Curricular Guidelines for Oral Biology

Curricular Guidelines for Oral Biology

Reprinted from: Journal of Dental Education 48:5 (1984)

The following curriculum guidelines are the result of efforts within the American Association of Dental Schools by the Section on Oral Biology. They were developed in response to a request from the AADS Executive Committee and were reviewed by the Council of Sections Administrative Board and the Executive Committee.

Although the guidelines are recommendations only, their use as course development aids is suggested by AADS policy. Any questions on these guidelines may be addressed to the Journal's editor, the Executive Director, or the Chairman of the Section on Oral Biology.

These guidelines have been developed for educational institutions as curriculum development aids. They are not official policy statements of the AADS or recommendations for restrictive requirements. The curriculum guideline committee of the Section on Oral Biology consisted of:

Ernest Hausman, State University of New York at Buffalo
Israel Kleinberg, State University of New York at Stony Brook (Co-chairman)
Michael Reed, University of Mississippi
Murray Robinovitch, University of Washington
Gerald I. Roth, University of Kentucky
Burton L. Shapiro, University of Minnesota (Co-chairman)
Richard P. Suddick, University of Texas

I. Introduction
The discipline of oral biology deals with the structure, development, and functions of the oral tissues, their interrelationships, and their relation to other organ systems in both health and disease.

In many schools, much of this discipline is taught as part of the traditional basic health science courses of anatomy, biochemistry, physiology, microbiology, pharmacology, immunology, and pathology. Traditionally, this function has been performed by basic health science departments of medical schools. In other cases it is taught by basic health science departments, units, or individuals within dental schools. In still other schools, oral biology departments or divisions have been created with the primary responsibility for teaching this material as an entity distinct from and following, or coincident with, core courses in the above basic health sciences. The rationale for a distinct program in oral biology is to provide (1) a focus for the traditional basic health sciences, and (2) a base of oral biological knowledge upon which clinical subjects of the dental curriculum and dental practice can rest.

Because of the different ways in which oral biology has evolved, its position in the dental curriculum and the types of faculty responsible for its teaching will vary from school to school. Consequently, the educational guidelines presented here should be considered as applying to a core of material that may be taught as an entity or may be covered within the dental curriculum as part of several courses or programs.

II. Primary educational goals
The goals of a curriculum in oral biology ought to include development of the following:

  1. Comprehension of the scope of oral biology and its role in the dental curriculum and in the practice of dentistry.
  2. Understanding the biological basis of oral phenomena, whether normal or pathological.
  3. Understanding how oral biological knowledge is acquired and how growth of such knowledge leads ultimately to a high quality of dental care.
  4. Understanding how diagnostic methods arising from oral biological research aid in the advancement and performance of clinical dentistry.
  5. Understanding of oral biology as the basis for preventive dentistry clinical procedures.

III. Prerequisites
Courses in basic health science that include anatomy, biochemistry, physiology, microbiology, pharmacology, pathology, and immunology. Oral biology is preferably taught as an entity but some curriculums may not permit this. Parts may be taught as additions to, or as parts of, the above basic health science courses or even as parts of some clinical sciences.

IV. Sequencing
In general, the placing of oral biology courses within the dental curriculum is most appropriate after the basic health sciences and before most of the clinical subjects. However, some of the teaching might appropriately overlap and be taught simultaneously with certain basic science courses in the curriculum, and some will undoubtedly overlap with clinical courses. Its sequencing will probably vary considerably in different schools.

V. Faculty
For a course in oral biology to be effective, faculty members teaching the course should be able to interact with instructors who teach the basic health sciences as well as those who teach the didactic portion of clinical courses and instruct in the clinic. In this regard, a significant proportion of oral biology faculty should include individuals with both dental and Ph.D. degrees, a Ph.D. degree in oral biology, or equivalent training or experience. Staff should be located in an environment that fosters maximum interaction between basic scientists and clinicians.

VI. Course content
The material presented below has been divided into several systems or units, based on the view that oral biology is a distinct entity arising from the integration of the basic health science disciplines in the examination and understanding of oral structures and phenomena. Recognition of oral biology as an entity becomes difficult, if not impossible, if it consists largely of a series of inclusions within the traditional basic health sciences and/or certain clinical disciplines.

