Journal of the Canadian Dental Association最新文献

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.

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.

Objectives: To determine the number and diagnoses of caries-related complaints presenting at Canada's largest children's hospital emergency department (ED) and the costs associated with treatment over 5 years.

Methods: We carried out a retrospective review of the health records of all children who presented to The Hospital for Sick Children, Toronto, with caries-related emergency complaints from 1 January 2008 to 31 December 2012. A caries-related complaint was defined as a chief complaint of pain or swelling resulting from the sequelae of dental decay (reversible pulpitis, irreversible pulpitis, abscess or cellulitis), as recorded in the chart by the treating physician or dentist. Visit information included chief complaint, final diagnosis, treatment rendered and patient disposition at discharge. Decision Support Services, a hospital department that analyzes resource use and associated costs, calculated the institutional costs for the episodes of emergency care.

Results: There were 1081 visits over the 5-year period, with a 19% increase in visits over that time. The most common presenting complaint was pain (50.8%) and the most common diagnosis abscess (35.6%). A dentist was consulted for 60.0% of the children and dental treatment in the ED was provided for 25.9%. The mean cost of treatment per patient was Can$575.17 (95% confidence interval $501.91-$648.43).

Conclusions: Over the 5-year study period, dental visits to this tertiary care pediatric hospital increased. The most common complaint was pain, and the diagnosis for about a third of these cases was abscess. Dental consultation was often included in the management of these patients and the resultant cost of these visits was about Can$600/patient.

Objectives: Oral hairy leukoplakia (OHL) is caused by Epstein-Barr virus (EBV) and is often associated with HIV and other immunosuppressive conditions. It is rare in HIV-negative patients, but has been reported in patients who use immune-modulating medications (e.g., cyclosporine). The objectives of this study were to determine the occurrence of OHL in HIV-negative patients and report Langerhans cell counts in these lesions.

Study design: A series of 7 new cases of OHL among HIV-negative patients is described. Langerhans cells were counted using an immunoperoxidase stain for CD1a and light microscopy.

Results: The 7 patients were male, ranging in age from 26 to 69 years. Clinically, all lesions were diagnosed as leukoplakia on the lateral border of the tongue. Microscopic examination revealed hyperparakeratosis and candidiasis in some cases, acanthosis and a band-like zone with clearing of cells in the upper spinous layer, which were EBV-positive by in-situ hybridization. There was a significant decrease in Langerhans cell counts in OHL patients.

Conclusion: OHL can occur in HIV-negative patients.

Purpose: The hydrophilicity of some elastomeric impression materials has not been fully established. The purpose of this study was to measure and compare the advancing contact angle of water on the surface of several set elastomeric impression materials.

Materials and methods: We tested various consistencies of vinyl polysiloxane (VPS; Imprint 4) and vinyl polyether silicone (VPES; EXA'lence) with a polyether (PE; Impregum Soft) control. Impression discs (25.07 mm) were made using a metal die and ring. Deionized ultra-filtered water was placed on each disc and contact-angle measurements were made at 0, 15, 30, 45 and 60 s using a video contact angle drop shape analysis machine. The data were analyzed using repeated ANOVA and a post-hoc test with Bonferroni correction.

Results: VPS contact angles reached a mean of 10.1° ± 0.2° at 60 s vs. 40.7° ± 0.1° for VPES. Overall, VPS contact angles were smaller than those for VPES at all measured times. However, heavy and super quick heavy VPS had much higher contact angles at 0 s compared with other VPS consistencies. There was a significant difference in contact angles between VPS and VPES (mean difference 33.9°, p < 0.05) and between VPS and PE (mean difference 32.8°, p < 0.05) but not between VPES and PE (P = 0.196). VPS heavy and super quick heavy were significantly different from other VPS materials (p < 0.05), but not from each other (p = 1.00).

Conclusions: Set VPS is more hydrophilic than VPES. Contact-angle values of VPS indicated super hydrophilicity. VPES was hydrophilic, with measurements similar to the PE control. Thus, VPS impression materials may be excellent in terms of spreading and copying wet surfaces.

Objectives: To explore the psychosocial impacts of dentistry as described by patients.

Methods: I conducted 6 qualitative interviews with people whose access to dental care had been limited because of financial barriers, but who had recently undergone significant treatment through a dental outreach program.

Results: In addition to physical benefits (including improved sleep and diet), participants discussed how dental treatment led to a greater level of confidence and an improved self-concept. They provided powerful examples of how this confidence boost improved their social interactions and relationships. They also felt more confident about their employability.

Conclusion: The benefits of adequate dental care extend well beyond its physical and medical aspects. Dental health is connected inextricably with people's sense of self and social functioning. The far-reaching consequences of dentistry explored in this research raise questions about the inequalities in Canada's current system and the need to address them.