Providing dental insurance can positively impact oral health outcomes in Ontario.

BACKGROUND: Universal coverage for dental care is a topical policy debate across Canada, but the impact of dental insurance on improving oral health-related outcomes remains empirically unexplored in this population. METHODS: We used data on individuals 12 years of age and older from the Canadian Community Health Survey 2013-2014 to estimate the marginal effects (ME) of having dental insurance in Ontario, Canada's most populated province (n = 42,553 representing 11,682,112 Ontarians). ME were derived from multi-variable logistic regression models for dental visiting behaviour and oral health status outcomes. We also investigated the ME of insurance across income, education and age subgroups. RESULTS: Having dental insurance increased the proportion of participants who visited the dentist in the past year (56.6 to 79.4%, ME: 22.8, 95% confidence interval (CI): 20.9-24.7) and who reported very good or excellent oral health (48.3 to 57.9%, ME: 9.6, 95%CI: 7.6-11.5). Compared to the highest income group, having dental insurance had a greater ME for the lowest income groups for dental visiting behaviour: dental visit in the past 12 months (ME highest: 17.9; 95% CI: 15.9-19.8 vs. ME lowest: 27.2; 95% CI: 25.0-29.3) and visiting a dentist only for emergencies (ME highest: -11.5; 95% CI: - 13.2 to - 9.9 vs. ME lowest: -27.2; 95% CI: - 29.5 to - 24.8). CONCLUSIONS: Findings suggest that dental insurance is associated with improved dental visiting behaviours and oral health status outcomes. Policymakers could consider universal dental coverage as a means to support financially vulnerable populations and to reduce oral health disparities between the rich and the poor.

Dentists' Capacity to Mitigate the Burden of Oral Cancers in Ontario, Canada.

BACKGROUND: In Canada, although the incidence of smoking-related oral cavity cancers has decreased, oropharyngeal cancers associated with human papilloma virus (HPV) are on the rise. During their routine interactions with patients, dentists have the opportunity to intervene. This study was conducted to assess dentists' capacity to prevent and detect oral cancers and to identify the barriers and facilitators that affect this capacity. METHODS: A 25-item, self-administered questionnaire was emailed to Ontario dentists through their regulatory body. It aimed to assess their perceptions about various aspects of oral cancer prevention and detection, including their knowledge, attitudes and practices. A binary logistic regression model was constructed for each modifiable risk factor (smoking, alcohol use, HPV) to identify the predictors of dentists' readiness to discuss with patients the connection between risk factors and oral cancers. RESULTS: Of the 9975 dentists contacted, 932 completed the survey. Most respondents (92.4%) believed that they are adequately trained to recognize the early signs and symptoms of oral cancer. However, only 35.4% of respondents said that they are adequately trained to obtain biopsy samples from suspected lesions. In addition, only a small proportion (< 40%) of the dentists believed that they are adequately trained to address relevant risk factors. Compared with dentists who said that they are adequately trained and currently assess a given risk factor, the odds of discussing the risk factor were consistently and significantly lower among those who said that they are inadequately trained (OR: smoking 0.11, alcohol 0.52, HPV 0.36) and among those who do not currently assess that risk factor (OR: smoking 0.12, alcohol 0.22, HPV 0.23). CONCLUSIONS: This study suggests that the capacity of Ontario dentists to detect and prevent oral cancers is limited by lack of training in using oral cancer screening tools and addressing risk factors. To mitigate this barrier, dentists' capacity could be enhanced by improving their training in detecting oral cancers and their readiness to assess and address the risk factors.

Suboptimal oral health and the risk of cardiovascular disease in the presence of competing death: a data linkage analysis.

OBJECTIVE: The objective of this study is to simultaneously assess the associations between suboptimal oral health (SOH) and cardiovascular disease (CVD) and competing death (CD). METHODS: Ontario residents aged 40 years and over who participated in the Canadian Community Health Survey 2003 and 2007-2008 were followed until December 31, 2016 for the incidence of CVD or CD. SOH was assessed based on self-rated oral health and inability to chew. Multivariable competing risk analysis was adjusted for socioeconomic characteristics, behavioural factors and intermediate health outcomes. RESULTS: The study sample included 36,176 participants. Over a median follow-up of 9.61 years, there were 2077 CVD events and 3180 CD events. The fully adjusted models indicate 35% (HR = 1.35, 95% CI: 1.12-1.64) increase in the risk of CVD and 57% (HR = 1.57, 95% CI: 1.33-1.85) increase in the risk of CD among those who reported poor oral health as compared to those who reported excellent oral health. The fully adjusted models also indicate 11% (HR = 1.11, 95% CI: 0.97-1.27) increase in the hazard of CVD and 37% (HR = 1.37, 95% CI: 1.24-1.52) increase in the hazard of CD among those who reported inability to chew. CONCLUSION: This study provides important information to contextualize CVD risk among those with SOH. The competing risk analysis indicates that those with SOH may benefit from additional interventions to prevent CVD and CD. Accordingly, managing the risk of CVD among those with SOH should fall under a more comprehensive approach that aims at improving their overall health and well-being.