A. The oral mineralized tissues
The oral cavity contains a variety of mineralized tissues which share common composition characteristics and properties yet show differences that suit each for its role in the oral cavity. The structure, function, mode of development, and involvement in various demineralization-remineralization phenomena are central to this unit of instruction.
  1. Amelogenesis and structure of enamel
  2. Dentinogenesis and structure of dentin; role in root formation
  3. Cementogenesis and structure of cementum; role in the attachment apparatus
  4. Microanatomy, physiology, and innervation of the pulp
  5. Chemistry of formation and solubilization of the various calcium phosphate salts
  6. Principles of crystal symmetry
  7. Crystallography of apatite and other calcium phosphates
  8. Mechanisms of biological calcification
  9. Principles of demineralization-remineralization phenomena
  10. Inorganic and organic composition of teeth
  11. Role of fluoride and carbonate in calcium phosphate solubility and dental tissue demineralization-remineralization phenomena
  12. Abnormal development and mineralization of enamel, dentin, and cementum
  13. Cell and hard tissue interaction phenomena
  14. Development of the dental caries lesion
  15. Pulpal mineralization and dentin-pulp phenomena
  16. Age changes in the oral mineralized tissues
  17. Nutritional and hormonal influences on the oral mineralized tissues
  18. Relationship of oral mineralized tissues to each other and to oral soft tissues
  19. Permeability of oral mineralized tissues
B. The oral mucosa and periodontium
The mucosa lining the oral cavity varies significantly in its structure and function. In some areas of the mouth it protects the underlying structures; in others it provides a means of transepithelial absorption and around the teeth it provides a unique epithelial structure and controls passage of crevicular fluid. The periodontium includes the tissues surrounding the teeth and is included in this section because in a sense it is contiguous with the oral mucosa.
  1. Microanatomy and ultrastructure of the oral mucosa; regional variation and its significance
  2. Epithelial cell and oral mucosa metabolism
  3. Epithelial cell renewal and keratinization processes
  4. Epithelial cell adhesion and aggregation phenomena; bacterial, tooth, and epithelial-epithelial interactions
  5. Transmucosal absorption
  6. Soft tissue wound healing
  7. Abnormal cell differentiation in the oral mucosa
  8. Microanatomy and ultrastructure of the sulcular, junctional, and marginal epithelial nature of the junctional epithelial attachment
  9. Physiology and composition of sulcular fluid
  10. Microanatomy, ultrastructure, and function of the periodontal ligament
  11. Microcirculation of the gingiva and periodontium
  12. Biochemistry of the structural proteins of the periodontium
  13. Microanatomy and ultrastructure of alveolar and associated bone
  14. Physiology and biophysics of bone and its remodeling
  15. Biology of hard tissue healing
  16. Oral immunological mechanisms
  17. Periodontal non-immunological and immunological response phenomena
  18. Nutritional and hormonal influences on the oral mucosa and periodontium
C. Salivary glands and saliva
Three pairs of major salivary glands and a large number of minor glands provide saliva to the oral cavity. The structure and function of the glands, their oral and systemic relationships, the composition and functions of the secretions they produce along with the physiology of salivary secretion, form the basis for this unit.
  1. Microanatomy, ultrastructure, and innervation of the various salivary glands
  2. Physiology of salivary gland secretion
  3. Neurological and pharmacological control of salivary gland secretion
  4. Chemical composition and physical properties of saliva
  5. Influence of saliva on the oral tissues
  6. Circadian rhythms and their salivary effects
  7. Nutritional and hormonal influences on salivary gland function and saliva composition
  8. Salivary immune and non-immune defense mechanisms
  9. Salivary secretion of drugs and their oral effects
  10. Salivary gland regeneration
  11. Saliva and taste perception
  12. Saliva and oral microbial interactions
D. Oral microbial systems
Oral hard and soft tissues are covered with microbial populations that are part of a complex ecology involving interactions with teeth, gingiva, mucosa, saliva, and diet. The properties of individual bacteria and the composition and properties of the mixed populations found in the mouth comprise this section.
  1. Specific microbes found in the oral cavity
  2. Acquisition of a normal flora
  3. Microbial composition of plaque on the teeth and oral soft tissues
  4. Chemical composition, formation, and metabolism of dental plaque; role of fluoride in oral microbial metabolism
