 Dec;231(12):749-53. https://doi.org/10.1038/s41415-021-3775-4
    » https://doi.org/10.1038/s41415-021-3775-4
  • 5
    Peres MA, Macpherson LM, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: a global public health challenge. Lancet. 2019 Jul;394(10194):249-60. https://doi.org/10.1016/S0140-6736 (19)31146-8
    » https://doi.org/10.1016/S0140-6736 (19)31146-8
  • 6
    Bernabe E, Marcenes W, Hernandez CR, Bailey J, Abreu LG, Alipour V, et al.; GBD 2017 Oral Disorders Collaborators. GBD 2017 Oral Disorders Collaborators. Global, regional, and national levels and trends in burden of oral conditions from 1990 to 2017: a systematic analysis for the global burden of disease 2017 study. J Dent Res. 2020 Apr;99(4):362-73. https://doi.org/10.1177/0022034520908533
    » https://doi.org/10.1177/0022034520908533
  • 7
    Sabbah W, Tsakos G, Chandola T, Sheiham A, Watt RG. Social gradients in oral and general health. J Dent Res. 2007 Oct;86(10):992-6. https://doi.org/10.1177/154405910708601014
    » https://doi.org/10.1177/154405910708601014
  • 8
    Wen PY, Chen MX, Zhong YJ, Dong QQ, Wong HM. Global Burden and Inequality of Dental Caries, 1990 to 2019. J Dent Res. 2022 Apr;101(4):392-9. https://doi.org/10.1177/00220345211056247
    » https://doi.org/10.1177/00220345211056247
  • 9
    Eaton K, Yusuf H, Vassallo P. Editorial: The WHO Global Oral Health Action Plan 2023-2030. Community Dent Health. 2023 May;40(2):68-9. https://doi.org/10.1922/CDH_Jun23Editorial02
    » https://doi.org/10.1922/CDH_Jun23Editorial02
  • 10
    World Health Organization. WHO Draft Global Oral Health Action Plan (2023-2030). 2023 [cited 2023 Sep 17]. Available from: https://cdn.who.int/media/docs/default-source/ncds/mnd/oral-health/eb152-draft-global-oral-health-action-plan-2023-2030-en.pdf?sfvrsn=2f348123_19&download=true
    » https://cdn.who.int/media/docs/default-source/ncds/mnd/oral-health/eb152-draft-global-oral-health-action-plan-2023-2030-en.pdf?sfvrsn=2f348123_19&download=true
  • 11
    FDI World Dental Federation. Access to oral health through primary health care. 2023 [cited 2023 Sep 17]. Available from: https://www.fdiworlddental.org/sites/default/files/2023-05/FDI%20Access%20to%20Oral%20Health%20Care%20White%20Paper.pdf
    » https://www.fdiworlddental.org/sites/default/files/2023-05/FDI%20Access%20to%20Oral%20Health%20Care%20White%20Paper.pdf
  • 12
    Pitts NB, Mayne C. A global consensus for achieving a dental cavity-free future. JDR Clin Trans Res. 2021;6(3):264-7. https://doi.org/10.1177/23800844211020298
    » https://doi.org/10.1177/23800844211020298
  • 13
    Latin American Oral Health Association. Sobre nós: quem somos. São Paulo; 2023 [cited 2023 Sep 17]. Available from: https://laoha.org/sobre-nos/
