Teaching Cariology in Asia and Arabia

In 2018, European Organisation for Caries Research (ORCA) decided to shift the focus to Asia and Arabia which unite almost 50% of the global population and to designate the Education Platform 2020 to the teaching in cariology in these regions. Based on this meeting during the ORCA congress 2020, this paper reports the outcome of a structured questionnaire assembled for 4 Asian and 4 Arabian countries, and it develops the perspective to support standardized, evidence-based national curricula in cariology for undergraduate students. Despite the decline of dental caries in many countries, it remains to be the most prevalent oral disease with a high global burden [Carvalho and Schiffner, 2019; Kassebaum et al., 2015; Lagerweij and van Loveren, 2015; Petersson and Bratthall, 1996; Splieth et al., 2019]. Thus, it looks advisable to standardize the different aspects in cariology such as terminology [Machiulskiene et al., 2020], caries management [Paris et al., 2020], or education on a global level. Following this approach, an Undergraduate Core Curriculum in Cariology (UCCC) [Schulte et al., 2011] was developed by the ORCA in cooperation with the Association of Dental Education in Europe (ADEE) to structure and standardize evidence-based and comprehensive teaching in cariology on a global level. Starting at the European level, 171 dental schools which were members of ADEE were invited to complete a questionnaire on the structure of teaching in cariology at their institution and on the willingness to develop a common undergraduate core curriculum in cariology. Due to the high and positive response (89%), ORCA progressed with a steering group to develop five domains from the knowledge base, diagnostics, prevention, and therapy to evidence-based cariology in clinical and public health. This draft was specified in a joint workshop in Berlin/Germany 2010 with 75 invited participants from 24 European countries as well as 3 countries from North and South America in five working groups for the different domains, finalized in a subsequent review and published by the chairs of the five working groups [Schulte et al., 2011]. The 5 domains of the UCCC deal with different aspects of teaching cariology which can be obtained by the correlating titles of each domain.

The UCCC was in line with the trend for standardization in teaching and the development of national curricula and education standards in many fields [Bennett et al., 2020], which started in dentistry about 20 years ago [European Society of Endodontology, 2001; Plasschaert et al., 2005; European Academy of Paediatric Dentistry, 2009]. It also created a cooperation with the implementation of according curricula in Colombia, Canada, Chile, Spain, the USA, and the Caribbean [Martignon et al., 2013; Martignon et al., 2014; Fontana et al., 2016; Tikhonova et al., 2020; Abreu-Placeres et al., 2021; Cortés-Martinicorena et al., 2021].

Representatives of different Asian and Arabian countries were contacted to provide information on the situation in undergraduate education in cariology. University teachers of 4 Asian (China, India, Republic of Korea, Russia) and 4 Arabian countries (Egypt, Saudi-Arabia, Lebanon, the UAE), who are also all authors of the article, consented to answer a comprehensive questionnaire on the structure of the dental education in their country which contained the following items:

• undergraduate teaching in general

• extent and the content regarding cariology in particular

• responsibilities between the different departments

• structure of the curriculum in cariology

• measures of standardization

The representatives filled out a standardized questionnaire form and gave a presentation at the ORCA education platform meeting in 2020. Afterwards, the information was condensed and the items were summarized in the tables seen in the result section and presented descriptively.

Cariology is taught in the depicted four Asian and four Arabian countries with a wide range of numbers of universities obviously related to the population of the country from 3 (Lebanon) to 313 (India) with relevant differences regarding the proportions of public versus private universities (Table 1). However, only few countries have a national curriculum for dentistry or cariology which is mostly not compulsory. Partially, the domain “Cariology” is clearly described, but it is usually split up in courses taught by different departments (Table 2). For example, in India, the departments oral medicine, oral pathology, pedodontics and preventive dentistry, conservative dentistry, and public health dentistry participate in teaching cariology to cover aspects like the aetiology, pathogenesis, epidemiology, diagnosis, and caries management. Specific “stand-alone” departments for cariology rarely exist. If the denomination exists, they are, e.g., part of a combined department for cariology and endodontics. Consequently, no specifically entitled professors/chairs for cariology are mentioned (Table 2).

