Oral Cavity and Oropharyngeal Cancer Surveillance and Control in Alberta: A Scoping Review.

OBJECTIVES: This scoping review provides a comprehensive overview of oral cavity cancer (OCC) and oropharyngeal cancer (OPC) in Alberta. METHODS: A database search was conducted up to 2018 using Web of Science, Scopus, Medline, PubMed and Embase, along with a manual search of gray literature. Data from the Alberta Cancer Foundation's dedicated fund for research, Cancer Surveillance and Reporting and Alberta Cancer Registry were also collected. RESULTS: Our review included 8 published papers and 14 other sources, including data on 3448 OCC and OPC patients from Surveillance and Reporting and Alberta Cancer Registry. Cancer registry data (2005-2017) showed that most OCC and OPC lesions were diagnosed at an advanced clinical stage, with a significantly large number of advanced OPC lesions in stage IV (OCC 45.2%, OPC 82.4%); 47.9% of these patients died. Survival rates were lowest in rural and First Nations areas. In Alberta, 35% of HPV-associated cancers were linked to OPCs, which were more prevalent in men and younger age groups. No routine public oral cancer screening program currently exists in Alberta. General practitioners and dentists refer patients to specialists, often with long waiting times. CONCLUSION: OCC and OPC patients in Alberta continue to be diagnosed in stage IV and experience high mortality rates.

ORAL HEALTH STATUS OF IMMIGRANT AND REFUGEE CHILDREN IN NORTH AMERICA: A SCOPING REVIEW.

OBJECTIVES: The aim of this scoping review was to assess the oral health status of the children of refugees and immigrants ("newcomers"); the barriers to appropriate oral health care and use of dental services; and clinical and behavioural interventions for this population in North America. METHODS: Explicit inclusion and exclusion criteria were used in searching electronic databases to identify North American studies between 2007 and 2014 that reported oral health status, behaviours and environment of children of newcomers. Additional studies from 1995-2008 were found in a recently published review. Pertinent data from all selected studies were summarized. RESULTS: Overall, 32 relevant North American studies were identified. In general, children of newcomers exhibit poorer oral health compared with their non-newcomer counterparts. This population faces language, cultural and financial barriers that, consequently, limit their access to and use of dental services. Intervention programs, such as educational courses and counseling, targeting newcomer parents or their children are helpful in improving the oral health status of this population. CONCLUSIONS: Children of newcomers are suffering from poor oral health and face several barriers to use of dental care services. The disparity in dental caries between children of newcomers and their counterparts can be reduced by improving their parents' literacy in the official language(s) and educating parents regarding good oral health practices. An appropriate oral health policy remains crucial for marginalized populations in general and newcomer children in particular.

WORK PATTERN DIFFERENCES BETWEEN MALE AND FEMALE ORTHODONTISTS IN CANADA.

OBJECTIVE: To examine sex-specific differences in the demographics and work patterns of Canadian orthodontists. METHODS: Questionnaires were mailed and emailed to a random sample of 384 orthodontists: 289 men and 95 women. Questions regarding work patterns and personal demographics were created and results were compared by sex. RESULTS: The response rate was 53.9%. The demographics and work patterns for male and female orthodontists were similar for most variables. Women were found to be 6 years younger; have 6 fewer years of work experience; expect to retire earlier; be more often married to a professional in full-time employment; and be more likely to take a leave of absence during their career than their male colleagues. Age significantly affected the number of hours worked per week and number of phase II starts per year; both variables increased with increasing age until approximately 50 years, after which they decreased with age. Having children did not significantly affect any of the analyzed variables. CONCLUSIONS: As the practice of female orthodontists was not found to be substantially different from that of men, it is not possible to speculate whether the increasing number of women specializing in orthodontics will provoke a significant change in the profession. As this is the first survey of its kind in Canada, these results may be used as a reference for future comparisons to determine work patterns and trends in the orthodontic workforce.

Parental awareness and dental attendance of children among African immigrants.

To assess parental awareness of their child's dental status and the relationship between parental awareness and children's dental attendance. Participants were children aged 6 years or younger and their African parents who had lived in Canada for up to 10 years. Demographics and parents' perceived dental status were collected. Children's normative dental status was determined by dental examinations. 125 pairs of parents and children aged 21-72 months were included. 52% of the children never had a dental visit. Dental status of 44% of children was rated as good by parents, among them, 56% had dental decay. Parental assessments did not coincide with the clinical assessments of 62% of children. No correlation was found between parental awareness and children's dental attendance. Children of African immigrants are at high risk for developing severe dental decay because of low parental awareness and lack of regular dental visits.

Barriers to utilization of dental services for children among low-income families in Alberta.

OBJECTIVES: To explore reasons for underutilization of dental services covered by a governmental funded program in Alberta. METHODS: A survey questionnaire was sent to 4,000 randomly selected clients of Alberta Health Benefit program. Only respondents with children were included in the analysis. Reasons were explored among those who indicated that their children did not receive any dental services in the year prior to the survey (non-users). Difficulties faced by those who reported receiving at least one dental service (users) were also collected. RESULTS: Among 795 returned surveys, 597 had at least one child. A total of 1,303 children aged 1 to 19 years (mean age = 11.79 years, SD = 4.2) were included in the analysis. Of the 1,303 children, 443 (34%) did not receive any covered dental services (non-users); the most common reason (50.7%) was 'no perceived need' labeled for the replies 'my child was too young or had no dental problems' followed by perceived insufficient coverage (38.6%). The most common challenge reported by the dental care users was also insufficient coverage (44.9%). About 57% of parents were aware of the covered yearly fluoride application; however, only 34.3% of their children received fluoride and 14.2% had sealants. CONCLUSIONS: Low-income families underutilized available dental benefits for children. Perceived need seemed to be the primary determinant of utilization. Parental awareness about the coverage did not seem to promote the utilization of preventive measures for young children.

