Impact of Delayed Dental Treatment during the COVID-19 Pandemic in an Undergraduate Dental Clinic in Southwestern Ontario, Canada - A Retrospective Chart Review.

OBJECTIVES: To investigate the impact of a COVID-19 mandated lockdown on the type and frequency of dental services accessed at an undergraduate dental clinic in southwestern Ontario. METHODS: We retrieved anonymized sociodemographic (n = 4791) and billing data (n = 11616) of patients for 2 periods of 199 days, before (T1) and after (T2) lockdown. We applied descriptive statistics and used Student's t test to compare the type and frequency of dental services provided between the 2 periods. We mapped forward sortation area (FSA) codes of each patient. RESULTS: Of the 4791 patients seen collectively in T1 and T2, most (67%) sought care before the lockdown. In both periods, most patients were ≥ 60 years of age (51.8%), female (33.9%) and residing in an urban area (88.6%). Compared with T1, there was a significant increase in middle-aged adults (p = 0.002) and significantly fewer patients earning over CAD 100 000 (p = 0.021) in T2. A total of 11616 billable procedures were carried out during T1 and T2: in T1, most procedures were preventative, whereas in T2, most were related to urgent care. Significantly fewer males than females sought urgent care, regardless of time. Finally, mapping showed a decrease in patients from Toronto, central and northern Ontario and clustering of patients in southwestern Ontario. CONCLUSION: We noted an overall reduction in billed services following the COVID-19 lockdown. The decrease in both billed services and patients seen during T2 demonstrates the impact of COVID-19 on access to timely and definitive dental care during the first 2 years of the pandemic.

Teledentistry use during the COVID-19 pandemic: perceptions and practices of Ontario dentists.

BACKGROUND: Teledentistry has demonstrated to expedite oral health consultations, diagnosis, and treatment planning while mitigating COVID-19 transmission risk in dental offices. However, the use of teledentistry by clinicians remains suboptimal. Therefore, this study aimed to determine the perceptions and practices of teledentistry among dentists during the COVID-19 pandemic in Ontario, Canada, and identify associated factors. METHODS: A cross-sectional study using an online 39 item survey was conducted among Ontario dentists in December 2021. The questionnaire inquired about socio-demographic attributes, as well as perceptions of teledentistry use during the pandemic, and its future application. Descriptive statistics including frequency distribution of categorical variables and univariate analysis of continuous variables were conducted. Chi-square test was used determine the associations between professionals' attributes such as age, gender, years of practice, and location of practice, and respondents use of teledentistry. SPSS Version 28.0 was used for statistical analysis. RESULTS: Overall, 456 dentists completed the survey. The majority were general dentists (91%), worked in private practices (94%), were between 55 and 64 years old (33%), and had over 16 years of professional experience (72%). Approximately 49.3% reported using teledentistry; 13% started before the pandemic, and 36% during the pandemic. The most common reason for non-utilization was a lack of interest (54%). Respondents identified patient triage, consultation, and patient education as the three most important uses of teledentistry. Female dentists (p < 0.05), dentist working in private practice (p < 0.05), and those who worked in a single dental office (p < 0.05) adopted teledentistry more during the pandemic. Respondents who accessed more resources were more likely to report greater utilization of teledentistry, while those who reported being unconformable with teledentistry (p < 0.05) reported less utilization. Additionally, participants who reported feeling comfortable discussing teledentistry with others (p < 0.05), were more inclined to use it in the future. CONCLUSIONS: Participants expressed mixed perceptions toward teledentistry with more than half indicating it is reliable for patient triaging and patient follow-ups. Despite the increased utilization during the COVID-19 pandemic, participants' lack of interest in teledentistry emerged as a barrier to its use. More education and knowledge dissemination about teledentistry's areas of application and technical aspects of use can increase interest in this tool, which may lead to a greater uptake by dental professionals.

Unfavourable beliefs about oral health and safety of dental care during pregnancy: a systematic review.

