An Overview of Pedagogical Approaches to Caries-Control Medications in Canadian Dental and Dental Hygiene Programs.

OBJECTIVE: To investigate pedagogical approaches and perceived barriers to teaching about caries-control medications, particularly silver diamine fluoride (SDF), in Canadian undergraduate dental and dental hygiene programs. METHODS: In summer 2018, a 9-item questionnaire was distributed to all 10 dental schools and 32 dental hygiene programs in Canada. It enquired about the types of caries-control medications used, teaching methods and perceived barriers to instruction on managing active caries with SDF. METHODS: In summer 2018, a 9-item questionnaire was distributed to all 10 dental schools and 32 dental hygiene programs in Canada. It enquired about the types of caries-control medications used, teaching methods and perceived barriers to instruction on managing active caries with SDF. RESULTS: The response rate was 80% (n = 8) from dental schools and 72% (n = 23) from dental hygiene programs. All curricula included information about conventional caries-control medications: fluoride, silver nitrate and povidone iodine. In all programs, instruction regarding SDF was predominantly didactic: 93% of programs presented lectures on SDF and 30% of programs included clinical teaching and use of SDF in primary dentition only. The lack of consensus on clinical protocols outlining the number and frequency of SDF applications to arrest caries was cited by 43% of the programs as a barrier to clinical teaching. CONCLUSION: There is some variation across Canada in pedagogical approaches to caries-control medications and the inclusion of SDF in curricula. Poorly defined clinical protocols were reported as the main barrier to didactic and clinical use of SDF in undergraduate dental education programs.

Perceptions of access to oral care at a community dental hygiene clinic for women involved with the criminal justice system.

Background: Women involved with the criminal justice system are often marginalized or vulnerable and may face oral health inequities. Through a community-engaged program at a Canadian university, dental hygiene students provided preventive care at an organization supporting this population. This study explored the impact of these oral care services from client and organization staff perspectives. Methods: One focus group with 6 clients, 2-person interviews with 4 clients, individual interviews with 3 clients, and one focus group with 4 organization staff members were conducted. Discussions were audio recorded, transcribed verbatim, and analysed thematically. The concept of access, proposed by Penchansky and Thomas (1981) and Saurman (2015), was used as the conceptual framework to organize the themes. Results: Nine themes were identified from the focus group and interview discussions: limited options, convenience, realistic expectations, respect and attention, no judgement, physical environment, communication, clients' unique needs, and appropriate messaging. Discussion: The clinic's close proximity and services, for which women did not need to pay out-of-pocket, facilitated access to preventive care. The person-centred and trauma-informed care further facilitated access. However, access to comprehensive care through referrals was limited by cost and likely issues of stigmatization from other dental care providers. Clinic aesthetics, advertising, and communication between the students and women receiving care also hindered access. Conclusion: Preventive oral care services provided at this clinic for marginalized and vulnerable women who have been involved with the criminal justice system were valued by clients and staff. Findings will help inform future community-based dental hygiene clinics for this population.

Contexte: Les femmes qui font face au système de justice pénale sont souvent marginalisées ou vulnérables et peuvent être confrontées à des inégalités en matière de santé buccodentaire. Dans le cadre d'un programme engagé sur le plan communautaire, mis en place dans une université canadienne, des étudiants en hygiène dentaire ont prodigué des soins préventifs dans une organisation qui soutient cette population. La présente étude a exploré les répercussions de ces services de soins buccodentaires du point de vue des clients et du personnel de l'organisation. Méthodologie: Un groupe de discussion comprenant 6 clients, des entrevues à 2 personnes avec 4 clients, des entrevues individuelles avec 3 clients et un groupe de discussion avec 4 membres du personnel de l'organisation ont été menées. Les discussions ont fait l'objet d'un enregistrement sonore, puis ont été transcrites textuellement et analysées par thèmes. Le concept d'accès, proposé par Penchansky et Thomas (1981) et Saurman (2015), a été utilisé à titre de cadre conceptuel pour organiser les thèmes. Résultats: Le groupe de discussion et les entrevues ont permis de définir 9 thèmes : choix limités, commodité, attentes réalistes, respect et attention, absence de jugement, environnement physique, communication, besoins uniques des clients, et messages appropriés. Discussion: La proximité et les services de la clinique, pour lesquels les femmes n'avaient pas à payer de leur poche, ont facilité l'accès aux soins préventifs. Les soins axés sur la personne et les soins adaptés au traumatisme ont davantage facilité l'accès. Cependant, l'accès à des soins complets par l'intermédiaire de renvois a été limité par le coût et les enjeux de stigmatisation probables de la part d'autres fournisseurs de soins dentaires. L'esthétique de la clinique, la publicité et la communication entre les étudiants et les femmes recevant les soins ont également entravé l'accès. Conclusion: Les clients et le personnel ont attribué une valeur aux soins buccodentaires préventifs fournis à cette clinique réservée aux femmes marginalisées et vulnérables qui ont été impliquées dans le système de justice pénale. Les résultats permettront d'orienter les cliniques communautaires futures d'hygiène dentaire destinées à cette population.

