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.

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.

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.

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.

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.

Confronting dental uncertainty in old age.

OBJECTIVE: To provide an overview of the literature about uncertainty in health care and how it relates to the oral health care of older people. BACKGROUND: The medical literature describes uncertainty in health care from the initial informed-consent to its impact on a patient's ability to cope with undesirable outcomes. METHODS: A narrative review of the medical, dental and psychological literature was conducted to identify pertinent information on the theory and implications of uncertainty in healthcare. The findings are infused into a case-report illustrating the recurrence of uncertainty experienced by an older woman who had multiple treatments over several years to restore her dentition damaged severely by dental caries. RESULTS: Uncertainty originates from inadequate understanding, incomplete information and undifferentiated alternatives leading to unnecessary diagnostic tests and healthcare costs. A conceptual taxonomy clarifies the characteristics of uncertainty in the context of scientific, practical or personal sources and offers management possibilities through effective communications to identify choices and probabilities that help patients to adapt and cope with adverse events. CONCLUSIONS: Uncertainty pervades healthcare. It can lead patients to self-blame, anger and withdrawal from care unless it is communicated effectively so that they can adapt and cope with the disappointment of adversity and continue with alternative approaches to care.

Oral health care for children in countries using dental therapists in public, school-based programs, contrasted with that of the United States, using dentists in a private practice model.

The United States faces a significant problem with access to oral health care, particularly for children. More than 50 countries have developed an alternative dental provider, a dental therapist, practicing in public, school-based programs, to address children's access to care. This delivery model has been demonstrated to improve access to care and oral health outcomes while providing quality care economically. We summarize elements of a recent major review of the global literature on the use of dental therapists, "A Review of the Global Literature on Dental Therapists: In the Context of the Movement to Add Dental Therapists to the Oral Health Workforce in the United States." We contrast the success of a school-based model of caring for children by dental therapists with that of the US model of dentists providing care for children in private practices.

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.

Chronicling the dental therapist movement in the United States.

There have been three attempts to introduce dental therapists (DTs) to the US dental workforce. This account will review early failed attempts to develop DTs, the recent successful Alaska initiative, the Minnesota legislature's authorization of DTs, state dental associations' deliberations on therapists in the workforce, and the efforts of national advocacy groups, foundations, and state legislatures to promote workforce innovation. It concludes with a discussion of the opposition to therapists from elements of organized dentistry.

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.

Perspectives of board certified pediatric dentists on adding a pediatric oral health therapist to the dental team.

PURPOSE: The purpose of this study was to determine the perspectives of board certified pediatric dentists regarding adding a pediatric oral health therapist/dental therapist to the dental team. METHODS: A 27-item online survey was e-mailed to all diplomates of the American Board of Pediatric Dentistry Questions assessed knowledge and opinions regarding the concept of a pediatric oral health therapist, as well as perspectives on the parameters under which such a person could practice. Survey results were tabulated and frequency distributions calculated. RESULTS: Seventy-five percent of respondents had limited or no knowledge regarding the concept of a pediatric oral health therapist; 79% had limited or no knowledge regarding the use of dental therapists in Alaska. Seventy-one percent disagreed with adding a therapist to the dental team. Pediatric dentists practicing in the public sector were more knowledgeable and supportive. Sixty-six percent indicated they treated children with Medicaid/CHIP insurance. Of those, most disagreed that therapists would enable them to care far more children. CONCLUSIONS: Pediatric dentists are generally not knowledgeable regarding the role of therapists internationally Nevertheless, the majority oppose adding such an individual to the dental team in the United States.

Socio-ecological factors associated with returning for post-operative care after dental treatment under general anesthesia.

PURPOSE: The aim of this study was to determine if specific variables in a theorized socio-ecological model are associated with returning for post-operative care after dental treatment under general anesthesia. METHODS: A 26 item cross-sectional survey assessing socio-ecological variables of 100 families of patients receiving dental treatment under general anesthesia was conducted. Chi-square tests and logistic regressions were used to investigate associations between returning for post-operative care with child, family, clinic and environmental variables described in the proposed socio-ecological model. RESULTS: Forty-seven percent of patients returned for post-operative care. Children without a dental home had lower odds of returning than children referred from a continuous source of care. Children with an ASA II/III classification had lower odds of returning for post-operative care than children who were ASA I. CONCLUSIONS: One child level and one environmental level variable in the theorized socio-ecological model had an impact on whether patients returned for post-operative care after dental treatment under general anesthesia. Further investigation of socio-ecological variables influencing dental health behaviors is needed.

