A systematic review of caries risk in children <6 years of age.

BACKGROUND: For caries risk assessment (CRA) tools for young children to be evidence-based, it is important to systematically review the literature to identify factors associated with the onset of early childhood caries (ECC). AIM: This updated systematic review aimed to identify current evidence on caries risk in young children. DESIGN: A comprehensive and systematic literature search of relevant databases was conducted to update a previous systematic review and identify risk factors associated with ECC. Potential risk factors were identified based on strength of association using odds ratios, hazard ratios, relative risk, etc. GRADE was used for rating quality evidence through consensus. RESULTS: Twenty-two studies met inclusion criteria for the search from mid-2017 to 2021. Twenty-five publications from the prior systematic review, from 1997 to mid-2017, were also included. Several socioeconomic, behavioral, and clinical variables were identified as ECC risk factors. Factors included the following: age, socioeconomic status, frequency of and supervised toothbrushing, fluoride exposure, breast- and bottle-feeding, feeding habits, absence of a dental home, past caries experience, active non-cavitated lesions, visible plaque, enamel defects, and microbiome. CONCLUSION: This study provides updated evidence of risk factors for ECC that could be included in CRA tools.

Children's Oral Health Initiative: workers' perspectives on its impact in First Nations communities. / Initiative en santé buccodentaire des enfants : le point de vue des intervenants quant à ses effets dans les communautés des Premières Nations.

INTRODUCTION: Since 2004, the Children's Oral Health Initiative (COHI) has been working in many First Nations and Inuit communities in Canada to address oral health disparities, specifically early childhood caries (ECC). The COHI community-based approach improves early childhood oral health (ECOH) by balancing prevention with minimally invasive dentistry. The goal is to reduce the burden of oral disease, mainly by minimizing the need for surgery. We investigated program success in First Nations communities in the province of Manitoba, from the perspective of COHI staff. METHODS: First Nations community-based dental therapists and dental worker aides participated in three focus groups and an in-depth semistructured interview. The collected data were thematically analyzed. RESULTS: Data from 22 participants yielded converging and practitioner-specific themes. Participants reported that dental therapists and dental worker aides provide access to basic oral care in their communities including oral health assessments, teeth cleaning, fluoride varnish applications and sealants. The participants agreed that education, information sharing and culturally appropriate parental engagement are crucial for continuous support and capacity building in the community programs. Low enrolment, difficulty accessing homes and getting consent, limited human resources as well as lack of educational opportunities for dental worker aides were identified challenges. CONCLUSION: Overall, the participants reported that the COHI program positively contributes to ECOH in First Nations communities. However, increased community-based training for dental workers, community awareness about the program, and engagement of parents to facilitate culturally appropriate programming and consent processes are critical to improving program outcomes.

Quality of life in an adolescent orthodontic population.

OBJECTIVES: To investigate adolescent orthodontic patient experiences and quality of life with fixed appliances compared to Invisalign. MATERIALS AND METHODS: Adolescent patients in active treatment with Invisalign or fixed appliances for a minimum of 6 months were provided with the Child Oral Health Impact Profile-Short Form 19 questionnaire, along with additional items of interest that were assessed separately. Pearson's χ2 test was used to compare responses (P < .05), and unpaired t-tests (P < .05) were used to test for differences in mean satisfaction, quality of life, and domain scores. RESULTS: In total, 74 patients (37 in each treatment group) participated. Overall, no significant differences were noted in the mean quality of life, satisfaction, or domain scores between the two groups. A significant difference was noted in the time taken to adjust to appliances, with the Invisalign group demonstrating faster adaptation. Additionally, the fixed appliance group was 3.8 times more likely to report missing school because of their appliance (95% confidence interval [CI]: 1.2, 12.5) and 2.7 times more likely to report having difficulty eating certain foods (95% CI: 1.1, 7.1). When the sample of females between the ages of 14 and 18 was analyzed, the Invisalign group reported feeling attractive more often than the fixed appliance group. CONCLUSIONS: Both treatment groups were generally very satisfied with their treatment modality. The overall quality of life of adolescent orthodontic patients undergoing treatment with fixed appliances and Invisalign for a minimum of 6 months was similar.