Exploring residential care aide experiences with oral malodour in long-term care.

Aim: To determine what experiences do residential care aides (RCAs) have with individuals living with oral malodour in a long-term care (LTC) facility? Design: Study investigation was done using an interpretive qualitative approach paired with a social constructivism interpretive framework. Methods: The study was conducted in May of 2015 through face-to-face interviews with RCAs, which were recorded and transcribed verbatim, observations of RCAs in their work environment, as well as RCA personal logs of their daily experiences with odour during caregiving. Thereafter, data were analysed and coded for emerging themes. Results: Five major themes were identified after grouping the codes: 1) attitudes and behaviours when caring for residents with malodour; 2)RCA knowledge of oral malodour; 3) level of job satisfaction among RCAs that care for residents with malodour; 4) culture and malodour; and 5) challenges of care giving compounded by malodour. These themes depict the overall experiences of study participants.

Dental Insurance and Treatment Patterns at a Not-For-Profit Community Dental Clinic.

OBJECTIVES: To examine patient demographics, distance traveled and dental-related treatment provided according to type of dental insurance at a large, not-for-profit community dental clinic (CDC) in Vancouver, Canada. METHODS: Using electronic dental records, we assessed the use of private and government-sponsored (public) dental insurance at the CDC in 2014 and 2015 at the appointment and procedure levels. Study variables included patient demographics, distance traveled, type of treatment provided, type of dental insurance and cost of treatment. RESULTS: Examination of records from 9524 appointments involving 16 639 procedures revealed that 44% (4190 appointments) were made by patients with private insurance and 31.4% (2995) by those with public insurance. Patients with private dental insurance were 1.27 times more likely (p < 0.001) to have restorative treatment than those with public-sponsored dental insurance. Procedures involving tooth extraction were 14.2 times more likely (p < 0.001) to be performed in patients with public insurance than those with private insurance. CONCLUSIONS: Access does not equal equity; although the CDC enables access by various populations, its ability to provide equitable treatment is compromised by external factors. CDCs may have a vital role in oral health equity; however, dental treatment continues to be dictated by financial reimbursement.

Perceived oral health and access to care among men with a history of incarceration.

Objectives: To explore the perceptions of oral health and access to care experiences of men with a history of incarceration and to identify factors contributing to current oral health inequities within their community. Methods: A qualitative approach was used via focus group discussions among 18 men with a history of incarceration and 10 staff members of a non-profit organization working with individuals who are involved in or at risk of involvement with the criminal justice system. All discussions were audiorecorded and transcribed verbatim. A thematic analysis was undertaken using N-Vivo 10™, a qualitative data management program. Results: The participants ranged in age from 29 years to 69 years, came from a variety of ethnic backgrounds, and had different prison setting experiences. Five major themes emerged: not on the radar, stigma of incarceration, being shot down, caught in the system, and institutional conditioning. Conclusions: The personal backgrounds, experiences with health and dental care during prison time, and the unique challenges faced by men with a history of incarceration influenced their perceptions and their ability to access dental services. Dental professionals can help to change these perceptions and experiences by creating a safe space for these individuals to access and receive care comfortably.

