Investigating the perceptions and experiences of Canadian dentists on dental regulatory bodies' communications and guidelines during the COVID-19 pandemic.

OBJECTIVE: Dental regulatory bodies aim to ensure the health and safety of dentists, dental staff patients and the public. An important responsibility during a pandemic is to communicate risk and guidelines for patient care. Limited data exist on the perceptions and experiences of dentists navigating new guidelines for mitigating risk in dental care during the pandemic. The objective of this study was to use a qualitative approach to explore how dentists in Canada experienced and perceived their regulatory bodies' communication about COVID-19 risks and guidelines during the pandemic. METHODS: Participants were Canadian dentists (N = 644) recruited through the email roster of nine provincial dental associations or regulatory bodies. This qualitative analysis was nested within a prospective longitudinal cohort study in which data were collected using online questionnaires at regular intervals from August 2020 to November 2021. To address the objective reported in this paper, a conventional qualitative content analysis method was applied to responses to three open-ended questions included in the final questionnaire. RESULTS: Participants encountered challenges and frustrations amid the COVID-19 pandemic, grappling with diverse regulations and communications from dental bodies. While some bodies offered helpful guidance, many participants felt the need for improved communication on guidelines. Dentists urged for expedited, clearer and more frequent updates, expressing difficulty in navigating overwhelming information. Negative views emerged on the vague and unclear communication of COVID-19 guidelines, contributing to confusion and frustration among participants. CONCLUSION: As COVID-19 persists and in planning for future pandemics, these experiential findings will help guide regulatory bodies in providing clear, timely and practical guidelines to protect the health and safety of dentists, dental staff, patients and the public.

Validity and reliability of the COVID-19 Anxiety Syndrome Scale in Canadian dentists.

BACKGROUND: The COVID-19 pandemic has resulted in a high level of mental health problems for the population worldwide including healthcare workers. Several studies have assessed these using measurements for anxiety for general populations. The COVID-19 Anxiety Syndrome Scale (C-19ASS) is a self-report measure developed to assess maladaptive forms of coping with COVID-19 (avoidance, threat monitoring and worry) among a general adult population in the United States. We used it in a prospective cohort study of COVID-19 incidence rates in practising Canadian dentists. We therefore need to ensure that it is valid for dentists in French and English languages. This study aimed to evaluate the validity of the C-19ASS in that population. METHODS: Cross-sectional data from the January 2021 monthly follow-up in our prospective cohort study were used. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed. RESULTS: The results of EFA revealed a 2-factor structure solution that explained 47% of the total variance. The CFA showed a good model fit on the data in both English and French languages. The Cronbach's alpha indicated acceptable levels of reliability. Furthermore, the C-19ASS showed excellent divergent validity from the Generalized Anxiety Disorder-7 (GAD-7) scale. CONCLUSIONS: The C-19ASS is valid and reliable instrument to measure COVID-19-related anxiety in English and French among Canadian dentists. PRACTICAL IMPLICATIONS: This validated measure will contribute to understanding of the mental health impact of the pandemic on dentists in Canada and enable the dental regulatory authorities and organizations to intervene to help dentists.

Virtual Oral Health across Canada: A Critical Comparative Analysis of Clinical Practice Guidances during the COVID-19 Pandemic.

During the COVID-19 pandemic, teledentistry was suggested as a cost-effective and promising approach to improve access to oral health care. In response, Canadian provincial and territorial dental regulatory authorities (DRAs) published teledentistry-related clinical practice guidances (TCPGs). However, an in-depth comparison between them is needed to understand their gaps and commonalities so as to inform research, practice, and policy. This review aimed to provide a comprehensive analysis of TCPGs published by Canadian DRAs during the pandemic. A critical comparative analysis of these TCPGs published between March 2020 and September 2022 was conducted. Two members of the review team screened the official websites of dental regulatory authorities (DRAs) to identify TCPGs and performed data extraction. Among Canada's 13 provinces and territories, only four TCPGs were published during the relevant time period. There were some similarities and differences in these TCPGs, and we identified gaps pertaining to communication tools and platforms, and measures to safeguard patients' privacy and confidentiality. The insights from this critical comparative analysis and the unified workflow on teledentistry can aid DRAs in their development of new or an improvement to existing TCPGs or the development of nationwide TCP guidelines on teledentistry.