BACKGROUND: Oral conditions such as gingivitis and periodontitis are correlated with adverse pregnancy outcomes such as preeclampsia, preterm birth and low birth weight. Oral health-related unfavourable beliefs can have negative influences on oral health behaviours including hesitation in accessing preventative dental treatments and dental service utilization. The objective of this systematic review was to examine unfavourable beliefs that expectant or new mothers frequently hold about oral health and the safety of dental care during pregnancy. METHODS: An electronic database search on PubMed, Scopus, CINAHL, and MEDLINE (Ovid) followed by forward and backward citation tracing of the included studies was conducted. All English primary studies regardless of the year of publication were independently screened by two reviewers to identify studies addressing unfavourable beliefs about oral health and dental care during pregnancy. The CLARITY tool was applied to assess the risk of bias in the included studies. RESULTS: Out of a total of 5766 records, 39 quantitative and six qualitative studies met the inclusion criteria. The commonly held unfavourable beliefs were regarding the safety of dental services utilization and dental treatment procedures, the adverse impacts of pregnancy on oral health, and oral hygiene necessity during pregnancy. The most discussed unfavourable beliefs included "pregnant women lose their teeth because of pregnancy" (n = 18), "dental treatments are not safe and harm the fetus" (n = 17), and "the developing baby absorbs calcium from the mother's teeth" (n = 14). CONCLUSIONS: Unfavourable beliefs about oral health and dental care utilization are common among pregnant women and new mothers. The literature suggests that a low level of oral health knowledge and seeking information from social networks can contribute to such beliefs. This has implications for health promotion.

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.

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.

"Expectation is Always that the Practitioner Might Not Be Okay with Queerness": Experiences of LGBTQ+ With the Healthcare System in Saskatchewan, Canada.

This project aimed to explore the experiences of perceived mistrust and stigma by the LGBTQ+ members while accessing healthcare services in Saskatchewan, Canada. In partnership with local organization, a community-based participatory research (CBPR) approach was employed and, semi structured descriptive interviews were conducted. Sixteen participants ranging from age 20-60 were recruited and interviewed. Inductive coding method with thematic data analysis was performed, and descriptive comprehensive results were produced. The LGBTQ+ community reported negative experiences within the context of four emerging themes: (a) perceived stigma and discrimination in healthcare settings, (b) practitioners' LGBTQ+-specific healthcare knowledge, (c) the need for LGBTQ+-specific cultural sensitivity and inclusion, and (d) a call for changes in healthcare policy. Each theme and its corresponding experiences serve as a baseline of information to demonstrate the need for improved access to safe healthcare and increased sustainable health for the LGBTQ+ community members. This calls for training and education, establishing cultural sensitivity, and mandating policy changes could improve the experiences of the LGBTQ+ community members.

The two-spirit, lesbian, gay, bisexual, transgender, queer, and other sexual and gender identity curriculum in Canadian Dental Schools: What are the gaps and proposed next steps?

OBJECTIVES: This study aimed to investigate gaps in the delivery of two-spirit, lesbian, gay, bisexual, transgender, queer, and other sexual and gender identity (2SLGBTQ+) curricula and identify curricular challenges within Canadian dental schools. METHODS: A 21-item closed-ended questionnaire was distributed to curriculum experts across 10 dental schools in Canada. The survey questions were organized into three sections: institution characteristics, current 2SLGBTQ+ content and delivery, and opinions on the improvement of the 2SLGBTQ+ curriculum. Microsoft Excel (2020) was used to perform a descriptive analysis of the survey responses. RESULTS: Nine dental schools participated in the survey. All participating schools reported the offering of undergraduate, graduate, and degree completion programs. The most reported methods of teaching 2SLGBTQ+ content were 'lecture-based teaching' (n = 5), 'small-group teaching' (n = 4), and 'case-based discussions' (n = 4). The most common topics taught were 'gender identity' (n = 7) and '2SLGBTQ+ discrimination in healthcare care settings' (n = 7). The topics of 'sex reassignment surgery,' 'alcohol, tobacco, or other substance use by 2SLGBTQ+ people,' '2SLGBTQ+ pediatric and adolescent oral health issues,' 'coming out,' and 'sex reassignment surgery' were not included or were unknown by the majority of dental schools (n = 8). Overall, participants were unsatisfied with the level of 2SLGBTQ+-specific content covered at their institution and reported a 'lack of space within the curriculum and time constraints' as a barrier to implementation (n = 8). CONCLUSION: Community-based research is needed to identify the unmet oral health needs of the 2SLGBTQ+ population, which can be translated into the development of a risk-based oral health curriculum within Canada and beyond.