Objectifs: Explorer la perception sur la santé buccodentaire et l'accès aux soins des hommes ayant des antécédents d'incarcération et cibler les facteurs qui contribuent aux inégalités actuelles en matière de santé buccodentaire au sein de leur communauté. Méthodologie: Une approche qualitative a été utilisée au moyen de groupes de discussion comprenant 18 hommes ayant des antécédents d'incarcération et 10 membres du personnel d'un organisme sans but lucratif qui travaillent avec des personnes impliquées ou à risque d'être impliquées dans le système de justice pénale. Toutes les discussions ont fait l'objet d'un enregistrement sonore et ont été transcrites mot pour mot. Une analyse thématique a été effectuée au moyen du programme de données qualitatives N-Vivo 10MD. Résultats: Les participants étaient âgés de 29 ans à 69 ans, étaient issus d'origines ethniques variées et avaient vécu différentes expériences en milieu carcéral. Cinq thèmes principaux sont ressortis, y compris ce qui ne figure pas sur l'écran radar, les préjugés associés à l'incarcération, être rejetés, être coincés dans le système, et le conditionnement institutionnel. Conclusions: Les antécédents personnels, les expériences en matière de santé et de soins buccodentaires au cours de la peine d'emprisonnement, et les enjeux uniques auxquels sont confrontés les hommes ayant des antécédents d'incarcération ont influencé leur perception des services buccodentaires et leur capacité d'y accéder. Les professionnels dentaires peuvent aider à changer la perception et les expériences de ces personnes en créant un endroit sécuritaire pour eux, qui leur permet d'accéder aux services et de les recevoir confortablement.

Relationship between salivary haemoglobin and number of remaining teeth in older Koreans.

OBJECTIVE: We investigated the relationship between saliva and dental biofilm characteristics, oral hygiene behaviours and the number of remaining teeth in a sample of older Koreans. MATERIALS AND METHODS: This cross-sectional study included 133 participants, aged 65 years and older, recruited from senior welfare facilities in Incheon, South Korea. The outcome variable was the number of remaining teeth, and its associations with the independent variables of participants' general characteristics, salivary haemoglobin level, dental biofilm acidogenicity, salivary flow rate and oral hygiene behaviours were assessed. For statistical analyses, chi-squared test and step-wise multiple linear regression were used. RESULTS: The multiple linear regression model, which included all related factors identified in the bivariate analyses, showed that older adults who had high salivary haemoglobin levels (P < .05), brushed their teeth using the horizontal scrub method (P< .001), and did not use an interproximal cleaning device (P < .01) were more likely to have fewer remaining teeth. However, dental biofilm acidogenicity was not associated with the number of remaining teeth. CONCLUSION: The number of remaining teeth was associated with salivary haemoglobin level, appropriate toothbrushing technique and interdental cleaning. These findings suggest that the monitoring of salivary haemoglobin may contribute to the prevention of tooth loss caused by periodontal disease.

Exploring dental student participation in interdisciplinary care team conferences in long-term care.

OBJECTIVE: The purpose of this study was to explore how the participation of dental hygiene students in interdisciplinary care conferences conducted in long-term care (LTC) facilities influenced the staff's awareness of oral health, the student's provision of care as well as the student's ability to work on an interdisciplinary team. BACKGROUND: Oral health in LTC continues to be poor despite many educational and clinical interventions. The care of a frail elder requires an interdisciplinary team approach, yet dental professionals are often absent from these teams. As an educational intervention, dental hygiene students, in addition to providing clinical care to residents and education to staff in a LTC facility, have been participating in interdisciplinary care conferences for 4 years. METHODS: Nine LTC facility staff and eight students participated in two focus groups and five personal interviews to discuss their experiences of the care conferences. Narratives were transcribed verbatim and thematic analysis was conducted. RESULTS: Four major themes emerged that described the essence of the experience of involving dental professionals within interdisciplinary care conference: (i) addressing oral health, (ii) reciprocal learning, (iii) dealing with complexity and (iv) impact of collaborative care. CONCLUSION: Overall, students found the educational intervention to be worthwhile that allowed for the development of interdisciplinary skills and a greater understanding of dental geriatrics. The dental support in care conferences was welcomed by the staff as it facilitated a new way of exchanging knowledge and experiences so that a more holistic approach to care could be undertaken by all.