Mostly the content taught regarding cariology was close to the UCCC covering most of the 5 domains from basic science to dental public health. Apart from the few countries with a compulsory national curriculum for cariology or dentistry, the other representatives thought that a good chance for a standardized curriculum in cariology on the basis of the UCCC exists – not only in their own university, but also on a national level (Table 3). Table 3 also lists the obstacles to the introduction on a national level. Partially, some items or even complete domains were considered to need modification or to be implemented to improve the undergraduate curriculum in cariology in the specific universities or countries. Overall, there was an optimistic outlook regarding the teaching of cariology according to the UCCC in different countries in Asia and Arabia (Table 3).

To our knowledge, this is the first overview on the teaching of cariology in various Asian and Arabian countries. It includes the largest Asian countries and a wide range of Arabian countries representing about half of the global population. As the representatives have a valid insight in the regulations on teaching dentistry in their countries, the answers regarding the existence of a national curriculum and the content and responsibilities for teaching cariology in their own universities can be considered very accurate.

In most Asian and Arabian countries and universities, there seems to be some variation in teaching cariology, but there is a trend to standardize this into a national curriculum, often based on competencies that graduating dentists should fulfil [Li et al., 2021]. Sometimes accreditation boards are responsible to ensure an adequate quality. Within countries, it could be difficult which body or experts have the authority to define the national curriculum. Thus, the approach to define components of these curricula by the according international scientific associations and societies could be an interesting solution. This process was initiated, e.g., by the European Society of Endodontology [European Society of Endodontology, 2001], and the European Academy of Paediatric Dentistry [European Academy of Paediatric Dentistry, 2009], and also by ORCA as the leading global organisation for caries research [Schulte et al., 2011].

The Core Curriculum in Cariology provides a framework for the items that should be taught in cariology during the undergraduate education in dentistry without being too detailed about the current interpretation of the state of art. As caries follows the same biological concepts globally, the approaches to teaching its underlying biological principles, aetiology and epidemiology, prevention, diagnostics, or treatment should also be comparable. Therefore, curricula based on the UCCC were successfully implemented in various countries such as Chile, Colombia, Spain, the USA, and the Caribbean [Martignon et al., 2013; Fontana et al., 2016; Tikhonova et al., 2020]. Like in the present paper the adaptation went into two directions: universities filled the gaps in their curriculum according to the catalogue of the UCCC while some domains were split up or increased. Especially domain V which covers the principles of evidence-based dentistry and also community/public health dentistry could be divided into separate identities because it is likely that this domain could be taught by different departments.

In conclusion, the UCCC presents a very flexible instrument for teaching cariology in a comprehensive approach from biological and epidemiological determinants to disease management which includes the classical preventive, diagnostic, and therapeutic procedures. This was confirmed for the Asian and Arabian countries in this paper. With increasing globalization and migration, the UCCC offers clear advantages for an (inter)national standardization to achieve comparable dental education in cariology. As it was already developed by experts from around the world, it saves resources to organize this process in every country or even university, as positive examples from several countries show.

The authors thank ORCA and especially the Education Board for the opportunity of meeting at the ORCA education platform.

Ethics approval was not required according to the regulations of the Ethics Committee at the University of Greifswald, as this publication uses publicly available data or statements by the authors.

The authors declare no conflict of interest.

No external funding was used. The authors completed the questionnaires and wrote the paper in their personal time, mainly paid by the according university.

C.H.S. conceptualized the design of the study and the questionnaire and the drafted the manuscript. The Asian and Arabian author gave the details for their country and revised the manuscript. Results and tables were compiled by J.S. who also drafted the manuscript, while M.H.A. drafted the results and critically revised the manuscript.

All data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author.