Healthcare access and barriers to utilization among transgender and gender diverse people in Africa: a systematic review.

Background: Transgender and gender diverse (TGD) people face significant challenges in accessing timely, culturally competent, and adequate healthcare due to structural and systemic barriers, yet there is a lack of research exploring the access and utilization of healthcare services within African TGD communities. To address this gap, this systematic review explored: (1) barriers to accessing healthcare services and gender-affirming hormone therapy (GAHT) faced by TGD people, (2) demographic and societal factors correlated with the utilization of healthcare services and GAHT, (3) common healthcare and support services utilized by TGD people, and (4) patterns of accessing healthcare services and GAHT within TGD communities. Methods: A systematic literature search was conducted in PubMed, Embase, and Scopus in September 2023. Eligible studies included peer-reviewed original research, reports, and summaries published in the English language assessing health service accessibility and utilization of TGD people in Africa between January 2016 and December 2023. Results: From 2072 potentially relevant articles, 159 were assessed for eligibility following duplicate removal, and 49 were included for analysis. Forty-five articles addressed barriers to accessing healthcare services and GAHT, seven focused on demographic and societal factors correlated with the utilization of healthcare services and GAHT, 16 covered common healthcare and support services utilized by TGD people, and seven examined patterns of accessing healthcare services and GAHT. Findings suggested a limited availability of health services, inadequate knowledge of TGD healthcare needs among healthcare providers, a lack of recognition of TGD people in healthcare settings, healthcare-related stigma, and financial constraints within African TGD communities. An absence of studies conducted in Northern and Central Africa was identified. Conclusions: TGD people in Africa encounter significant barriers when seeking healthcare services, leading to disparity in the utilization of healthcare and resulting in a disproportionate burden of health risks. The implications of these barriers highlight the urgent need for more high-quality evidence to promote health equity for African TGD people. Trial registration: PROSPERO CRD42024532405. Supplementary Information: The online version contains supplementary material available at 10.1186/s44263-024-00073-2.

Cost-related avoidance of oral health service utilization among lesbian, gay, and bisexual individuals in Canada.

OBJECTIVES: This study estimates the frequency of cost-related oral health service avoidance (CROHSA) among lesbian, gay, and bisexual (LGB) individuals in Canada relative to heterosexual persons. METHODS: Heterosexual and sexual minority individuals in Canada were compared using the national probability-based Canadian Community Health Survey 2017-2018. Logistic regression was used to quantify associations between LGB status and CROHSA. Mediators were tested following Andersen's behavioral model of health service utilization and included partnership status, oral health status, presence of dental pain, educational attainment, insurance status, smoking status, general health status, and personal income. RESULTS: From our sample of 103,216 individuals, 34.8% of LGB individuals reported avoiding oral health care due to cost compared to 22.7% of heterosexual persons. Disparities were most pronounced among bisexual individuals (odds ratio [OR] 2.29 95% confidence interval [CI] 1.42, 3.49). Disparities persisted despite adjustment for confounding using age, gender/sex, and ethnicity (OR 2.23 95% CI 1.42, 3.49). Disparities were fully mediated by eight hypothesized mediators namely, educational attainment, smoking status, partnership status, income, insurance status, oral health status, and the presence of dental pain (OR 1.69 95% CI 0.94, 3.03). In contrast, lesbian/gay individuals did not have elevated odds of experiencing CROHSA compared to heterosexual individuals (OR 1.27 95% CI 0.84, 1.92). CONCLUSION: CROHSA is elevated for bisexual individuals relative to heterosexual individuals. Targeted interventions should be explored to improve oral healthcare access among this population. Future research should assess the role of minority stress and social safety on oral health inequities among sexual minority groups.

