Journal of the Canadian Dental Association最新文献

Current epidemiological data suggest that the prevalence of diabetes in Canada is increasing. Patients with poor glycemic control are more prone to oral manifestations of diabetes, including periodontal disease, salivary gland dysfunction, halitosis, burning mouth sensation, delayed wound healing and increased susceptibility to infections. Diabetic patients are also at risk of experiencing an intraoperative diabetic emergency in the dental office. Therefore, dentists must appreciate and implement important dental management considerations while providing care to diabetic patients. In this article, we discuss the diagnosis, oral findings, dental care and emergency management of diabetic patients.

Electronic cigarettes (e‑cigarettes) are widely available, and their use is increasing worldwide. They are promoted as a safer alternative to combustible cigarette smoking and as an effective smoking cessation aid. E‑cigarettes are designed to provide smokers with the desired nicotine dose without burning tobacco. They contain flavoured humectants that include nicotine in concentrations of 0-36 mg/mL. Evidence suggests that e‑cigarettes are a better nicotine delivery method than combustible cigarettes and have reduced adverse general and oral health effects, compared with combustible cigarettes. However, although e‑cigarettes might be an acceptable harm-reduction strategy, the differential effects of e‑cigarettes and combustible cigarettes have been based on self-reported perceptions. In addition, a growing number of young people, who have never engaged in combustible cigarette smoking, are smoking e‑cigarettes, which may not be harmless. We analyzed peer-reviewed publications available through PubMed to summarize the effects of e‑cigarettes on oral health.

Background: In Canada, although the incidence of smoking-related oral cavity cancers has decreased, oropharyngeal cancers associated with human papilloma virus (HPV) are on the rise. During their routine interactions with patients, dentists have the opportunity to intervene. This study was conducted to assess dentists' capacity to prevent and detect oral cancers and to identify the barriers and facilitators that affect this capacity.

Methods: A 25-item, self-administered questionnaire was emailed to Ontario dentists through their regulatory body. It aimed to assess their perceptions about various aspects of oral cancer prevention and detection, including their knowledge, attitudes and practices. A binary logistic regression model was constructed for each modifiable risk factor (smoking, alcohol use, HPV) to identify the predictors of dentists' readiness to discuss with patients the connection between risk factors and oral cancers.

Results: Of the 9975 dentists contacted, 932 completed the survey. Most respondents (92.4%) believed that they are adequately trained to recognize the early signs and symptoms of oral cancer. However, only 35.4% of respondents said that they are adequately trained to obtain biopsy samples from suspected lesions. In addition, only a small proportion (< 40%) of the dentists believed that they are adequately trained to address relevant risk factors. Compared with dentists who said that they are adequately trained and currently assess a given risk factor, the odds of discussing the risk factor were consistently and significantly lower among those who said that they are inadequately trained (OR: smoking 0.11, alcohol 0.52, HPV 0.36) and among those who do not currently assess that risk factor (OR: smoking 0.12, alcohol 0.22, HPV 0.23).

Conclusions: This study suggests that the capacity of Ontario dentists to detect and prevent oral cancers is limited by lack of training in using oral cancer screening tools and addressing risk factors. To mitigate this barrier, dentists' capacity could be enhanced by improving their training in detecting oral cancers and their readiness to assess and address the risk factors.

Objectives: To summarize evidence relating cannabis smoking and oral disease and highlight any potential influence of cannabis smoking on clinical care and dental public health.

Methods: Using rapid evidence review, a librarian facilitated a systematic search of 5 electronic databases in August and September 2018 and updated it in March 2019, yielding 581 publications. Two researchers screened the documents using pre-established inclusion criteria: article was based on primary or secondary data; cannabis smoking was an exposure; at least 1 cannabis-related oral health outcome was reported; participants were humans; and the article was available in English or French. Data from retained articles were analyzed for themes without meta-analysis.

Results: We synthesized and summarized 23 articles in 2 broad categories: cannabis and oral disease; and cannabis, clinical care and dental public health. Current evidence shows that smoking cannabis is harmful to the health of the periodontium. The association between smoking cannabis and other oral disease (dental caries, soft tissue lesions and oral cancers) is sparse and inconsistent, although studies suggest that cannabis smoking is an underlying risk factor. Cannabis smoking can lead to an altered mental state that can delay dental treatment of the patient. Further, interactions between smoked cannabis and adrenaline-containing local anesthetics can result in life-threatening consequences.

Conclusions: Cannabis smoking is harmful to the periodontium. Further research is needed to fully understand how cannabis smoking affects oral disease and how dental professionals should integrate this knowledge into clinical care and dental public health.

Objectives: To examine patient demographics, distance traveled and dental-related treatment provided according to type of dental insurance at a large, not-for-profit community dental clinic (CDC) in Vancouver, Canada.

Methods: Using electronic dental records, we assessed the use of private and government-sponsored (public) dental insurance at the CDC in 2014 and 2015 at the appointment and procedure levels. Study variables included patient demographics, distance traveled, type of treatment provided, type of dental insurance and cost of treatment.

Results: Examination of records from 9524 appointments involving 16 639 procedures revealed that 44% (4190 appointments) were made by patients with private insurance and 31.4% (2995) by those with public insurance. Patients with private dental insurance were 1.27 times more likely (p < 0.001) to have restorative treatment than those with public-sponsored dental insurance. Procedures involving tooth extraction were 14.2 times more likely (p < 0.001) to be performed in patients with public insurance than those with private insurance.

Conclusions: Access does not equal equity; although the CDC enables access by various populations, its ability to provide equitable treatment is compromised by external factors. CDCs may have a vital role in oral health equity; however, dental treatment continues to be dictated by financial reimbursement.

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.