# Geriatric Dentistry Curriculum in Six Continents
## 4 Discussion  
A report of the presence of GD in the curricula of some dental schools is presented. To achieve this, we contacted 506 dental schools from 65 countries to complete an online questionnaire. Eighty-three dental schools completed the questionnaire (16.4%). Briefly, our results found that GD was being taught in the curricula of all responding schools. This report is particularly important because it is the first to compile information from dental schools across the six continents. GD was a compulsory course in 67.5% of the responding schools, compared to the 89.0-92.8% reported [9; 13; 14] in the USA and the 82.0% in Europe [15]. However, [PERSON] et al. in 2017 [2] reported similar findings from European dental schools (52.0%). Additionally, 62.7% of the schools were teaching GD as a combination of didactic courses and clinical rotations. These results represent a remarkable increase compared to previous surveys which have reported teaching of GD only in 15.8-28.0% of the responding dental schools [11; 16; 17]. Nevertheless, the teaching format of GD varies among countries and dental schools, similar to previous reports [3; 4; 9; 10]. In 62.7% of dental schools with GD as a didactic course also had a clinical component located at an extramural site, which was higher than 26.8% reported for Europe in 2017 [2] but lower than in the USA in 1981 [12], 2003 [11], and 2012 [17], as well as in Austria, Switzerland and Germany [16] (see Table S6 in Supporting Information). Also, 71.0% of Chilean schools had an outreach clinical rotation site [3]. There is evidence that if dental students have clinical experiences through extramural rotations it will improve their confidence to provide care and improve the chances that they will care for frail older adult patients after graduation [18; 19; 20]. In this study, a clinical component was reported in 66.3% of the schools, which was higher than the 61% described in a previous European study [15]. Mandatory/compulsory clinical experiences for dental students in the USA increased from 59% in 1974 to 67% in 2003 [17] and to 67.9% in 2016 [9], compared with 71.4% reported in our study. It should be noted, however, that not all USA dental schools responded to the survey, and from the five responses from American schools, two responded their clinical education program in GD was elective. With regard to the content of the syllabus in GD, the results of the past four decades in the USA [9], show a tendency of teaching traditional topics, associated with oral medicine and prosthodontics. These topics include, \"medical problems of elderly people\"; \"oral and dental tissue changes associated with aging\"; and \"oral manifestations of systemic disease\". Other important subjects such as \"barriers to dental care\", \"socio-economic problems\", \"demographic distribution of elderly people\" and \"oral management of the functionally independent adult\" have also been taught over the last 40 years. When we asked the dental schools about their intention to expand their GD curriculum, 51.0% of dental schools reported that they were currently planning to expand, which was similar to 47.1% of European schools [2] and 53.6% of USA schools [4] reported in previous studies. We found that clinical geriatric care was being delivered by students at remote sites, 49.0% in old people's homes and 41.2% in nursing homes, similarly to previous reports [6; 9; 17]. As stated earlier, students who spend more time with older adults during dental school expressed more confidence in their knowledge in how to treat frail older adults and were more likely to treat them after graduation [18; 19; 20]. In 2017, it was found that prosthodontics, preventive and community and family dentistry departments were mainly responsible for teaching these courses in the USA [4], Austria, Switzerland and Germany [16]. Most of the respondents to our survey stated that multiple departments wereresponsible for teaching didactic and clinical GD, followed by prosthodontics (Table 3).