Journal of the Canadian Dental Association最新文献

Background: This study aimed to describe dental care provision and the perceptions of dentists in Nova Scotia, Canada, during 1 week of the COVID-19 pandemic, shortly after the closing down of non-emergency, in-person care.

Methods: A survey was distributed to all 542 registered dentists in Nova Scotia, asking about dental care provision during 19-25 April 2020. Most answers were categorical, and descriptive analyses of these were performed. Data from the 1 open-ended question were analyzed using an inductive approach to identify themes.

Results: The response rate was 43% (n = 235). Most dentists (181) provided care but only 13 provided in-person care. From the open-ended question, 4 concerns emerged: communication from the regulatory authority; respondents' health and that of their staff; the health of and access to care for patients; and the future of their business.

Conclusion: Most respondents remained engaged in non-in-person dental care using various modes. They expressed concerns about their health and that of their staff and patients as well as about the future of their practice.

Practical implications: Dentists and dental regulatory authorities should engage in discussions to promote the health of dental staff and patients and quality of care during the chronic phase of the pandemic.

Background: This study determined the fluoride content of green tea from various parts of Asia, where green tea originates.

Methods: We brewed 2.5 g each of 4 types of green tea (from China, South Korea, Japan and Sri Lanka) using deionized water heated to boiling. Water was cooled to 71°C, then tea was steeped for 2 minutes. This process was repeated 20 times, thus providing 20 samples for each tea type. In addition, 20 control samples of deionized water were brewed to the same specifications. Samples were analyzed using a fluoride probe, and statistical power was calculated.

Results: The tea samples from different countries varied in the amount of fluoride they contained. The Chinese sample contained the most fluoride, while the Japanese sample contained the least. Means and interquartile ranges of fluoride concentration were calculated for each sample: Sri Lanka 3.58 ppm (0.1425), Chinese 6.83 ppm (0.140), South Korean 5.36 ppm (0.0975), Japanese 1.88 ppm (0.1375) and control 0.33 ppm (0.0078).

Conclusion: The origin of tea and environmental factors, such as pollution, groundwater, air and the soil in which it was grown appear to directly affect the amount of fluoride that accumulates in the plants. Considering the fluoride content revealed by this study, green tea consumption habits should be taken into account when prescribing adjunct fluoride therapy as part of a preventative program for patient care.

Background: To investigate, among Ontario dentists, (1) self-reported barriers to access to sedation and general anesthesia (GA) services and (2) their current use of sedation and GA.

Methods: Of Ontario dentists practising, 3001 were randomly selected to complete a 16-question survey by mail or online in 2011. Mixed analysis of variance (ANOVA) followed by independent-sample t tests or 1-way ANOVA evaluated the relation between dentists' views and demographic variables including sex, clinical experience and size of primary practice.

Results: Of the participants (n = 1076; 37.9% response rate), 69.7% were male, 84.4% were general practitioners, mean time in practice was 20.6 years (0.5-42 years) and 42.2% were in cities of over 500 000 people. Most dentists (60.2%) provided anesthesia services, although 38.2% indicated lack of training and the belief that there is no patient demand (25.3%) as reasons not to use anesthesia in their offices. Nitrous oxide was used 17.5% of the time for all dental procedures except implants. Barriers to referral of patients for anesthesia services included high costs associated with sedation/GA (72.2%) and patient fear of anesthesia (33.5%).

Conclusion: This study identified a perceived lack of patient demand, lack of dentist training, high costs of sedation/GA and patient fear of sedation/GA as primary barriers to use of sedation/GA in Ontario dental practices. The use of various anesthesia modalities is diverse, with 60.2% of dentists providing sedation/GA.

Objectives: This scoping review provides a comprehensive overview of oral cavity cancer (OCC) and oropharyngeal cancer (OPC) in Alberta.

Methods: A database search was conducted up to 2018 using Web of Science, Scopus, Medline, PubMed and Embase, along with a manual search of gray literature. Data from the Alberta Cancer Foundation's dedicated fund for research, Cancer Surveillance and Reporting and Alberta Cancer Registry were also collected.