    » https://laoha.org/sobre-nos/
  • 14
    Sampaio FC, Malheiros Z, Benítez C, Stewart B, Bönecker M. Dental caries in Latin American and Caribbean countries: urgent need for a regional consensus. Braz Oral Res. 2021 May;35 suppl 1:e057. https://doi.org/10.1590/1807-3107bor-2021.vol35.0057
    » https://doi.org/10.1590/1807-3107bor-2021.vol35.0057
  • 15
    Paiva SM, Abreu-Placeres N, Camacho ME, Frias AC, Tello G, Perazzo MF, et al. Dental caries experience and its impact on quality of life in Latin American and Caribbean countries. Braz Oral Res. 2021 May;35 suppl 1:e052. https://doi.org/10.1590/1807-3107bor-2021.vol35.0052
    » https://doi.org/10.1590/1807-3107bor-2021.vol35.0052
  • 16
    Martignon S, Roncalli AG, Alvarez E, Aránguiz V, Feldens CA, Buzalaf MA. Risk factors for dental caries in Latin American and Caribbean countries. Braz Oral Res. 2021 May;35 suppl 1:e053. https://doi.org/10.1590/1807-3107bor-2021.vol35.0053
    » https://doi.org/10.1590/1807-3107bor-2021.vol35.0053
  • 17
    Ricomini Filho AP, Chávez BA, Giacaman RA, Frazão P, Cury JA. Community interventions and strategies for caries control in Latin American and Caribbean countries. Braz Oral Res. 2021 May;35 suppl 1:e054. https://doi.org/10.1590/1807-3107bor-2021.vol35.0054
    » https://doi.org/10.1590/1807-3107bor-2021.vol35.0054
  • 18
    Pozos-Guillén A, Molina G, Soviero V, Arthur RA, Chavarria-Bolaños D, Acevedo AM. Management of dental caries lesions in Latin American and Caribbean countries. Braz Oral Res. 2021 May;35 suppl 1:e055. https://doi.org/10.1590/1807-3107bor-2021.vol35.0055
    » https://doi.org/10.1590/1807-3107bor-2021.vol35.0055
  • 19
    Sampaio FC, Bönecker M, Paiva SM, Martignon S, Ricomini Filho AP, Pozos-Guillen A, et al. Dental caries prevalence, prospects, and challenges for Latin America and Caribbean countries: a summary and final recommendations from a Regional Consensus. Braz Oral Res. 2021 May;35 suppl 1:e056. https://doi.org/10.1590/1807-3107bor-2021.vol35.0056
    » https://doi.org/10.1590/1807-3107bor-2021.vol35.0056
  • 20
    Cariology. Braz Oral Res. 2021 [cited 2023 Sep 17];35 Suppl 1. Available from: https://laoha.org/ebooks/BOR-v35_ebook-en.pdf
    » https://laoha.org/ebooks/BOR-v35_ebook-en.pdf
  • 21
    Paiva SM, Prado IM, Perazzo MF, Guarnizo-Herreño CC, Acevedo AM, Castillo JL, et al. Situational diagnosis of policies in Latin American and Caribbean countries for the use of fluoride and reduction of sugar consumption. Braz Oral Res. 2023;37(suppl):e121.
  • 22
    Sampaio FC, Bönecker M, Paiva SM, Arthur RA, Cohen-Carneiro F, Ditterich R, et al. Consensus for teaching dental caries in the Portuguese Language at Brazilian dental schools. Braz Oral Res. 2023;37(suppl):e120.
