Journal of the Canadian Dental Association最新文献

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

Objective: To determine Manitoba dentists' perspectives on the oral health of LTC residents and to identify the types of barriers and factors that prevent and enable them to provide care to these residents.

Methods: Manitoba general dentists were surveyed about their history of providing care and their views on the provision of care to LTC residents. Descriptive statistics, bivariate analysis and logistic regression analysis were carried out.

Results: Surveys were emailed to 575 dentists, with a response rate of 52.5%. Most respondents were male (62.8%), graduates of the University of Manitoba (85.0%), working in private practice (89.8%) and located in Winnipeg (72.4%). Overall, only 26.2% currently treat LTC residents. A predominant number of respondents identified having a busy private practice (60.0%), lack of an invitation to provide dental care (53.0%) and lack of proper dental equipment (42.6%) as barriers preventing them from seeing LTC residents. Receiving an invitation to provide treatment, professional obligation and past or current family or patients residing in LTC were the most common reasons why dentists began treating LTC residents.

Conclusion: Most responding dentists believe that daily mouth care for LTC residents is not a priority for staff, and only a minority of dentists currently provide care to this population.

Objective: The objective of this study was to assess the shear bond strength (SBS) of orthodontic brackets bonded to uncut enamel with universal self-etch 1-step adhesive systems.

Methods: Extracted uncut premolars (n = 160) were randomly divided into 4 groups for treatment with Scotchbond Universal Adhesive (SU), All-Bond Universal (BU), Clearfil Universal Bond (CU) or the control, Adper Scotchbond Multi-Purpose Adhesive. Following bonding of brackets on tooth surfaces, teeth were stored in distilled water for 24 h and 6 months, and brackets were tested for SBS. The adhesive remnant index (ARI) and quantitative percentage of remaining resin (%RR) were recorded. Scanning electron microscopy was used to analyze debonded surfaces qualitatively. SBS and %RR data were analyzed by 2-way ANOVA followed by the Tukey test (α = 0.05).

Results: At neither time did these universal adhesives achieve satisfactory SBS for orthodontic treatment. The control group had the highest SBS, ARI score and mean %RR (and these differences were significant), while the BU group had the lowest SBS. SBS mean values and ARI scores decreased over time for SU and BU, but remained stable for CU. There was no difference in %RR among the universal adhesives tested.

Conclusion: None of the universal adhesives used in self-etch mode achieved SBS values (at 24 h and 6 months) that were satisfactory for orthodontic treatment.

Background: The spatial arrangement of primary health care (PHC) services is influenced by many factors and varies across provider types. In Canada, unlike physician services, certain PHC services (i.e., dentistry, physiotherapy) are not fully funded under the health care system. As a result, one might expect the arrangement of these services to differ by neighbourhood, even in dense metropolitan areas.

Objective: This study examines the intra-urban variability of geographic access to dental (DS) and physiotherapy (PT) services in relation to family physician (FP) services in an urban area and identifies underserviced neighbourhoods.

Methods: Practice location information was gathered from publicly available and routinely updated provincial sources (physician, physiotherapy and dentistry regulatory colleges). A neighbourhood accessibility score for all 3 PHC services was calculated using a GIS-based, 3-step floating catchment area method. A set of parameters, such as catchment type (road network buffer), size (3 km radius) and census centroids (dissemination areas), was used.

Results: The overall access scores for FP, PT and DS services (based on the 281 FPs, 226 PTs, and 152 DSs) were 1.45 (SD 0.94), 1.18 (SD 0.81) and 0.79 (SD 0.53) providers/1000 population, respectively. Spatial comparison of the accessibility scores indicated a greater proportion of the Saskatoon population has lower access scores (< 0.5/1000 population) for both physiotherapy (n = 79 450) and dental (n = 101 270) services compared with family physician services (n = 64 420). Exploration of the relation between PHC service arrangement and key sociodemographic variables (e.g. low income, education levels) showed that a considerable proportion of those in each sociodemographic group has poor PT and DS access.