Utilization of dental services by children in low-income families in Alberta.

OBJECTIVE: To explore the utilization of dental services for children among low-income families receiving assistance from 2 provincial health benefit programs in Alberta. METHODS: A survey questionnaire was used in telephone interviews with 820 randomly selected clients of the Alberta Child Health Benefit (ACHB) and the Alberta Adult Health Benefit (AAHB) programs. Data related to utilization of dental services were analyzed. RESULTS: Among respondents to the questionnaires, 377 (93.1%) of 405 ACHB clients and 356 (85.8%) of 415 AAHB clients agreed that the programs helped them or their children to obtain dental services that they would not otherwise be able to receive. However, only 222 (54.8%) of the 405 ACHB respondents and 136 (57.4%) of 237 respondents with children covered by the AAHB program reported that their youngest child had received at least 1 dental service in the 12 months before the survey. Children in the 2 youngest age cohorts (i.e., those 4 years of age or younger) were less likely to have received each of several specific dental services, including a dental examination or checkup, and children 5 to 14 years of age were more likely to have received these dental services. The most used dental service for all age groups was a dental examination or checkup, and the least used was extraction. CONCLUSIONS: Despite the great need, low-income families underutilized the dental benefits for children offered by Alberta Employment and Immigration, which are designed to assist low-income Albertans. Parental awareness about public funding for dental services that is available did not seem to provide enough motivation to seek dental care for young children.

Understanding parents' oral health behaviors for their young children.

Young children with extensive dental decay often require a general anesthetic (GA) to enable dental treatment. The purpose of this study was to develop a grounded theory to help our understanding of the processes that influence parental adoption of dentally healthy behaviors following the experience of their child's "dental general anesthetic." Twenty six interviews were conducted. Data were analyzed and a conceptual model was generated. Overall, the dental GA experience had an immediate, but short-lived, impact on parental behavior change. Parents had difficulty over time maintaining these behaviors. Social influences, family context, and parenting strategies were the key categories that influenced parental behavior change; however, parenting strategies occupied the central position in the model. Cultural beliefs, actions of dental professionals, and media/advertising were some of the identified barriers to behavior change. Those parents who were more confident in their ability to successfully carry out dentally healthy practices were more likely to maintain them over time.

A conceptual model of parental behavior change following a child's dental general anesthesia procedure.

PURPOSE: The purpose of this study was to investigate parents' challenges to long-term maintenance of healthy behaviors following their child's dental general anesthesia (GA). METHODS: Twenty-six in-depth interviews were conducted with parents of children younger than 6 years of age who had dental treatment under GA. The interviews were scheduled at various time periods following the surgery. Compared were the responses of: (1) "relapse" families, whose child had new cavities at the 6-month recall; and (2) "no relapse" families, who were caries-free at recoil. A grounded theory approach to data analysis was used. RESULTS: "Relapse" parents: (1) valued baby teeth differently; (2) perceived their child to be less susceptible to new cavities; and (3) expressed lower self-efficacy for controlling their child's oral health compared to "no relapse" parents. They also appeared to be: (1) in earlier stages of change; (2) less receptive to advice from others, including professionals; and (3) more permissive regarding their child's desires. "Relapse" parents did not seem to have any immediate plans to change their "home-care" behaviors. CONCLUSION: GA did not appear to affect long-term preventive behaviors for all parents. Readiness to change seemed to be an important predictor of whether parents adopted and maintained preventive behaviors to improve their child's oral health.

Effect of povidone-iodine on Streptococcus mutans in children with extensive dental caries.

PURPOSE: The purpose of this pilot project was to determine the effect of a 10% povidone-iodine solution on plaque Streptococcus mutans and on incidence of new caries in young children following dental rehabilitation under general anesthesia. METHODS: Twenty-five children ages 2 to 7 years, scheduled for dental treatment under general anesthesia, were enrolled. Children in the experimental group (N = 13) had povidone-iodine applied 3 times at 2-month intervals. Control children (N = 12) had no treatment. Plaque samples were taken from all children at baseline, 6 months and cultured for total bacteria and S mutans. Dental examinations were conducted at baseline, 6 months, and 1 year. RESULTS: Experimental and control children had similar dietary habits, caries experience, and S mutans levels at baseline. All children's S mutans counts decreased significantly at 6 months (P = .003). The difference between the 2 groups was not significant (P = .58). At 1 year, 5 of 8 children in the control group had new caries compared to 2 of 11 children in the experimental group (P = .06). Povidone-iodine was well accepted by participating families. CONCLUSIONS: Extensive one-time restorative dental treatment resulted in a significant suppression S mutans levels at 6 months. Further exploration of the role of povidone-iodine in caries management is indicated.