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Department of Cariology and Comprehensive Care

Chair: Mark S. Wolff , D.D.S., Ph.D., Professor of Cariology and Comprehensive Care

Associate Chair: James M. Kaim, D.D.S., M.S., Professor of Cariology and Operative Dentistry

Overview
The Department of Cariology and Comprehensive Care is responsible for the teaching of dental anatomy, cariology, and operative dentistry and aesthetic dentistry. In addition, one of the important goals of the department is to prepare students to provide comprehensive care to patients in a modern group practice setting. As a result, junior and senior students are integrated in group practices under the direction of group practice directors. Group practice directors mentor students in each of their groups toward competency and discipline requirements with the assistance of generalist and specialty faculty. In this regard, Cariology and Comprehensive Care interacts closely with all the specialty areas to meet the established goals and objectives of the department. Critical thinking is augmented through small group case discussion and through interdisciplinary seminars.  Additionally, group interaction, with junior-year students acting as junior members of the group, and practice management seminars and assignments provide all members of the group the opportunity to gain the fundamental elements of managing a dental practice. 

Operative dentistry at New York University College of Dentistry dates back to the late 19th century. Professor E. Bingham Trip established the department while serving the College from 1897-1940. Operative dentistry has undergone significant changes in the last 40 years including the development of the high-speed drill, the use of lasers, particle abrasion, bleaching, bonding, and computer-generated restorations. In addition aesthetic dentistry has become a major emphasis in the current teaching program. In 2000 the Department of Operative Dentistry became the Department of Cariology and Operative Dentistry in recognition of the need to focus on prevention and treatment of caries using a medical model coupled with a surgical model.  In 2005, the Department of General Dentistry and Practice management merged with the Department of Cariology and Operative Dentistry to create the Department of Cariology and Comprehensive Care.  This merger permitted the smooth integration of pre-clinical concepts into the clinical domain with students receiving an evidence based preclinical and clinical education.

The first 10 years of the new millennium bring with them an opportunity to be in the forefront of change. Adhesive techniques and materials have permitted dentistry to move from many of the precepts that were developed at the end of the 19th century by G. V. Black, the father of the principles of operative dentistry, in favor of a more tooth-conserving surgical approach. New restorative materials permit students to consider repairing, rather than totally replacing, old restorations. Proven bonding techniques along with better tooth-colored materials permit more conservative and aesthetic restorations. New products, including mouth rinses, toothpastes, varnishes and even vaccines, may lead to drastic reductions in dental caries. Remineralization, reversal of early carious lesions, treatment of existing carious lesions, repair/replacement of existing restorations, diverse treatment of a patient’s aesthetic needs and the emerging field of ecological modification of tooth surfaces for caries prevention ensures the future of operative dentistry.

The Department of Cariology and Comprehensive Care continues to be responsible for the training of dental students throughout their four years of matriculation. The department is dedicated and committed to continuing to be a leader in providing the knowledge and skills, coupled with clinical training, which will permit graduates to provide state-of-the-art dental care to a worldwide population.


Curriculum
The Department of Cariology and Comprehensive Care provides academic training for all classes in the undergraduate program.


First Year
The Department of Cariology and Comprehensive Care’s Simulation Program offers courses in Dental Anatomy and Operative Dentistry. The Clinical Foundations, Dental Anatomy, and Dental Biomaterials course introduces first-year students to the form, function, and occlusion of teeth.  This multidisciplinary course provides the students’ first introduction to the dental environment. Course content begins with discussions of health promotion and epidemiology that is designed to establish a foundation for the remaining portion of both the freshman and sophomore curricula.  The course places emphasis on tooth morphology and its relationship to normal physiologic function and overall aesthetics. Students use wax and composite to create ideal tooth size, shape, and contour for the permanent and primary dentition using a simulated dental arch. A separate course in Cariology and Operative Dentistry stresses the etiology, prevention, and surgical intervention for the infectious disease “caries,” as well as the restoration of defects for functional and/or aesthetic reasons. Single Tooth Restorations I and Biomaterials provides pre-clinical training through the use of dental simulators.  This is next in a series of three General Dentistry Simulation (GDS) courses presented in the first year curriculum. Here, students take their knowledge of dental anatomy and biomaterials and learn the principles and procedures for single tooth restorations for both the permanent and primary dentitions. Procedures are performed in a simulation environment with careful supervision of each step in cavity preparation. Exercises are evaluated using the same Clinical Competency forms that students experience in their clinical training during the third and fourth years. All techniques and materials are identical to those performed on patients in the group practice areas.  The final training course in the first year is Single Tooth Restorations II and Biomaterials. This is the third course in the series.  This GDS course builds on the student’s experience. The techniques and concepts taught in lecture and laboratory extend to more complex procedures that are still limited to single tooth restorations.


Second Year
Complex Restorations I
Starting in the second year, students learn the principles of crown preparation, occlusion, and fixed prosthodontics. Continuing the theme of an integrated curriculum, within Complex Restorations I (CRI), the concepts of clinical endodontics, periodontics, and pediatric dentistry are introduced where appropriate. The course is sequenced to provide optimal learning; as an example, endodontic procedures are taught immediately prior to dowel fabrication. Biomaterials considerations are presented in an integrated fashion, whenever appropriate throughout the course. During CRI, students fabricate three-unit splints, create provisional restorations and dowels.


Complex Restorations II
Taking place parallel to the CRI course, CRII presents the principles of removable prosthodontics. Students are guided from diagnosis, preliminary, and final impressions through the wax up of both removable partial prosthesis and complete dentures. Again, related concepts in biomaterials and biocompatibility are discussed.