Delivering dental care as we emerge from the initial phase of the COVID-19 pandemic: teledentistry and face-to-face consultations in a new clinical world.

At a time when access to health care and services for the global population is a concern due to the COVID-19 pandemic, health professionals and their teams are struggling to find a way to adapt their practices. Dental professional organizations and decision-makers are required to provide guidance in a rapidly evolving environment based on the current data, available research, and existing knowledge. Continuous progress in the information communication technology field and universal access to social communication platforms have allowed clinicians to creatively transcend some of the existing traditional barriers in clinical and technological workflows. The aim of this paper is to provide insight and propose future directions concerning the use of teledentistry for dental care in crisis situations such as the COVID-19 pandemic as well as the continuous implementation of teledentistry in noncrisis scenarios. This paper provides information to support the use of teledentistry as a promising avenue for dental professionals when possible, during and possibly beyond the outbreak.

Information service in head and neck cancer care-a qualitative study.

AIM: We aimed to understand how information was delivered to head and neck (H&N) cancer patients and describe the perceptions of the H&N patients concerning information delivery. METHODOLOGY: This qualitative investigation was a part of our larger quantitative study that was conducted with H&N cancer patients at two academic hospitals in Montreal. After obtaining the ethical approval, a purposeful sample of participants was recruited from the main study until the content of the information gathered reached saturation. Data were collected by observing the information delivery and interviewing the study participants and Nurse Pivots. All observations and interviews were audiotaped. Data were transcribed verbatim; transcripts were developed, audited, and subjected to a thematic analysis. RESULTS: Eleven H&N patients participated in the study. We found that the doctors were the main source of information at both hospitals; one hospital delivered information systematically to every patient using a multimedia-based information disseminating tool while the second hospital delivered information verbally in an ad hoc manner. Those who received information using the multimedia tool understood what was said to them and were better prepared for the next step, while those who received information verbally did not retain much, were confused, and expressed dissatisfaction. CONCLUSIONS: Although the doctors were the main source of information, patients experience difficulties in understanding what was said to them. Comprehensive information together with audiovisuals, when provided to H&N cancer patients based on their needs, seems to improve their understanding of their cancer and prepare them for their treatment.

Providing care to people on social assistance: how dentists in Montreal, Canada, respond to organisational, biomedical, and financial challenges.

BACKGROUND: Dentists report facing difficulties and experiencing frustrations with people on social assistance, one of the social groups with the most dental needs. Scientists ignore how they deal with these difficulties and whether they are able to overcome them. Our objective was to understand how dentists deal with critical issues encountered with people on social assistance. METHODS: We conducted in-depth, semi-structured interviews with 33 dentists practicing in Montreal, Canada. The interview guides included questions on dentists' experiences with people on social assistance and potential strategies developed for this group of people. Analyses consisted of interview debriefing, transcript coding, and data interpretation. RESULTS: Dentists described strategies to resolve three critical issues: missed appointments (organisational issue); difficulty in performing non-covered treatments (biomedical issue); and low government fees (financial issue). With respect to missed appointments, dentists developed strategies to maximise attendance, such as motivating their patients, and to minimise the impact of non-attendance, like booking two people at the same time. With respect to biomedical and financial issues, dentists did not find any satisfactory solutions and considered that it was the government's duty to resolve them. Overall, dentists seem reluctant to exclude people on social assistance but develop solutions that may discriminate against them. CONCLUSIONS: The efforts and failures experienced by dentists with people on social assistance should encourage us to rethink how dental services are provided and financed.

A systematic review of stress in dental students.

