|ORIGINAL RESEARCH ARTICLE
|Year : 2014 | Volume
| Issue : 3 | Page : 238-242
The perceived relevance of tooth carving in dental education: Views of practicing dentists and faculty in West India
Meghanand T Nayak1, Priya Sahni1, Abhishek Singhvi1, Anjali Singh2
1 Department of Oral and Maxillofacial Pathology, Vyas Dental College and Hospital, Pali Road, Jodhpur, Rajasthan, India
2 Department of Oral Medicine and Radiology, Vyas Dental College and Hospital, Pali Road, Jodhpur, Rajasthan, India
|Date of Web Publication||26-Feb-2015|
Meghanand T Nayak
Department of Oral and Maxillofacial Pathology, Vyas Dental College and Hospital, Pali Road, Jodhpur, Rajasthan - 342 011
Source of Support: None, Conflict of Interest: None
Background: Teaching dental anatomy includes observation and analysis of natural teeth and carving wax models to accurately reproduce the morphology of teeth. The aim of this survey was to assess the importance of tooth carving in its relevance to clinical practice in the opinion of practicing clinicians throughout west India. Methods: Faculties of 27 dental colleges and dental practitioners of the Rajasthan and Gujarat states in western India were contacted through e-mail, telephone and mail. A total of 1866 subjects were contacted of which 1722 responded. The perceived relevance of tooth carving in clinical practice was assessed through a 14-item multiple choice questionnaire. Questions ranged from the queries of clinicians' interest in tooth carvings, their opinion of the practical significance of this exercise during their training to their clinical practice, and their recommendations regarding tooth carving. Results: A total of 69.1% of respondent practitioners believe that the tooth carving exercise influences their clinical practice, and 93.4% recommend tooth carving to be continued in the undergraduate dental curriculum. Discussion: The results indicated that most dentists in west India valued what they learned through tooth carving and that they use this knowledge in their practice. This information supports the continued teaching of tooth carving in the undergraduate dental curriculum.
Keywords: Anatomy, dental education, questionnaire, survey, syllabus, tooth
|How to cite this article:|
Nayak MT, Sahni P, Singhvi A, Singh A. The perceived relevance of tooth carving in dental education: Views of practicing dentists and faculty in West India. Educ Health 2014;27:238-42
|How to cite this URL:|
Nayak MT, Sahni P, Singhvi A, Singh A. The perceived relevance of tooth carving in dental education: Views of practicing dentists and faculty in West India. Educ Health [serial online] 2014 [cited 2020 Feb 21];27:238-42. Available from: http://www.educationforhealth.net/text.asp?2014/27/3/238/152177
| Background|| |
Dental anatomy is a basic subject of dental education, one of the foundation courses in the preclinical dental curriculum. This subject, taught in the preclinical years, teaches information that students will later use routinely in their dental practice. Dental anatomy introduces students to the surface outline of the oral cavity, the external and internal morphology of each individual tooth and the relationship between teeth within the arch and between arches of both primary and permanent dentition. , The subject covers the relationship of the skull bones to teeth, the complex joints that enable and control lower jaw movement relative to the cranium, the muscles that bring about movement and mastication, and the blood vessels and the nerves that supply these structures. , Thus, the study of dental anatomy is one of the basic components of the knowledge and skills needed to practice all phases of dentistry. 
In most dental schools throughout the world, teaching dental anatomy is a twofold process. Students first observe natural teeth, analyze drawings and study textbooks. Next, students carve various materials (wax, plaster or plastic) to reproduce a given reference model of teeth in various sizes.  The first process is mandatory: Students must know "the common traits of each tooth, the difference between the maxillary and mandibular arches, and the differences between the arch components of each class".  Beltran-Aguilar suggests that collecting intact natural human teeth is becoming more difficult with increasing tooth retention in the industrialized countries.  Carving to produce a reference model introduces geometric references for restoring teeth.  Although practical exercises are focused on training manual dexterity, these established methods reveal some weak points that can cause frustration for both students and faculty. ,
The goal of the preclinical dental curriculum is to provide students with well-rounded and balanced preclinical exposure to give them the basic knowledge and skills needed for competence in modern dental practice.  The preclinical operative dentistry requires long teaching hours, particularly laboratory exercises involving waxing procedure and laboratory preparation on extracted or artificial teeth. Students' learning through these activities is typically passive, and the assessment of students' performance is criticized as subjective. 