Conclusion: This research has identified accessibility gaps and serves to inform the development of health policies focused on equitable distribution and funding of PHC services based on population health needs.

Background: Early childhood dental decay or caries (ECC) is common, often painful and costly to the health care system, yet it is largely preventable. A public health approach is needed, especially as socially vulnerable children most at risk for ECC are less likely to access conventional treatment. Exposure to intimate partner violence (IPV) in the family represents an important social vulnerability for children, yet little is known about ECC in this context. We explored the relation between ECC and exposure to IPV as well as opportunities for community-based early interventions to prevent ECC.

Methods: We searched 5 electronic databases. All primary research and reviews that focused on childhood decay and exposure to IPV or that referred to community settings (specifically women's shelters) for oral health service delivery were included.

Results: Of 198 unique documents identified, 12 were included in the analysis. Although limited, our findings suggest a positive relation between exposure to IPV and ECC, the mechanisms of which are not well studied. Women's-shelter-based prevention programs may hold promise in terms of detecting and addressing ECC. Over the time frame of the literature reviewed, we observed a subtle shift in emphasis away from individual behaviours and biological models toward upstream societal structures.

Conclusions: The available literature suggests that the issue of ECC and IPV may be poised to embrace a public health approach to early intervention, characterized by community collaboration, interprofessional cooperation between dentistry and social work and an equitable approach to ECC in a socially vulnerable group.

Purpose: This study aimed to examine the oral health status of seniors residing in Providence Health Care (PHC) long-term care facilities in 2002 and 2012.

Methods: Staff dentists with the University of British Columbia Geriatric Dentistry Program made a complete oral health assessment of 799 elderly residents of 7 long-term care PHC facilities in 2002 and 381 residents in the 5 remaining PHC facilities in 2012. The 2012 data were divided into those for 275 residents who had received treatment in previous years and 106 new residents. All consenting residents were examined by dentists using the clinical oral disorder in elders (CODE) index detailing their medical and oral health status and medications. On completion of the oral health assessment, the dentist documented the need for specific dental treatment and reassessment.

Results: Comparing the cohorts from 2002 and 2012, the mean age of the residents who had CODE assessments increased from 85 years to 86 years, the proportion of men increased from 31% to 35%, the mean number of medical conditions per resident remained unchanged (2.6 to 2.5), but the mean number of prescribed medications has increased from 4.0 to 4.6. The percentage of residents with natural teeth increased from 56% to 76%. The proportion of edentulous residents recommended for denture-related treatment decreased from 21% to 10%. The 106 new residents in 2012 had higher treatment needs than the 275 original residents, but fewer required extractions than in 2002. Although the mean number of teeth per resident examined increased from 14.6 to 17.4 over the study period, the need for restorations remained at 20%, and the need for extraction of teeth decreased from 22% to 6%. The proportion of residents with healthy periodontium increased from 14% to 21%, but the need for dental hygiene services increased from 43% to 80%.

Conclusions: The profile of long-term care residents who consented to an oral health assessment changed over the first decade of the new millennium, with an increase in mean age and number of prescribed medications, number of retained natural teeth and the need for dental hygiene services, but a decrease in the need for extractions.

Background: There is conflicting evidence regarding the association between vitamin D and periodontal disease. The purpose of this study was to explore that relation.

Methods: This cross-sectional study used data from the Canadian Health Measures Survey for respondents 13-79 years of age. Vitamin D status was determined by measuring plasma 25-hydroxyvitamin D (25(OH)D) concentrations. Periodontal disease was defined by gingival index (GI) and calculated loss of attachment (LOA). Statistical analyses included bivariate tests and multiple logistic regression.

