Global Dental Education

Current Cariology Education in Dental

Schools in Spanish-Speaking Latin American
Countries
Stefania Martignon, Ph.D.; Juliana Gomez, P.D. (Pediatric Dentistry); Marisol Tellez,
Ph.D.; Jaime A. Ruiz, M.Sc.; Lina M. Marin, M.Sc.; Maria C. Rangel, M.Sc.
Abstract: This study sought to provide an overview of current cariology education in Spanish-speaking Latin American dental
schools. Data collection was via an eighteen-item survey with questions about curriculum, methods of diagnosis and treatment,
and instructors’ perceptions about cariology teaching. The response rate was 62.1 percent (n=54), and distribution of participating
schools by country was as follows: Bolivia (four), Chile (four), Colombia (twenty-four), Costa Rica (one), Cuba (one), Domini-
can Republic (two), El Salvador (two), Mexico (six), Panama (two), Peru (four), Puerto Rico (one), Uruguay (two), and Venezu-
ela (one). Forty percent of the responding schools considered cariology the key axis of a course, with a cariology department in
16.7 percent. All schools reported teaching cariology, but with varying hours and at varying times in the curriculum, and 77.8
percent reported having preclinical practices. The majority reported teaching most main teaching topics, except for behavioral
sciences, microbiology, saliva and systemic diseases, caries-risk factors, root caries, erosion, and early caries management strate-
gies. The most frequently taught caries detection methods were visual-tactile (96.3 percent), radiographic (92.6 percent), and the
International Caries Detection and Assessment System (ICDAS) (61.1 percent). Respondents said their schools’ clinics make an
operative treatment decision when radiolucency is in the inner half of enamel (42.3 percent) for radiographic criteria and when
the lesion is visually non-cavitated (5.8 percent). All respondents reported that their schools teach preventive strategies, but only
43.4 percent said they tie it to risk assessment and 40.7 percent said they implement nonsurgical management regularly.
Dr. Martignon is Associate Professor, Caries Research Unit UNICA, Dental Faculty, Universidad El Bosque, Bogotá, Colombia;
Ms. Gomez is Associate Instructor, Caries Research Unit UNICA, Dental Faculty, Universidad El Bosque, Bogotá, Colombia;
Dr. Tellez is Associate Professor, Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, PA, USA; Jaime
Ruiz is Professor, Caries Research Unit UNICA, Dental Faculty, Universidad El Bosque, Bogotá, Colombia; Lina Marin is As-
sistant Instructor, Caries Research Unit UNICA, Dental Faculty, Universidad El Bosque, Bogotá, Colombia; and Ms. Rangel is
Dean, Dental Faculty, Universidad El Bosque, Bogotá, Colombia. Direct correspondence and requests for reprints to Dr. Stefania
Martignon, Caries Research Unit UNICA, Dental Faculty, Universidad El Bosque, Av. Cra 9 No. 131A-02, Bogotá, Colombia;
martignonstefania@unbosque.edu.co.
Keywords: caries, cariology, cariology teaching, curriculum, dental education, Latin America
Submitted for publication 4/20/12; accepted 8/8/12

T
he modern understanding of caries has shifted
from the traditional concept of caries being
only an endpoint—a cavity—towards the car-
ies process itself, especially since there is evidence
that the caries process can be arrested, mainly in its
first manifestations.1-3 These changes have had at
least three consequences in the conception of caries
and the clinical diagnosis process: 1) there are dif-
ferent degrees of caries severity, involving enamel
and dentin lesions; 2) visual examination has become
more reliable for caries detection and assessment; and
3) caries management is no longer considered to rely
solely on operative treatment but includes non-op-
erative strategies, so that treatment decisions should
be made according to a comprehensive synthesis of
diagnosis at both tooth/surface and patient levels.4
As a result, the clinical, epidemiological, research,
and educational implications of caries management
need to be considered.