There is an on-going discussion about the value of tooth carving exercise in the undergraduate dental curriculum. Opinions vary on the effectiveness of the tooth carving exercise and its relevance to students' later dental practice. This discussion has principally been based only on the personal opinions of educators. ,,,, Students' perceptions of their education are a valuable source of information for curriculum planners. As educators, we believe that the dental curriculum planning concerning tooth carving exercise should include the recommendations of dental students, educators and dental clinicians.
The aim of this study was to analyze the perceived importance of tooth carving during training to practicing clinicians in western India, and to assess its perceived relevance to their present day clinical practice. The study also sought to learn practicing clinicians' recommendations for improving the teaching of dental anatomy.
| Methods|| |
A total of 27 dental colleges were identified in the states of Rajasthan and Gujarat in western India. We used a variety of channels to identify educators in these institutes for survey. The faculties were contacted through e-mail, telephone and mail. The authors contacted faculty of a few institutes to obtain information on educators. For the remaining instates, organizational websites were also used to get information on faculty. We identified approximately, 1100 educators working in these 27 dental colleges, of whom 385 were contacted.
Community dental practitioners in these two states were identified and contacted by the authors at various dental association meetings and state dental conferences. A total of 2200 community dentists attended these meetings, of whom a convenience sample of 1481 were surveyed. Dental students, dental auxiliaries and practitioners with less than one year clinical experience were excluded.
The questionnaire was e-mailed to eligible subjects, or when we did not have email addresses we mailed hardcopy questionnaires. The questionnaire required approximately 10 min to complete. Participating dentists were made aware that the data would be used for publication. Participants were asked to report their gender, number of years since they obtained their primary dental qualifications, and their total years of clinical experience in dentistry. The survey form also contained a place to provide suggestions, from which we hoped to gain understanding of issues not addressed in our survey forms.
A total of 603 e-mails and 379 postal mails were received; while remaining 740 forms were hand collected during various state meets and conferences. The response rate was recorded as 92.3%, with 144 practitioners failing to complete or return the form. This survey's high response rate can be attributed to the multiple approaches used to reach subjects.
Ethical clearance was obtained from the Vyas Dental College and Hospital Institutional Review Board to conduct this survey.
The relevance of tooth carving in a clinical scenario was assessed by means of a specially designed questionnaire that consisted of 14 questions. The questions included subjects' interest in tooth carvings and their views on practical significance of this exercise in clinical practice. This questionnaire addressed their past experience with teeth carving, its current clinical applications and recommendations/views on teaching teeth anatomy.
Response value percentages were calculated for each question, and Chi-square test analysis was used to compare responses from educators and private practitioners. The data were analyzed using IBM SPSS software version 11.0.
| Results|| |
A total of 1722 dental practitioners responded to this survey and were included in analyses, including 346 of 385 surveyed educators (89.9%) and 1346 of 1481 surveyed community practicing dentists (92.7%). The age, gender, educational backgrounds, mode of practice and average years of clinical practical experience of the survey respondents is presented in [Table 1]. The mean age of male and female participants was 33.5 and 30.9 years, respectively. The average number of years in practice was 5.4 years, and most were working in private practice settings.
No significant differences were found for responses from educators and community practitioners for any survey items pertaining to views on tooth carving; therefore, data for both groups are presented together in [Table 2]a and b. Among the total 1722 survey respondents, 98.3% reported that they did wax tooth carving in their undergraduate studies, but only 50% reported that they actually liked the tooth carving exercise. Only 7.3% had carved a full sets of both permanent and deciduous teeth, while half (49.1%) had carved only few permanent teeth.
A majority 62.3% of survey respondents agreed that carving influenced their knowledge of tooth anatomy. They believed that carving was helpful in restorative dentistry (62.6%), understanding dental occlusion (53.8%) and overall improved their clinical skills (65%).
A total of 90% of respondents agreed that the total time allotted for tooth carving in undergraduate dental syllabus was relevant, and 93.4% of respondents recommend that tooth carving should be continued in the undergraduate dental curriculum. In contrast, most respondents (61.3%) felt that tooth carving should not be used in assessments in annual exams.