First Nations and Metis peoples' access and equity challenges with early childhood oral health: a qualitative study.

BACKGROUND: Inequities in early childhood oral health are evident amongst Indigenous peoples and communities in Manitoba, Canada. Early childhood caries (ECC) is decay in primary dentition in children under 6 years of age. A severe form of the disease occurs at a higher rate in Indigenous populations compared to the general population. ECC has been strongly associated with social determinants of health. METHODS: Focus groups and sharing circles were conducted with four First Nations and Metis communities in urban and rural communities in Manitoba. There were eight groups in total of purposively sampled participants (n = 59). A grounded theory approach guided thematic analysis of audio recorded and transcribed data. RESULTS: Indigenous participants experienced challenges similar to those found in the general population, such as encouraging and motivating parents and caregivers to establish regular oral hygiene routines for their children. However other challenges reported, disproportionately affect Indigenous communities. These include poor access to dental care, specifically no dental offices within 1 h driving radius and not having transportation to get there. Not having evidence-based oral health information to support good oral hygiene practices, preventing parents from making the best choices of oral hygiene products and oral health behaviours for their children. Poverty and food insecurity resulting in poor nutritional choices and leading to ECC. For example, feeding children sugary foods and beverages because those are more readily avialble than healthy options. Confusing or difficult encounters with dental professionals, highlighted as a factor that can erode trust, reduce compliance and impact continued attendance at dental offices. CONCLUSION: Closing existing early childhood oral health gaps for First Nations and Metis peoples and communities requires equity-oriented healthcare approaches to address specific problems and challenges faced by these populations. Family, community and systemic level interventions that directly implement community recommendations are needed.

Early childhood oral health promotion for First Nations and Métis communities and caregivers in Manitoba. / Promotion de la santé buccodentaire des jeunes enfants auprès des collectivités et des fournisseurs de soins des Premières Nations et des Métis du Manitoba.

INTRODUCTION: Early childhood caries is a public health concern, and the considerable burden exhibited by Indigenous children highlights the oral health inequities across populations in Canada. Barriers include lack of access to oral health care and lack of culturally appropriate oral health promotion. The purpose of this study was to determine where and how First Nations and Métis parents, caregivers and community members learn about caring for young children's oral health, and what ideas and suggestions they have on how to disseminate information and promote early childhood oral health (ECOH) in Indigenous communities. METHODS: Sharing circles and focus groups engaged eight groups of purposively sampled participants (n = 59) in four communities in Manitoba. A grounded theory approach guided thematic analysis of audiorecorded and transcribed data. RESULTS: Participants said that they learned about oral health from parents, caregivers and friends, primary care providers, prenatal programs, schools and online. Some used traditional medicines. Participants recommended sharing culturally appropriate information through community and prenatal programs and workshops; schools and day care centres; posters, mailed pamphlets and phone communication (calls and text messages) to parents and caregivers, and via social media. Distributing enticing and interactive oral hygiene products that appeal to children was recommended as a way to encourage good oral hygiene. CONCLUSION: Evidence-based oral health information and resources tailored to First Nations and Métis communities could, if strategically provided, reach more families and shift the current trajectory for ECOH.

What is Being Taught to Canadian Undergraduate Dental Students About the Oral Health of Long-Term Care Residents?

INTRODUCTION: Residents of long-term care (LTC) facilities face many oral health challenges, which are often complicated by their underlying medical conditions, use of medications and limited access to oral health care. OBJECTIVE: To determine to what extent accredited university-based dental and dental hygiene programs in Canada prepare students in the areas of geriatric oral health and oral health of LTC residents. METHODS: Accredited dental and dental hygiene programs across Canada were assessed for the degree of education and training that is presented to students on the oral health of LTC residents. A survey questionnaire, emailed to programs, was used to gather descriptive statistics (frequencies, means and standard deviations), and bivariate analysis (χ2 and t tests) was completed. A p value ≤ 0.05 was considered significant. RESULTS: Representatives of all 4 dental hygiene and 9 out of 10 dental schools responded. All four dental hygiene and seven dental programs (77.8%, 7/9) stated that geriatric oral health is an integral part of their curriculum. The majority (91.6% [11/12], 4 dental hygiene and 7 of 9 dental schools) reported that their program educates students about medically, physically and cognitively compromised geriatric patients. Eight programs (3 dental hygiene and 5 dental schools), stated that they provide clinical training opportunities with LTC residents. However, some programs reported certain barriers preventing them from providing such clinical training opportunities. CONCLUSION: Oral health educational institutions must ensure that curricula are current and evidence-based to reflect the overall oral health needs of today's aging population.

