Community and individual socioeconomic inequalities and dental caries from childhood to adolescence: A 10-year cohort study.

PURPOSE: To evaluate the effect of individual and contextual socioeconomic inequalities in the occurrence of untreated dental caries during the transition from childhood to adolescence. METHODS: This 10-year prospective cohort study followed up an initial sample of 639 1-5 years old schoolchildren from southern Brazil. After 7 and 10 years from the baseline (T1), two other reassessments were conducted (T2 and T3), respectively. Untreated dental caries was measured through the International Caries Detection and Assessment System (ICDAS- scores 3, 5 and 6) at T1 and T3. Socioeconomic status (SES) at the contextual and individual level was assessed at T1. At T2, socioeconomic, behavioural and psychosocial characteristics were evaluated as possible pathways of explanation. Structural equation modelling was used to estimate the direct and indirect effects among the variables over 10 years. RESULTS: A total of 429 adolescents were reevaluated at 10-year follow-up (cohort retention rate of 67.1%). About 30.6% presented untreated dental caries at T3. Low individual SES at T1 directly impacted a higher occurrence of dental caries at T3. Non-white skin colour at T1 also indirectly impacted a higher occurrence of dental caries at T3 through low individual SES at T1 and lower household income at T2. Contextual SES did not predict, directly or indirectly, dental caries at T3. CONCLUSION: There is strong evidence that socioeconomic inequalities at the individual level play an important role on the occurrence of dental caries from childhood to adolescence. On the other hand, there was no evidence that contextual SES influences the occurrence of dental caries over time.

British Columbia Dentists' Perceptions and Practices Regarding HPV Vaccinations: A Cross-sectional Study.

INTRODUCTION: Human papillomavirus (HPV), as the most common form of sexually transmitted infection, has been implicated in almost one-third of oropharyngeal cancers. One way to prevent HPV infections is through vaccination. This study aimed to investigate whether dentists in British Columbia (BC) were willing to discuss, refer and administer the vaccine in a dental practice setting. METHODS: Our cross-sectional study used a survey consisting of 14 questions pertaining to demographics, scope of practice, barriers to discussing the HPV vaccine and willingness to engage in HPV vaccination. On 1 April 2021, the survey was distributed to all practising dentists in BC via a URL link; the link remained active for 30 days. Descriptive and inferential statistics were used to analyze results, and statistical significance was set at p < 0.05. RESULTS: Of the 201 respondent who completed a survey, 168 (84%) agreed that discussing the link between HPV and oropharyngeal cancer falls within their scope of practice. Fewer agreed that recommending (74%) and administering (39%) the HPV vaccine were within their scope of practice. Barriers that may contribute to this unwillingness included lack of professional policies and guidelines. Although a significant proportion of respondents were willing to educate patients on HPV, they were unwilling to discuss sexual history in a dental setting (p = 0.02). CONCLUSIONS: Despite a willingness to discuss and refer patients for HPV vaccination, most respondents were unwilling to administer the vaccine in a dental setting, as they perceived the act to fall outside their scope of practice. There remains a reluctance to engage in vaccination activities in dental settings in BC.

Exploring stressors and coping strategies among dental students during COVID-19 pandemic in British Columbia.

OBJECTIVE: The COVID-19 pandemic has caused stress among undergraduate dental students; coping mechanisms might be employed to deal with such stress. A cross-sectional study was conducted to explore the coping strategies employed by dental students at the University of British Columbia (UBC) in response to their self-perceived stressors during the pandemic. METHODS: An anonymous 35-item survey was distributed to all four cohorts of UBC undergraduate dental students enrolled in the 2021-2022 academic year, 229 students in total. The survey gathered sociodemographic information, self-perceived COVID-19-related stressor, and coping strategies via the Brief Cope Inventory. Adaptive and maladaptive coping were compared among the years of study, self-perceived stressors, sex, ethnicity, and living situations. RESULTS: Of the 229 eligible students, 182 (79.5%) responded to the survey. Of the 171 students that reported a major self-perceived stressor, 99 (57.9%) of them were stressed about clinical skill deficit due to the pandemic; fear of contraction was reported by 27 (15.8%). Acceptance, self-distraction, and positive reframing were the most used coping strategies among all students. The one-way ANOVA test revealed a significant difference in the adaptive coping scores among the four student cohorts (p = 0.001). Living alone was found to be a significant predictor for maladaptive coping (p < 0.001). CONCLUSION: The main cause of stress related to the COVID-19 pandemic for dental students at UBC is their clinical skills being negatively affected. Coping strategies including acceptance and self-distraction were identified. Continued mitigation efforts should be made to address students' mental health concerns and create a supportive learning environment.