The aim of this study was to systematically review the available literature on the levels, causes, and impact of stress among dental students. The investigators searched eight electronic databases: Medline, Medline in process, Psychinfo, ERIC, Embase, Cochrane Library, Web of Science, and SCOPUS. Two independent reviewers conducted the selection, data extraction, and quality appraisal for included studies. The investigators then coded both quantitative and qualitative studies using similar codes and pooled results from studies that used the Dental Environment Stress questionnaire to demonstrate dental students' stress levels. The search initially identified 4,720 studies, of which 124 studies were included in the final qualitative synthesis and twenty-one were included in the meta-analysis. Evidence from this research showed that dental students experience considerable amounts of stress during their training. This stress is mainly due to the demanding nature of the training. In addition, studies suggest adverse effects of elevated stress on students' health and well-being. Most of the available literature is based on cross-sectional studies; thus, future longitudinal studies are needed to follow students throughout their curriculum. In addition, further research needs to explore and test stress management interventions.

Sources of stress in Canadian dental students: a prospective mixed methods study.

The objectives of this study were to describe sources of stress in predoctoral dental students and first-year residents at one dental school and to understand how these sources evolved during the four-year curriculum and in the first year after graduation. The study used a mixed methods design. Quantitative data were collected from subjects in each of the five cohorts of students and residents, every month for a period of one year (other than the summer holiday period; N varied each month from 77 to 127). Sources of stress were measured using the Dental Environment Stress questionnaire (DES). The investigators administered the DES twice, once at the end of each academic semester, and used DES categories that emerged from factor analysis to assess monthly sources of stress. Qualitative data collected through individual interviews (N=6) were aimed at understanding the main sources of stress in each year of the curriculum. Results from both quantitative and qualitative phases demonstrated that the main stressors for all dental students throughout the year were examinations and grades as well as workload. Students in the clinical years were also concerned about patient treatment. The residents and final-year students reported future plans as an additional stressor. Over the year, there was a significant increase for workload stress in the fourth year (p<0.05); in the third year there was a significant increase in patient treatment stress (p<0.05) with a significant decrease for personal factors (p<0.05). The study demonstrated that sources of stress in these students and first-year residents varied according to their stage in the program and the period of the year.

How health professionals perceive and experience treating people on social assistance: a qualitative study among dentists in Montreal, Canada.

BACKGROUND: In Canada, the prevalence of oral diseases is very high among people on social assistance. Despite great need for dental treatment, many are reluctant to consult dental professionals, arguing that dentists do not welcome or value poor patients. The objective of this research was thus to better understand how dentists perceived and experienced treating people on social assistance. METHODS: This descriptive qualitative research was based on in-depth semi-structured interviews with 33 dentists practicing in Montreal, Canada. Generally organized in dentists' offices, the interviews lasted 60 to 120 minutes; they were digitally recorded and later transcribed verbatim. The interview transcripts were coded with NVivo software, and data was displayed in analytic matrices. Three members of the research team interpreted the data displayed and wrote the results of this study. RESULTS: Dentists express high levels of frustration with people on social assistance as a consequence of negative experiences that fall into 3 categories: 1) Organizational issues (people on social assistance ostensibly make the organization of appointments and scheduling difficult); 2) Biomedical issues (dentists feel unable to provide them with adequate treatment and fail to improve their oral health); 3) Financial issues (they are not lucrative patients). To explain their stance, dentists blame people on social assistance for neglecting themselves, and the health care system for not providing adequate coverage and fees. Despite dentists' willingness to treat all members of society, an accumulation of frustration leads to feelings of powerlessness and discouragement. CONCLUSIONS: The current situation is unacceptable; we urge public health planners and governmental health agencies to ally themselves with the dental profession in order to implement concrete solutions.

Oral pain and its covariates: findings of a Canadian population-based study.

