Journal of the Canadian Dental Association最新文献

Although radiation therapy is a common treatment for head and neck cancer, osteoradionecrosis (ORN) represents a major complication during or after treatment. Hyperbaric oxygen is often mentioned as a prophylactic and therapeutic treatment for ORN. In this article, we review the literature on hyperbaric oxygen therapy in head and neck irradiated patients. The widespread use of such therapy for the prevention and treatment of ORN appears to be based mainly on personal beliefs and experience, as no consensus exists in the scientific literature about its efficacy. Randomized controlled trials are, thus, needed to assess the real impact of hyperbaric oxygen therapy in head and neck irradiated patients. More fundamental research is also needed to clarify the pathophysiology of ORN, which in turn would help identify appropriate treatments.

Background: Statistics Canada's population health surveys may be an important source of up-to-date evidence on fluoridation and population oral health. The objective of this study was to examine the validity of a geographic measure of fluoridation from a national survey (based on site of data collection), by comparing it with estimates of fluoride level from urine samples.

Methods: The data source is the environmental urine subsample (n=2563) from Cycle 2 (2009-2011) of the Canadian Health Measures Survey. Mean comparison and multivariable linear regression were used to examine whether urinary fluoride levels differed between respondents classified as "fluoridated" versus "non-fluoridated" based on data collection site.

Results: Respondents who attended data collection sites classified as fluoridated had significantly higher mean urinary fluoride levels than those who attended sites classified as non-fluoridated. This effect was robust to adjustment for covariates and was somewhat stronger among an "exposed" subpopulation (defined based on tap water consumption and residential history) compared with a non-exposed subpopulation. No apparent added value was associated with using a more precise geographic indicator based on home postal code.

Conclusions: Fluoridation status based on data collection site seems crude, but is actually reasonably accurate compared with fluoride level in urine, in the context of a large national Canadian survey of urban and rural residents. Although findings are of limited use for individual-level risk assessment, they may be of interest to dental public health researchers and to those engaged in public health surveillance, because they inform efficient and readily available options for monitoring fluoridation status in populations.

Objective: The objective of this study was to assess the current status of Canadian predoctoral implant programs in terms of director demographics, curriculum characteristics and preferences in the techniques that are used to teach and carry out implant therapy. We compared the findings to analogous data recently acquired from dental schools in the United States.

Methods: A survey instrument was sent electronically to directors of predoctoral implant programs at all 10 accredited dental schools in Canada.

Results: All 10 dental schools responded to the survey. Program directors were affiliated with prosthodontics (90%) or oral surgery (10%) departments. Most Canadian institutions (90%) formally integrate their implant program into the third year of the curriculum. Clinical implant curricula include simulated exercises and direct patient care under supervision in 90% of predoctoral programs. Frequently taught restorative modalities include the posterior single-tooth implant crown (100%), mandibular implant-retained overdenture (90%), anterior implant-supported single crown (60%) and posterior 3-unit implant-supported bridge (50%). All programs reported the routine use of guided surgery planning software and surgical guides to aid in implant treatment planning. Preferred clinical protocols include implant-level impressioning (90%), use of open-tray impression copings (70%), custom abutment fabrication (60%), coronal fixation by screw-retention (60%) and use of titanium (100%) or zirconia (60%) abutments. Half of the program directors reported feeling that graduating students were adequately prepared to provide implant therapy on graduation. The demographics of Canadian directors of predoctoral implant programs were very similar to those of their counterparts in the United States. The largest divergences existed in clinical curriculum preferences and subjective perception of student preparedness in oral implantology on graduation.

Conclusion: Greater homogeneity exists among Canadian dental schools with regard to predoctoral implant program curricula, compared with those in the United States. Further investigation is warranted to examine the reasons for Canadian program directors' current perceptions of lack of preparedness of graduating predoctoral students.

Objective: Comprehensive data on the characteristics and opinions of graduating dental students in Canada are lacking. Specifically, only minimal information is available on graduates' immediate career plans and factors that may influence their decisions regarding these plans. Our aim was to gather such data to allow better understanding of this issue and improve the design of future studies on this topic.

Methods: The Career Development Committee at the school of dentistry, University of Alberta, designed a short survey to be administered to graduating students over 5 years to gain insight into their immediate career plans and opinions on career services at the school. Preliminary results from 2012-2014 are reported here.

Results: With a response rate of close to 90% (n = 99/111), the data reveal considerable differences in immediate career plans between the surveyed students and those in other schools in Canada and the United States. Of the students, 89% were planning to work in a general dental practice and only 9% were planning to enroll in advanced education, including general practice residency training.

Conclusion: More research is needed to better understand the factors affecting career path decisions of students.

Introduction: Many Canadian children are affected by early childhood caries (ECC) and require treatment under general anesthesia. The purpose of this study was to determine the burden of day surgery for children with ECC in Canada.

Methods: Day surgery abstracts for children 6 years of age with ECC were extracted from the Canadian Institute for Health Information Discharge Abstract Database and National Ambulatory Care Reporting System for 4 years, 2010/11 to 2013/14. All provinces and territories participated except Quebec. Variables considered included sex, age, proportion of immigrants in the neighbourhood, Aboriginal concentration, material deprivation index and rurality. Rates were calculated for the pooled 4-year cohort.

Results: The overall rate of dental surgery to treat ECC was 12.1 per 1000 children 12-59 months of age, accounting for 31.0% of all day surgeries performed on this age group in Canada. Rates of dental surgery for children from neighbourhoods with a high proportion of Aboriginal people were 7.8 times those for children living in areas with a low proportion (84.5 vs. 10.9 per 1000). For children from rural regions of Canada, rates were 3.2 times those of urban dwelling children (31.2 vs. 9.8 per 1000). Children from the least-affluent regions had dental surgery rates 3.7 times higher than those from the most-affluent communities (25.7 vs. 6.9 per 1000). Total hospital-associated costs of treating ECC under general anesthesia averaged $21184545 annually.

Conclusion: Dental surgery for ECC is far too common and occurs more often among children from the least-affluent households, rural regions and communities with a high proportion of Aboriginal people. Dental surgery rates can serve as an important population health indicator.

Purpose: To assess morbidity and mortality associated with oral and maxillofacial surgery procedures requiring general anesthesia among children with aspiration tendency requiring enteral feeding.

Material and methods: A retrospective chart review was conducted of children surgically treated under general anesthesia by the oral and maxillofacial surgery service at the Hospital for Sick Children in Toronto, Canada. Medical and dental records over a 9-year period (January 1, 2000 to January 1, 2010) were reviewed. Data were collected on demographics, primary illness, coexisting medical conditions, procedures performed, medications administered, type of airway management used, duration of general anesthesia, American Society of Anesthesiologists' physical status classification and adverse events.

Results: During the period reviewed, 28 children underwent 35 oral and maxillofacial surgery procedures under general anesthesia. The mean patient age was 12 years (range 4-17 years). No deaths occurred. Of the 35 surgeries, 10 (29%) were associated with at least 1adverse event. Adverse events included 1incident of respiratory distress, 2incidents of fever, 5incidents of bleeding, 1incident of seizure and 4incidents of oxygen saturation below 90% for more than 30s.

Conclusions: Children with a history of aspiration tendency that necessitates enteral feeding, who undergo oral and maxillofacial surgery under general anesthesia, are at increased risk of morbidity. Before initiating treatment, the surgeon and parents or guardians of such children should carefully consider these risks compared with the anticipated benefit of surgery.