Precursors of insulin resistance underlying periodontitis in adolescents aged 17-18 years.

OBJECTIVE: To investigate the association between insulin resistance markers and periodontitis in adolescents, analyzing confounder variables and the adiposity as a mediator. METHODS: This is population-based study is representative of adolescents aged 17-18 years from public schools in São Luís, Brazil (n = 405). Insulin resistance was assessed using the Model of Assessment of the Homeostasis of the Insulin Resistance Index (HOMA-IR) and its percussor triglycerides/HDL-cholesterol ratio (TG/HDL-c). The outcome was Initial Periodontitis, a latent variable estimated by the common variance shared among bleeding on probing, probing depth ≥ 4 mm, and clinical attachment loss ≥ 4 mm. The association between insulin resistance and Initial Periodontitis was modeled via pathways triggered by socioeconomic status, smoking, alcohol, and Adiposity, using structural equation modeling. RESULTS: Higher TG/HDL-c was directly associated with higher Initial Periodontitis (standardized coefficient [SC] = 0.130, p < 0.001). HOMA-IR was not associated with periodontal outcome (SC = 0.023, p = 0.075), but it was with Adiposity (SC = 0.495, p < 0.001). Higher TG/HDL-c was associated with Adiposity (SC = 0.202, p < 0.001). CONCLUSION: The insulin resistance markers were associated with early signs of periodontal breakdown among adolescents, suggesting a possible relationship between diabetes and periodontitis commences early in life.

Students' appraisal of a preparedness model for the provision of oral health care during a pandemic.

BACKGROUND: The COVID-19 pandemic has impacted the provision of oral health care worldwide, prompting the discussion of preparedness. This study aimed to perform an initial appraisal of the usability, spatial representation, and clarity of a newly developed preparedness model from the perspective of senior undergraduate dental students at the University of British Columbia, Vancouver, Canada, enrolled in the 2020-21 academic year. Answers were analyzed thematically via an inductive coding process between March and June 2021. RESULTS: All the 111 students in years 3 (#55) and 4 (#56) appraised the preparedness model, generating more than 200 pages of text. Four main themes were identified across the essays: streamlined depiction, information-based approach, adaptability to an ever-changing situation, and room for improvement. Although the majority of students appraised the model as being useful in fostering information-seeking behaviour, few students disagreed with the model's portrayal and made further suggestions. CONCLUSIONS: Preparedness models can better guide oral health care providers during a health crisis such as a pandemic. The recently developed preparedness model was appraised as useful by senior undergraduate dental students, although alternative portrayals of the model were suggested. A comprehensive assessment of the newly developed model (and of its variations) is warranted to better support oral health care service delivery during a pandemic.

Access to oral care is a human rights issue: a community action report from the Downtown Eastside of Vancouver, Canada.

To offer a critical reflection on an impoverished neighborhood in Vancouver, Canada, and their access to oral health care. A review of how a lack of publicly funded oral health care affects the most vulnerable, uninsured, and underserved citizens is performed. Personal and professional accounts on how entrepreneurial innovations of not-for-profit organizations can help to close the gap in access to oral health care are offered using the Vancouver Area Network of drug users (VANDU) and the PHS Community Services Society as case studies in British Columbia. Despite the efforts put forward by not-for-profit organizations such as the VANDU and the PHS Community Services Society, a national oral health care plan is warranted though still not a political imperative. Underserved citizens have a right to oral health care that is compassionate, collaborative, accessible, and affordable.

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.

Higher sugar intake is associated with periodontal disease in adolescents.