Results: At the bivariate level, 25(OH)D concentrations below the cutoff levels of 50 nmol/L and 75 nmol/L were associated with GI. However, multiple regression analyses for GI revealed no association with mean 25(OH)D level or either concentration. Although no significant association between LOA and 25(OH)D status was identified at the bivariate level, a statistically significant association was observed between LOA and 25(OH)D levels < 75 nmol/L on multiple regression analysis. However, mean 25(OH)D concentrations and those < 50 nmol/L were not associated with LOA on multiple regression analysis.

Conclusion: Vitamin D status was inversely associated with GI at the bivariate level, but not at the multivariate level. Conversely, vitamin D status was not associated with LOA at the bivariate level, but it was inversely associated with LOA at the multivariate level. These results provide modest evidence supporting a relation between low plasma 25(OH)D concentrations and periodontal disease as measured by GI and LOA.

Objective: The use of hospital emergency departments (EDs) for non-traumatic dental problems places a significant strain on the health care system and resources. The objective of this scoping review was to identify factors associated with patients' use of EDs for such problems.

Methods: Embase, Medline-Ovid, Scopus and Web of Science databases were searched, and primary studies, systematic reviews and meta-analyses from Canada and the United States, published in English between 2007 and 2017 were selected for inclusion.

Results: Of 469 articles, 22 met our inclusion criteria: 6 were conducted in Canada and 16 in the United States. Identified factors associated with ED use for non-traumatic dental problems included patient demographics (age, gender, race/ethnicity, comorbidities, oral health status), accessibility (time of day, day of week, geographic location, access to dental practitioner), economic influences (insurance, inability to afford dental care, income) and social demographics (community language, homelessness, repeat use).

Conclusion: The factors identified in this review can inform future research studies and program planning to address ED use for non-traumatic dental problems.

Objectives: To conduct an environmental scan and categorize the scope of medical and oral health care services for people living with HIV (PLWHIV) across the province of British Columbia (BC).

Methods: Data were collected using online search engines such as Google and Yahoo, as well as the websites of health services agencies and community/not-for-profit organizations in BC. Informal telephone conversations were conducted to confirm findings from the online scan. Available services were categorized in terms of scope (e.g., prevention, treatment or support) and geographic location in relation to the latest rates of new HIV infections per 100 000 people. In 2014, the number of people in BC known to be infected with HIV was 12 100, with the rate of new infections at 261 per 100 000 people.

Results: We identified 104 organizations that were providing services exclusively for PLWHIV; these organizations were unevenly distributed across 40 out of 51 cities in BC. Of all the services offered at these organizations, 59% were preventive and educational in nature, 15% were related to treatment services for HIV-related conditions and 38% entailed support services including social assistance. Only 3% of the 104 organizations offered basic dental care. Services of any kind tended to cluster around metropolitan areas of high HIV prevalence, including Vancouver, while northern BC remains underserved despite having the second highest rate of new HIV infections in the province.

Conclusions: This study reveals a mismatch between the number and scope of services available for PLWHIV and the distribution of HIV infection across BC. Almost half of the services identified by the environmental scan were preventive, and only 3% offered some form of dental treatment exclusively to PLWHIV in BC.

Objectives: This study aimed at developing a model pathway to use of oral health care by homeless people based on their own perceptions and experiences with oral health care and related services in Vancouver.

Methods: We applied Gelberg-Andresen's behavioural model for vulnerable populations to predict health care use and interviewed 25 homeless adults (18 men and 7 women; age range 25-64 years) to develop a model pathway of care. Data collection and thematic analysis were carried out concurrently and iteratively to construct the pathway, which aimed at mutual decision-making and organization of the care process.

Results: Thematic analysis identified 4 main themes: government-sponsored oral health programs, homeless support, oral health outreach initiatives and professional education.

Conclusions: The model pathway helps to explain the factors that enable homeless people to access oral health care. It may also help dental teams foster positive care-seeking behaviour relevant to this vulnerable population so that oral disorders can be managed more sympathetically and effectively.