Even though the prevalence of caries has
declined worldwide, in developing countries such
as those in Latin America, caries continues to be a
public health problem5 associated with barriers to
health care access and economic, educational, and
social inequalities.6-8 The responsibility for develop-
ment of appropriate oral health care as the basis for
clinical decision making should be with the dental
schools,9 and education of future practitioners must
follow an evidence-based curriculum.10 Like dental
schools in North American and European countries

1330 Journal of Dental Education  ■  Volume 77, Number 10

that share interests in national and international or-
ganizations, Spanish-speaking Latin American and
Caribbean dental schools have became members
of the Organization of Dental Faculties, Schools,
and Departments–Latin American and Caribbean
Universities Union (Organización de Facultades,
Escuelas y Departamentos de Odontología–Unión de
Universidades de América Latina y el Caribe, OFE-
DO-UDUAL), an institution that seeks to promote
student and faculty academic exchange and curricular
concerns across dental schools.11 To contribute to this
international understanding of oral health issues, the
aim of our study was to assess cariology education
for undergraduate students in Spanish-speaking Latin
American dental schools.
Methods
A cross-sectional study of Spanish-speaking
Latin American dental schools was conducted
from 2009 to 2011. We designed a thirty-item
questionnaire about cariology education based
on questions from the following sources: surveys
conducted by Clark and Mjör,12 a survey admin-
istered by the American Dental Education As-
sociation’s Section on Cariology,13 a chapter by
Kidd and Fejerskov in their cariology textbook,14
discussions from International Caries Detection and
Assessment System (ICDAS) annual meetings,15
and concepts discussed by the authors. The ques-
tions aimed to assess four main areas: curriculum,
diagnosis, treatment, and perceptions about how
the teaching of cariology is being incorporated into
the respondent’s school. This study was considered
exempt by the Universidad El Bosque Institutional
Review Board.
The initial questionnaire was validated in terms
of content in 2009, by assessing the understanding
of the questions’ meaning, content, and language.
Five cariology teachers from Universidad El Bosque
conducted the first assessment. Their suggestions led
us to reduce the questionnaire to twenty-three items.
The second assessment was conducted with the help
of two focus groups of twenty faculty members
each: one was conducted in Bogotá, Colombia, with
members of the Colombian Association of Dental
Schools (Asociación Colombiana de Facultades de
Odontología, ACFO); and one was conducted at
the International Association for Dental Research
(IADR) Latin American Annual Congress in Isla
Margarita, Venezuela. These focus groups followed
an assessment guideline. The moderator explained
October 2013  ■  Journal of Dental Education
the purpose of the study and asked the participants
to read the questionnaire, after which discussion
was held. The focus group sessions were audio-
recorded, and a reporter took notes. The analyses
of these transcriptions searched for coincident and
non-coincident points and led to modifications of
questions and answer options. The Latin American
focus group led also to Spanish language adaptations.
The final questionnaire consisted of eighteen ques-
tions (seven close-ended multiple-choice, six scaled,
four close-ended dichotomous, and one open-ended).
The number of questions administered by dimensions
evaluated was as follows: curriculum (seven), diag-
nosis (five), treatment (five), and perceptions (one).
The sample for the study was obtained by con-
venience. Eighty-seven dental schools were invited
to participate, including all schools associated with
OFEDO-UDUAL (n=54), all schools associated with
ACFO (n=24), and other schools from the Universidad
El Bosque database (n=21). Some schools were mem-
bers of more than one of these groups. The number of
dental schools invited to participate from the following
countries was as follows: Argentina (one), Bolivia
(four), Chile (four), Colombia (twenty-four), Costa
Rica (one), Cuba (one), Dominican Republic (four),
Ecuador (three), El Salvador (two), Honduras (one),
Mexico (twenty-seven), Panama (two), Peru (four),
Puerto Rico (one), Uruguay (two), and Venezuela (six).
The dental schools’ deans/chairs were sent a
letter of invitation for their school to participate in
the study, including a brief description of the project.
They were asked to provide the name and contact
information of the primary cariology faculty mem-
bers at their school. Those faculty members were
then invited to participate and were instructed to
complete the survey either online using the platform
Moodle (Module Object-Oriented Dynamic Learning
Environment) from the Universidad El Bosque or in
a Word document to be returned by e-mail. Three
reminders were sent to invited faculty members and
the schools’ deans/chairs via e-mail. Data from the
questionnaires were transferred to an Excel (Microsoft
Office, 2010) database, and consistency checking was
done to minimize the possibility of errors. Descrip-
tive analyses were conducted exploring frequency
distributions of categorical variables and mean/SD
of continuous variables with the Epi Info software.16
Results
A total of fifty-four questionnaires were com-
pleted out of the eighty-seven sent, for a response
1331
 rate of 62.1 percent. The distribution of responding
schools by country was as follows: Bolivia (four),
Chile (four), Colombia (twenty-four), Costa Rica
(one), Cuba (one), Dominican Republic (two), El
Salvador (two), Mexico (six), Panama (two), Peru
(four), Puerto Rico (one), Uruguay (two), and Ven-
ezuela (one).
