Oral health status of long-term care residents-a vulnerable population.

OBJECTIVE: To conduct an observational, cross-sectional survey of the oral health status of adults ≥ 45 years of age in rural and urban long-term care (LTC) facilities in Nova Scotia, Canada. METHODS: Residents capable of informed consent were recruited by LTC staff in a stratified random sample of LTC facilities. Calibrated personnel administered standard clinical and quality-of-life instruments. RESULTS: Of the 335 adults (74% female) surveyed (mean age 80.8 ± 11.6 years), only 25% reported having regular dental care. Although 76% described their oral health as good or excellent, 41% were edentulous, 41% had some mucosal abnormality, 36% reported xerostomia and 25% had perceived or self-reported untreated dental conditions. Most mandibular dentures were nonretentive (59%) and almost half were unstable (49%). Among the dentate, 51% had untreated coronal caries, 44% had untreated root caries and 67% had attachment loss of ≥ 4 mm at ≥ 1 site. Predictors of coronal decay were a debris score ≥ 2 (adjusted odds ratio [adj OR] = 2.12; p = 0.045) or a history of smoking (adj OR = 1.02 per year of smoking; p = 0.024). Predictors of root caries were participants' perceiving a need for dental treatment (adj OR = 2.56; p = 0.015) or a history of smoking (adj OR = 1.02 per year of smoking; p = 0.026). CONCLUSIONS: This epidemiologic study of the oral health of LTC residents revealed a high prevalence of untreated oral disease and low use of oral care services, highlighting the need for better access to oral care for this population.

Assessing the oral health of an ageing population: methods, challenges and predictors of survey participation.

OBJECTIVES: To examine predictors of participation and to describe the methodological considerations of conducting a two-stage population-based oral health survey. METHODS: An observational, cross-sectional survey (telephone interview and clinical oral examination) of community-dwelling adults aged 45-64 and ≥65 living in Nova Scotia, Canada was conducted. RESULTS: The survey response rate was 21% for the interview and 13.5% for the examination. A total of 1141 participants completed one or both components of the survey. Both age groups had higher levels of education than the target population; the age 45-64 sample also had a higher proportion of females and lower levels of employment than the target population. Completers (participants who completed interview and examination) were compared with partial completers (who completed only the interview), and stepwise logistic regression was performed to examine predictors of completion. Identified predictors were as follows: not working, post-secondary education and frequent dental visits. CONCLUSION: Recruitment, communications and logistics present challenges in conducting a province-wide survey. Identification of employment, education and dental visit frequency as predictors of survey participation provide insight into possible non-response bias and suggest potential for underestimation of oral disease prevalence in this and similar surveys. This potential must be considered in analysis and in future recruitment strategies.

Patterns of opioid prescribing by dentists in a pediatric population: a retrospective observational study.

BACKGROUND: Dentists are regular prescribers of opioid analgesic medications; however, there are few published data on their prescribing practices for children. The aim of this study was to assess opioid prescribing practices of dentists for pediatric patients. METHODS: We conducted a retrospective study (2011/12 to 2017/18) using administrative health data of opioid prescribing practices of dentists in Nova Scotia for children and adolescents (age < 18 yr). The main variables of interest were opioid "type" and "load" dentists prescribed (number of dispensed prescriptions/yr, days supplied/prescription and dosage/d per prescription in milligrams of morphine equivalents [MME]). RESULTS: Dentists accounted for a mean of 18.3% (standard deviation 1.5%) of all opioid prescribers for the pediatric population annually but were responsible for 59.9% of all opioid prescriptions and 48.6% of total MME dispensed during the 7-year study period. Oral and maxillofacial surgeons were responsible for 80.7% of all dental-related opioids dispensed. Codeine was most frequently prescribed (78.6% of total MME), followed by oxycodone (11.1%). There were significant downward trends over the study period in the total amount of opioid analgesics dispensed (r = -0.903, p < 0.01), primarily due to a reduction in the total amount of codeine dispensed and number of days supplied per prescription (r = -0.837, p < 0.05). Few opioids were dispensed to children less than 12 years. INTERPRETATION: Dentists in Nova Scotia reduced prescriptions of opioids in the pediatric population between 2011/12 and 2017/18, which may indicate that current opioid prescribing principles are influencing dentists' prescribing habits. Nonetheless, patients and parents should receive appropriate counselling as to the proper use, risks, storage and potential for misuse of opioids when prescribed.

Integrating photo-stimulable phosphor plates into dental and dental hygiene radiography curricula.

It is not known whether the integration of photo-stimulable phosphor (PSP) plates into dental and dental hygiene curricula creates unique learning challenges for students. The purpose of this two-year study was to determine if dental hygiene students had more and/or different types of errors when using PSP plates compared to film and whether the PSP imaging plates had any particular characteristics that needed to be addressed in the learning process. Fifty-nine first-year dental hygiene students at one Canadian dental school were randomly assigned to two groups (PSP or film) before exposing their initial full mouth series on a teaching manikin using the parallel technique. The principal investigator determined the number and types of errors based on a specific set of performance criteria. The two groups (PSP vs. film) were compared for total number and type of errors made. Results of the study indicated the difference in the total number of errors made using PSP or film was not statistically significant; however, there was a difference in the types of errors made, with the PSP group having more horizontal errors than the film group. In addition, the study identified a number of unique characteristics of the PSP plates that required special consideration for teaching this technology.