Results: Our review included 8 published papers and 14 other sources, including data on 3448 OCC and OPC patients from Surveillance and Reporting and Alberta Cancer Registry. Cancer registry data (2005-2017) showed that most OCC and OPC lesions were diagnosed at an advanced clinical stage, with a significantly large number of advanced OPC lesions in stage IV (OCC 45.2%, OPC 82.4%); 47.9% of these patients died. Survival rates were lowest in rural and First Nations areas. In Alberta, 35% of HPV-associated cancers were linked to OPCs, which were more prevalent in men and younger age groups. No routine public oral cancer screening program currently exists in Alberta. General practitioners and dentists refer patients to specialists, often with long waiting times.

Conclusion: OCC and OPC patients in Alberta continue to be diagnosed in stage IV and experience high mortality rates.

Objective: To investigate pedagogical approaches and perceived barriers to teaching about caries-control medications, particularly silver diamine fluoride (SDF), in Canadian undergraduate dental and dental hygiene programs.

Methods: In summer 2018, a 9-item questionnaire was distributed to all 10 dental schools and 32 dental hygiene programs in Canada. It enquired about the types of caries-control medications used, teaching methods and perceived barriers to instruction on managing active caries with SDF.

Methods: In summer 2018, a 9-item questionnaire was distributed to all 10 dental schools and 32 dental hygiene programs in Canada. It enquired about the types of caries-control medications used, teaching methods and perceived barriers to instruction on managing active caries with SDF.

Results: The response rate was 80% (n = 8) from dental schools and 72% (n = 23) from dental hygiene programs. All curricula included information about conventional caries-control medications: fluoride, silver nitrate and povidone iodine. In all programs, instruction regarding SDF was predominantly didactic: 93% of programs presented lectures on SDF and 30% of programs included clinical teaching and use of SDF in primary dentition only. The lack of consensus on clinical protocols outlining the number and frequency of SDF applications to arrest caries was cited by 43% of the programs as a barrier to clinical teaching.

Conclusion: There is some variation across Canada in pedagogical approaches to caries-control medications and the inclusion of SDF in curricula. Poorly defined clinical protocols were reported as the main barrier to didactic and clinical use of SDF in undergraduate dental education programs.

Background: Government-funded and pro bono dental care are important to populations with limited means. At the same time, dentistry is experiencing a gender shift in the practising profession. As a result, we aimed to determine the factors associated with the provision of government-funded and pro bono dental care and whether there are gender differences.

Methods: We conducted a secondary data analysis of the results of a 2012 survey of a representative sample of Ontario dentists. Descriptive, bivariate and multivariable analyses were carried out.

Results: The 867 survey respondents represented a 28.9% response rate. On average, Ontario dentists reported that 15.7% of their practice consisted of government-funded patients and they provided $2242 worth of pro bono care monthly. Male and female dentists reported similar levels of both (p > 0.05). Being a practice owner and having more pediatric patients influenced levels of government-funded patients. Being internationally trained, of European ethnicity, single, and income status affected levels of monthly pro bono care. Gender-stratified analysis revealed that, among female dentists, household responsibilities was a unique factor associated with the proportion of government-funded patients, as was international training, personal income and ethnic origin for levels of pro bono care.

Conclusion: Overall, male and female dentists are similar in the provision of government-funded and pro bono care, but various factors influence levels of each in both groups.

For more than half a century, oral anticoagulant and antiplatelet therapy has been used to decrease the risk of thromboembolism, prolonging the lives of countless patients. Patients taking antithrombotic agents may be at risk of excessive hemorrhage. Dentists commonly see such patients, and this can pose a challenge, as adequate hemostasis is crucial for the success of invasive dental treatment. Many dentists refer these patients, as they lack understanding or fear uncontrollable bleeding during and after surgery. In this clinical review, we discuss the mechanisms of hemostasis, drugs that can interfere with these pathways and how to safely and effectively manage patients who are taking antithrombotic agents. We include which procedures are considered safe, which are riskier in terms of bleeding, what laboratory tests must be reviewed before treatment, drug interactions with commonly prescribed dental drugs, as well as agents that can aid in hemostasis. Although antithrombotics cause an increase in bleeding, there is general consensus that treatment regimens should not be altered before routine dental procedures when the risk of bleeding is moderate to low. Procedures that require drug alterations include extractions of more than 3 teeth, crown lengthening, open-flap surgery, surgical extractions and periodontal surgery.

