The use of general anesthesia for dental treatment of children with special healthcare needs in Alberta, Canada.

BACKGROUND: Children with special healthcare needs (SHCN) often require specialized interventions due to their disabilities. Dental general anesthesia (DGA) is a treatment modality, which improves their access to care but concerns about repeated DGAs persist. AIM: This study investigated DGA utilization in children with SHCN and identified factors associated with multiple DGAs in Alberta, Canada (2010-2020). DESIGN: This retrospective population-based study used administrative data encompassing all children (<18 years) undergoing DGA in publicly funded facilities. Children were identified as SHCN based on their diagnosis codes and categorized into behavioral/psychiatric disorders, mental/intellectual disabilities, physical disabilities, systemic conditions, syndromes/congenital anomalies, physical-mental disabilities, and disabilities with medical conditions. RESULTS: This study analyzed 3884 DGA visits for children with SHCN, predominantly males aged 6-11 and from low-income families. Mental/intellectual disabilities were prevalent (31.8%), and autism was the leading disease. Caries was the primary dental diagnosis across all groups, whereas pulp problems were higher in psychiatric/behavioral disorders (23.6%), and periodontal problems were more common in physical-mental disabilities (13.2%). 28.7% had multiple DGAs, with younger age, disabilities with medical conditions, mental/intellectual disabilities, and initial pulp treatments, increasing the likelihood of multiple DGAs. CONCLUSION: This study highlights the importance of individualized prevention and less conservative treatments for younger children to reduce oral health disparities.

A novel model for curriculum design: Preparation, planning, prototyping, and piloting.

Dental education continuously strives to provide students with positive and meaningful learning experiences. Developing or improving a curriculum usually encompasses three main phases: design, implementation, and evaluation. Most research on curriculum development in dental education has focused on the last two phases. Our commentary addresses this gap by describing a new model for curriculum design that effectively guided the design phase of the complete overhaul of the four-year Doctor of Dental Surgery curriculum at the School of Dentistry, University of Alberta. Built on the strengths of pre-existing curriculum design models, the new model provided enough structure and rigour to support the complexity required during a complete curriculum redesign whilst still allowing sufficient consultation and flexibility to encourage stakeholder engagement. The steps of the new 4P's model (preparation, planning, prototyping, and piloting) and main actions within each step are described. Challenges observed in each step and strategies to address them are reported. Other institutions embarking on renewing or redesigning a curriculum at a program level may benefit from using a curriculum design process similar to the 4P's model. Recommendations are discussed including the inclusion of educational consultants in the curriculum renewal committee, the importance of a leadership that effectively supports curriculum reform, purposeful engagement of stakeholders during each step of the design phase and ensuring that project and change management occur concurrently.

Community water fluoride cessation and rate of caries-related pediatric dental treatments under general anesthesia in Alberta, Canada.

OBJECTIVE: This study examined the rate of caries-related dental treatments under general anesthesia (GA) in fluoridated and non-fluoridated communities in Alberta, Canada, between 2010 and 2019. METHODS: This retrospective, population-based study included all children ( < 12 years of age) living in Calgary (non-fluoridated) and Edmonton (fluoridated) who underwent caries-related dental treatments under GA at publicly funded facilities. Demographics and dental data were extracted from health administrative databases for three time periods of 2010/11 (pre-cessation), 2014/15, and 2018/19 (post-cessation). RESULTS: Among 2659 children receiving caries-related treatments under GA, the mean (SD) and median (IQR) age were 4.8 (2.3) and 4 (3-6) years, respectively, and 65% resided in the non-fluoridated area. The analysis revealed that the cessation of water fluoridation was significantly associated with an increased rate of caries-related GA events per 10,000 children in both age groups (0-5 and 6-11 years), with a more pronounced effect in 0-5-year-olds in non-fluoridated areas. The risk of dental treatments under GA was also positively associated with post-cessation time. CONCLUSION: Discontinuing water fluoridation appears to negatively affect young children's oral health, potentially leading to a significant increase in caries-related dental treatments under GA and oral health disparities in this pediatric population.

RéSUMé: OBJECTIF: Cette étude a examiné la fréquence des traitements dentaires liés aux caries sous anesthésie générale (AG) dans les communautés fluorées et non fluorées en Alberta, Canada, entre 2010 et 2019. MéTHODES: Cette étude rétrospective, basée sur la population, a inclus tous les enfants (< 12 ans) vivant à Calgary (non fluorée) et à Edmonton (fluorée) qui ont subi des traitements dentaires liés aux caries sous AG dans des établissements financés par des fonds publics. Les données démographiques et dentaires ont été extraites des bases de données administratives de la santé pour trois périodes : 2010/11 (pré-arrêt), 2014/15 et 2018/19 (post-arrêt). RéSULTATS: Parmi les 2 659 enfants recevant des traitements liés aux caries sous AG, l'âge moyen (DS) et la médiane (IQR) étaient de 4,8 (2,3) et 4 (3­6) ans, respectivement, et 65 % résidaient dans la zone non fluorée. L'analyse a révélé que l'arrêt de la fluoration de l'eau était significativement associé à une augmentation du taux d'événements liés aux caries sous AG parmi 10 000 enfants dans les deux groupes d'âge (0­5 et 6­11 ans), avec un effet plus prononcé chez les 0­5 ans dans les zones non fluorées. Le risque des traitements dentaires sous AG était également positivement associé au temps post-arrêt. CONCLUSION: La cessation de la fluoration de l'eau semble avoir un impact négatif sur la santé bucco-dentaire des jeunes enfants, entraînant potentiellement une augmentation significative des traitements dentaires liés aux caries sous AG et des disparités en matière de santé bucco-dentaire dans cette population pédiatrique.