OBJECTIVE: To describe the prevalence of oral pain in Canada and to identify its covariates. METHODS: Data were derived from the 2007-2009 Canadian Health Measures Survey. Data were analyzed for a total of 5284 respondents (2558 males, 2726 females) aged 6-79 years. The outcome variable was self-reported pain in the mouth in the past 12 months. Bivariate and multivariate analyses were used to investigate the relationship between oral pain and 4 sets of covariates: socio-demographic factors, dental service utilization, oral health behaviours and clinical oral health. RESULTS: Oral pain in the past 12 months was reported by 11.7% of respondents. Oral pain was slightly, but not significantly, more prevalent among females than males (13.6% vs. 10.0%). The lowest and highest prevalence of oral pain were reported by children and young adults, respectively. Multivariate analyses suggested that oral pain was significantly more prevalent among adolescents and adults, those in the lowest income groups, those who avoided a dental professional because of the cost and those with untreated decayed teeth. CONCLUSION: Canadians with financial barriers to accessing dental care and those with untreated dental decay were at risk of having dental pain. These findings have important implications for the provision of dental care in Canada.

The magnitude of oral health inequalities in Canada: findings of the Canadian health measures survey.

OBJECTIVES: This study aimed to measure the magnitude of income-related inequality for four oral health outcomes in Canada. The degree of oral health inequality according to sex was also compared. METHODS: Data for this study are from the year 2007 to 2009 Canadian Health Measure Survey (CHMS). The sample size consisted of 4951 Canadians aged 6-79 (2409 men and 2542 women). The oral health indicators used were the number of decayed teeth, number of missing teeth, number of filled teeth, and oral pain in the past year. Socioeconomic status was measured as equivalized household income. We used the relative concentration index to quantify health inequalities. Data analyses were performed using STATA 11.1 and ADePT (4.0). RESULTS: The number of decayed teeth, the number of missing teeth and the prevalence of oral pain decreased with increasing income, while the number of filled teeth increased with increasing income. The relative concentration indices for decayed teeth, missing teeth, filled teeth and for oral pain were -0.264, -0.157, 0.085, and -0.120, respectively. There was a statistically significant deviation from equality for the four oral health outcomes and this was generally present for both sexes. The relative concentration indices for decayed teeth were statistically significantly larger than other oral health outcomes. The relative concentration indices for women were greater than those of males indicating a greater magnitude of inequality among women. CONCLUSIONS: There was a higher concentration of decayed teeth, missing teeth and oral pain in the worse off, while the more affluent had a greater concentration of filled teeth. The numbers of decayed teeth was the most unequal aspect of oral health comparatively. There was a sex difference in the pattern of oral health inequalities with greater magnitude of inequality present among women in terms of the number of decayed and missing teeth. Health policymakers should consider the magnitude of health inequalities according to outcome and between sexes in their decision to tackle oral health inequalities.

Cross-cultural adaptation and validation of a Brazilian version of an instrument to assess impairments related to oral functioning of people with Down syndrome.

BACKGROUND: An instrument was developed in Canada to assess impairments related to oral functioning of individuals with four years of age or older with Down syndrome (DS). The present study attempted to carry out the cross-cultural adaptation and validation of the instrument for the Brazilian Portuguese language and to test its reliability and validity. FINDINGS: After translation and cross-cultural adaptation, the instrument was tested on caregivers of people with DS. Clinical examination for malocclusion was carried out in people with DS by two calibrated examiners. Inter and Intra examiner agreement was assessed by Intraclass Correlation Coefficient (ICC) and ranged from 0.92 to 0.97 respectively. Total of 157 people with DS and their caregivers were able to compose the sample. They were selected from eight institutions for people with DS in five cities of southeastern Brazil. The mean age of people with DS was 20.7 [±13.1] and for caregivers was 53.1 [±13.7]. The mean instrument score was 18.6 [±9.0]. Internal reliability ranged from 0.49 to 0.80 and external reliability ranged from 0.78 to 0.88. Construct validity was verified by significant correlations identified between malocclusion and the total instrument; and caregivers' educational level and the instrument (p<0.05). Discriminant validity was proved as the instrument presented different mean comparing people with DS and non-DS (p<0.05). CONCLUSIONS: Initial validity tests indicated that the instrument related to the oral health for people with DS may be a valid instrument to this segment of the population in Brazil.