Curriculum Questions
To Question 1 (“Is cariology teaching at
your school the axis or part of a course?”), cariol-
ogy was reported to be the key axis of a course in
fewer than half of the responding schools (42.3
percent). Two schools (3.7 percent) did not answer
this question. To Question 2 (“Which department
teaches cariology at your school?”), there was an
independent Department of Cariology in charge of
teaching cariology in 16.7 percent of the schools.
The next most frequently named departments that
teach cariology were the Department of Operative/
Restorative Dentistry (14.8 percent) and Department
of Pediatric Dentistry (11.1 percent). In 9.3 percent of
the schools, two departments were in charge, and in
almost one-fourth (24.0 percent) there was a combi-
Figure 1. Departments that teach cariology in responding dental schools (n=54)
1332
nation of more than two departments (Figure 1). To
Question 3 (“Which caries textbook is recommended
for cariology teaching at your school?”), more than
one textbook was recommended for the majority of
responding schools (70.4 percent). The textbooks
most often used were Thylstrup and Fejerskov17
(27.8 percent), Fejerskov and Kidd18 (27.8 percent),
Henostroza19 (18.6 percent), Seif20 (18.6 percent),
and two cariology clinical management guidelines
edited in Colombia: González et al.21 (15.2 percent)
and Martignon et al.22 (15.2 percent). Other textbooks
used in five or fewer schools were two published in
English (Axelsson23 and Kidd24) and four published
in Spanish (Cárdenas,25 Barrancos,26 Moncada and
Urzúa,27 and Silverstone28).
To Question 4 (“In which year/s do students
have theoretical cariology teaching?”), 27.8 percent
of responding schools said it was in the second year,
followed by a combination of teaching in the second
and third years (18.5 percent) and only in the third
year (14.8 percent). Of the responding schools, 24.1
percent reported starting cariology teaching in the
first year, with 9.3 percent starting in the second year
and 5.6 percent in the third year. To Question 5 (“How
Journal of Dental Education  ■  Volume 77, Number 10
many hours per week are the students being taught
about cariology?”), more than half of these schools
(53.7 percent) reported devoting two weekly hours to
the teaching of cariology, with 37.0 percent reporting
between three and seven hours and 9.3 percent more
than seven hours. Regarding the request in Question
6 to indicate the topic/s being taught in the respon-
dent’s curriculum, Table 1 shows the percentage of
schools teaching each subject. To Question 7 (“Do
your students have preclinical practice workshops
about theoretical concepts before their first contact
with patients?”), most schools (77.8 percent) said
students participate in preclinical practice workshops
before having contact with patients.
Diagnosis Questions
Concerning caries detection methods (Question
8: “Which caries detection method/s is/are being
taught at your school?”), more than nine out of ten
said they teach visual/tactile techniques (96.3 per-
cent) and radiographic interpretation (92.6 percent).
Large percentages also reported teaching DMF (72.2
percent), the ICDAS system (61.1 percent), and
activity assessment of caries lesions (64.8 percent).
Other methods mentioned were magnification (25.9
percent) and fluorescence-based methods (14.8
percent). To Question 9 (“If caries risk assessment
is taught in your school, please indicate which risk
factors are considered”), only one dental school
(1.9 percent) reported not incorporating caries risk
assessment into the curriculum. Table 2 shows the
percentage of schools teaching each subject.
To Question 10 (“When do patients have bite-
wing radiographs taken?”), the most common reason
reported was to confirm visual/tactile diagnosis (61.1
percent), followed by the patient being considered at
a high risk for caries (51.8 percent), diagnosis on a
regular basis (50.0 percent), for monitoring purposes
(44.4 percent), and for diagnostic purposes in a re-
call after five years (35.2 percent). Two schools (3.8
percent) did not answer Question 11: “From what
radiolucency depth (caries severity stage) of the le-
sion does your school indicate operative treatment?”