The fear of letting go and the Ivory Tower of dental educational training.

ISSUE: Clinical training in dental education is complex and happens mostly within a well-controlled environment such as a university dental clinic where oral health care services are delivered; it is mostly student-centered. While such training is important, it is also possible to augment and enhance it by training predoctoral dental students outside such a clinic within off-site community-based placements using a more person-centered approach. However, there seems to exist a reluctance in recognizing and utilizing the work produced in these off-site placements holistically as an integral part of students' clinical assessment. APPROACH: Community-based clinical experience adds value to the training of our predoctoral dental students. This perspective describes the benefits of community placements and recognizes their importance in the clinical and professional development of a future graduate. It also presents a way to assess students' performance that by-and-large mirrors that of the university dental clinic while striking a balance between student-centered education and person-centered care. IMPACT: In this perspective, we argue that the clinical work delivered at a community placement ought to be weighted equitably with the clinical work delivered at a university clinic when assessing students' competency as a whole. Our message is to keep a balance of student-centered education and person-centered care to the benefit of all those involved.

A survey of amalgam use to guide dental education curriculums.

OBJECTIVES: To identify behavioral, preferential, and professional factors influencing the use of amalgam in private practices; and to compare the incidence of the placement of amalgam versus composite resin restorations in the province of Ontario and its pedagogical implications on dental curricula. METHODS: Participants responded anonymously to a 23-question online survey about their current use of dental amalgam and composite resins as well as their opinions regarding both dental materials. The explanatory variables were associated bivariately with the outcome variables, and the most significant predictors were identified using the multivariate analysis. RESULTS: Higher percentages of amalgam use were reported among clinicians who trained in Canada only (P = .009), who graduated before 1980 (p = <.001) and who work outside private practice (p = <.001). Familiarity with amalgam was higher among clinicians who are female (p = <.001), older (p = <.001), trained only in Canada (p = .017), who graduated prior to 2000 (p = <.001), and who work in locations with populations over 100,000 (p = .042). Familiarity with composite resin was higher among clinicians who graduated more recently (p = .002). A higher percentage of females (p = <.001), younger clinicians (p = <.001), recent graduates (p = <.001), and clinicians who work in private practice (p = .043) suggested that over 50% of dental student training time be allocated to amalgam. CONCLUSIONS: Decreased amalgam use was reported by later dental graduates and private practitioners; this may be impacted by familiarity with dental amalgam. As amalgam remains a safe and effective dental material, its removal may not be prudent. Dental educators play a crucial role in the future of amalgam opinion and use.

Five-Year Clinical Performance of Complex Class II Resin Composite and Amalgam Restorations-A Retrospective Study.

The aim of this retrospective study was to investigate the clinical performance of posterior complex resin composite (RC) and amalgam (AM) restorations after a five-year period. One hundred and nineteen complex Class II restorations placed by dental students were evaluated using the USPHS criteria. Data were analyzed using Chi-square, Mann-Whitney, and Wilcoxon tests at a 0.05 level of significance. After five years, the percentages of clinically satisfactory complex Class II RC and AM restorations were 78% and 76.8%, respectively. The main reasons for the failure of AM restorations included secondary caries (Bravo-10.1%), defective marginal adaptation (Charlie-8.7%), and fracture of the tooth (Bravo-7.2%). RC restorations presented failures related to the fracture of the restoration (Bravo-16%) and defective marginal adaptation (Charlie-8.2%). There was a significantly higher incidence of secondary caries for AM restorations (AM-10.1%; RC-0%; p = 0.0415) and a higher number of fractures for RC restorations (AM-4.3%; RC-16%; p = 0.05). Regarding anatomy, AM restorations presented a significantly higher number of Alfa scores (49.3%) compared to RC restorations (22.4%) (p = 0.0005). The results of the current study indicate that complex class II RC and AM restorations show a similar five year clinical performance.

