Journal of the Canadian Dental Association最新文献

Introduction: The Mandibular Function Impairment Questionnaire (MFIQ) was developed for clinical assessment of functional impairment in patients with temporomandibular disorder (TMD). It allows patients to rank difficulty performing 17 jaw-related functions as low, moderate or severe. Our study was designed to determine whether the MFIQ is also helpful in differentiating TMD from other causes of orofacial pain in a clinical setting.

Methods: A retrospective study was conducted at a private oral medicine/orofacial pain clinic. New patients who attended with orofacial pain complaints were selected (n = 174). All patients had filled out the MFIQ as part of new patient intake forms.

Results: The study population consisted of 120 TMD patients, 25 patients with burning mouth syndrome (BMS), 19 with oral lesions (OLs) and 10 with trigeminal neuralgia (TN). TMD patients had significantly greater difficulty taking a large bite, yawning, chewing hard and resistant foods including meat, raw carrot, and apples compared with OL and BMS patients. The MFIQ alone was not able to distinguish between TMD and TN.

Conclusions: The MFIQ is a short questionnaire that is openly accessible and can be completed relatively quickly by patients in a general dentistry clinic. High ranking of difficulty for items associated with taking a large bite, chewing hard or resistant food and yawning in the presence of complaint of orofacial pain should raise suspicion of TMD and TN as a possible source of the pain.

Objectives: To compare trends in teaching and placement of composite resin versus amalgam in posterior restorations in Canadian dental schools with those in the United States.

Methods: Secondary descriptive and statistical analyses were performed on data from 2 previous studies. The data consisted of responses to questionnaires on teaching policies and the proportion of posterior restorations (amalgam and composite resin) performed in Canadian and US dental schools. Fisher's exact test and 2-sample z-test were used to compare the proportions.

Results: Canadian dental schools allocated less time than US schools to teaching composite resin restorations (p = 0.006): 22.2% of Canadian schools versus 76.4% of US schools devoted more than 50% of preclinical teaching time to such restorations. Canadian dental schools also dedicated more time to teaching amalgam restorations (p = 0.041): 33.3% of Canadian schools versus 8.8% of US schools devoted 50-75% of preclinical teaching time to amalgam restorations. Between 2008 and 2018, a significantly higher proportion of composite resin restorations were performed in US dental schools than in Canadian schools (p < 0.001).

Conclusions: In Canadian dental schools, teaching of posterior composite resin restorations was more conservative than in US schools. There was no consensus among Canadian and US dental schools on composite resin preparation techniques or contraindications. Clear, standardized guidelines pertaining to composite resin teaching policies are suggested.

Objectives: A growing body of literature highlights the negative impact of the COVID-19 pandemic on the mental health of health care professionals. This paper explores the effects of gender and work/life factors on dentists' mental health before and during the pandemic.

Methods: Data were obtained from a cross-sectional, online survey of Canadian dentists, which was part of a broader study of Canadian professionals' mental health challenges conducted in 2020-2021. Using logistic regression, we compared the influence of life stress, work stress, gender and role in practice on dentists' self-rated mental health before and during the pandemic.

Results: Respondents reported that their mental health had worsened during the pandemic. Among survey respondents (n = 397), women dentists (50%) reported worse mental health than men (39%). Those who had higher levels of work and life stress reported more mental health challenges both before and during the pandemic.

Conclusions: Our findings point to the need for more attention to dentists' mental health and highlight the need for gender-sensitive mental health resources and supports for Canadian dentists.

Background: Osteomyelitis (OM) of the jaw is a rare medical condition. In this review, we provide a descriptive analysis of the experience with this condition at a single tertiary health care centre in Canada over 10 years.

Materials and methods: We conducted a retrospective chart review of adult patients aged ≥ 18 years presenting with OM of the jaw at the University of Manitoba Health Sciences Centre between January 2009 and May 2019. We included cases with consistent clinical symptoms and radiographic and/or microbiologic evidence of OM of the jaw. Excluded were cases with a previous history of head and neck cancer, radiation therapy in the head and neck regions and use of anti-resorptive medications.

Results: Of the 37 patients who met our criteria, the mean age was 44 years (standard deviation [SD] ± 16 years), 21 (56.8%) were male, 16 (43.2%) were diagnosed with acute OM and 21 (57.8%) with chronic OM. Underlying comorbidities, such as diabetes mellitus and chronic kidney diseases, were reported in 6 (16.2%) and 3 patients (8.1%), respectively. Traumatic injuries to the facial skeleton were the most common predisposing factor (11 patients [29.7%]). The most commonly isolated infective organisms were viridans group streptococci (VGS; 75.8%), followed by Prevotella spp. (45.4%). Results showed a higher level of resistance to penicillin of the isolated organisms in chronic OM compared with acute OM.

Conclusions: This description of acute and chronic forms of OM of the jaw will enable clinicians to better understand OM patient profiles, leading to early diagnosis, improved patient care and better outcomes.