Over 40 percent of the schools (42.3 percent) reported
making an operative treatment decision when the
radiolucency is present in the inner enamel half up to
the enamel-dentinal junction (EDJ) (Figure 2). One
school (1.9 percent) did not answer Question 12: “At
which clinical visual/tactile severity stage of the le-
sion does your school indicate operative treatment?”
Of the responding schools, 5.8 percent reported mak-
ing an operative treatment decision when the visual
October 2013  ■  Journal of Dental Education
Table 1. Spanish-speaking Latin American dental
schools teaching theoretical topics in cariology, by
percentage of total respondents to this question (n=54)
Percentage of
Theoretical Topic Respondents
Caries classification 100%
Anatomy and histology of dental hard tissues 100%
Dental caries etiology 100%
Behavioral sciences 51.8%
Caries epidemiological description/analysis 88.8%
Clinical/histological appearance of carious 100%
lesions
Caries detection and diagnosis 100%
Caries risk assessment 87.0%
Early caries management (prevention/ 100%
arrestment/remineralization)
Removal of dental hard tissues affected by 100%
caries
Caries management in populations 64.8%
Caries detection, risk assessment, and 100%
management considerations in young
children
Considerations for caries associated with 100%
restorations
Considerations for root caries 79.6%
Dental erosion 64.8%
Table 2. Spanish-speaking Latin American dental
schools teaching caries risk assessment factors, by per-
centage of total respondents to this question (n=53)
Percentage of
Caries Risk Assessment Factor Respondents
Caries experience 88.6%
Plaque/oral hygiene 100%
Related diseases 77.3%
Bacteria (Lactobacillus/S. Mutans) 71.7%
Fluoride exposure (systemic/professional/ 94.3%
self-care)
Diet (contents/frequency) 96.2%
Saliva secretion 62.2%
Lifestyle/self-care 81.1%
assessment detects a non-cavitated lesion and 37.7
percent when it corresponds to a micro-cavity/enamel
breakdown (Figure 3).
Treatment Questions
Question 13 asked: “If early caries management
(caries prevention, arrestment, remineralization) is
taught in your school, please indicate which topics
are considered.” Table 3 shows the percentage of
schools teaching each topic. To Question 14 (“How
1333
 Figure 2. Radiographic operative treatment decision thresholds at responding dental schools (n=54)

Figure 3. Visual-tactile operative treatment decision thresholds at responding dental schools (n=54)

1334 Journal of Dental Education  ■  Volume 77, Number 10

often does the risk assessment drive caries man-
agement in the clinical practice of your school?”),
almost half of the responding schools (49.1 percent)
answered occasionally, 43.4 percent regularly, and
7.5 percent never. One dental school said it does not
incorporate caries risk assessment (1.9 percent). To
Question 15 (“In which way is oral health education
communicated to patients being treated at your school
clinic?”), 63.0 percent of the responding schools said
that most patients receive specific individual oral
health education, while patients at 33.3 percent of
these schools receive only collective oral health edu-
cation and 3.7 percent receive a combination of both.
To Question 16 (“How often are non-operative
caries management strategies being implemented at
your school clinic?”), more than half of the respond-
ing schools (51.9 percent) said they occasionally
implement non-operative caries management strate-
gies; 40.7 percent said they do so on a regular basis
and 7.4 percent never. One school (1.9 percent) did
not answer Question 17: “Does your school teach
how to repair/reseal restorations as alternatives to op-
erative treatment?” Of the responding schools, most
(71.7 percent) reported teaching how to repair/reseal
restorations as alternatives to operative treatment.
Perceptions
Finally, Question 18 asked: “Do you believe
cariology is being taken into account in an appro-
priate way within your school curriculum?” Almost
two-thirds of the responding schools (63.0 percent)
said they consider that cariology is not being taken
into account in an appropriate way in their curricu-
lum and would favor the development of a cariology
curriculum.
