Sophisticated technology and modern teaching methods shape dentistry curriculum at the University of Eastern Finland

There are certain benefits of being able to design and plan a dentistry curriculum from scratch and to build a learning environment accordingly. This was exactly the case for the Institute of Dentistry at the University of Eastern Finland (UEF) in the autumn of 2010, when the university started offering dental education as a response to the pressing need for dentists in the region.

The result was – and still is – a modern teaching and learning environment with state-of-the-art technology as well as a modern curriculum, which emphasises digital workflows and a holistic approach to oral health care, and even incorporates management training as part of the studies. The facilities are equipped with Planmeca dental units and intraoral X-ray systems, which the students start using immediately after the preclinical stage of their studies.

All operations take place in close collaboration with other health care institutions in the region, including the wellbeing services county of North Savo, the Kuopio University Hospital and the Savonia University of Applied Sciences, which offers education in dental hygiene. In fact, the management of the facilities is also divided between these institutions, with the wellbeing services county being in charge of the teaching clinic, for example.

The learning environment of the Institute of Dentistry at the University of Eastern Finland is equipped with Planmeca dental units.

Seamless transition from simulation to clinical work

Every year, 41 students are admitted to the basic degree studies in dentistry at UEF, which take 5.5 years to complete. For the first two years, the students are building their basic knowledge, skills and proficiencies mainly with a theoretical framework. From the third year onwards, the students move from preclinical to the clinical stage, learning clinical work for 2.5 years in total; first in a simulation environment and later with real patients in the teaching clinic. After that, all students undergo a practical training at a dental clinic for a minimum of six months.

With the help of state-of-the-art equipment, the dentistry students at UEF are offered a seamless transition from the simulation environment to working in the teaching clinic. Both learning environments incorporate identical Planmeca Compact™ i Touch dental units, with which the students learn to operate in an authentic working environment right from the get-go. When the students move from simulation to the teaching clinic, they can simply repeat what they have learnt in simulation.

Having identical units in both environments instead of using mere phantom heads in simulation is a unique approach to dental education in Finland – and quite rare worldwide, too.

“Back in 2013 when the simulation environment and the teaching clinic were opened, we were one the first universities in the world to incorporate the same dental units in the simulation environment that are used in the actual teaching clinic as well. Identical units were chosen to ensure the students would also learn to pay attention to the patient positioning as well as their own ergonomics from day one, in addition to the actual clinical procedures,” explains Professor Liisa Suominen, Head of the Institute of Dentistry.

The students are practising in simulation on an authentic dental unit with a phantom head and torso.

The phantom heads include neck joints that bend with the headrest.

Special focus on wellbeing

In simulation, the treatment units are exactly the same as they are in real patient care. Attached to a dental unit is a torso with a phantom head and neck joints that bend with the headrest just like a real person’s neck would do. The torso also includes the chest area, which requires students to pay close attention to the anatomy of their patient.

“Once we have demonstrated the basic features and infection control routines in simulation, our students immediately start training with dental chairs on their own,” tells University Teacher Jonna Kumpulainen. “Planmeca units have proven very durable and reliable, also in continuous student use.”

The students often switch between different units for each training session, which prevents them of getting used to any general settings. This way, they learn to adapt the headrest routinely for each patient and in order to reach the optimal position for working in the mandibular and maxillary arch. Additionally, the students learn to pay attention to their own working ergonomics and correct their postures already in the simulation phase.

“We photograph and capture videos of our students working in simulation and later in the teaching clinic. According to our experience, the students often understand immediately what they are doing wrong when they see their working positions with their own eyes. We also give them verbal feedback on their working positions, but videos are more effective. The students appreciate the videos, too,” Kumpulainen explains.