Infective endocarditis (IE) remains one of the most serious diseases with a high morbidity and mortality rate. Although the condition is more common in the medical field in a hospital setting, dentists must have a thorough understanding of the overall pathogenesis, epidemiology, risk factors and signs and symptoms that may be present in their patient population. In 2021, the American Heart Association (AHA) updated its guidelines on IE, emphasizing the specific criteria that put a patient at risk of acquiring IE, specific dental procedures that can increase the risk of IE by inducing bacteremia and an antibiotic prophylaxis regimen to act as a preventive measure if needed. This literature review gives the dental practitioner a general overview of the AHA guidelines as well as information on prevention in their at-risk patients and the need to emphasize a well-structured, consistent daily oral hygiene routine.

Objectives: Although routine dental care is essential for both oral and overall health, in Canada, access to such care is uneven. Those with low or medium income and no workplace dental coverage often face financial barriers in accessing dental care. However, the factors that affect access - income, employer-provided health benefits and public dental care subsidy programs - have changed over the decades. This study examines the net impact of these factors on long-term trends in dental care access among different groups in Canada over the past 5 decades.

Methods: Using data from 1 235 268 respondents to 20 Canadian cross-sectional surveys administered between 1972 and 2017, we estimated the proportion of people who had at least 1 consult with a dental professional over the past 12 months. Prevalence trends by region, age group, education and income level were compared.

Results: In each age group, the proportion of people consulting a dental professional at least annually gradually increased over the last 5 decades. During the recession of the early 1990s, a temporary drop in use occurred, particularly among younger age groups. We noted significant regional differences in use among individuals in the same age group: rates were highest in Ontario and British Columbia and lowest in Quebec and the Atlantic provinces. Marked differences in use by level of education and income persisted over the 5 decades. Dental care use was significantly higher among those with higher levels of education and higher incomes. The increase in overall rates of dental care use suggest that an increasing fraction of Canadians have higher incomes or are better educated, or both. Nevertheless, about a third of Canadians ≥ 15 years did not receive dental care in 2015.

Conclusions: Given that dental care is almost wholly privately funded and displays a high degree of income-related inequity, there is an urgent need for policy action to address unequal access to dental care in Canada.

Patients with recurrent or persistent dentoalveolar pain usually believe that endodontic treatment or extracting a tooth will alleviate it, and most cannot conceive that the pain might not be tooth related. Understanding that dental procedures of any kind will be ineffective when a tooth-related pathology is ruled out and that a nonodontogenic etiology best explains the "toothache" pain goes against their beliefs. In this article, we present an overview of basic concepts to help manage such cases by briefly outlining possible causes of nonodontogenic pain as well as diagnostic pitfalls that may lead to questionable treatments. The decision to provide dental treatment is justified only when definitive peripheral mechanisms driving the pain are uncovered and the multitude of factors that might contribute to the various presentations of persistent dental pain have been considered. Otherwise, patients might be managed with treatments that are not the norm for those with unremitting tooth pain in general dental practice. We also make suggestions for clinicians to assure that patients with recurrent or persistent dental pain receive a thorough work-up that considers odontogenic and nonodontogenic sources to arrive at the correct diagnosis before treatment, taking psychosocial factors into account when devising the treatment plan.

Objectives: To investigate the impact of a COVID-19 mandated lockdown on the type and frequency of dental services accessed at an undergraduate dental clinic in southwestern Ontario.

Methods: We retrieved anonymized sociodemographic (n = 4791) and billing data (n = 11616) of patients for 2 periods of 199 days, before (T1) and after (T2) lockdown. We applied descriptive statistics and used Student's t test to compare the type and frequency of dental services provided between the 2 periods. We mapped forward sortation area (FSA) codes of each patient.

Results: Of the 4791 patients seen collectively in T1 and T2, most (67%) sought care before the lockdown. In both periods, most patients were ≥ 60 years of age (51.8%), female (33.9%) and residing in an urban area (88.6%). Compared with T1, there was a significant increase in middle-aged adults (p = 0.002) and significantly fewer patients earning over CAD 100 000 (p = 0.021) in T2. A total of 11616 billable procedures were carried out during T1 and T2: in T1, most procedures were preventative, whereas in T2, most were related to urgent care. Significantly fewer males than females sought urgent care, regardless of time. Finally, mapping showed a decrease in patients from Toronto, central and northern Ontario and clustering of patients in southwestern Ontario.

Conclusion: We noted an overall reduction in billed services following the COVID-19 lockdown. The decrease in both billed services and patients seen during T2 demonstrates the impact of COVID-19 on access to timely and definitive dental care during the first 2 years of the pandemic.

Professors Elham Emami and Samira Rahimi organized and co-led an international interdisciplinary workshop in June 2023 at McGill University, built upon an intersectoral approach addressing equity, diversity and inclusion within the field of AI.