Aesthetic Dentistry
The aesthetic dentistry component takes place toward the latter portion of the sophomore-year curriculum. Students learn how to perform an aesthetic evaluation on a patient, using clinical examples of relevant cases. This includes the collection of data and dental records with specific emphasis on micro- and macro aesthetic zones. In addition, there is a focus on smile design with specific emphasis on midline discrepancies, arch discrepancies, facial form, tooth size and shape, lip line, and axial inclination of teeth. Embrasure space, as a component in aesthetic outcomes, is also addressed. Students learn how to perform both in office and at home bleaching techniques.

Students are presented concepts of diagnosis and treatment planning for patients who would benefit from varying levels of orthodontic services and are introduced to principles and concepts involved in the clinical evaluation of the patient, cephalometric analysis, space analysis, and the use of the Invisalign™ technique.


Cariology/General Dentistry
This component of GDS provides a transition from the Simulation Lab to patient care. It builds on the foundation knowledge gained in the first year with emphasis on classic and contemporary preparations in General Dentistry. Students update their familiarity with cariology, caries diagnosis, caries risk assessment, and remineralization techniques.  The simulation program finishes immediately before the students’ transition into the clinics.

Third Year
General Dentistry Clinic
The students incorporate the knowledge and skills acquired during the first two years into direct patient care. Working under direct faculty supervision, students are able to perform the non-surgical and surgical procedures required to attain competency.  The General Dentistry Clinic course has been formulated and designed to prepare the student to provide comprehensive care to patients in a modern group practice setting. While most care is usually delivered by a single student, some patients may be treated by other members of the group depending on the complexity of the required care and other factors. The members of the group are responsible for the delivery of comprehensive dental care including continual maintenance of the treated patient’s oral health.

Practice Management
This course is designed to assist the general dental practitioner in acquiring the skills and knowledge necessary to manage a sound business operation, which facilitates the delivery of quality oral health care. Students are also taught emergency procedure in case of a bioterrorist attack. Seminars are given by outside experts affiliated with the College. This course is provided to students during the spring semester of the academic year.

Fourth Year
Students continue to treat patients under faculty supervision working toward completing the required department competencies.  As part of the General Dentistry clinic the student treats patients in a comprehensive fashion four to five days each week.  Supervision within the clinic is principally by the Department of Cariology and Comprehensive Care.  Specialist faculty from the disciplines of Endodontics, Periodontics and Prosthodontics join the Comprehensive Care faculty within the student’s home clinical facility supervising care and providing dental consultations.  As part of the clinical experience, students complete a complex Portfolio Case which they independently treatment plan, treat and report on in their senior year.  Small group meetings held once monthly allow case presentation, practice management and clinical literature review to be conducted in small groups.  All fourth-year students are required to complete several aesthetic procedures including indirect posterior aesthetic restorations and dental bleaching.  Some students have an opportunity to provide advanced aesthetic care to patients at the Rosenthal Institute, under the direct supervision of Cariology and Comprehensive Care faculty.  In addition to the clinical course, the Department of Cariology and Comprehensive Care provides students specific training and evaluation opportunities for preparation required for licensing examinations.  The department conducts an intensive licensing preparation and remediation program for all fourth-year students.

Practice Management
This course is designed to assist the general dental practitioner in acquiring the skills and knowledge necessary to manage a sound business operation, which facilitates the delivery of quality oral health care. Students are also taught emergency procedure in case of a bioterrorist attack. Seminars are given by outside experts affiliated with the College. This course is provided to students during the spring semester of the academic year.

Honors Program in Aesthetic Dentistry
The Honors Program in Aesthetic Dentistry is offered to selected fourth-year students who have expressed an interest in aesthetic dentistry and who have demonstrated superior knowledge and skills in operative dentistry. Students in this program are offered the opportunity to assist and provide direct patient care for more complex aesthetic cases.

Honors in Hospital Rotation (Lincoln Hospital)
The Lincoln Hospital rotation gives a few select students the opportunity to practice general dentistry in a hospital setting for two-month periods of rotation. Students provide comprehensive care to those individuals seeking care from the hospital as well as those patients cared for by the hospital.

Junior/Senior Rotation in Faculty Practice
The Faculty Practice rotation permits students to provide care at the University Faculty Practice office.  The Faculty Practice provides a wide variety of comprehensive dental care to varying student/staff populations who have affiliations with New York University.

Research
The Department of Cariology and Comprehensive Care has a clinical research centered program.  A particular emphasis is on clinical studies for modification of tooth surfaces to remove the ecologic niches critical for viability of bacteria associated with the carious process. Additional clinical research on burs that selectively cut only carious dentin are being conducted by members of the department in the newly opened Bluestone Center for Clinical Research.

The Department of Cariology and Comprehensive Care conducts industrial funded and NIDCR funded research in a variety of areas. Members of the department have expertise in clinical trials involving dental materials, dentinal hypersensitivity, implant restoration, oral malodor, gingivitis, calculus accumulation, periodontal disease and tooth whitening. In addition, Department members conduct research to understand the relative contribution of genetics and environment to oral diseases. This can be accomplished utilizing epidemiological approaches, analysis of the oral microbiota and of host-derived markers to characterize the exacerbation and prevention of oral diseases.

Current research funding within the department is $550,000 per year.

Other Activities
The Department of Cariology and Operative Dentistry also supports a full-time International Program in Aesthetic Dentistry.