OBJECTIVES: Analyze the association between higher added sugar exposure and periodontal disease in adolescents (18-19 years old). MATERIALS AND METHODS: This was a cross-sectional study nested to RPS Cohorts Consortium, São Luís, Brazil (n = 2515). The exposure was percentage of daily calories from added sugar (≥ 10%), estimated from a quantitative food frequency. The outcome was periodontal disease estimated by the number of teeth affected by bleeding on probing, periodontal probing depth ≥ 4 mm, and clinical attachment level ≥ 4 mm at the same site. A theoretical model was depicted in a directed acyclic graph to identify the minimal sufficient adjustment set: household income, adolescent's educational level, sex, alcohol use, and smoking. Periodontal disease was categorized into < 2 teeth affected, 2 to 3 teeth affected, and ≥ 4 teeth affected to estimate prevalence ratios (PR) by multinomial logistic regression. To test for consistency, means ratio (MR) were estimated using zero-inflated Poisson. RESULTS: High sugar intake was associated with ≥ 4 teeth affected by periodontal disease (PR = 1.42; 95% confidence interval (CI) = 1.03-1.94; p = 0.030); consistency Poisson analysis reinforced these results (MR = 1.15; 95% CI = 1.03-1.29; p = 0.011). CONCLUSION: High level of added sugar intake was associated with greater extent of periodontal disease in adolescents. CLINICAL RELEVANCE: High sugar intake was associated with periodontal disease in adolescents, supporting the integrated hypothesis of dental caries and periodontal disease and giving impetus to future clinical investigation on the effect of restriction of added sugar consumption in periodontal parameters, which potentially may change traditional treatment protocols of periodontal disease.

Perceptions of access to oral care at a community dental hygiene clinic for women involved with the criminal justice system.

Background: Women involved with the criminal justice system are often marginalized or vulnerable and may face oral health inequities. Through a community-engaged program at a Canadian university, dental hygiene students provided preventive care at an organization supporting this population. This study explored the impact of these oral care services from client and organization staff perspectives. Methods: One focus group with 6 clients, 2-person interviews with 4 clients, individual interviews with 3 clients, and one focus group with 4 organization staff members were conducted. Discussions were audio recorded, transcribed verbatim, and analysed thematically. The concept of access, proposed by Penchansky and Thomas (1981) and Saurman (2015), was used as the conceptual framework to organize the themes. Results: Nine themes were identified from the focus group and interview discussions: limited options, convenience, realistic expectations, respect and attention, no judgement, physical environment, communication, clients' unique needs, and appropriate messaging. Discussion: The clinic's close proximity and services, for which women did not need to pay out-of-pocket, facilitated access to preventive care. The person-centred and trauma-informed care further facilitated access. However, access to comprehensive care through referrals was limited by cost and likely issues of stigmatization from other dental care providers. Clinic aesthetics, advertising, and communication between the students and women receiving care also hindered access. Conclusion: Preventive oral care services provided at this clinic for marginalized and vulnerable women who have been involved with the criminal justice system were valued by clients and staff. Findings will help inform future community-based dental hygiene clinics for this population.

Contexte: Les femmes qui font face au système de justice pénale sont souvent marginalisées ou vulnérables et peuvent être confrontées à des inégalités en matière de santé buccodentaire. Dans le cadre d'un programme engagé sur le plan communautaire, mis en place dans une université canadienne, des étudiants en hygiène dentaire ont prodigué des soins préventifs dans une organisation qui soutient cette population. La présente étude a exploré les répercussions de ces services de soins buccodentaires du point de vue des clients et du personnel de l'organisation. Méthodologie: Un groupe de discussion comprenant 6 clients, des entrevues à 2 personnes avec 4 clients, des entrevues individuelles avec 3 clients et un groupe de discussion avec 4 membres du personnel de l'organisation ont été menées. Les discussions ont fait l'objet d'un enregistrement sonore, puis ont été transcrites textuellement et analysées par thèmes. Le concept d'accès, proposé par Penchansky et Thomas (1981) et Saurman (2015), a été utilisé à titre de cadre conceptuel pour organiser les thèmes. Résultats: Le groupe de discussion et les entrevues ont permis de définir 9 thèmes : choix limités, commodité, attentes réalistes, respect et attention, absence de jugement, environnement physique, communication, besoins uniques des clients, et messages appropriés. Discussion: La proximité et les services de la clinique, pour lesquels les femmes n'avaient pas à payer de leur poche, ont facilité l'accès aux soins préventifs. Les soins axés sur la personne et les soins adaptés au traumatisme ont davantage facilité l'accès. Cependant, l'accès à des soins complets par l'intermédiaire de renvois a été limité par le coût et les enjeux de stigmatisation probables de la part d'autres fournisseurs de soins dentaires. L'esthétique de la clinique, la publicité et la communication entre les étudiants et les femmes recevant les soins ont également entravé l'accès. Conclusion: Les clients et le personnel ont attribué une valeur aux soins buccodentaires préventifs fournis à cette clinique réservée aux femmes marginalisées et vulnérables qui ont été impliquées dans le système de justice pénale. Les résultats permettront d'orienter les cliniques communautaires futures d'hygiène dentaire destinées à cette population.