The students are also educated to take the general wellbeing of their patients into account to ensure they receive the treatment they need – dental or medical. With a holistic approach to oral health, the students learn to consider dentistry as part of the overall health care and recognise various factors that could cause symptoms in the oral cavity. For example, undiagnosed diabetes might manifest through recurring carious lesions or periodontitis might be more difficult to treat due to an ongoing inflammatory process caused by excess weight. Similarly, students at UEF are taught to suspect and treat sleep apnoea with oral appliances or recognise bruxism as a potential cause for frequent headaches.

In the teaching clinic, the students train working techniques and positions they have learnt in simulation.

Built-in infection control secures operations at all times

Clean water and internal infection control have always been a priority for Planmeca and considered already in the product development of Planmeca dental units. At UEF, all Planmeca Compact i Touch dental units are equipped with a centralised automated waterline cleaning system that purifies water through electrochemical activation, eliminating biofilm and providing clean water to the dental units at all times.

“During the Covid-19 pandemic, we did not need to make any major changes to our clinical environment, although the Regional State Administration Agency’s regulations set strict limits on our operations. Not only are all our dental units equipped with well-functioning water cleaning systems, but they are also stationed in their own cubicles, similar to real dental clinics, which allowed us to maintain safety distances quite easily,” Liisa Suominen tells.

For added protection against respiratory droplets, the cubicle walls in the teaching clinic were extended in the summer of 2020. Otherwise, the daily operations could continue as usual since the staff and students were already used to wearing protective gloves and facial masks in clinical work and performing various infection control routines on a regular basis.

“The main prerequisite for continuing clinical training throughout the pandemic was the ability to provide a safe working space for every student. The simulation environment was divided into two separate areas already in 2010, which also helped us to organise training in a safe way for smaller groups,” Jonna Kumpulainen continues.

The learning environment consists of a simulation environment for dental hygienists, managed by the Savonia University of Applied Sciences (1), a simulation environment for dentists, managed by the University of Eastern Finland (2), a teaching clinic for dentists managed by the wellbeing services county of North Savo (3 & 5) with two separate demonstration units (6), and a teaching clinic for dental hygienists managed by the Savonia University of Applied Sciences (4). Sterile processing department is located in the middle of the premises.

In the teaching clinic, the walls between the dental unit cubicles were extended as a result of the Covid-19 pandemic.

Digitalisation affects all areas of dental education – including teaching

During the 13 years that have passed since the opening of the Institute of Dentistry at the Eastern University of Finland, teaching digital dentistry has become a more and more important part of the curriculum. According to Tiina Rantamo, Head of Odontology Education Unit of Kuopio University Hospital, who is responsible for the operations and development of the teaching clinic, digital workflows are already emphasised in prosthodontics as well as in orthodontics to ensure the students learn to utilise digital tools early on.

“We have invested in teaching digital workflows as well as in digital equipment,” Rantamo tells. “The first intraoral scanners were acquired as early as in 2010, and we have two milling units for a wide range of prosthetic works.”

Digitalisation not only transforms the way dentists are working, but also the way dentistry is taught. At the Institute of Dentistry at UEF, for example, the teacher controls all the student workstations from their own computer in the simulation room. Similarly, the teacher also authorises taking X-ray images with intraoral imaging simulation cabinets and approves the images from their own workstation. In the simulation environment, the students can also follow teaching from their simulation unit using headphones, which also allows having two student groups in the simulation facilities at the same time.

UEF was also the first university in Finland to acquire haptic VR equipment for dental education. The VR devices provide haptic feedback for students the same way real patients would do, helping students learn practical skills and exercise tooth preparations in a realistic way. The devices have proven particularly useful in practising drilling on a digital impression before working with real patients. In the future, new digital solutions and VR equipment could help facilitate learning even if there would be lack of suitable patients in need of tooth extraction or root canal therapy.

“We are looking forward to brand-new solutions that will allow our students to train their skills in different ways,” Liisa Suominen says.

From the left: Liisa Suominen, Tiina Rantamo and Jonna Kumpulainen.

Text: Mari Suominen
Images: Courtesy of Institute of Dentistry at the University of Eastern Finland