Correlation of HIV-infection and HIV/HCV Co-infection with Oral Health Status of Inner-City Sub-population in Saskatchewan, Canada.

OBJECTIVES: To identify the correlation of HIV-infection and HIV/HCV co-infection with the oral health status of patients accessing an inner-city dental clinic in Saskatchewan, Canada. MATERIALS AND METHODS: A cross-sectional chart review of 2000 electronic patient records was performed from an inner-city community dental clinic. Utilizing Andersen and Newman framework of health service utilization, simple, bivariate and multivariate comparisons were conducted. RESULTS: More than half of the patients 53% (n=1,065) were within the ages of 36 to 65. The patient charts represented a mixture of ethnicities including immigrants to Canada (e.g., from Syria, Iran, Europe, China) and Indigenous people. Six percent (n=111) of patients were recorded positive for HIV/AIDS, while 3% (n=46) of patients recorded both HIV/HCV-co-infection. Forty-five percent (n=844) of patients had dental decay. In the bivariate analyses, smoking ([mean]: 3.0 vs. 2.1), being positive for HIV ([mean]: 4.1 vs. 2.6] and HCV ([mean]: 3.7 vs. 2.7) appeared to be associated with higher number of mean decayed teeth. Drug or alcohol addiction (p<.0001), HIV-positive status (p<.0001), and diagnosis of a mental disorder (p=.0037) were associated with the missing teeth. The multivariate analysis confirmed either HIV-positive or HCV-positive had a higher DMF rate compared with those without. Patients who were both HIV and HCV-positive had an estimated DMF rate almost double of those without either condition (IRR=1.84, p<.0001). CONCLUSION: Several psychosocial factors, HIV-infection and HCV-infection were associated with higher number of decayed and missing teeth.

Oral Health and Psychosocial Predictors of Quality of Life and General Well-Being among Adolescents in Lesotho, Southern Africa.

BACKGROUND: Adolescents' quality of life is reported to be significantly associated with physical and social wellbeing. Although adolescents are 30% of the Southern African population, no previous studies have focused on this group in relation to oral health and quality of life. METHODS: A 40-item survey and clinical oral examinations were conducted in public schools in Maseru from 10 to 25 August 2016. Simple, bivariate, and multivariate regressions were used to evaluate the associations of oral health and psychosocial factors with self-reported general health status and quality of life. RESULTS: A total of 526 participants, aged 12-19 years old, responded to the survey and participated in the clinical examinations. The majority reported a good (good/very good/excellent) quality of life (84%) and general health (81%). Bivariate results showed that self-reported general health in this population was significantly influenced by age. The presence of toothache and sensitivity in the adolescents were significantly associated with poor (fair/poor) self-reported general health and were found to be the best predictors for self-general health and quality of life. CONCLUSIONS: The absence of dental conditions such as toothache and tooth sensitivity can lead to a better perception of general health and Quality of Life in adolescents.

Impact of the Poor Oral Health Status of Children on Their Families: An Analytical Cross-Sectional Study.

The impact of poor oral health may not just be limited to the children themselves but can impact their families. The current study aims to perform psychometric analyses of the Arabic version of the Family Impact Scale and investigate the association of its domains with the oral health status of children. This cross-sectional study was carried out in a sample of 500 parent-child dyads from high schools of Jazan city of the Kingdom of Saudi Arabia. The Arabic version of the Family Impact Scale was subjected to reliability and validity tests. The explanatory variables in the current study are: the oral health status, parents combined income, parents' education, age and sex of the child. The descriptive analysis was reported using proportions, this was followed by the bivariate and multivariable analyses. About 24.2% of children were reported to have fair, poor, and very poor oral health. A lower frequency of family impact corresponded with better oral health (OH) status of children (p < 0.001). The likelihood of parent's taking time off from work and having financial difficulties was nearly two-times greater if their children had poor oral health. Similarly, interruption in sleep and other normal activities of parents is four times and five times greater, respectively, if the child has poor oral health status. Thus, the poor oral health of school children in the Jazan region of Saudi Arabia is a matter of grave concern as it is observed to be associated with family impacts; particularly affecting the parent's work, sleep, and other normal family activities.