Nearly two-thirds (63.2%) of respondents believed that the knowledge through tooth carving is important for both dental technicians and dental graduates, and two-thirds (66.6%) felt that use of manikin models for practicing carving was insufficient. Although they generally favored tooth carving, 69.6% of respondents agreed that learning tooth anatomy can be further improved with the help of computer simulation techniques.
| Discussion|| |
The practice of dentistry requires knowledge of tooth morphology, physiology and occlusion. Knowledge of the forms of particular teeth and the skill to reproduce them are essential for all workers in the field of operative dentistry.  Woelfel  describes learning the concepts of dental anatomy as 'foreign' language, which students will use for rest of their professional lives.
Most respondents of this study reported that they carved teeth during their undergraduate course: Tooth carving has been a part of dental curriculum in India for more than 50 years. Most respondents reported that they carved only a few permanent teeth, as dental schools emphaze permanent teeth.
Sivapathasundaram  suggests that carving root anatomy is a waste of time and energy, and that carving root anatomy is a dreadful exercise that does not contribute to students' overall understanding of tooth anatomy. In this study, most respondents believed that both crown and root carving were important in their clinical practice.
Some authors suggest that tooth carving practices changes dentistry from a biological science into a mechanical science, and suggest that tooth carving can safely be discarded from the undergraduate dental syllabus. ,, Ponniah  and Baskar  suggest that learning tooth morphology can equip a student to become a good technician and not a better clinician. Our survey probed practicing clinicians' opinions on whether knowledge through tooth carving is more important for dental technician than dental graduates: Six out of ten respondents believed that tooth carving is important for both technicians and dentists. We note that the vertical integration of basic and clinical sciences is an important means to 'link theoretical ideas with practice' and is one element of effective teaching. 
By carving teeth anatomy, the dental student begins to develop psychomotor skills for restoring the teeth to proper form and function.  Students acquire the knowledge to identify teeth, recognize and diagnose tooth anomalies and treat or manage dental pathology. Some educators believe that the tooth anatomy can be learned by collecting and studying of intact extracted teeth and tooth carving may not be necessary. 
Dentists require knowledge of dental morphology in their daily practice in their need to constantly restructure the dental organ and reinstate function. Patil  suggests that students in dentistry must carve teeth directly in a patient's mouth in the form of various direct and indirect restorative procedures, like amalgam restorations, composite restorations, direct filling gold restorations. He also recommends that restorations such as posterior metal or porcelain inlays, onlays or crowns, anterior ceramic crowns or laminates, requires dentist to carve the wax patterns. We suggest that tooth carving is unmatched as a means for teaching dental anatomy.
The vast majority of respondents in this study felt that the total curriculum time allotted to tooth carving they received as students was appropriate, and they think that carving should be continued in undergraduate dental curriculum. In contrast, six out of ten respondents felt that tooth carving should not be used as an assessment tool in annual exams.
Some authors have advocated for students to practice cavity preparation and carving on extracted teeth, which is comparable to cavity preparation in patient's mouth. Our respondents did not agree with this opinion and emphasized that tooth carving is necessary to gain manual dexterity. Despite support from these practicing dentists, there is a general consensus among educators that learning tooth morphology through the traditional techniques of carving wax, plaster or resin models needs updating. There is a sense that developing alternative methods like computer-graphics to aid in teaching three-dimensional dental anatomy of the adult dentition are important for motivating and teaching students. ,, Most respondents in our survey felt that computer simulations will be useful supplements in helping students learn the anatomy of teeth.
Due to a lack of a pilot test, it is possible that the meaning of some questionnaire items was unclear to participants. The study was cross-sectional in design, therefore temporal ambiguity is another limitation. Although our respondents were well aware about the carving exercise, the results may be affected by ceiling effect due to type and nature of the questions.
| Conclusion|| |
Tooth carving exercise is an integral part of first year undergraduate dental training program. Its purpose is to familiarize students with the many anatomical landmarks of each tooth to help students learn tooth anatomy and functional physiology. In this study, dental faculty and community practitioners showed their interest in this topic through their high study participation rate. They reported that they found tooth carving when they were students had helped build their manual dexterity required in clinical practice. This survey suggests that clinically applicable learning improves conceptual understanding and psychomotor skills. Most respondents believed that this exercise is an effective method for learning tooth anatomy and should be continued in the undergraduate dental syllabus.
| Acknowledgments|| |
The authors are thankful to the dentists who participated in this study.
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[Table 1], [Table 2]