Objectives: Early childhood caries (ECC) originates prenatally. This study investigated whether a relation exists between levels of vitamin D in the umbilical cord and caries in offspring.

Methods: A prospective cohort of expectant mothers was selected from a high-risk urban population receiving prenatal care in Winnipeg, Canada. Participants self-selected into 1 of 2 groups. The intervention group received 2 oral prenatal doses of 50 000 international units (IU) of vitamin D in addition to routine prenatal care. The control group received routine prenatal care. A prenatal questionnaire was completed at the first visit. Umbilical cord blood was analyzed for 25 hydroxyvitamin D (25(OH)D). At the time of their infant's first birthday, participants returned for a follow-up questionnaire and a dental examination of the infant. A p value ≤ 0.05 was significant.

Results: In all, 283 women were recruited (mean age 23.4 ± 5.6 years), 141 in the intervention group and 142 in the control group. The mean cord 25(OH)D level was 49.6 ± 24.3 nmol/L and did not differ between the groups. For the follow-up visit, 175 women returned. Overall, 26.3% of infants had ECC, and the mean decayed tooth (dt) score was 0.94 ± 2.16 teeth (range 0-16). There was no significant difference in prevalence of ECC between the intervention and control groups (p = 0.21). Poisson regression determined an inverse relation between 25(OH)D levels and dt scores (p = 0.001). Socioeconomic factor index (SEFI), age and enamel hypoplasia, but not vitamin D supplementation were significantly and independently associated with dt. Multiple logistic regression models also revealed that higher SEFI score, age and enamel hypoplasia were associated with ECC.

Conclusion: No relation was found between the 2 groups and prevalence of ECC. However, significance was seen in an inverse relation between 25(OH)D levels and the number of decayed primary teeth. Further studies with higher levels of vitamin D supplementation are needed.

Objective: To gain a better understanding of the extent to which rectangular collimation is being used in private practice and the barriers to adoption by practitioners.

Methods: Licensed dentists in private practice were asked to answer a survey composed of 17 multiple-choice questions and 1 open-ended question regarding demographics, radiation safety, image receptor type, intraoral imaging techniques and use of rectangular collimation.

Results: Among all participants (n = 82), 86.6% used digital systems (n = 71) and 13.4% conventional film (n = 11). Most (74.0%, n = 60) were aware of the benefits of using rectangular collimation, with 5.5% reporting not knowing of the existence of this device (n = 3). Only 12.9% of the dentists reported using rectangular collimation routinely (n = 10). The youngest and oldest age groups had the lowest compliance rates, 5.6% and 0%, respectively.

Conclusion: Although 74.0%, (n = 60) of private practitioners were aware of the benefits of using rectangular collimation to reduce radiation dose, only 12.2% (n = 10) used it routinely for intraoral imaging. Barriers to implementing rectangular collimation in private practice settings included challenges in training support staff and fear of an increase in the occurrence of technical errors that would result in re-exposure of patients.

Objective: The aim of this study was to determine and analyze the survival rates of dental implants placed by undergraduate dental students under supervision at the University of Alberta's School of Dentistry over a 10-year period.

Methods: Charts from patients who received either single or multiple dental implants between 1 January 2007 and 31 July 2017 were reviewed. Patients' age, sex, American Society of Anesthesiologists (ASA) class and implant site data were extracted and compiled for statistical analysis.

Results: Of 299 implants placed in 189 patients, 1 failed and required removal.

Conclusion: In this study, the survival rate of implants placed over a 10-year period was 99.7%. Supervision by certified specialists, strict case selection criteria and maintenance and care protocols at the university's dental clinic likely contribute to the high survival rate.