A Survey of Local Anesthesia Education in Turkish Dental Schools

A Survey of Local Anesthesia Education in
Turkish Dental Schools
Ceyda Özçakır Tomruk; İnci Oktay; Kemal S˛ençift
Abstract: The aim of this study was to evaluate differences with regard to local anesthesia education in Turkish dental schools.
Questionnaires designed to collect information about local anesthesia education were sent to the heads of the Departments of
Oral and Maxillofacial Surgery of seventeen Turkish dental schools. Eleven returned the completed survey for a response rate of
64 percent. It was determined that dental schools begin the theoretical part of their local anesthesia (LA) curricula during the first
half of the third year. Most dental schools start teaching the practical aspects during the second half of the third year on average—half
a year after the beginning of the theoretical background. The first injection in humans, usually a fellow student (82
percent), is mostly supervised by an oral and maxillofacial surgeon. The number of injections under supervision usually depends
upon the individual capabilities of the student. None of the schools said they required permission of a medical ethics committee
for injections on fellow students. Seventy-three percent of the schools said they were satisfied with their current LA teaching and
were not planning to make any changes. Overall, LA teaching programs showed minor variations across the surveyed Turkish
dental schools.
Dr. Tomruk is Assistant Professor, Department of Oral Surgery, University of Yeditepe; Dr. Oktay is Professor, Department of
Pedodontics, University of Yeditepe; and Dr. Şençift is Professor, Department of Oral Surgery, University of Yeditepe. Direct
correspondence and requests for reprints to Dr. Ceyda Özçakır Tomruk, Department of Oral Surgery, University of Yeditepe,
Bagdat Cad. No. 238 Göztepe, İstanbul 34728, Turkey; ceyda.ozcakir@yeditepe.edu.tr.
Keywords: local anesthesia, local anesthesia education, dental anesthesia, oral surgery, Turkey
Submitted for publication 3/2/12; accepted 5/4/12
Local anesthesia (LA) has been defined as a
loss of sensation in a circumscribed area of
the body caused by a depression of excitation
in nerve endings or an inhibition of the conduction
process in peripheral nerves. 1 LA is required to allow
invasive dentistry to be carried out in a painless
manner. Teaching the mechanism of anesthetics and
the ability to deliver anesthetic injection techniques
correctly is an important aspect of dental curricula. 2
In the current profile for the European dentist, competency
6.34 states that “a dentist must be competent
at infiltration and block local anesthesia in the oral
cavity for restorative and surgical procedures or other
treatment, as needed, for orofacial pain management,
including management of potential complications of
local anesthesia.” 3
Teaching the principles of dental anesthesia
provides an excellent opportunity to integrate the
clinical and basic science curricula. 4 Decisions for
proper patient care requiring anesthesia modalities
necessitate that students are able to apply the didactic
knowledge they acquired from anatomy, physiology,
pharmacology, and medical emergencies courses. 5
Teaching LA is a complex and comprehensive
process for both basic science and clinical faculty
members, and the transition to the first injection of
a patient is often difficult for dental students. 6 Many
newly qualified dentists indicate current LA courses
do not provide adequate preparation for the initial
demands of a general practice. 7 To date, there is relatively
scarce information on teaching LA to dental
students. The aim of this study was to evaluate the
differences with regard to local anesthesia teaching
in Turkish dental schools.
Materials and Methods
An eighteen-item questionnaire-based study
was designed to gather information about local
anesthesia education at Turkish dental schools. The
survey was conducted in April and May 2011. Data
were collected from surveys sent to the chiefs of
oral and maxillofacial surgery departments at dental
schools in Turkey.
Seventeen out of thirty-eight dental schools
in Turkey were asked to complete the survey. The
remaining twenty-one dental schools were excluded
because they had only been founded within the last
five years. These schools were deemed not to have
enough experience with all years of a five-year curriculum.
348 Journal of Dental Education ■ Volume 77, Number 3

