Developing a land-based oral health promotion project with an Indigenous community in northern British Columbia, Canada.

In British Columbia, Canada, First Nations children and youth consistently present with a higher incidence of dental disease. Efforts to improve the oral health status of Indigenous populations have had mixed success, and programs have typically been offered through a Western lens. Recent years have brought calls for oral health professionals to embrace a more holistic approach to health promotion, representative of Indigenous cultures. Colonization has been considered a negative health determinant as it led to the destruction of culture, language, and the removal of Indigenous peoples from their traditional lands. Self-determination and cultural connection are critical to mitigating cultural genocide. Health promotion projects have the potential to support these goals. Fundamental to decolonizing oral health promotion is the development of a sustainable program founded in the traditional ways of Indigenous health and healing. The purpose of this short communication is to report on a collaborative oral health project that used cultural connection as the framework for oral health promotion in a remote Indigenous community.

En Colombie-Britannique, au Canada, les enfants et les jeunes des Premières Nations présentent systématiquement une incidence plus élevée de maladies dentaires. Les efforts visant à améliorer l'état de santé buccodentaire des populations autochtones ont connu un succès mitigé, bien que les programmes aient généralement été offerts dans une optique occidentale. Ces dernières années, les professionnels de la santé buccodentaire ont été appelés à adopter une approche plus globale de la promotion de la santé, représentative des cultures autochtones. La colonisation a été considérée comme un déterminant négatif de la santé, car elle a mené à la destruction de la culture et de la langue, ainsi que l'expulsion des Autochtones de leurs terres traditionnelles. L'autodétermination et le lien culturel sont essentiels pour atténuer le génocide culturel. Les projets de promotion de la santé ont le potentiel de soutenir ces objectifs. L'élaboration d'un programme durable fondé sur les méthodes traditionnelles de santé et de guérison autochtones est essentielle à la décolonisation de la promotion de la santé buccodentaire. L'objectif de cette brève communication est de faire le point sur un projet de santé buccodentaire collaboratif qui a utilisé le lien culturel à titre de cadre pour la promotion de la santé buccodentaire dans une communauté autochtone éloignée.

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.

Uncertainties around COVID-19 from the perspectives of oral health care workers during the first wave of SARS-CoV-2 infections in British Columbia, Canada.

BACKGROUND: The first wave of COVID-19 infections caused disturbances in all aspects of personal and professional lives. The aim of this study was to explore the ways in which that first wave of novel coronavirus infections resulted in uncertainties, as experienced by members of the oral health care workforce in British Columbia, Canada. METHODS: This qualitative inquiry purposefully recruited frontline oral health care workers, including dentists, dental hygienists, certified dental assistants, and administrative staff, via remote semi-structured interviews between April 20 and May 4, 2020. Coding, categories, and themes were inductively assigned. RESULTS: A total of 45 interviews, lasting between 39 and 74 minutes each, were conducted involving 18 dentists (6 females), 12 dental hygienists (11 females), 6 certified dental assistants (all females), and 9 administrators/front-desk staff (7 females). Fifty-one hours of audio recordings and more than 650 single-spaced pages of transcripts were produced. Five main themes emerged pertaining to uncertainties surrounding COVID-19, patient care, personal lives and infectiousness, concern for the future, and variations among different pandemics. Certitudes were less evident, but surfaced mostly when considering a potential new normal resulting from the pandemic. CONCLUSION: Participants indicated that the uncertainties they felt were dependent upon what is known, and unknown, about the pandemic and the provision of oral health care during the first wave of infections. Future studies are needed to include the viewpoints of oral health care workers from other provinces, as well the perceptions of patients who received oral health care during the height of the first wave of the pandemic.

Changes in Oral Health Policies and Guidelines During the COVID-19 Pandemic.

