Journal of the Canadian Dental Association最新文献

Objective: The aim of this study was to evaluate the accuracy of 3 thermosensitive microsensors that record "wear time" of removable oral appliances (OAs).

Methods: For in vitro testing, TheraMon (sensor T, n = 20), AIR-AID SLEEP (sensor A, n = 30) and DentiTrac (sensor D, n = 16) microsensors were placed in a water bath to simulate long and short durations of wear. Their accuracy was also assessed when they were embedded in 3 materials: acrylic, polyvinylchloride and thermoactive acrylic. In vivo testing included 14 volunteers, who wore maxillary retainers embedded with sensors A and D for 30 nights. Logs of appliance use were compared with readouts from the sensors.

Results: In the in vitro long duration of wear assessment, sensor A, with a mean absolute response difference (MARD) of 1.67 min. (SD 1.41), was significantly more accurate than sensor T (MARD 3.53 min., SD 9.80) and sensor D (MARD 4.48 min., SD 8.46). For short duration of wear, sensor A (MARD 1.41 min., SD 3.60) and sensor T (MARD 1.68 min., SD 7.64) were equal in accuracy and significantly better than sensor D (MARD 14.07 min., SD 10.20). The embedding material had no effect on the recording accuracies of the microsensors. In vivo, there was no significant difference between sensors A and D.

Conclusion: All 3 microsensors are highly accurate and reliable and can be used to record wear time of a removable OAs fabricated from various materials.

Oral appliances (OAs) are frequently used in orthodontics and for the treatment of obstructive sleep apnea. Because OAs can be inserted and removed by patients themselves, the patient's cooperation is a major component of effective treatment. In this review, we provide an overview of factors studied in the past that affect adherence to OA use in orthodontics and dental sleep medicine. We also describe future directions in adherence and the use of objective microsensor technology to measure adherence in these patients. Because removable oral appliances (OAs) can be inserted and removed by patients themselves, their cooperation and adherence to therapy are necessary to achieve success.1,2 Removable OAs, such as headgear, removable retainers and functional appliances, are used in orthodontics to correct malocclusions. In the field of sleep medicine, removable OAs are increasingly used as an option in the treatment of patients with obstructive sleep apnea (OSA).

The use of resin composites and adhesives in dental restorations is ubiquitous. However, the longevity of resin composites is less than that of comparable restorative materials, mainly because of higher fracture rates and greater prevalence of secondary caries. Dental resin composites and adhesives contain ester links, which are vulnerable to biochemical hydrolysis by esterase activity from human saliva and bacteria. In this article, we review biodegradation processes that occur in the oral cavity and their contribution to the premature failure of resin composites. Biodegradation causes deterioration of resin composite bulk and the composite-tooth interface and releases by-products, such as methacrylic acid, triethylene glycol and bishydroxy-propoxy-phenyl-propane. These by-products have been shown to affect cariogenic bacterial growth and virulence. A compromised restoration-tooth interface allows saliva and oral bacteria to infiltrate the spaces between the tooth and the composite, exacerbating the effects of biodegradation, undermining the restoration and leading to recurrent caries, hypersensitivity and pulpal inflammation. It is important to consider the biochemical stability of these materials to advance their chemistry beyond the current formulations and conceive more biochemically stable and better-performing dental resin composites and adhesives.

We examine the perspectives of 14 key informants with extensive knowledge of dental care provision in Canada regarding systemic factors that could push Canadians to participate in dental tourism. Drawing on interview discussions about Canadians' access to dental care and their participation in dental tourism, we identify systemic factors related to how dental care is financed and delivered, rising costs of dental care and consumerism in terms of their potential role in Canadians' decisions to purchase dental care abroad. Further research on individual experiences accessing and using dental care, both in Canada and abroad, could help provide a better understanding of how these factors are informing Canadians' decision-making regarding dental care and, as a result, access to needed care.

Traditionally, periodontal hand instruments are honed or sharpened during patient care as they dull easily during contact with enamel, calculus and cementum. This approach is taught in dental and hygiene schools around the world and remains the standard of care. Recently, some professional organizations have questioned whether this practice should be abandoned because of safety issues. Questions have been raised whether sharpening stones can be properly sterilized and whether the sharpening of contaminated instruments poses a health hazard for the provider. Using bacteria culture techniques and scanning electron microscopy, we tested whether contaminated ceramic sharpening stones can be sterilized. Our results demonstrate that the stones were sterile after being subjected to the manufacturer's sterilization protocol. In addition, over the last year, no incidents related to periodontal instrument sharpening have been reported among nearly 400 students at the faculty of dentistry, University of British Columbia, where chair-side sharpening is taught. Therefore, we conclude that ceramic sharpening stones can be sterilized using normal office protocols and that chair-side sharpening adds little risk beyond routine handling of operatory or periodontal instruments during patient care when proper protocols are followed.

Aim: To assess the prescribing decisions of general dentists in Vancouver and endodontists in British Columbia regarding analgesics and antibiotics for patients with endodontic disease. An additional aim was to determine whether gender, clinical experience or practice location have an impact on such decisions.