RéSUMé: OBJECTIF: L'objectif de la présente étude est d'évaluer simultanément les liens entre la santé bucco-dentaire sous-optimale et les maladies cardiovasculaires (MCV) et le décès concurrent (DC). MéTHODES: Les résidents de l'Ontario de 40 ans et plus ayant participé à l'Enquête sur la santé dans les collectivités canadiennes 2003 et 2007-2008 ont fait l'objet d'un suivi évaluant les risques de MCV ou de DC. La santé bucco-dentaire sous-optimale a fait l'objet d'une évaluation axée sur l'autoévaluation de l'état de santé bucco-dentaire et l'incapacité à mastiquer. L'analyse multivariable des risques concurrents a été adaptée aux caractéristiques socioéconomiques, aux facteurs comportementaux et aux résultats intermédiaires en matière de santé. RéSULTATS: L'échantillon à l'étude comprenait 36 176 participants. Après un suivi médian de 9,61 ans, 2 077 incidents de MCV et 3 180 DC ont été recensés. La modélisation complète indique une hausse des risques de MCV de 35 % (indice de risque (IR) = 1,35, intervalle de confiance (IC) à 95 % : 1,12-1,64) et une hausse des risques de DC de 57 % (IR = 1,57, IC à 95 % : 1,33-1,85) parmi les participants ayant signalé une piètre santé bucco-dentaire comparativement aux personnes ayant déclaré une excellente santé bucco-dentaire. La modélisation complète indique également une hausse des risques de MCV de 11 % (IR = 1,11, IC à 95 % : 0,97-1,27) et une hausse des risques de DC de 37 % (IR = 1,37, IC à 95 % : 1,24-1,52) parmi les participants ayant déclaré une incapacité à mastiquer. CONCLUSION: La présente étude fournit d'importants renseignements nous permettant de contextualiser les risques de MCV chez les personnes ayant une piètre santé bucco-dentaire. L'analyse des risques concurrents indique que les personnes ayant une santé bucco-dentaire sous-optimale pourraient bénéficier d'interventions supplémentaires afin de prévenir les MCV et les DC. Par conséquent, la gestion des risques de MCV chez les personnes ayant une santé bucco-dentaire sous-optimale devrait relever d'une approche plus globale visant à améliorer la santé et le bien-être en général.

Reporting of absolute and relative risk measures in oral health and cardiovascular events studies: A systematic review.

OBJECTIVES: To understand the magnitude of risk of health events, such as cardiovascular diseases (CVD), related to poor oral health, both relative and absolute risk measures should be reported. Our aim was to investigate the extent to which absolute and relative measures of risk are reported in longitudinal studies that assess the association between oral health indicators (OHIs) and CVD. METHODS: A systematic search of longitudinal studies investigating the association of any OHI with CVD was carried out using the Embase, Medline and Cochrane library databases. The search covered each database from its inception date to August 2021. Data about reporting relative and absolute risks of the relationship between CVD and OHI from the abstract were extracted. If the relative risk for OHIs and CVD was reported in the abstract, then the underlying absolute risks were searched from the full text, and it was assessed whether it was similarly adjusted for confounding than was the relative risk in the abstract. RESULTS: One hundred-six articles were included. From these, 85 (80%) studies reported the association of OHIs and CVD with one or more relative risks in the abstract. Of those 85 studies, the underlying absolute risks were accessible or calculable from the abstract or full text of 60 studies. However, of these 60 studies, in only 10 (12%), the underlying absolute risks were similarly adjusted, as were the relative risks in the abstract. The absolute risks of CVD by OHIs were rarely reported without corresponding relative risks in the abstract (n = 2, 2%). Median absolute risk difference in the CVD risk between exposure levels to which the first relative risk in the abstract referred was 1.8% (interquartile range 0.6-4.6, n = 63). CONCLUSIONS: Focusing on relative risks over absolute risks was a common practice in literature. Reporting similarly adjusted underlying absolute risks of relative risks was rare in most studies, despite those being helpful for comprehending the magnitude of CVD-risk increase related to poor oral health. Current reporting practices could lead to an overinterpretation of risk increase of CVD related to poor oral health.

