Journal of the Canadian Dental Association最新文献

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.

Introduction: Residents of long-term care (LTC) facilities face many oral health challenges, which are often complicated by their underlying medical conditions, use of medications and limited access to oral health care.

Objective: To determine to what extent accredited university-based dental and dental hygiene programs in Canada prepare students in the areas of geriatric oral health and oral health of LTC residents.

Methods: Accredited dental and dental hygiene programs across Canada were assessed for the degree of education and training that is presented to students on the oral health of LTC residents. A survey questionnaire, emailed to programs, was used to gather descriptive statistics (frequencies, means and standard deviations), and bivariate analysis (χ2 and t tests) was completed. A p value ≤ 0.05 was considered significant.

Results: Representatives of all 4 dental hygiene and 9 out of 10 dental schools responded. All four dental hygiene and seven dental programs (77.8%, 7/9) stated that geriatric oral health is an integral part of their curriculum. The majority (91.6% [11/12], 4 dental hygiene and 7 of 9 dental schools) reported that their program educates students about medically, physically and cognitively compromised geriatric patients. Eight programs (3 dental hygiene and 5 dental schools), stated that they provide clinical training opportunities with LTC residents. However, some programs reported certain barriers preventing them from providing such clinical training opportunities.

Conclusion: Oral health educational institutions must ensure that curricula are current and evidence-based to reflect the overall oral health needs of today's aging population.

Objectives: Fluoride varnish (FV) has been shown to prevent dental caries. Physicians and nurses may be ideally situated to apply FV during well-child visits. Currently, public health units across Ontario have been successfully piloting this intervention. Yet, challenges remain at both the political and practice levels. The objectives of this research were to understand the perspectives of key stakeholders on making FV application a routine primary care practice in Ontario and to consider the potential enabling factors and barriers to implementation.

Methods: In this qualitative study, 16 key stakeholders representing medicine, nursing, dentistry, dental hygiene, public health and government were interviewed. Interview data were transcribed and coded, and a conceptual framework for implementing change to daily health care practice was used as a guide for thematic analysis.

Results: Our findings suggest that there is an opportunity for interdisciplinary care when considering children's oral health. There is also motivation and acceptance of this specific intervention across all fields. However, we found that concerns related to funding, knowledge and interprofessional relationships could impede implementation and limit any potential short- or mid-term window for meaningful policy and practice change.

Conclusion: With respect to introducing FV into medical practice for children under 5 years of age, the many factors required to implement immediate change are arguably not in alignment. However, policymakers and practitioners are motivated and have identified opportunities for change that may form the foundation for this program in the future.

Objectives: The main objective of a 2012-2013 clinical study on the oral health of Quebec elementary school students was to assess the oral health status of Grade 2 and Grade 6 students. We assessed various stages of caries and created caries indicators for primary and permanent dentitions combined.

Methods: Oral health examination of 2875 Grade 2 students and 2788 Grade 6 students, enrolled in public and private, French- and English-language schools, was carried out at schools. The examinations were performed by 16 trained and calibrated dentists using International Caries Detection and Assessment System (ICDAS) II criteria. A 3-level sampling design ensured that the study was representative for the province of Quebec.

Results: Mean indexes for decayed, missing, filled primary teeth (dmft) and secondary teeth (DMFT) or surfaces (dmfs and DMFS) for all stages of caries were as follows. Grade 2 students: dmft 3.96, DMFT 1.88, dmft + DMFT 5.84, dmfs 8.33, DMFS 2.96 and dmfs + DMFS 11.28. Grade 6 students: dmft 1.94, DMFT 4.98, dmft + DMFT 5.98, dmfs 4.04, DMFS 7.86 and dmfs + DMFS 9.96. Most students (90% for Grade 2 and 92% for Grade 6) had a dmfs + DMFS > 0.

Conclusion: Tooth decay remains a public health problem in Quebec. The findings testify to the importance of reinforcing preventive measures to better control dental caries among youth. It is advantageous to use ICDAS II in the context of oral health surveillance at a population level and to present the results as a combination of primary and permanent dentitions.

Objective: To investigate the efficacy of silver diamine fluoride (SDF) with 5% fluoride varnish (FV) in treating cavitated caries in young children and to explore the association between SDF treatment and oral-health-related quality of life (OHRQoL).

Methods: Children with active dentinal caries in primary teeth underwent treatment with 38% SDF and 5% FV at baseline and 4 months later. Treated lesions were assessed 4 and 8 months after baseline. Child-level analysis focused on classifying SDF treatment as completely successful if all of a child's treated lesions were arrested or incompletely successful if at least 1 lesion was not arrested. The Early Childhood Oral Health Impact Scale questionnaire was completed at second and third visits. Statistical analyses included descriptive and bivariate methods. A p value ≤ 0.05 was considered significant.

Results: This pilot study enrolled 40 children with 239 caries lesions; mean age 40.2 ± 14.9 months and 45% male. Lesion arrest rates after 1 and 2 applications of SDF were 74.1% and 96.2%, respectively. Children who reportedly brushed twice daily were more likely to be in the completely successful group compared with those who brushed less (p = 0.006). Those in the completely successful group had a significantly lower mean baseline dmft score than those in the incompletely successful group (p = 0.048). No significant difference in OHRQoL was observed between the 2 groups.

Conclusions: SDF with 5% FV is an effective approach to the management of early childhood caries; more than 1 application is recommended, along with regular follow up of patients and twice daily brushing. OHRQoL was not found to be affected by the level of success of SDF treatment.

Introduction: Evidence-based practice (EBP) is an expectation of medical professionals and is positively received in the dental community. Investigations of evidence-based dentistry (EBD) have discussed its use in broad terms and daily clinical practice, but there is only limited information about its use and barriers with respect to particular dental specialities.

Methods: A cross-sectional questionnaire was developed to survey implementation and obstacles to EBP; EBD specific to periodontics; and preferences for types of dissemination of evidence. The target population was active general dentists in Nova Scotia (n = 446). An email link to the questionnaire was distributed to dentists, and reminders were sent 4 and 10 days later.

Results: The response rate was limited (16.6%). Most respondents were comfortable evaluating the growing body of research, although many reported use of low-level evidence, including that from other health professionals or expert opinion. A common barrier to use was insufficient time. Respondents who found strong evidence for certain periodontal procedures were more likely to refer these procedures, which included tissue regeneration and periodontics related to endodontics. On-site lecture-based dissemination was preferred by most respondents.

Conclusion: General evidence-based concepts and use were similar to EBD results reported elsewhere, although external validity is limited by our low response rate and narrow target population. Specific data related to periodontics may be useful in directing a modified questionnaire to a broader target population. Respondents who are truly interested in EBD and responded to our questionnaire may ultimately benefit the most from our results, where further educational opportunities can be tailored to overcome the identified barriers and aid in more effective translation of evidence-based periodontal decisions in a general dental practice.