Dental Education During the COVID-19 Pandemic

Dr. Carter: We're here today with Dr. Satheesh Elangovan, a member of the editorial board of Practice Update Clinical Dentistry Channel, and our topic for discussion is dental education during a pandemic. First, what do you see as the role of augmented and virtual reality simulation technology in pre-clinical dental instruction?

Dr. Elangovan: We have several augmented and virtual reality-based applications and devices that were available for dental education even prior to the COVID-19 pandemic. I think the social distancing requirement and the need to deliver educational content in a distant education fashion brought to light the true potential of these virtual tools when it comes to education delivery at the time of crisis. Though these virtual tools are in early stages of development and currently require larger equipment, further refinements would allow us to effectively integrate them in the dental curriculum, even beyond this pandemic.

The three-dimensional nature of some of these applications could allow for effective transfer of knowledge and I believe will be very well received by students, especially if it can be used in personal devices such as tablets or phones.

Dr. Carter: Dental schools address risks that practitioners face from blood-borne infections and recommend universal precautions but lack robust training regarding droplet and aerosol-borne infection. What educational and clinical strategies might you suggest to address this going forward?

Dr. Elangovan: In a very recent study published in the Journal of American Dental Association, Dr. Estrich and colleagues, they reported the prevalence of COVID-19 among practicing U.S. dentists to be less than 1%. Therefore, it is very clear that we, as a dental community, we are strictly adhering to the infection control guidelines in order to minimize disease transmission in the clinical setting. I feel as dental professionals, we are definitely more aware and mindful of droplet or aerosol-borne infections, now more than before. The dental schools having regular training in infection control is highly important.

As long as we continue to treat all our patients using universal precautions and use sterilization and infection control protocols, we will continue to be a safe place for our students, patients and providers. For sure, the pandemic has changed our universal precautions and infection control protocols that now include N95 masks, HEPA filters, or extraoral suction units. I'm sure the safety guidelines and infection control guidelines will evolve over time in the coming months and, in line with that, our infection control trainings and protocols in dental colleges will evolve as well.

Dr. Carter: Good points. What actions should dental faculty and administrators be undertaking to evaluate the risks of providing dental care in the open clinic setting that most dental schools currently have?

Dr. Elangovan: Thank you, Dr. Carter. That's a great question because that is very unique to dental education. The open clinical training setting we see in almost all dental school is definitely a big challenge for every institution to deliver clinical education and patient care in a safe manner. Each clinical setup, the floor plan, the engineering controls that comes with it, are so different between institutions. There are so many factors that could dictate the safe delivery of patient care in such a setting.

To name a few, the availability of intra and extraoral suction units, the distance of separation between the units, the height of the wall barrier between the units, if there is one, and also what type of engineering controls a school has and the availability of personal protective equipment, such as N95 respirators and the availability of extraoral suction units, are important factors to be considered.

Since the clinical settings are unique to any single institution, I think a thorough assessment of the floor plan, the engineering controls and conduction of an in-house aerosol study to assess the type of splatter that is generated by different instruments, like ultrasonic and high-speed handpiece for the specific floor plan, will provide valuable information for the administrators to identify deficiencies and make the required changes to address them.

Dr. Carter: Excellent points. In conclusion, how can dental educators strengthen interprofessional education to enable future dentists to have the ability to assist front-line efforts in pandemics yet to come?

Dr. Elangovan: Sure, again, a great question. This pandemic definitely has brought to light some gaps in dental curriculum and potential opportunities for future. Dental colleges have implemented interprofessional education, or IPE, into their curriculum in unique ways, and I believe that this could be a great platform for dental students to interact with students from other healthcare professions and get trained in clinical competencies that allow them to be front-line workers in future pandemics. A different yet related item is that a large number of dental patients visit emergency departments in hospitals for preventable dental care needs, which at the time of a pandemic, utilizes a lot of resources that otherwise would be used to treat patients with emergency medical needs. The bottom line is, we have to train our future dentists to effectively work together with our medical colleagues at the time of crisis and interprofessional education can be a great venue to achieve this goal.

Dr. Carter: Yes, indeed. The COVID-19 pandemic has given us much to ponder and much to plan for concerning dental education during a pandemic. I'd like to thank you very much for the discussion today, I appreciate it, Dr. Elangovan.

Dr. Elangovan: I want to thank you, Dr. Carter. It was great talking to you.