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.

Multidisciplinary trauma management: a case report.

This case report documents the dental management of two permanent maxillary central incisors with a severe intrusive labial luxation injury in conjunction with one complicated and one uncomplicated crown fracture. Additionally, there was a fracture of the labial cortical plate which remained attached to the overlying soft tissue. The two affected teeth and fractured labial plate of bone were surgically repositioned and splinted. Endodontic therapy was completed on the two incisors and the two crown fragments, which had been maintained wet, were re-attached. The report describes a multidisciplinary approach to trauma management and case progress over a 20-month period.

A practice profile of board certified pediatric dentists based upon characteristics of the dental home.

PURPOSE: This study's purposes were to: (1) develop a practice profile of board certified pediatric dentists based upon the characteristics of the dental home; and (2) suggest a construct for an index that could assist in the determination of the existence of a dental home. METHODS: A survey was conducted of American Board of Pediatric Dentistry diplomates. Questions were asked that profiled practices based on the 7 characteristics of a dental home: (1) accessibility; (2) family centered; (3) continuous; (4) comprehensive; (5) coordinated; (6) compassionate; (7) culturally competent. RESULTS: Seventy-five percent of respondents were knowledgeable about the dental home and reported that they regularly apply the concept in practice; 95 percent believed that it is important for a practice to function as a dental home. A dental home assessment tool was thought to be potentially useful by 72 percent of respondents. While 73 percent said a dental home cannot exist independently of a specific dental office, academic/public health respondents were more likely to respond that it could. CONCLUSIONS: Participants' variability in responses suggests that functional criteria associated with the 7 characteristics of a dental home would be helpful in determining the success of providing a dental home. A potential construct for a dental home index was suggested.

Effect of a financial incentive on returning for post-operative care following general anesthesia.

UNLABELLED: The aim of this study was to examine whether the use of a ten dollar financial incentive improved parental compliance in returning for their child's post-operative care appointment following dental treatment under general anesthesia at the University of Kentucky Pediatric Dentistry residency program. STUDY DESIGN: Parents/guardians of 69 children scheduled for dental treatment carried out under general anesthesia at the University of Kentucky Pediatric Dentistry residency program from Oct 2007 to March 2008 were offered a $10 incentive if they returned for their one week post-operative care appointment. All subjects who returned received a $10 incentive by mail. A control consisting of 100 patients treated at the University of Kentucky Pediatric Dentistry residency program from October 2006 to April 2007 was used to determine historical return rates for post-operative care after dental treatment under general anesthesia. RESULTS: Sixty-six percent (66%) of the control group returned for their post-operative care appointment. Sixty-five percent (65%) of the incentive group returned for their post-operative care appointment. CONCLUSION: Offering a $10 incentive did not increase the return rate for post-operative care following dental treatment under general anesthesia in a small study population.

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.

Opinions of Early Head Start staff about the provision of preventive dental services by primary medical care providers.

OBJECTIVE: This study investigates the opinions of the Early Head Start (EHS) staff about physicians and nurses providing preventive dental services for children in EHS. METHODS: A cross-sectional survey was undertaken of the EHS staff having contact with families in EHS programs in North Carolina (NC). A self-completed questionnaire solicited their opinions (agree, disagree, don't know) about whether physicians and nurses can "provide preventive dental care" and "identify dental problems" in infants and toddlers. Staff knowledge (four items) and attitudes (five items) were tested for their association with whether staff had an opinion (agree/disagree versus don't know) and if so, what that opinion was (agree versus disagree) using the generalized estimating equation method. RESULTS: Questionnaires were completed by 476 staff (98 percent response) in 18 programs (100 percent response). The majority of staff believed that physicians and nurses can provide preventive dental services (66 percent) and identify dental problems (52 percent). Staff placing importance on ensuring access to dental care and who were knowledgeable about fluoride uses were more likely to have an opinion. Among staff with an opinion, those familiar with the NC program where these services are provided in medical offices were more likely to agree that physicians and nurses can provide preventive services and identify problems. CONCLUSIONS: Although the opinions of the majority of the EHS staff are not a barrier to using primary medical care providers to deliver preventive dental care, education is needed for staff who are unfamiliar with this approach.