The Effectiveness of Silver Diamine Fluoride and Fluoride Varnish in Arresting Caries in Young Children and Associated Oral Health-Related Quality of Life.

OBJECTIVE: To investigate the efficacy of silver diamine fluoride (SDF) with 5% fluoride varnish (FV) in treating cavitated caries in young children and to explore the association between SDF treatment and oral-health-related quality of life (OHRQoL). METHODS: Children with active dentinal caries in primary teeth underwent treatment with 38% SDF and 5% FV at baseline and 4 months later. Treated lesions were assessed 4 and 8 months after baseline. Child-level analysis focused on classifying SDF treatment as completely successful if all of a child's treated lesions were arrested or incompletely successful if at least 1 lesion was not arrested. The Early Childhood Oral Health Impact Scale questionnaire was completed at second and third visits. Statistical analyses included descriptive and bivariate methods. A p value ≤ 0.05 was considered significant. RESULTS: This pilot study enrolled 40 children with 239 caries lesions; mean age 40.2 ± 14.9 months and 45% male. Lesion arrest rates after 1 and 2 applications of SDF were 74.1% and 96.2%, respectively. Children who reportedly brushed twice daily were more likely to be in the completely successful group compared with those who brushed less (p = 0.006). Those in the completely successful group had a significantly lower mean baseline dmft score than those in the incompletely successful group (p = 0.048). No significant difference in OHRQoL was observed between the 2 groups. CONCLUSIONS: SDF with 5% FV is an effective approach to the management of early childhood caries; more than 1 application is recommended, along with regular follow up of patients and twice daily brushing. OHRQoL was not found to be affected by the level of success of SDF treatment.

Indigenous community members' views on silver diamine fluoride to manage early childhood caries.

OBJECTIVES: Early childhood caries (ECC) continues to be the leading reason for pediatric dental surgery in Canada and is particularly prevalent among Indigenous children. Silver diamine fluoride (SDF) offers an alternative method to manage non-restoratively caries. It is important to determine Indigenous communities' views on and receptivity toward SDF. AIM: To understand Indigenous community members' views on pediatric dental surgery to treat ECC under general anesthesia (GA) and receptivity to SDF as an alternative to restorative surgery. METHODS: Focus groups and sharing circles congruent with an Indigenous ways of gathering information were conducted. Three interviewers engaged eight groups of First Nation and Metis communities in three rural Indigenous communities and ne metropolitan urban setting in Manitoba, Canada. Overall, 59 individuals participated. Open coding was guided by grounded theory and further analysis using Nvivo 12 software™. RESULTS: Participants mean age was 35.6 years, 88 percent (52 individuals) had a least one child, and 32 percent (19 individuals) were employed. Eight themes emerged, including respondents' fear of dental surgery under GA, fear of pain after dental surgery, parents' need for more information before accepting SDF treatment, and concern about the black staining of treated lesions. CONCLUSIONS: Indigenous parents' acceptance of SDF as a treatment option is contingent on having more information and assurance that treatment under GA can be avoided. Understanding Indigenous parents' views may ensure better acceptance of SDF as a minimally invasive treatment option to manage ECC. A cautious and informative approach to SDF implementation in Indigenous communities is recommended.

Should dental school faculty be measured and compensated using academic productivity models? Two viewpoints.

Operationalizing faculty contributions in ways that align with organizational mission can be difficult, particularly when monetizing effort. Conventional compensation methods may result in faculty effort going undefined, resulting in more subjectivity in recognition and compensation. Inequities lead to faculty marginalization, fragmentation, decreased motivation, and attrition. Dental faculty retirements are expected to increase, as 81% of men and 19% of women faculty aged 60 years and older in 2015-2016. We present opposing perspectives on the use of educational value units (EVUs) in academic dentistry. The first viewpoint articulates that such models improve recruitment and retention by objectifying (a) faculty performance measurement, (b) academic productivity improvements, and (c) compensation determination. The counterpoint suggests EVUs are deterrents to faculty retention due to challenges with objectively quantifying performance measures, a potential inherent bias linked to gender, and the undervaluing of teaching quality or collaborative practices.