Discussion
At a time when the paradigm shift in cariology
has led to conceptual and practical changes world-
wide, ours is the first survey to assess the teaching
of cariology in Spanish-speaking Latin American
countries. A study in Europe recently resulted in
a similar report,29 and a study in the United States
has also been conducted.13 This trend is leading to
the restructuring of cariology in the curriculum for
undergraduate dental students, with the first proposal
coming from Europe.30
Our study faced an inherent limitation because
there is uncertainty about the existing universe of
dental schools in Spanish-speaking Latin American
October 2013  ■  Journal of Dental Education
Table 3. Spanish-speaking Latin American dental
schools teaching early caries management, by percent-
age of total respondents to this question (n=54)
Percentage of
Early Caries Management Topics Respondents
Professional plaque removal 96.3%
Oral hygiene instructions 94.4%
Cariogenic diet management 85.2%
Fluoride 92.6%
Management of hyposalivation 61.1%
Dental sealants 92.6%
Calcium-based strategies 27.6%
Xylitol-based strategies 38.8%
Antibacterial strategies 74.0%
pH neutralization strategies 53.7%
countries: there are no reliable databases and the
number of private schools has grown considerably
in the last years. The Latin American Dental Fed-
eration (FOLA-FDI)31 reports 119 dental schools in
the eighteen Spanish-speaking associated countries,
excluding Puerto Rico, but with no data for Mexico
and Colombia and without contact information.
OFEDO/UDUAL, the Latin American dental schools
association, had fifty-four associated dental schools
in 2009.11 We were able to contact the deans in twen-
ty-two additional Spanish-speaking Latin American
dental schools and in the twenty-four schools in
Colombia associated with the ACFO, seven of which
were OFEDO/UDUAL members as well. In total, we
secured complete contact data for eighty-seven dental
schools in Latin America, which corresponds to the
sample size; these included sixteen of the nineteen
Spanish-speaking countries.
Our efforts to contact the largest number of
schools and countries possible and the multiple
reminders sent resulted in a response rate of 62.1
percent. This level is similar to that in the study
conducted by Clark and Mjör12 in North America (66
percent) in 2001 but low when compared to the study
conducted in Europe by Schulte et al.29 (72 percent)
and to a recent study in the United States by Fontana
et al.13 (83 percent). Our response rate reflects the
inherent difficulties of conducting studies of this
nature. As contact with Colombian schools was easier
for us, all of them responded (n=24), accounting for
44.4 percent of the total respondents.
The continuing influence of the surgical ap-
proach to caries can be seen across these schools.
Although the respondents from most of these schools
(63.0 percent) reported a perception that cariology
1335
 is not being properly addressed in their school’s
curriculum, all of them include it in their teaching
competences (42.3 percent as an axis course). This
demonstrates cariology is considered a key com-
ponent of undergraduate dental education across
Spanish-speaking Latin America and is consistent
with the findings from Europe.29 Our findings along
with the great variation in answers regarding cur-
riculum aspects (questions 1-5) support the idea that
common cariology competences should be developed
for Spanish-speaking Latin American countries. The
wide number of cariology textbooks recommended
and the inclusion of caries management guidelines
as textbooks reflect the changing paradigm process
but also the need for writing and publishing modern
textbooks in Spanish.
As in the research in Europe,29 our study found
broad consensus about the majority of the fifteen
main areas that should be taught, with 100 percent
agreement in nine areas. Main areas with less agree-
ment were behavioral sciences (51.8 percent) and
caries management in populations and dental ero-
sion (both with 64.8 percent). There was around 80
percent agreement regarding root caries, caries risk
assessment, and caries epidemiological description/
analysis. The same trend was observed for the main
teaching areas regarding caries risk, but with less con-
sensus on factors related to systemic diseases, saliva,
microorganisms, and lifestyle/self-care. Early caries
management, hyposalivation management, and use
of modern remineralizing agents were considered the
most lacking teaching aspects. The lower agreement
regarding these aspects reflects gaps in the knowledge
base for cariology teaching according to Schulte et
al.30 The same observation applies to less consensus
on dental education in public health, management
of caries according to risk, management of caries in
elderly patients, and non-carious wear.