Exploring lay public and dental professional knowledge around HPV transmission via oral sex and oral cancer development.

BACKGROUND: Human papillomavirus (HPV) has been associated with certain types of oropharyngeal cancers and yet, the level of knowledge that dental professionals and the lay public have in terms of HPV transmission, oral sexual activities, and oral cancer development needs exploration. The aim of this study was to assess the knowledge held by practicing dental professionals as well as the lay public regarding Human Papillomavirus (HPV) transmission through oral sex and subsequent oropharyngeal cancer development. METHODS: Textual data were collected from a public forum with dental professionals in. Vancouver, who discussed the HPV-oral sex-oral cancer triad, and from survey data gathered from 212 lay public participants (also in Vancouver) who answered a 13-item questionnaire on the perceived risks of oral sex in terms of HPV infection and oropharyngeal cancer development. The data were analyzed statistically by age group, gender, and sexual orientation using descriptive statistics, while an ANOVA test was used to compare variation in the responses to the survey (p-value = 0.05). RESULTS: The forum engaged 46 health care professionals, many of whom were aware of the potential risks for head and neck cancer development due to HPV infection, while also questioning "how to effectively talk about HPV with patients." The survey revealed that 34.5% of the participants believed that oral sex is an activity with no or low risk for the transmission of HPV, while 84% of participants believed the same sexual practices were of low or no-risk for HIV (Human Immunodeficiency Virus) transmission. Most participants (82%) never discussed oral sexual activities with their physicians or dentists/dental hygienists. CONCLUSIONS: The general public remains mostly unaware of the potential links between HPV infection and oropharyngeal cancer. Physicians and dental providers should discuss oral sexual practice with their patients to raise awareness.

Availability of Medical and Oral Health Services for People Living with HIV in British Columbia, Canada.

OBJECTIVES: To conduct an environmental scan and categorize the scope of medical and oral health care services for people living with HIV (PLWHIV) across the province of British Columbia (BC). METHODS: Data were collected using online search engines such as Google and Yahoo, as well as the websites of health services agencies and community/not-for-profit organizations in BC. Informal telephone conversations were conducted to confirm findings from the online scan. Available services were categorized in terms of scope (e.g., prevention, treatment or support) and geographic location in relation to the latest rates of new HIV infections per 100 000 people. In 2014, the number of people in BC known to be infected with HIV was 12 100, with the rate of new infections at 261 per 100 000 people. RESULTS: We identified 104 organizations that were providing services exclusively for PLWHIV; these organizations were unevenly distributed across 40 out of 51 cities in BC. Of all the services offered at these organizations, 59% were preventive and educational in nature, 15% were related to treatment services for HIV-related conditions and 38% entailed support services including social assistance. Only 3% of the 104 organizations offered basic dental care. Services of any kind tended to cluster around metropolitan areas of high HIV prevalence, including Vancouver, while northern BC remains underserved despite having the second highest rate of new HIV infections in the province. CONCLUSIONS: This study reveals a mismatch between the number and scope of services available for PLWHIV and the distribution of HIV infection across BC. Almost half of the services identified by the environmental scan were preventive, and only 3% offered some form of dental treatment exclusively to PLWHIV in BC.

Beliefs about managing dental problems among older people and dental professionals in Southern Brazil.

OBJECTIVES: To explore the sociocultural context in which patients and dentists in urban and rural communities in Southern Brazil interpret dental problems. METHOD: Beliefs and experiences related to dental problems were explored in eight focus groups involving a total of 41 older patients, and in direct interviews with two dentists and two dental assistants. The interactions were audio recorded and transcribed for thematic analysis. RESULTS: The beliefs and experiences of the participants focused on four main themes: cultural beliefs; dental services; decisions to extract teeth; and expectations for change. A culture of pre-nuptial tooth loss and complete dentures was considered beneficial to young women. Although dental services at the time were scarce in the region, demands for relief of pain were extensive despite the fear and anxiety of the participants. Extraction of teeth and fabrication of complete dentures were the usual dental treatments available, although some participants felt that dentists withheld other treatment options. Participants were hopeful that dental services would improve for their children. CONCLUSIONS: Patients and dental professionals in urban and rural communities of Southern Brazil managed dental problems within a culture of limited access and availability of services that favoured dental extractions and complete dentures.