Methods: A 4-page survey was developed and distributed to approximately half the general dentists in Vancouver (n = 259) and all of the endodontists in British Columbia (n = 50). Basic demographic questions were followed by 7 clinical scenarios and a list of endodontic diagnoses. Participants were asked questions regarding their decisions to prescribe analgesics and antibiotics.

Results: The overall response rate was 49%: 72% of endodontists responded, compared with 45% of general dentists. A substantial proportion of clinicians prescribed opioid analgesics and antibiotics in the various clinical scenarios. The rate of prescription of opioid analgesics ranged from 4%-47% for the various scenarios; the rate of prescription of antibiotics was 5%-88%. General dentists reported prescribing opioid analgesics and antibiotics more often than endodontists. Gender, clinical experience and practice location did not seem to have an impact on the decision to prescribe opioid analgesics or antibiotics.

Conclusions: Based on the results of our survey, a significant proportion of dental professionals in British Columbia prescribe opioid analgesics and antibiotics during endodontic procedures when they are likely not required. General dentists tend to prescribe these medications more often than endodontists. We found no apparent differences in terms of gender, clinical experience or practice location. Dentists must be conscientious when prescribing these medications as over-prescription has negative consequences.

Objectives: This pilot study at the dentistry department of BC Children's Hospital (DD-BCCH) in Vancouver, British Columbia, Canada, aimed to explore issues of access to dental services for children with special health care needs (CSHCN).

Methods: Caregivers of CSHCN, who were patients of record at DD-BCCH, were recruited to participate in this study. We collected sociodemographic characteristics, insurance coverage and medical diagnosis, and information on caregivers' perceptions of enabling factors and barriers to dental services using a pretested survey instrument with 33 closed and open-ended questions. We also obtained referral source, insurance coverage and medical diagnosis from the child's dental record. We analyzed quantitative data descriptively and qualitative comments from caregivers thematically.

Results: Common medical diagnoses among this sample of CSHCN (n = 50) were: genetic disorder/syndrome, developmental delay, sensory impairments and autism. Half of the children were referred by a medical professional; most (90%) had had a dental appointment within the last year that included preventive treatment. Although most caregivers reported some available dental benefits, affordability of dental services was a concern. Lack of dentist's training or comfort treating CSHCN, because of the complexity of the child's medical condition or behavioural challenges was also a reported barrier.

Conclusions: The complexity of the child's medical status, the limited ability of dentists to provide care and financial obstacles were commonly reported barriers to care. Current efforts may best be focused on encouraging the province's health professionals, including dentists, to facilitate early referral to tertiary-level care for CSHCN whom they consider medically or behaviourally complex beyond their skill or comfort level.

Objective: Recently, there has been great interest in the use, abuse and over-prescribing of opioid analgesics for children. However, there is a paucity of evidence on patterns of prescribing of both narcotic and non-narcotic analgesics for children by dentists.

Methods: We used a population-wide prescription drug database (PharmaNet) in British Columbia, Canada, to examine prescribing and dispensing of analgesics surrounding dental procedures. We examined all drugs prescribed for children by dentists between 1997 and 2013, as we had access to data on drug doses and days of medication supply. We also examined trends in the use of various narcotic and non-narcotic analgesics and benzodiazepines.

Results: In total, 268 691 children were prescribed at least 1 study drug by a dentist. Codeine was the most frequently prescribed: 50% of children received codeine for more than 3 days. Duration of use of codeine was greatest among children ≥12 years, the longest duration of use being 5 days.

Conclusions: Our study reveals that codeine prescription by dentists increased over the 16-year study period. Codeine is prescribed by dentists for 50% of children; prescriptions are for too long a duration to avoid potential morphine accumulation and are not in line with current treatment guidelines.

Objective: This study aims to assess barriers to the use of deep sedation/general anesthesia (DS/GA) identified by dentists in Ontario.

Methods: An email invitation to a web-based survey was distributed to all licensed dentists and specialists who have provided an email address to the provincial regulator (n = 5507). Descriptive and regression analyses were performed to explore practice and demographic factors associated with the use of DS/GA.

Results: The response rate was 18.3%. A quarter (24.8%) of respondents reported inadequate access to DS/GA. Access was poorest in rural communities and greatest in the Greater Toronto Area (GTA). Overall, 74.5% of dentists indicated that they had used DS/GA in the past 12 months. Use was defined as having provided the service or referred a patient in the past 12 months. Non-use was most likely among general dentists, part-time dentists, dentists > 64 years and dentists in urban locations. Wait times and travel distances were reported as longer for medically complex patients. The most common reasons for non-use of DS/GA were a lack of perceived demand and additional costs to patients. For DS/GA users, the greatest barrier was additional costs to patients.

Conclusion: Access to DS/GA in Ontario is not uniform; it remains a challenge in rural communities and regions outside the GTA, especially in the north. Use is lowest among general dentists and urban dentists despite adequate access, with dentists' perception of need for DS/GA and cost to the patient acting as major barriers. Education for dentists and better insurance coverage for patients may improve access for these patients.