Not all the schools in our study reported having
their students participate in preclinical practice work-
shops (77.8 percent), and attention to the transference
of theoretical concepts to clinical practice seems to be
even lower (48 percent). These varying attitudes may
reflect the existing mixture of paradigms discussed by
Fejerskov.32 Concerning the detection and assessment
of dental caries in the clinic, bitewing radiographs
were not being taken on a regular basis for diagnostic
purposes in the schools in our study even though
nearly all reported teaching the use of radiography
(92.6 percent) and most Latin American countries are
regarded as high-caries risk populations.5 Just over
60 percent of the schools (61.1 percent) reported
1336
using a caries system that includes non-cavitated
lesions, namely ICDAS; nevertheless, 5.8 percent
of the schools reported their clinics make operative
treatment decisions when the visual appearance of the
lesion corresponds to a brown/white spot lesion and
42.3 percent of them when the radiographic appear-
ance of the lesion shows a radiolucency in the inner
half of the enamel. These clinical practices reflect a
lack of adherence to the current caries paradigm.32
Furthermore, the fact that 37.7 percent of these
schools’ clinics treat operatively when the lesion is
visually assessed as a micro-cavity is also related to
the traditional manner of treating caries. This practice
seems to be persisting although it is now known that
these types of lesions are regarded as needing a more
comprehensive individual lesion assessment (radio-
graphic detection to assess the depth of the radiolu-
cency more accurately); depending on this and the
individual caries risk in many lesions, a non-invasive
treatment could be provided.4,15 Our study suggests
that non-operative caries management strategies are
not being implemented on a regular basis across these
schools, although they should be encouraged based
on the theoretical teaching of cariology.
The respondents in our study agreed about
the difficulty of developing standardized concepts
among faculty members from different areas/depart-
ments such as microbiology, pediatric dentistry, and
operative/restorative dentistry although the resulting
inconsistencies make it more difficult for students in
clinical practice. The need to develop standardized
treatment principles is also hindered by the wide
range of areas/departments responsible for caries
education and by generational differences among
faculty members. These challenges continue to delay
universal acceptance of the paradigm shift in caries,
as Fejerskov discussed in his key article published
in 2004.32
Conclusion
Even with the sample limitations of our study,
the results give the picture of a mixture of very
modern concepts with some more traditional ones
regarding cariology education in Spanish-speaking
Latin American dental schools, but the wide interest
reported in expanding the teaching of dental caries
for undergraduate dental students was notable. In
Colombia, our results have helped stimulate the
development of a nation-wide consensus among the
twenty-four ACFO dental schools regarding cariol-
Journal of Dental Education  ■  Volume 77, Number 10
ogy education for undergraduate students, following
the first goal of the Alliance for a Cavity-Free Future
(ACFF) of the Colombian Chapter. Other countries
such as Brazil, Mexico, and Venezuela and organi-
zations such as OFEDO/UDUAL are beginning to
move in these directions as well. Future research on
this topic should include a broader sample and should
also assess cariology research, continuing education,
and public health; conducting qualitative analyses in
these areas would also be useful.
Acknowledgments
This study received internal funding from
Universidad El Bosque.
REFERENCES
1. Baelum V, Fejerskov O, Manji F. The “natural history”
of dental caries and periodontal diseases in developing
countries: some consequences for health care planning.
Tandlaegebladet 1991;95(4):139-48.
2. Kidd EAM, Fejerskov O. What constitutes dental caries?
Histopathology of carious enamel and dentin related to the
action of cariogenic biofilms. J Dent Res 2004;83(Spec
Iss C):35-8.
3. Fontana M, Zero D. Bridging the gap in caries manage-
ment between research and practice through educa-
tion: the Indiana University experience. J Dent Educ
2007;71(5):579-91.
4. Ekstrand KR, Ricketts DNJ, Kidd EAM. Occlusal car-
ies: pathology, diagnosis, and logical management. Dent
Update 2001;28(8):380-7.
5. Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S,
Ndiaye C. The global burden of oral diseases and risks to
oral health. Bull World Health Organ 2005;83(9):661-9.
6. Ismail A. Woosung S. The impact of universal access to
dental cares on disparities in caries experience in children.
J Am Dent Assoc 2001;132(3):295-303.
7. Quiñonez RB, Keels MA, Vann WF Jr, McIver FT, Heller
K, Whitt JK. Early childhood caries: analysis of psycho-
social and biological factors in a high-risk population.
Caries Res 2001;35(5):376-83.
8. Harris R, Nicoll AD, Adair PM, Pine CM. Risk factors
for dental caries in young children: a systematic review
of the literature. Community Dent Health 2004;21(1
Suppl):71-85.