  • 23
    Fukushima M, Iwaku M, Mjör IA. Cariology in Japanese dental schools. Int Dent J. 2004 Oct;54(5):269-72. https://doi.org/10.1111/j.1875-595X.2004.tb00292.x
    » https://doi.org/10.1111/j.1875-595X.2004.tb00292.x
  • 24
    Schulte AG, Buchalla W, Huysmans MC, Amaechi BT, Sampaio F, Vougiouklakis G, et al. A survey on education in cariology for undergraduate den- tal students in Europe. Eur J Dent Educ. 2011;15 Suppl 1:3-8. https://doi.org/10.1111/j.1600-0579.2011.00708.x
    » https://doi.org/10.1111/j.1600-0579.2011.00708.x
  • 25
    Martignon S, Gomez J, Tellez M, Ruiz JA, Marin LM, Rangel MC. Current cariology education in dental schools in Spanish-speaking Latin American countries. J Dent Educ. 2013 Oct;77(10):1330-7. https://doi.org/10.1002/j.0022-0337.2013.77.10.tb05607.x
    » https://doi.org/10.1002/j.0022-0337.2013.77.10.tb05607.x
  • 26
    Sampaio FC, Rodrigues JA, Bönecker M, Groisman S. Reflection on the teaching of cariology in Brazil. Braz Oral Res. 2013;27(3):195-6. https://doi.org/10.1590/S1806-83242013000300001
    » https://doi.org/10.1590/S1806-83242013000300001
  • 27
    Ferreira-Nóbilo NP, Rosário de Sousa ML, Cury JA. Cariology in curriculum of Brazilian dental schools. Braz Dent J. 2014;25(4):265-70. https://doi.org/10.1590/0103-6440201300149
    » https://doi.org/10.1590/0103-6440201300149
  • 28
    Díaz-Yokens M, González S, Giacaman RA, Araya-Bustos F, Moncada G, Martignon S. Cariology Curriculum in Chilean Universities. Rev Clín Periodoncia Implantol Rehabil Oral. 2018;11(2):98-101. https://doi.org/10.4067/S0719-01072018000200098
    » https://doi.org/10.4067/S0719-01072018000200098
  • 29
    Tikhonova S, Girard F, Fontana M. Cariology education in Canadian dental schools: where are we? Where do we need to go? J Dent Educ. 2018 Jan;82(1):39-46. https://doi.org/10.21815/JDE.018.006
    » https://doi.org/10.21815/JDE.018.006
  • 30
    Raphael SL, Foster Page LA, Hopcraft MS, Dennison PJ, Widmer RP, Evans RW. A survey of cariology teaching in Australia and New Zealand. BMC Med Educ. 2018 Apr;18(1):75. https://doi.org/10.1186/s12909-018-1176-4
    » https://doi.org/10.1186/s12909-018-1176-4
  • 31
    Splieth CH, Abudrya MH, Anandakrishna L, Cheng L, Al-Khalifa KS, Kim BI, et al. Teaching Cariology in Asia and Arabia. Caries Res. 2022;56(2):109-15. https://doi.org/10.1159/000524168
    » https://doi.org/10.1159/000524168
  • 32
    Martignon S, Pitts NB, Goffin G, Mazevet M, Douglas GV, Newton JT, et al. CariesCare practice guide: consensus on evidence into practice. Br Dent J. 2019 Sep;227(5):353-62. https://doi.org/10.1038/s41415-019-0678-8
    » https://doi.org/10.1038/s41415-019-0678-8
  • 33
    Schulte AG, Pitts NB, Huysmans MC, Splieth C, Buchalla W. European Core Curriculum in cariology for undergraduate dental students. Eur J Dent Educ. 2011 Nov;15(s1 Suppl 1):9-17. https://doi.org/10.1111/j.1600-0579.2011.00694.x
    » https://doi.org/10.1111/j.1600-0579.2011.00694.x
  • 34
    Martignon S, Marín LM, Pitts N, Jácome-Liévano S. Consensus on domains, formation objectives and contents in cariology for undergraduate dental students in Colombia. Eur J Dent Educ. 2014 Nov;18(4):222-33. https://doi.org/10.1111/eje.12091
    » https://doi.org/10.1111/eje.12091
  • 35
    Fontana M, Guzmán-Armstrong S, Schenkel AB, Allen KL, Featherstone J, Goolsby S, et al. Development of a Core Curriculum Framework in Cariology for U.S. Dental Schools. J Dent Educ. 2016 Jun;80(6):705-20. https://doi.org/10.1002/j.0022-0337.2016.80.6.tb06133.x
    » https://doi.org/10.1002/j.0022-0337.2016.80.6.tb06133.x
  • 36