Oral Health Status and Patterns of Dental Service Utilization of Adolescents in Lesotho, Southern Africa.

This study aimed to characterize the best predictors for unmet dental treatment needs and patterns of dental service utilization by adolescents in the Kingdom of Lesotho, Southern Africa. A self-reported 40-item oral health survey was administered, and clinical oral examinations were conducted in public schools in Maseru from August 10 to August 25, 2016. Associations between psychosocial factors with oral health status and dental service utilization were evaluated using simple, bivariate, and multivariate regressions. Five hundred and twenty-six survey responses and examinations were gathered. The mean age of student participants was 16.4 years of age, with a range between 12 and 19 years of age. More than two thirds (68%; n = 355) of participants were female. The majority reported their quality of life (84%) and general health to be good/excellent (81%). While 95% reported that oral health was very important, only 11% reported their personal dental health as excellent. Three percent reported having a regular family dentist, with the majority (85%) receiving dental care in a hospital or medical clinic setting; only 14% had seen a dental professional within the previous two years. The majority of participants did not have dental insurance (78%). Clinical examination revealed tooth decay on 30% of mandibular and maxillary molars; 65% had some form of gingivitis. In multivariate analysis, not having dental education and access to a regular dentist were the strongest predictors of not visiting a dentist within the last year. Our results suggest that access to oral health care is limited in Lesotho. Further patient oral health education and regular dental care may make an impact on this population.

A Case-Control Study of Type 2 Diabetes Mellitus and Periodontitis in Saudi Arabian Adults.

OBJECTIVE: The relationship between type 2 diabetes mellitus (T2DM) and periodontitis is bidirectional and has been investigated. However, the evidence from the middle-eastern region is sparse. The current report assessed the association between uncontrolled T2DM and periodontal status from a sample of the Saudi Arabian adult population. METHODS: A case-control study was carried out. Cases were adults diagnosed with periodontitis (clinical attachment loss ≥1 mm) and controls were patients from the same dental setting with no gum conditions matched with age, sex, and location. Diabetes was recorded using HbA1c readings. The other health conditions including hypertension, epilepsy, bronchitis, thyroid disorders, and arthritis were obtained from medical records. Data on the use of tobacco and related products (smoking, khat/qat, sheesha, shammah) were gathered using a self-perceived questionnaire. Frequencies, percentages, p-values, crude and adjusted odds ratios (OR) with 95% confidence intervals were computed. RESULTS: Overall sample comprises 166 cases and 332 controls with a mean age of 37.5 years. Multivariable analysis indicated uncontrolled T2DM as an important predictor for periodontitis among Saudi Arabian adults, and they had nearly three times greater odds (OR: 2.779; 95% CI: 1.425-5.419; p=0.003) of being diagnosed with periodontitis in contrast to non-diabetics. Secondary findings revealed that cigarette ever-users were two times more likely to be suffering from periodontitis than never-users, and those brushing once per day or less had five times greater odds of developing periodontitis as compared to those brushing twice daily. CONCLUSION: To conclude, the current evidence from Saudi Arabia is supportive of earlier studies and an awareness of this association is warranted among all healthcare providers and patients in the region for early detection of periodontitis.

What are the self-reported unmet dental treatment needs of people living with HIV in British Columbia? A case of minority subpopulation in Canada.