The aim of this study was to describe the changes in oral health policies and guidelines in response to the Coronavirus disease 2019 (COVID-19) pandemic in different countries and regions around the world. Information on oral health policies and guidelines from 9 countries (Canada, China including Hong Kong, Egypt, India, Japan, New Zealand, Nigeria, Switzerland, and Thailand) were summarized, and sources of the information were mostly the national or regional health authorities and/or dental council/associations. The changes made to the oral health guidelines depended on the severity of the COVID-19 pandemic. This included suspension of non-emergency dental care services at the peak of the COVID-19 outbreak, and easing the restrictions on non-essential and elective dental care when the pandemic became under control. The COVID-19 risk mitigation strategies include strict adherence to infection control practices (use of hand sanitizers, facemask and maintaining social distancing), reducing the amount of aerosol production in the dental setting, and managing the quality of air in the dental treatment rooms by reducing the use of air conditioners and improving air exchange. The COVID-19 pandemic has shown a major impact on dental practice. Dental professionals are trying to adapt to the new norms, while the medium to long-term impact of COVID-19 on dentistry needs further investigation.

A Pan-Canadian narrative review on the protocols for reopening dental services during the COVID-19 pandemic.

The current coronavirus disease 2019 (COVID-19) pandemic is impacting the way in which dental services are provided. The aim of this narrative review was twofold: to summarize key areas from the Canadian protocols available for the reopening and restructuring of dental services across the country and to critically review these protocols based on existing evidence. A narrative review of the existing Canadian protocols, written in English and French, was undertaken between April 15 and July 13, 2020. The protocols were obtained by searching through regulatory bodies and websites from professional organizations, and from personal contacts through academic institutions and policy leaders. The data extraction form focused only on protocols related to dentistry, and the information was compiled by a hired assistant. Content was categorized via group discussions with the research team on eight areas: office management and procedures, patient and staff screening, treatment procedures, office layout, risk reduction, personal protective equipment, supporting information, and length and readability. Thirteen protocols were identified and offered substantial variation in the level of details provided. All but two protocols specified proper donning/doffing of personal protective equipment, while all protocols recommended daily monitoring of COVID-19 related signs and symptoms in staff and patients. They varied in terms of recommended mask types, eye and face shield protection, and head coverings. While all protocols aimed at restructuring emergency dental services, their recommendations were often not based on the published evidence. This narrative review summarized key areas from 13 provincial and territorial protocols in Canada to help oral health care providers plan the reopening of their services. The information conveyed across all documents was clear, but variance highlights the need for a coordinated effort to develop an evidence-based document for dental practitioners.

Thirty-Month Outcomes of Biodentine ® Pulpotomies in Primary Molars: A Retrospective Review.

Purpose: The purpose of this study was to evaluate the clinical and radiographic effectiveness of Biodentine® as a pulpotomy medicament for use in primary molars. Methods: A retrospective chart review was conducted on children who had received full-mouth dental rehabilitation under general anesthesia between January 1, 2013, and May 1, 2018. Three clinical outcomes (pain, pathologic mobility, and soft tissue pathology) and two radiographic outcomes (pathologic radiolucency and pathologic root resorption) defined a composite outcome of pulp therapy failure. Results: The final study sample consisted of 208 children with a mean age of 4.9 years. The total number of primary molars that received a Biodentine® pulpotomy over the 30-month posttreatment period was 608. Survival analyses determined that the cumulative probability of clinical survival at 30 months was 93.7 percent (95 percent confidence interval [95% CI] equals 83.7 percent to 99.2 percent) and radiographic survival probability was 85.6 percent (95% CI equals 76.3 percent to 93.7 percent). The majority (n equals 14 out of 20; 70 percent) of failed Biodentine® pulpotomies occurred before 18 months. Conclusions: Primary molar pulpotomies utilizing Biodentine® as the pulpal medicament had favorable clinical and radiographic results after 30 months. Biodentine® can be considered an alternative to other commonly used primary tooth pulpotomy medicaments.

The Effect of an Audiovisual Preoperative Intervention in Reducing Parental Anxiety Prior to a Child's Sedation Appointment: A Pilot Study.

Purpose: The purpose of this pilot study was to determine whether an audiovisual intervention was more effective than verbal instructions at reducing preoperative anxiety levels for parents whose children were having their first experience of dental treatment with the use of oral sedation. Methods: A prospective clinical trial was conducted. Parents were systematically assigned to either view an animated video (intervention group) or receive standardized verbal instructions (control group). Questionnaires modified from the Amsterdam Preoperative Anxiety and Information Scale were distributed to parents at the assessment appointment before the preoperative information was given (T0) and again at the subsequent sedation appointment (T1). The change in parental anxiety levels between T0 and T1 was measured (Δ equals T0-T1). Results: A total of 40 subjects comprised of 20 individuals each in the control and intervention group were included in the final analytical data set. There were no significant differences in the effectiveness of reducing preoperative parental anxiety between the audiovisual intervention and the verbal instructions. Conclusions: The audiovisual intervention was effective at reducing preoperative parental anxiety, but the reduction was not significantly different from using verbal instructions. Dentists may wish to incorporate audiovisual aids to supplement verbal instructions during the sedation preoperative consultation.