    Giacamán RA, Aranguiz V, Botelho J, Bustos I, Cabello R, Candiales Y, et al. Development of a competency-based curriculum in cariology for undergraduate dental students in Chile. Rev Clín Periodoncia Implantol Rehabil Oral. 2018;11(1):58-68. https://doi.org/10.4067/S0719-01072018000100058
    » https://doi.org/10.4067/S0719-01072018000100058
  • 37
    Abreu-Placeres N, Grau-Grullón P, Naidu R, García-Godoy F, Newton JT, Ekstrand KR, et al. Cariology consensus for undergraduates at dental schools in the Caribbean region. Eur J Dent Educ. 2021 Nov;25(4):717-32. https://doi.org/10.1111/eje.12651
    » https://doi.org/10.1111/eje.12651
  • 38
    Cortés-Martinicorena FJ, Ceballos L, Martínez-Pérez E, Hernández-Juyol M, Schulte AG, Almerich-Silla JM; Spanish Curriculum of Cariology Expert Group. Spanish curriculum in cariology for undergraduate dental students: proceedings and consensus. Eur J Dent Educ. 2022 May;26(2):317-28. https://doi.org/10.1111/eje.12706
    » https://doi.org/10.1111/eje.12706
  • 39
    Cowpe J, Plasschaert A, Harzer W, Vinkka-Puhakka H, Walmsley AD. Profile and competences for the graduating European dentist: update 2009. Eur J Dent Educ. 2010 Nov;14(4):193-202. https://doi.org/10.1111/j.1600-0579.2009.00609.x
    » https://doi.org/10.1111/j.1600-0579.2009.00609.x
  • 40
    Sourani A, Sohail M. The Delphi method: review and use in construction management research. Int J Constr Educ Res. 2015;11(1):54-76. https://doi.org/10.1080/15578771.2014.917132
    » https://doi.org/10.1080/15578771.2014.917132
  • 41
    Alonso MS, Antoniazzi JH. Libro del proyecto Latino-Americano de Convergencia en Educación Odontológica (PLACEO). São Paulo: Artes Médicas; 2010.
  • 42
    Bingham J. Guide to developing learning outcomes. Sheffield: Sheffield Hallam University; 1999.
  • 43
    Innes NP, Frencken JE, Schwendicke F. Don’t know, can’t do, won’t change: barriers to moving knowledge to action in managing the carious lesion. J Dent Res. 2016 May;95(5):485-6. https://doi.org/10.1177/0022034516638512
    » https://doi.org/10.1177/0022034516638512
  • 44
    Elouafkaoui P, Bonetti D, Clarkson J, Stirling D, Young L, Cassie H. Is further intervention required to translate caries prevention and management recommendations into practice? Br Dent J. 2015 Jan;218(1):E1. https://doi.org/10.1038/sj.bdj.2014.1141
    » https://doi.org/10.1038/sj.bdj.2014.1141
  • 45
    Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health. 2011 Jan;38(1):4-23. https://doi.org/10.1007/s10488-010-0327-7
    » https://doi.org/10.1007/s10488-010-0327-7
  • 46
    Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012 Apr;7(7):37. https://doi.org/10.1186/1748-5908-7-37
    » https://doi.org/10.1186/1748-5908-7-37
  • 47
    Pitts NB, Banerjee A, Mazevet ME, Goffin G, Martignon S. From ‘ICDAS’ to ‘CariesCare International’: the 20-year journey building international consensus to take caries evidence into clinical practice. Br Dent J. 2021 Dec;231(12):769-74. https://doi.org/10.1038/s41415-021-3732-2
    » https://doi.org/10.1038/s41415-021-3732-2
  • 48
    Vernazza CR, Pitts NB, Mayne C, Mazevet ME. Dental Policy Lab 1: towards a cavity-free future. Br Dent J. 2021 Dec;231(12):754-8. https://doi.org/10.1038/s41415-021-3723-3
    » https://doi.org/10.1038/s41415-021-3723-3
  • 49
    Chong GT. The yawning gap: waiting for cariology to germinate whilst periodontology is fruiting. Eur J Dent Educ. 2023 May;27(2):296-303. https://doi.org/10.1111/eje.12803
    » https://doi.org/10.1111/eje.12803

Publication Dates

  • Publication in this collection
    01 Dec 2023
  • Date of issue
    2023

History

  • Received
    22 Sept 2023
  • Accepted
    25 Sept 2023
  • Reviewed
    03 Oct 2023
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