Dentists' Views on Providing Care for Residents of Long-Term Care Facilities.

INTRODUCTION: People living in long-term care (LTC) facilities face many oral health challenges, often complicated by their medical conditions, use of medications and limited access to oral health care. OBJECTIVE: To determine Manitoba dentists' perspectives on the oral health of LTC residents and to identify the types of barriers and factors that prevent and enable them to provide care to these residents. METHODS: Manitoba general dentists were surveyed about their history of providing care and their views on the provision of care to LTC residents. Descriptive statistics, bivariate analysis and logistic regression analysis were carried out. RESULTS: Surveys were emailed to 575 dentists, with a response rate of 52.5%. Most respondents were male (62.8%), graduates of the University of Manitoba (85.0%), working in private practice (89.8%) and located in Winnipeg (72.4%). Overall, only 26.2% currently treat LTC residents. A predominant number of respondents identified having a busy private practice (60.0%), lack of an invitation to provide dental care (53.0%) and lack of proper dental equipment (42.6%) as barriers preventing them from seeing LTC residents. Receiving an invitation to provide treatment, professional obligation and past or current family or patients residing in LTC were the most common reasons why dentists began treating LTC residents. CONCLUSION: Most responding dentists believe that daily mouth care for LTC residents is not a priority for staff, and only a minority of dentists currently provide care to this population.

The Oral Health of Preschool Children of Refugee and Immigrant Families in Manitoba.

INTRODUCTION: Children of newcomers to Canada have been identified as at moderately high risk for developing early childhood caries (ECC). The purpose of this study was to investigate the oral health of preschool children of refugee and immigrant families in Winnipeg. METHODS: Children < 72 months of age and their parent or primary caregiver were recruited through several newcomer settlement agencies, dental clinics and community programs. Parents and caregivers completed a short questionnaire with the assistance of a research team member. Children underwent a dental examination. Results of the questionnaire were combined with those of the clinical examination and subjected to statistical analysis. RESULTS: We recruited 211 children. Their mean age was 40.2 ± 15.4 months, and 54.0% were boys. Overall, 45.5% of the children had ECC and 31.8% had severe ECC (S-ECC). The mean decayed, missing and filled teeth (dmft) score was 2.2 ± 3.8 (range 0-19), while the mean decayed, missing, filled surfaces (dmfs) score was 4.8 ± 11.0 (range 0-63). Infant dental enucleation was observed in 6 children. Logistic regression analyses showed that increasing age, the presence of debris on teeth, parents believing their child has dental problems and the presence of enamel hypoplasia were significantly and independently associated with ECC and S-ECC (p ≤ 0.05). CONCLUSIONS: ECC is prevalent in children of newcomer families in Manitoba. These data will inform advocacy efforts to improve access to dental care and tailor early childhood oral health promotion and ECC prevention activities for refugees and recent immigrants.

Evaluating the impact of a community developed collaborative project for the prevention of early childhood caries: the Healthy Smile Happy Child project.