The dental therapist movement in the United States: A critique of current trends.

Dental therapists are members of the oral health workforce in over 50 countries in the world typically caring for children in publically funded school-based programs. A movement has developed in the United States to introduce dental therapists to the oral health workforce in an attempt to improve access to care and to reduce disparities in oral health. This article critiques trends in the United States movement in the context of the history and success of dental therapists practicing internationally. While supporting the dental therapist movement, we challenge: a) the use of dental therapists treating adults, versus focusing on children; b) the use of dental therapists in the private versus the public/not-for-profit sector; and c) requirements that a dental therapist must also be credentialed as a dental hygienist.

Utilization of community health workers in Canada's Children's Oral Health Initiative for indigenous communities.

OBJECTIVE: The Children's Oral Health Initiative (COHI) is a federally funded community-based preventive dental programme implemented in geographically remote Canadian Indigenous communities. The study investigated the effect of the availability of local community health workers (COHI Aides) on access to the programme's preventive dental services for children. METHODS: Twenty-five communities were continuously enrolled in the COHI during the 7-year study period. Communities were categorized as having uninterrupted (all 7 years), intermittent (≥4 years) or sporadic (<4 years) service from a community health worker. Four outcome variables measured longitudinal changes in access to preventive dental services: (i) the number of enrolments; (ii) the number of enrolled children with multiple fluoride varnishes delivered; (iii) the number of enrolled children with sealants placed; and (iv) the number of enrolled children receiving ART. RESULTS: The general longitudinal trend for programme enrolment and each of the preventive dental service delivery outcomes was similar. Children in communities with uninterrupted service tended to have the highest rates of enrolment and service delivery, which remained constant over time. Children in communities with sporadic service tended to have persistently low rates of enrolment and service delivery over the study period. CONCLUSIONS: Community health workers were beneficial in promoting programme enrolment, as well as facilitating and augmenting the delivery of preventive dental services.

The perceptions of first nation participants in a community oral health initiative.

The Children's Oral Health Initiative (COHI) is a federally funded community-based preventive dental program for children and their caregivers living in geographically isolated Canadian Aboriginal communities. The goal of the program is to improve access to preventive dental services for children of 0-7 years of age. It utilises community health workers in collaboration with dental therapists to promote and deliver the program. Almost half of the province of Manitoba's (n=27) First Nations communities have implemented COHI since 2005. The objective of this investigation was to explore the opinions of COHI from the perspective of community members whose children had participated in the program. Purposeful selection identified caregivers of enrolled children for a semi-structured interview. The targeted caregivers had children who met at least one of the following criteria: (1) 0-2 years old; (2) 5-7 years old; (3) had two or more children either currently or formerly enrolled in COHI. Six open-ended questions guided the interview process. Content analysis was used to code transcripts and identify themes. One hundred and forty-one interviews were completed in 13 communities. Participants defined good oral health as the absence of dental cavities, which reflects a Western biomedical model of disease. The local, community-based nature of COHI was viewed as essential to its success in increasing access to preventive dental services and improving children and caregivers' oral health knowledge and behaviours. In conclusion, a local, community-based oral health prevention programme is perceived as having a beneficial effect on children and caregivers' oral health knowledge and behaviours. However, oral health preventive messages need to be further integrated into traditional Aboriginal holistic models of wellness.

The virtual dental home: a critique.

The Virtual Dental Home is a concept of the Pacific Center for Special Care of the Arthur A. Dugoni School of Dentistry in San Francisco. It is designed to improve access to dental care for underserved populations, specifically children and institutionalized adults. This article describes the development and implementation of the Virtual Dental Home, subsequently critiquing the concept. The criteria for a dental home are not met by the program. It is the equivalent of a traditional public oral health prevention and screening program, with the additional dimension of allowing dental hygienists and assistants to place interim glass ionomer restorations in dental cavities. The critique questions the need to insert a "cloud" dentist into the process. The routine utilization of radiographs is also challenged. The VDH not only lacks the attributes of a dental home, it has not been shown to be as efficient and effective as traditional programs staffed by dental hygienists and dental therapists. The article concludes by describing how programs utilizing dental therapists could address the deficiencies of the Virtual Dental Home, effectively improving access to oral health care for underserved populations.