  5. Plaque demineralization-remineralization phenomena and relation to formation of calculus
  6. Dynamics of oral microbial ecosystems
  7. Microbiology of dental caries
  8. Microbiology of periodontal disease
  9. Bacterial infections of the mouth
  10. Principles and modes of control of oral microorganisms
  11. Immunology of oral infections including aspects related to dental caries and periodontal disease
  12. Viral and mycotic infections of the mouth
  13. Oral malodor and the role of microorganisms
E. Oral-facial growth and development
Structural changes and mechanisms involved in oral facial growth and development are listed below.
  1. Development of the face, oral cavity, and associated structures
  2. Development of the tooth follicle and dentition
  3. Induction, differentiation, and transformation mechanisms
  4. Mechanical effects on bone and the facial skeleton
  5. Eruption and resorption
  6. Influence of diet on oral structures
  7. Hormonal influences on the oral structures
  8. Aging of oral tissues
F. Oral motor and sensor systems
The structure and function of the oral-facial neuro-musculature, the topics in this unit, are fundamental to mastication, deglutition, temporomandibular joint function, taste, pain, and proprioception.
  1. Microanatomy and ultrastructure of temperature, touch, pressure, and taste receptors of the oral cavity
  2. Physiology of pain in the orofacial region and its control
  3. Physiology of temperature and touch perception in the oral-facial region
  4. Dentin sensitivity and its control
  5. Biochemistry and physiology of taste perception
  6. Oral-facial reflexes including jaw, facial, tongue, laryngeal, pharyngeal, and palatal reflexes
  7. Biomechanics and structure of the temporomandibular joint
  8. Neurophysiology of mastication
  9. Kinesiology and electromyography of the oral musculature
  10. Phenomenon of deglutition
  11. Microcirculation and innervation of the tongue
  12. Role of tongue, lips, palate, and cheeks in speech and other oral phenomena
  13. Physiology of olfaction
  14. Food consistency and its effects on oral phenomena
G. Oral diagnostic methodology
Information and principles that underly oral diagnostic laboratory and clinical procedures are rooted in oral biological knowledge and research techniques. Application of this information to new and improved diagnostic and monitoring methods for use in clinical dentistry is the basis of this unit.
  1. 1. Laboratory and clinical techniques to examine oral cells, tissues, and structure.
    1. Biopsy of hard and soft tissues
    2. Light and electron microscopy
    3. Genetic examination techniques
  2. Collection, handling, and analysis of oral fluids
    1. Blood, saliva, and crevicular fluid sampling methods
    2. Principles of chromatography, electrophoresis, enzymology, radioimmunoassay and spectroscopy, and their application to analysis of oral fluids
  3. Laboratory clinical techniques for examining plaque and microorganisms in the oral cavity
    1. Dental plaque sampling, size determination, and analysis
    2. X-ray diffraction of plaque
    3. Microbiology techniques
    4. Immunology techniques
    5. Salivary sugar clearance measurement
  4. Principles and use of electronic and electro-optical instruments
    1. Ultraviolet and visible intra-oral photography for tooth and soft tissue examination and recording
    2. Gingival crevicular fluid flow measurement and composition analysis
    3. Electromyography for temporomandibular joint function
    4. Principles of design and use of electrodes for the oral cavity
    5. Tooth conductivity and iontophoresis for tooth sensitivity determination and treatment

VII. Specific behavioral objectives
Upon completion of a course in oral biology, the student will be able to:

  1. Understand the structure, function, and development of the oral mineralized tissues and their involvement in demineralization-remineralization phenomena.
  2. Understand the structure, physiology, and function of the oral mucosa and periodontium in protecting underlying structures, providing a means of transepithelial absorption, and controlling the passage of crevicular fluid.
  3. Understand the structure and function of salivary glands, systemic relationships, and composition and functions of the secretions of the salivary glands.
  4. Understand the properties of individual bacteria and composition and properties of mixed microbial populations found in the oral cavity.
  5. Understand the mechanisms involved in oral-facial growth and development.
  6. Understand the structure and function of the oral-facial neuro-musculature within the context of mastication, deglutition, temporomandibular joint function, taste, pain, and proprioception.
  7. Understand oral diagnostic laboratory and clinical procedures, how the procedures arise from oral biological knowledge and research techniques, and how they are applied in clinical dentistry.