Stigma Experiences in Marginalized People Living With HIV Seeking Health Services and Resources in Canada.

HIV stigma may prevent people from obtaining a timely diagnosis and engaging in life-saving care. It may also prevent those who are HIV infected from seeking health and education resources, particularly if they are from marginalized communities. We inductively explored the roots of stigma and its impact on health services and resource seeking as experienced by HIV-infected members of marginalized communities in Vancouver, British Columbia, Canada, using a community-based participatory research framework. Five peer-facilitated focus groups were conducted with 33 Aboriginal, Latino, Asian, and African participants. Thematic analysis of the experiences revealed four dominant themes: beginnings of stigma, tensions related to disclosure, experiences of service seeking, and beyond HIV stigma and discrimination. Persons living with HIV from Aboriginal and refugee communities continue to experience disproportionate rates of stigma and discrimination. Fear remains a prime obstacle influencing these groups' abilities and willingness to access care in various settings.

Oral health and the frailty syndrome.

The frailty syndrome is an ever-growing area of study among older adults because of its association with an increased risk of falls, hospitalization, institutionalization, dependency and mortality. Frailty is neither a disease nor a disability but is better understood as a medical syndrome of multisystem dysregulation that results in a diminished ability to overcome everyday stressors. The prevalence of frailty in any given population can vary widely, in part because of the way in which it is defined and measured, but in general it is higher among women and in those with advanced age and declining health. Whilst it is largely understood that older adults will differ biologically, psychologically and socially, and that each of these domains can impact oral health, we are only beginning to investigate how the mouth is affected in frailty. Given that both hard and soft structures contribute to oral health and disease status among older adults with varying degrees of impairment and disability, frailty adds yet another dimension to be considered. This paper will discuss how frailty can influence and be influenced by oral disorders, as well as the potential relationship to oral neglect and the resultant consequences among this vulnerable population.

The impact of oral health on body image and social interactions among elders in long-term care.

OBJECTIVE: The objective of this study was to explore how social interactions and body image are influenced by perceived oral health among older people who live in long-term care facilities. BACKGROUND: Social interactions among frail elders in long-term care (LTC) facilities are limited, but to what extent body image and oral health influence their social relations is poorly understood. A positive body image and the perception of adequate oral health are linked to increased social contacts, as well as improved health and well-being irrespective of age. However, as frailty increases, it is unclear whether appearance and oral health priorities remain stable. MATERIALS AND METHODS: Open-ended interviews were conducted with a purposefully selected group of cognitively intact, older men and women who exhibited varying degrees of frailty, social engagement and oral health conditions and lived in one of seven long-term care facilities. The interviews were analysed using a constant comparative technique, and a second interview with participants checked the trustworthiness of the analysis. RESULTS: Three major categories were expressed by the participants: (1) My mouth is fine; (2) It depends; and (3) Not that important. Within each category, there were several contributing and influencing factors. CONCLUSIONS: Social interactions among residents in LTC may be negatively impacted by poor oral health, but only if other personal and social issues are less bothersome than conditions with the mouth.

Social interactions, body image and oral health among institutionalised frail elders: an unexplored relationship.

OBJECTIVES: This paper draws on theories of ageing, body image and disfigurement, to explore the potential for relationships between oral health, body image and social interactions between institutionalised elders. BACKGROUND: Social relationships are important at all stages of life. A positive body image increases confidence in social interactions, which contributes substantially to health, well-being and quality of life. Body image can be negatively impacted by oral conditions, particularly those that are appearance related and do not meet cultural ideals. RESULTS: Typically, the oral health of frail elders in long-term care facilities is poor, but to what extent poor oral health and dysfunction influence body image, and social behaviours is unclear. CONCLUSIONS: We conclude that there is the potential for poor oral health conditions to contribute negatively to the social well-being in this population, but suggest that it requires further investigation.