Comparing inequalities in oral and general health: findings of the Canadian Health Measures Survey.

OBJECTIVE: The aim of this study was to measure and compare the magnitude of income-related inequalities for oral and general health outcomes in Canada. METHODS: Data for this study were from the 2007/09 Canadian Health Measures Survey (CHMS). The sample size consisted of 3,413 Canadians aged 18-79 (1,601 men and 1,812 women). Oral health indicators were the total number of decayed and missing teeth. General health was measured as obesity and high blood pressure. Socio-economic status was measured as equivalized household income. We used the concentration index (CI) to quantify income-related inequalities in these outcomes. Values for the concentration index range from -1 to +1 with negative (or positive) concentration indices showing that the outcome is more concentrated among the less well off (or among the better off). All statistical analyses were weight-adjusted for the complex survey design and standardized for age. RESULTS: The concentration indices for oral health outcomes (decayed teeth = -0.25, missing teeth = -0.15) were greater than for general health outcomes (obesity = -0.05, high blood pressure = -0.04). The concentration indices for oral health outcomes, in contrast to general health outcomes, were statistically significant. CONCLUSION: There were income-related inequalities for oral health outcomes with the disease concentrated more among the poor. Inequalities in oral health were greater than inequalities in general health. The variation in the funding of oral health care and general health care is likely to explain the differences in the magnitude of income-related inequalities for oral and general health.

Coping and psychological distress among head and neck cancer patients.

INTRODUCTION: Few studies have described the relationship between the psychological distress associated with head and neck cancer and how patients cope with their disease. PURPOSE: The purpose of this study is to investigate how head and neck cancer patients 6-12 months after their diagnosis cope with their disease and how their coping skills are related to their anxiety and depression levels. METHODS: We conducted a cross-sectional study among 157 head and neck cancer patients. We evaluated coping strategies using the Ways of Coping Checklist and anxiety and depression using The Hospital Anxiety and Depression Scale. RESULTS: Bivariate analyses revealed that there was an association between patients' levels of anxiety and depression and the type of coping strategies used. Patients with higher levels of anxiety and depression used more "blamed self", "wishful thinking", and "avoidance" coping strategies. These associations were further confirmed by multivariate linear regression analyses that controlled for age, gender, time since end of treatment, tumor stage, and occupation. CONCLUSION: These findings suggest that coping strategies in head and neck cancer patients vary according to their level of psychological distress. However, the cross-sectional nature of the data does not permit directional inferences for this association.

An investigation of the role of sense of coherence in predicting survival among Brazilians with head and neck cancer.

To test the hypothesis that people with head and neck (H&N) cancer with higher sense of coherence (SOC) have longer survival than those with lower SOC. A hospital-based prospective study of 162 subjects with newly diagnosed H&N cancer was conducted. Sense of coherence (SOC) was evaluated at baseline using the 13-item "Orientation to Life" questionnaire. Out of 162 subjects recruited at baseline, 152 were followed for up to 39 months from cancer diagnosis. One-year survival status was obtained for 140 subjects. No association was found between SOC and either 1-year survival status or survival length. The results of this study indicate that a high SOC, compared to lower SOC, does not seem to improve 1-year survival or survival length among this sample of Brazilians with H&N cancer.

An investigation of the correlates of sense of coherence in a sample of Brazilians with head and neck cancer.

The aim of this study was to investigate the correlates of Sense of Coherence (SOC) in Head and Neck (H&N) cancer patients during the initial months following their diagnosis. A sample of 162 subjects with newly diagnosed H&N cancer was recruited from a Brazilian hospital. SOC was evaluated using a validated instrument, and these data plus socio-demographic, behavioural and clinical data were collected using interviews. Correlates of SOC in the sample were analysed using multiple linear regression. The mean SOC score was 63.8 and the mean age was 57.7 years. Most of the subjects were male, had a partner and had low levels of education. The cancers were mainly in the oral cavity and diagnosed at a late stage. Analyses demonstrated that subjects who were men, who had a partner, who were working and those with an opportunity to talk openly had higher (i.e. stronger) SOC. No statistically significant association was observed between SOC and clinical variables or tobacco and alcohol consumption. These results suggest an association between SOC and socio-demographic and psychosocial covariates only in this sample of Brazilian H&N cancer patients.