Determinants of dentists' readiness to assess HPV risk and recommend immunization: A transtheoretical model of change-based cross-sectional study of Ontario dentists.

OBJECTIVES: To evaluate dentists' readiness to assess the history of human papilloma virus (HPV) infections and recommend immunization among their patients. MATERIALS AND METHODS: A link to a self-administered questionnaire was emailed to Ontario dentists. Dentists' readiness and its determinants were assessed based on Transtheoretical Model's 'stages' and 'processes' of change, respectively. Based on their current practices, dentists were either assigned to 'pre-action' or 'action+' stages. RESULTS: Of the 9,975 dentists contacted, 932 completed the survey; 51.9% participants were in action stage to assess the history of HPV infections and 20.5% to recommend immunization. Internationally-trained and those whose office's physical layout was not a concern to discuss patients' sexual history were more likely to assess the history. Dentists with higher knowledge about HPV vaccines, not concerned about the HPV vaccine safety, comfortable discussing sex-related topics with patients, or willing to exceed their scope of practice were more ready to recommend HPV immunization to their patients. CONCLUSION: Improving Ontario dentists' knowledge and communication skills and changing their self-perceived role regarding HPV infections and vaccination can increase their capacity to minimize the burden of HPV infections.

Ontario dentists' ease to discuss sensitive health issues with their patients: A cross-sectional study.

OBJECTIVES: With consistent calls for a more integrated approach to improve the healthcare system's effectiveness, the scope of practice for dentists has expanded; dentists are now seen to positively intervene to address several sensitive health issues among their patients. However, it is not clear how comfortable dentists feel in doing so. This study endeavored to assess self-perceived ease of dentists to discuss various sensitive health issues and if their socio-demographics influence their ease. METHODS: A self-administered online survey was sent to Ontario dentists (n = 9975) to assess their self-perceived ease in discussing five sensitive health issues with their patients: eating disorders, substance abuse, sexually transmitted infections (STIs), sexual behaviors, and physical abuse. Ordinal logistic regressions were performed along with descriptive analyses. RESULTS: The response rate was 9.3%. Over 50% of participants indicated difficulty discussing STIs, sexual behaviors and physical abuse. Younger dentists, female practitioners, dentists practicing in private settings, and those practicing in rural areas perceived more difficulty to discuss all five health issues. Place of training was also a significant predictor: internationally trained dentists perceived it easier to discuss eating disorders, substance abuse, and physical abuse while Canadian trained were more at ease to discuss STIs and sexual behaviors. CONCLUSION: This exploratory study identified that a large proportion of dentists are not comfortable discussing sensitive health issue with their patients. There are numerous opportunities for intervention in Canadian dental curriculums, continuing education programs, and communication practices to support dentists' discussions with patients about these important health concerns.

Changes in income-related inequalities in oral health status in Ontario, Canada.

OBJECTIVES: Oral health inequalities impose a substantial burden on society and the healthcare system across Canadian provinces. Monitoring these inequalities is crucial for informing public health policy and action towards reducing inequalities; however, trends within Canada have not been explored. The objectives of this study are as follows: (a) to assess trends in income-related inequalities in oral health in Ontario, Canada's most populous province, from 2003 to 2014, and (b) to determine whether the magnitude of such inequalities differ by age and sex. METHODS: Data representative of the Ontario population aged 12 years and older were sourced from the Canadian Community Health Survey (CCHS) cycles 2003 (n = 36,182), 2007/08 (n = 36,430) and 2013/14 (n = 41,258). Income-related inequalities in poor self-reported oral health (SROH) were measured using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) and compared across surveys. All analyses were sample-weighted and performed with STATA 15. RESULTS: The prevalence of poor SROH was stable across the CCHS cycles, ranging from 14.1% (2003 cycle) to 14.8% (2013/14 cycle). SII estimates did not change (18.7-19.0), while variation in RII estimates was observed over time (2003 = 3.85; 2007/08 = 4.47; 2013/14 = 4.02); differences were not statistically significant. SII and RII were lowest among 12- to 19-year-olds and gradually higher among 20- to 64-year-olds. RII was slightly higher among females in all survey years. CONCLUSION: Absolute and relative income-related inequalities in SROH have persisted in Ontario over time and are more severe among middle-aged adults. Therefore, oral health inequalities in Ontario require attention from key stakeholders, including governments, regulators and health professionals.