INTRODUCTION: To determine the effectiveness of the Healthy Smile Happy Child (HSHC) project, a community-developed initiative promoting early childhood oral health in Manitoba, Canada. Specific aims were to assess improvements in caregiver knowledge, attitudes, and behaviours relating to early childhood oral health, and the burden of early childhood caries (ECC) and severe ECC (S-ECC). METHODS: A serial cross-sectional study design was selected to contrast findings following the Healthy Smile Happy Child (HSHC) campaign in four communities with the previous baseline data. One community was a remote First Nation in northern Manitoba and another was a rural First Nation in southern Manitoba. The other two communities were urban centres, one of which was located in northern Manitoba. A community-development approach was adopted for the project to foster community solutions to address ECC. Goals of the HSHC program were to promote the project in each community, use existing community-based programs and services to deliver the oral health promotion and ECC prevention activities, and recruit and train natural leaders to assist in program development and to deliver the ECC prevention program. The HSHC coordinator worked with communities to develop a comprehensive list of potential strategies to address ECC. Numerous activities occurred in each community to engage members and increase their knowledge of early childhood oral health and ultimately lead them to adopt preventive oral health practices for their young children. Children under 71 months of age and their primary caregivers participated in this follow-up study. A -value ≤0.05 was statistically significant. RESULTS: 319 children (mean age 38.2±18.6 months) and their primary caregivers participated. Significant improvements in caregiver knowledge and attitudes were observed following the HSHC campaign, including that baby teeth are important (98.8%), that decay involving primary teeth can impact on health (94.3%), and the importance of a dental visit by the first birthday (82.4%). Significantly more respondents indicated that their child had visited the dentist (50.2%) and had started brushing their child's teeth (86.7%) when compared to baseline. Overall, 52.0% had ECC, 38.6% had S-ECC. The mean deft score was 3.85±4.97 (range 0-20). There was no significant change is ECC prevalence between the follow-up and baseline investigations. However, age-adjusted logistic regression for S-ECC in this follow-up study revealed a significant reduction in prevalence compared with the baseline study (=0.021). Similarly, age-adjusted Poisson regression revealed that there were significant reductions in both the decayed teeth and decayed, extracted and filled teeth scores between follow-up and baseline study periods (0.016 and .0001, respectively). CONCLUSIONS: Follow-up study results suggest that the HSHC initiative may have contributed to improvements in caregiver knowledge, attitudes, and behaviours towards early childhood oral health and subsequently modest yet statistically significant reductions in caries scores and the prevalence of S-ECC.

WHAT ARE CANADIAN DENTAL PROFESSIONAL STUDENTS TAUGHT ABOUT INFANT, TODDLER AND PRENATAL ORAL HEALTH.

INTRODUCTION: Establishing dental homes for children at an early age is an important step toward instilling good oral health practices and changing trajectories of oral health. The purpose of this study was to determine how accredited dental and dental hygiene programs in Canada prepare students in the areas of infant, toddler and prenatal oral health. METHODS: An electronic questionnaire was sent to associate deans (academic), program directors or curriculum directors of accredited dental (n = 10) and dental hygiene (n = 39) programs. Participants were asked about infant, toddler and prenatal oral health curricula taught at their institution. Descriptive statistics and bivariate analyses were used to assess the results. A p value = 0.05 was considered significant. RESULTS: Representatives of 10 dental (100%) and 25 dental hygiene (64.1%) programs responded. All dental and 56% of dental hygiene programs recommend a first visit by 12 months. Infant and toddler oral health was noted as a component of most schools' curriculum. Barriers to teaching about or providing clinical experiences in infant and toddler oral health include lack of time, patients, program resources and finances. Most dental (70%) and dental hygiene (82.6%) programs include prenatal oral health as a component of their curriculum, yet only 40% of responding dental and 70% of dental hygiene programs reported having designated time in their curriculum for it. Barriers preventing programs from teaching or providing clinical experiences regarding prenatal oral health include lack of time and patients. CONCLUSIONS: Many, but not all dental professional programs are teaching their students about the recommended age for a first dental visit. Better adherence to national guidelines will require programs to address current barriers impeding learning about this important topic and to provide creative opportunities for students regarding prenatal and infant and toddler oral health.

Improving oral care practice in long-term care.

At Deer Lodge Centre, oral care practice for adult dependent patients often included the use of sponge swabs and liquid mouth rinse, but the facility had no formal policy outlining best practice. The authors sought to develop such a policy by answering two main questions: Are sponge swabs effective in cleaning the oral cavity? What oral care is required for individuals with dysphagia and those who depend on others for oral care? After a review of the literature for pertinent guidance, a new protocol for oral care, based on tooth brushing and use of antibacterial gel, was implemented for one care unit. Patients showed improvements in oral health, specifically reductions in tartar, swollen and bleeding gums, ulcerations, debris and severe halitosis. Staff members were initially resistant to change, but resistance declined as they witnessed the benefits of tooth brushing. The use of sponge swabs also declined. This intervention confirmed that tooth brushing is appropriate as the gold standard of good oral care and showed that sponge swabs are ineffective for removing plaque. These principles have become the foundation of oral care policies and care plans at this facility.