Measuring parental-caregiver perceptions of child oral health-related quality of life: psychometric properties of the Brazilian version of the P-CPQ.

The Parental-Caregiver Perceptions Questionnaire (P-CPQ) is an instrument that assesses a parent's or a caregiver's perceptions regarding the impact of children's oral health status on quality of life. The aim of this study was to evaluate the psychometric properties of the Brazilian version of the P-CPQ. Following translation and cross-cultural adaptation, the P-CPQ was tested on 123 parents and caregivers of children between 11 and 14 years of age with dental caries and malocclusions. The parents/caregivers were recruited at dental clinics of the Federal University of Minas Gerais, where their children were receiving dental care. Psychometric properties were assessed through internal consistency, test-retest reliability, construct validity and discriminant validity. The mean P-CPQ score was 13.01 (SD=12.14) for the dental caries group and 16.57 (SD=13.13) for the malocclusion group. Internal reliability was confirmed by a Cronbach's alpha coefficient of 0.84. Test-retest reliability revealed satisfactory reproducibility (ICC=0.83). Construct validity was satisfactory, demonstrating significant correlations between global indicators and the total scale. The P-CPQ score was able to discriminate between different parental/caregiver perceptions of oral conditions in their children (dental caries and malocclusion). The results for the Brazilian version of the P-CPQ confirm that this questionnaire is a reliable and valid instrument to assess parental perceptions on the impact that oral health status has on children's life quality.

Psychometric properties of the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14) - short forms.

BACKGROUND: The need to evaluate the impact of oral health has led to the development of instruments for measuring oral health-related quality of life (OHQoL). One such instrument is the Child Perceptions Questionnaire (CPQ(11-14)), developed specifically for 11-to-14-year-old children. As this questionnaire was considered long (37 items), shorter forms were developed with 8 (Impact Short Form: 8--ISF:8) and 16 items (Impact Short Form: 16--ISF:16) to facilitate use in the clinical setting and population-based health surveys. The aim of the present study was to translate and cross-culturally adapt these CPQ(11-14) short forms for Brazilian Portuguese and evaluate the measurement properties of these versions for use on Brazilian children. METHODS: Following translation and cross-cultural adaptation, the ISF:8 and ISF:16 were tested on 136 children from 11 to 14 years of age in the city of Belo Horizonte, Brazil. The instrument was administered by a trained researcher who also performed clinical examinations. The measurement properties (i.e. criterion validity, construct validity, internal consistency reliability, test-retest reliability) were determined. Discriminant validity was tested between groups, which were divided into children with no cavities and no malocclusion; children with cavities and without malocclusion; and children with malocclusion and without cavities. RESULTS: The mean total score was 6.8 [standard deviation (SD) 4.2] for the ISF:8 and 11.9 (SD 7.6) for the ISF:16 (p < 0.001). Statistically significant associations were found between oral abnormalities and the subscales of the ISF:8 and ISF:16 (p < 0.05). Both test-retest stability and internal consistency, as measured by the intra-class correlation coefficient (ICC) (ISF:8 = 0.98 and ISF:16 = 0.97) and Cronbach's alpha (ISF:8 = 0.70 and ISF:16 = 0.84) proved to be adequate. Construct validity was confirmed from the correlation between the short form scores and oral health and overall well-being ratings. The score on the short forms of the CPQ(11-14) was able to discriminate between different oral conditions. Criterion validity was satisfactory (p < 0.05). CONCLUSION: The Brazilian versions of CPQ(11-14) ISF:8 and ISF:16 have satisfactory psychometric properties, similar to those of the original instrument.