Results
Of the seventeen dental schools contacted,
eleven (64.7 percent) responded to the survey. No response
was received from the remaining six schools,
even though notices were sent. The mean number of
dental students at the schools was 426±174 (between
115 and 700 per school), showing a wide variation;
the mean of yearly enrollment of dental students
was 100±38.
All of the dental schools said they begin the
theoretical background of local anesthesia curricula
during the first half of the third year. On average,
most dental schools begin to teach the practical aspects
during the second half of the third year, after
the theoretical background has been taught (Table
1). Overall results of the survey on teaching of local
anesthesia in curricula of Turkish dental schools are
shown in Table 2. Most dental schools use textbooks
and syllabi. The theoretical aspects of LA education
are assessed by either a written examination only
(100 percent) or both written and oral examinations
(82 percent). Sixty percent of the dental schools have
a practical examination to evaluate the students’
learning. In almost half of the schools, the students
practiced on non-human objects (e.g., fruits such
as oranges) before they started clinical practice on
humans. Ninety-one percent of the surveyed schools
reported being satisfied with their current local anesthesia
education; only 10 percent were planning
further changes including preclinical training models.
Discussion
Most practitioners recognize the importance
of dental anesthesia education and training. However,
little consensus exists regarding the extent of
anesthesia training that is appropriate for a dental
school’s undergraduate curriculum. This is the first
study to assess theoretical and clinical training in
local anesthesia in Turkish dental schools. Question-
naires were sent to the heads of the Department of
Oral and Maxillofacial Surgery of seventeen schools.
Completed questionnaires were returned by eleven
schools, resulting in a response rate of 64.7 percent.
The results show similarities as well as diversities.
One of the similarities is that the theoretical
instruction is separated from the practical instruction
and precedes the clinical teaching by half a year. One
of the differences is in administering local anesthetics
on non-human objects prior to starting work in
the clinics. At some dental schools, the students
administered LA on non-human objects such as an
orange, while the other students performed their
first injection on a fellow dental student. In most
cases (73 percent), dental students performed their
first injection on fellow dental students who do not
require dental treatment, under the supervision of
an oral and maxillofacial surgeon. These results are
consistent with the study conducted by Brand et al. 2
and with older reports about local anesthesia teaching
in the United States. 4,8
Electronic training models have been available
for more than twenty years. However, none of
the Turkish dental schools currently use electronic
training models before the initial injection on humans
although several dental schools reported plans to introduce
them in the near future. Furthermore, there is
no evidence that the electronic training models have
shown any superiority in the teaching of local anesthesia.
9 However, in the near future, the virtual reality
method may also play an important role in training
students on local anesthesia with the accumulation
of more data on its success. 10
Brand et al. evaluated dental students’ opinion
of their LA education and reported that programs
and rating of this teaching by dental students show
a wide variation across Europe. 9 However, students’
opinion was not considered in our study. It is evident
that feedback from the recipients of education will
provide useful information regarding the best methodology
to familiarize a novice with local anesthetic
techniques.
Table 1. Initial teaching of local anesthesia in curricula of Turkish dental schools (n=11)
Initial Teaching Theoretical Background Practical Aspects
Year 3, first half 11 (100%) —
Year 3, second half — 10 (81%)
Year 4, first half — 1 (9%)
March 2013 ■ Journal of Dental Education 349

Table 2. Teaching of local anesthesia in curricula of
Turkish dental schools (n=11)
Aspect of Education
Number (percentage)
Written material
Syllabus 1 (9%)
Textbook 1 (9%)
Syllabus and textbook 9 (82%)
Assessment type
Written examination 11 (100%)
Oral examination 9 (82%)
Practical examination 7 (64%)
Injection on non-human object
Yes
5 (45%; fruits
such as orange)
No 6 (55%)
First injection on each other
Yes 8 (73%)
No 3 (27%)
First injection on patients requiring
local anesthesia
Yes 4 (36%)
No 7 (64%)
First injection supervised by oral
and maxillofacial surgeon
Yes 9 (82%)
No 2 (18%;
other departments)
Need consent to do first injection
on each other
Yes 8 (73%)
No 4 (36%)
Need permission of medical ethics
committee to do first injection on
each other
Yes —
No 11 (100%)
Have postgraduate local anesthesia
course
Yes —
No 11 (100%)
Satisfaction with current local
anesthesia education
Yes 10 (91%)
No 1 (9%)
Planning changes in local
anesthesia education
Yes 3 (27%;
to use phantom heads)
No 8 (73%)
Dental anesthesia is a very important step of
dental treatment in all aspects of the profession, and
in some cases patients judge the skill and expertise
of the practitioner by his or her ability to carry out
a successful anesthesia. Thus, the professions must
ensure that qualified anesthetic skills are instilled in
students prior to graduation so that they will be able
to provide painless and comfortable dental care to
their patients when they start working independently.
Conclusions
Although the response rate limits detailed
interpretation, the results show a minor variation in
local anesthesia teaching at dental schools in Turkey.
When the similarities regarding dental curricula
increase between dental schools, student mobility
with exchange programs may increase all over the
country and world. Future studies regarding the students’
opinions of their local anesthesia education are
needed in order to support more specific conclusions
on this topic.
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