Saskatchewan's school-based dental program staffed by dental therapists: a retrospective case study.

OBJECTIVES: The poor oral health of Saskatchewan's children, in concert with a significant shortage of dentists, prompted the province in the early 1970s to seek an alternative method of addressing the oral health care needs of children. The result was the Saskatchewan Health Dental Plan (SHDP), which trained and employed dental therapists in school-based clinics to provide basic dental care to all children. The program was initiated over the opposition of Saskatchewan's dentists. The purpose of this research was to provide information and data previously not documented in the refereed dental literature regarding the only school-based program staffed by dental therapists to ever exist in North America. METHODS: This case study reviews the program's planning, opposition, implementation, and achievements based on a comprehensive review of published articles as well as a search of the grey literature. Additionally, Saskatchewan Health provided annual reports for each year of the program's existence. RESULTS: During its thirteen years of existence, the school-based program proved popular with parents and achieved significant success in providing necessary dental care for children. It was terminated in 1987 by the newly elected provincial Conservative government, which was not supportive of such social programs. CONCLUSIONS: The SHDP serves as a successful model of school-based dental care for children. However, the termination of the plan demonstrates the vulnerability of publicly funded dental health programs to conflicting political ideologies and special interest groups.

There is high patient acceptance of care provided by dental auxiliaries and students.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: The acceptability of care provided by dental auxiliaries: A systematic review. Dyer TA, Robinson PG. J Am Dent Assoc 2016; 147(4): 244-54. SOURCE OF FUNDING: Information not available TYPE OF STUDY/DESIGN: Systematic review.

The Children's Oral Health Initiative: An intervention to address the challenges of dental caries in early childhood in Canada's First Nation and Inuit communities.

OBJECTIVE: The objective of the Children's Oral Health Initiative (COHI) is to increase access to preventive oral health services provided to First Nations and Inuit (FN/I) children living on federal reserves and in remote communities. PARTICIPANTS: COHI targets preschool children; 5-7-year-olds; pregnant women; and parents/caregivers in FN/I communities. SETTING: The program was piloted in 2004 by Health Canada and is potentially available to all FN/I communities. However, the community must consent to the program's implementation and agree to support a community member to be trained as a COHI aide. INTERVENTION: Dental therapists and hygienists screen eligible children, apply fluoride varnish and sealants to children's teeth, and stabilize active dental caries with glass ionomer. An innovation was the development of a community oral health worker, the COHI Aide. The COHI Aide is a community member who serves as an advocate for preventive oral health in the community and provides instruction to children, parent/caregivers and expectant mothers in preventing dental caries. RESULTS: COHI was piloted in 41 communities in 2004. By 2014, the program had expanded to 320 FN/I communities, which represents 55% of all eligible FN/I communities. In 2012, 23,085 children had received COHI preventive oral health services. CONCLUSION: The results demonstrate COHI's success as a preventive oral health care delivery model in remote communities. Implementation and delivery of preventive oral health services has been enhanced by the sustained presence of a community-based COHI Aide.

Visualizing the Comorbidity Burden in Children with Autism Spectrum Disorder Receiving Dental Treatment Under General Anesthesia.

PURPOSE: The purposes of this study were to: (1) describe the comorbidity burden in children with autism spectrum disorder (ASD) receiving dental treatment under general anesthesia (GA); and (2) characterize the complexity of these concurrent comorbidities. METHODS: A retrospective chart review was completed of 303 children with ASD who received dental treatment under GA. All comorbidities, in addition to the primary diagnosis of ASD, were categorized using the International Classification of Diseases-10 codes. The interconnectedness of the comorbidities was graphically displayed using a network plot. Network indices (degree centrality, betweenness centrality, closeness centrality) were used to characterize the comorbidities that exhibited the highest connectedness to ASD. RESULTS: The network plot of medical diagnoses for children with ASD was highly complex, with multiple connected comorbidities. Developmental delay, speech delay, intellectual disability, and seizure disorders exhibited the highest connectedness to ASD. CONCLUSIONS: Children with autism spectrum disorder may have a significant comorbidity burden of closely related neurodevelopmental disorders. The medical history review should assess the severity of these concurrent disorders to evaluate a patient's potential ability to cooperate for dental treatment and to determine appropriate behavior guidance techniques to facilitate the delivery of dental care.