Dental Insurance and Treatment Patterns at a Not-For-Profit Community Dental Clinic.

OBJECTIVES: To examine patient demographics, distance traveled and dental-related treatment provided according to type of dental insurance at a large, not-for-profit community dental clinic (CDC) in Vancouver, Canada. METHODS: Using electronic dental records, we assessed the use of private and government-sponsored (public) dental insurance at the CDC in 2014 and 2015 at the appointment and procedure levels. Study variables included patient demographics, distance traveled, type of treatment provided, type of dental insurance and cost of treatment. RESULTS: Examination of records from 9524 appointments involving 16 639 procedures revealed that 44% (4190 appointments) were made by patients with private insurance and 31.4% (2995) by those with public insurance. Patients with private dental insurance were 1.27 times more likely (p < 0.001) to have restorative treatment than those with public-sponsored dental insurance. Procedures involving tooth extraction were 14.2 times more likely (p < 0.001) to be performed in patients with public insurance than those with private insurance. CONCLUSIONS: Access does not equal equity; although the CDC enables access by various populations, its ability to provide equitable treatment is compromised by external factors. CDCs may have a vital role in oral health equity; however, dental treatment continues to be dictated by financial reimbursement.

Perceived oral health and access to care among men with a history of incarceration.

Objectives: To explore the perceptions of oral health and access to care experiences of men with a history of incarceration and to identify factors contributing to current oral health inequities within their community. Methods: A qualitative approach was used via focus group discussions among 18 men with a history of incarceration and 10 staff members of a non-profit organization working with individuals who are involved in or at risk of involvement with the criminal justice system. All discussions were audiorecorded and transcribed verbatim. A thematic analysis was undertaken using N-Vivo 10™, a qualitative data management program. Results: The participants ranged in age from 29 years to 69 years, came from a variety of ethnic backgrounds, and had different prison setting experiences. Five major themes emerged: not on the radar, stigma of incarceration, being shot down, caught in the system, and institutional conditioning. Conclusions: The personal backgrounds, experiences with health and dental care during prison time, and the unique challenges faced by men with a history of incarceration influenced their perceptions and their ability to access dental services. Dental professionals can help to change these perceptions and experiences by creating a safe space for these individuals to access and receive care comfortably.

Objectifs: Explorer la perception sur la santé buccodentaire et l'accès aux soins des hommes ayant des antécédents d'incarcération et cibler les facteurs qui contribuent aux inégalités actuelles en matière de santé buccodentaire au sein de leur communauté. Méthodologie: Une approche qualitative a été utilisée au moyen de groupes de discussion comprenant 18 hommes ayant des antécédents d'incarcération et 10 membres du personnel d'un organisme sans but lucratif qui travaillent avec des personnes impliquées ou à risque d'être impliquées dans le système de justice pénale. Toutes les discussions ont fait l'objet d'un enregistrement sonore et ont été transcrites mot pour mot. Une analyse thématique a été effectuée au moyen du programme de données qualitatives N-Vivo 10MD. Résultats: Les participants étaient âgés de 29 ans à 69 ans, étaient issus d'origines ethniques variées et avaient vécu différentes expériences en milieu carcéral. Cinq thèmes principaux sont ressortis, y compris ce qui ne figure pas sur l'écran radar, les préjugés associés à l'incarcération, être rejetés, être coincés dans le système, et le conditionnement institutionnel. Conclusions: Les antécédents personnels, les expériences en matière de santé et de soins buccodentaires au cours de la peine d'emprisonnement, et les enjeux uniques auxquels sont confrontés les hommes ayant des antécédents d'incarcération ont influencé leur perception des services buccodentaires et leur capacité d'y accéder. Les professionnels dentaires peuvent aider à changer la perception et les expériences de ces personnes en créant un endroit sécuritaire pour eux, qui leur permet d'accéder aux services et de les recevoir confortablement.

A Model Pathway to Oral Health Care for Homeless People.