9. Baelum V. Caries management: technical solutions to bio-
logical problems or evidence-based care? J Oral Rehabil
2008;35(2):135-51.
10. Plasschaert AJ, Holbrook WP, Delap E, Martinez C,
Walmsley AD. Profile and competences for the European
dentist. Eur J Dent Educ 2005;9(3):98-107.
11. Sanz-Alonso M, Antoniazzi JH. Libro del proyecto lati-
noamericano de convergencia en educación odontológica
(PLACEO). São Paulo: Artes Médicas, 2010.
12. Clark TD, Mjör IA. Current teaching of cariology in North
American dental schools. Oper Dent 2001;26(4):412-8.
October 2013  ■  Journal of Dental Education
13. Fontana M, Horlak D, Sharples S, Wolff M, Young D.
Teaching of cariology in U.S. dental schools. J Dent Res
2012;91(Spec Iss A):Abstract 313.
14. Kidd E, Fejerskov O. The role of operative treatment in
caries control. In: Fejerskov O, Kidd E, eds. Dental caries,
the disease, and its clinical management. Oxford, UK:
Blackwell Munksgaard, 2008:355-65.
15. Pitts NB. Detection, assessment, diagnosis, and monitor-
ing of caries. Monographs in Oral Science, Vol. 21. Basel,
Switzerland: Karger AG, 2009.
16. Epi Info, version 3.2.2. Atlanta: Centers for Disease
Control and Prevention, 2004.
17. Thylstrup A, Fejerskov O. Textbook of clinical cariology.
Oxford, UK: Blackwell Munksgaard, 1994.
18. Fejerskov O, Kidd E. Dental caries, the disease, and its
clinical management. Oxford, UK: Blackwell Munks-
gaard, 2008.
19. Henostroza G. Caries dental: principios y procedimientos
para el diagnóstico. Lima: Universidad Peruana Cayetano
Heredia, 2007.
20. Seif T. Cariología. Caracas: Actualidades Médico Odon-
tológicas Latinoamérica, C.A.-AMOLCA, 1998.
21. González MC, Valbuena LF, Zarta OL, Martignon S, Are-
nas M, Leaño M, et al. Guías de práctica clínica basadas
en la evidencia: caries dental. Proyecto ISS, Universidad
El Bosque. Manizales: Editorial Gráficas JES, 1998.
22. Martignon S, González MC, McCormick V, Ruiz JA,
Jácome S, Guarnizo C. Guía de diagnóstico, prevención
y tratamiento de la caries dental. Asociación Colombiana
de Facultades de Odontología, Secretaría Distrital de
Salud de Bogotá. Bogotá: Secretaría Distrital de Salud
de Bogotá, 2007.
23. Axelsson P. A clinical textbook on diagnosis and risk pre-
diction of dental caries. Hanover Park, IL: Quintessence,
2000.
24. Kidd E. Essentials of dental caries. 3rd ed. Oxford, UK:
Oxford University Press, 2005.
25. Cárdenas D. Fundamentos de odontología: odontología
pediátrica. 3rd ed. Medellín: Corporación para Investiga-
ciones Biológicas, 2003.
26. Barrancos JC. Operatoria dental. 3rd ed. Buenos Aires:
Editorial Médica Panamericana, 1999.
27. Moncada G, Urzúa I. Cariología clínica: bases preventivas
y restauradoras. Santiago de Chile: Colgate, 2008.
28. Silverstone L. Caries dental: etiología, patología y pre-
vención. Mexico City, D.F.: Manual Moderno, 1985.
29. Schulte AG, Buchalla W, Huysmans MC, Amaechi BT,
Sampaio F, Vougiouklakis G, Pitts NB. A survey on edu-
cation in cariology for undergraduate dental students in
Europe. Eur J Dent Educ 2011;15(Suppl 1):3-8.
30. Schulte AG, Pitts NB, Huysmans MC, Splieth C, Buchalla
W. European core curriculum in cariology for undergradu-
ate dental students. Eur J Dent Educ 2011;15(Suppl 1):
9-17.
31. Latin American Dental Federation. Dental schools data
by country. At: www.folaoral.com/index.html. Accessed:
August 2, 2012.
32. Fejerskov O. Changing paradigms in concepts on dental
caries: consequences for oral health care. Caries Res
2004;38:182-91.
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