Self-Perceived Oral Health and Use of Dental Services by Pregnant Women in Surrey, British Columbia.

OBJECTIVE: The aim of this study was to determine the self-reported oral health status and needs and the patterns of use of dental services by a sample of pregnant women from diverse ethnic backgrounds in the city of Surrey, British Columbia, Canada. METHOD: A 34-item cross-sectional survey was administered to women enrolling in a prenatal program for 4 months in 2012/13. For data analysis, we used a 2-sample t test and tested categorical variables using a χ2 test. We used multivariable logistic regression analysis to estimate the odds ratio for the variables, self-reported oral health status and use of dental services. RESULTS: Of the 740 pregnant women who participated in this survey (87% of registrants), 30% were considered vulnerable because of inability to live within their household income, smoking status, self-reported depression, lack of dental insurance and time since last dental visit. Most respondents (84%) rated their oral health good or excellent. Almost half of the women had not visited a dental professional during the past year, while 23% saw a dental professional only for emergency purposes. Women with dental insurance were 6.6 times more likely to have visited a dental professional than those without insurance. CONCLUSION: Although most pregnant women considered dental care during pregnancy to be important, almost half had not visited a dental professional during the pregnancy.

Loss of Permanent First Molars in the Mixed Dentition: Circumstances Resulting in Extraction and Requiring Orthodontic Management.

Extraction of significantly compromised permanent first molars may be indicated during the mixed dentition stage of occlusal development. The purpose of this article was to review circumstances that can result in the loss of a permanent first molar-including dental caries, molar incisor hypomineralization, eruption disturbances of permanent teeth, and failure of restorative treatment to affirm that a complete dental arch is not necessary for the existence of a functional dental arch. The extraction of permanent first molar(s) with subsequent orthodontic treatment in a young patient can be considered a cost-effective alternative to placing complex restorations that require replacement over the lifespan. Approaches to establish a functional dental arch in the event of the loss of a permanent first molar(s) are outlined. Additionally, orthodontic diagnostic and treatment principles are reviewed. Case histories are provided to illustrate the clinical management of permanent first molar extractions to achieve a functional dental arch.

Identifying demographic variables related to failed dental appointments in a university hospital-based residency program.

PURPOSE: The objective of this study was to identify characteristics of pediatric patients who failed to keep the majority of their scheduled dental appointments in a pediatric dental clinic staffed by pediatric dental residents and faculty members. METHODS: The electronic records of all patients appointed over a continuous 54 month period were analyzed. Appointment history and demographic variables were collected. The rate of failed appointments was calculated by dividing the number of failed appointments with the total number of appointments scheduled for the patient. RESULTS: There were 7,591 patients in the analyzable dataset scheduled with a total of 48,932 appointments. Factors associated with an increased rate of failed appointments included self-paying for dental care, having a resident versus a faculty member as the provider, rural residence, and adolescent aged patients. Multivariable regression models indicated self-paying patients had higher odds and rates of failed appointments than patients with Medicaid and private insurance. CONCLUSIONS: Access to care for children may be improved by increasing the availability of private and public insurance. The establishment of a dental home and its relationship to a child receiving continuous care in an institutional setting depends upon establishing a relationship with a specific dentist.

Dental therapists: improving access to oral health care for underserved children.

Disparities in dental health care that characterize poor populations are well known. Children suffer disproportionately and most severely from dental diseases. Many countries have school-based dental therapist programs to meet children's primary oral health care needs. Although dental therapists in the United States face opposition from national and state dental associations, many state governments are considering funding the training and deployment of dental therapists to care for underserved populations. Dental therapists care for American Indians/Alaska Natives in Alaska, and Minnesota became the first state to legislate dental therapist training. Children should receive priority preference; therefore, the most effective and economical utilization of dental therapists will be as salaried employees in school-based programs, beginning in underserved rural areas and inner cities.