OBJECTIVES: This study aimed at developing a model pathway to use of oral health care by homeless people based on their own perceptions and experiences with oral health care and related services in Vancouver. METHODS: We applied Gelberg-Andresen's behavioural model for vulnerable populations to predict health care use and interviewed 25 homeless adults (18 men and 7 women; age range 25-64 years) to develop a model pathway of care. Data collection and thematic analysis were carried out concurrently and iteratively to construct the pathway, which aimed at mutual decision-making and organization of the care process. RESULTS: Thematic analysis identified 4 main themes: government-sponsored oral health programs, homeless support, oral health outreach initiatives and professional education. CONCLUSIONS: The model pathway helps to explain the factors that enable homeless people to access oral health care. It may also help dental teams foster positive care-seeking behaviour relevant to this vulnerable population so that oral disorders can be managed more sympathetically and effectively.

Stigma of addiction and mental illness in healthcare: The case of patients' experiences in dental settings.

OBJECTIVE: To explore the ways in which stigma is experienced in healthcare and dental settings by patients with a history of addiction and mental illness. METHODS: Audio-recorded, semi-structured interviews with a purposefully selected convenience sample of residents from two community treatment centres in Vancouver, Canada were conducted. The interview guide contained questions about experiences while seeking health and dental care and was based on an existing framework of labeling, stereotyping, exclusion, discrimination, and power imbalance. Interviews were transcribed verbatim for coding and thematic analysis. RESULTS: Twenty-five participants between 23 and 67 years of age were interviewed; 17 were males. Most had a self-reported history of depression combined with use of alcohol and crack-cocaine; most of them only sought dental care for emergency purposes. Textual analysis of more than 300 pages of transcribed interviews revealed that participants perceived stigma when they were negatively stereotyped as 'unworthy', labeled as 'different', excluded from the decision-making process, discriminated against, 'treated unfairly', and felt powerless when interacting in the heath and dental care systems. Conversely, positive experiences were characterized by empathy, reassurance and good communication, which were empowering for patients. CONCLUSIONS: When associated with stigma, mental illness and addictions have negative implications for accessing health and dental care. From our participants' perspectives, it seems that the lack of understanding about their life conditions by the healthcare professionals was the origin of stigma. We suggest that an increased social awareness of these health issues be enhanced among current and future health and dental care professionals to help improve care experiences for this marginalized population.

Exploring dental student participation in interdisciplinary care team conferences in long-term care.

OBJECTIVE: The purpose of this study was to explore how the participation of dental hygiene students in interdisciplinary care conferences conducted in long-term care (LTC) facilities influenced the staff's awareness of oral health, the student's provision of care as well as the student's ability to work on an interdisciplinary team. BACKGROUND: Oral health in LTC continues to be poor despite many educational and clinical interventions. The care of a frail elder requires an interdisciplinary team approach, yet dental professionals are often absent from these teams. As an educational intervention, dental hygiene students, in addition to providing clinical care to residents and education to staff in a LTC facility, have been participating in interdisciplinary care conferences for 4 years. METHODS: Nine LTC facility staff and eight students participated in two focus groups and five personal interviews to discuss their experiences of the care conferences. Narratives were transcribed verbatim and thematic analysis was conducted. RESULTS: Four major themes emerged that described the essence of the experience of involving dental professionals within interdisciplinary care conference: (i) addressing oral health, (ii) reciprocal learning, (iii) dealing with complexity and (iv) impact of collaborative care. CONCLUSION: Overall, students found the educational intervention to be worthwhile that allowed for the development of interdisciplinary skills and a greater understanding of dental geriatrics. The dental support in care conferences was welcomed by the staff as it facilitated a new way of exchanging knowledge and experiences so that a more holistic approach to care could be undertaken by all.

STIGMA AROUND HIV IN DENTAL CARE: PATIENTS' EXPERIENCES.

Tooth decay and other oral diseases can be highly prevalent among people living with HIV/AIDS (PLWHA). Even though dental professionals are trained to provide equal and non-judgemental services to all, intentional or unintentional biases may exist with regard to PLWHA. We conducted qualitative descriptive research using individual interviews to explore the experiences of PLWHA accessing dental care services in Vancouver, Canada. We interviewed 25 PLWHA, aged 23-67 years; 21 were men and 60% reported fair or poor oral health. Thematic analysis showed evidence of both self-stigma and public stigma with the following themes: fear, self-stigma and dental care; overcoming past offences during encounters with dental care professionals; resilience and reconciliation to achieve quality care for all; and current encounters with dental care providers. Stigma attached to PLWHA is detrimental to oral care. The social awareness of dental professionals must be enhanced, so that they can provide the highest quality care to this vulnerable population.

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.