OBJECTIVES: To identify associations of Andersen and Newman's (A&N) predisposing, enabling, and need factors with self-reported oral health status and self-reported unmet dental treatment needs in a sample of people living with HIV (PLHIV) in British Columbia (BC), Canada. METHODS: Participants responded anonymously to a 41-item online questionnaire with the following inclusion criteria: a) be at least 19 years old; b) self-identify as HIV-positive; c) be able to provide consent and be willing to voluntarily participate in the study; d) be residing in British Columbia; and e) be able to proficiently respond to the questions in English. Following the descriptive statistics, associations between A&N model factors and the main outcome variables (self-reported oral health status and self-reported dental treatment needs) were evaluated using bivariate inferential analyses. RESULTS: A total of 186 participants met the inclusion criteria. Approximately 40% (n = 74) of participants rated the health of their mouth as fair/poor and more than half (n = 112; 60.2%) reported having bleeding gums, tooth decay or tooth sensitivity. The bivariate analysis for the self-reported oral status as the outcome variable showed "having fair/poor general health" (P = 0.001), "unemployment" (P = 0.019), "avoiding dental treatment due to cost" (P = 0.005), and "not visiting a dental professional within the last year" (P < 0.001) as the strongest predictors. For the second outcome variable unmet dental treatment needs, the strongest predictors were "experience of being discriminated by dental professionals" (P = 0.001), "having fair/poor general health" (P = 0.006), and "suffering from past and current medical conditions due to HIV" (P < 0.001). CONCLUSIONS: Several predisposing, enabling and need factors from the A&N model were associated with self-reported oral health status and unmet dental treatment needs of PLHIV. Results from this study highlight the needs of improving access to affordable dental care to address the unmet oral health needs of PLHIV.

Effect of prosthetic rehabilitation on oral health-related quality of life of patients with head and neck cancer: a systematic review.

BACKGROUND: To review the evidence on the oral health-related quality of life (OHRQoL) of head and neck cancer survivors after they have been treated with prosthetic rehabilitation. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were utilized as the framework in designing, implementing and reporting the current review. Search of literature was done electronically using Medline, Embase, and Cochrane databases. Intervention component of the patient, intervention, comparison, outcome (PICO) for the current review was the prosthetic rehabilitation performed on the surgically treated head and neck cancer patients (participants); and outcome was the OHRQoL. Methodological index for non-randomized studies was the assessment tool utilized to report on the quality of the included studies. RESULTS: The initial search had identified 799 records and the final level of screening included eight articles. Six studies were experimental in design and two were cross-sectional. Cumulative sample of the head and neck cancer cases from the selected studies was 354, with 35.9 (14.9) and 72.4 (8.7) years as the highest and lowest mean age recorded from the included studies. More male cases (69.5%) were reported than female cases (30.5%) and squamous cell carcinoma was the most commonly diagnosed malignancy. Maxillary reconstruction and implant supported prosthesis were the choice of treatment for most of the cases. Different versions of oral health impact profile (OHIP) constructs were preferred by six studies. While, one study utilized University of Washington quality of life questionnaire and the other utilized European Organization for Research and Treatment of Cancer's Quality of Life Questionnaire. Arguably, three studies had compared the OHRQoL scores of head and neck cancer patients with healthy counterparts through a follow-up period ranging from 1 to 2 years. CONCLUSIONS: The included studies did not provide substantial evidence to demonstrate the improvement in OHRQoL of head and neck cancer patients after prosthetic rehabilitation. More prospective studies are needed with representative sample, robust methodology and a longer follow-up period. The current study provides a direction to the clinical decision-making process and the epidemiological research to enhance the patients and public health-related outcomes.

The Canadian Core Cariology Curriculum: Outcomes of a national symposium.

Despite the efforts that have been made in dental education and clinical practice to adopt the evidence-informed, risk-based, nonsurgical caries management approach, the surgical treatment approach continues to prevail. There is an urgent need to understand resistance to such a paradigm shift and establish a coordinated evidence-based Cariology teaching approach in Canadian dental schools so trainees are equipped to implement caries management in their practice. To work towards this goal, a two-day interinstitutional symposium was organized in Montreal, QC, bringing together clinical and research experts in cariology and dental education from all 10 Canadian dental schools to develop a consensus on an evidence-informed Core Cariology Curriculum, and strategies for its implementation. Through consensus, participants produced the Core Cariology Curriculum for Canadian dental schools and articulated the challenges and solutions for its implementation. Future work will include working collaboratively on the curriculum integration and evaluation.