Practice Trends and Job Satisfaction of Dental Therapists in Canada: Results from a National Survey

The objective of this research was to evaluate the practice trends, clinical services and job satisfaction of dental therapists in Canada. Licenced Canadian dental therapists were recruited to participate in this cross-sectional study. A total of 124 dental therapists completed the survey (~68% response rate), with 57.3% of respondents being over the age of 50. Most respondents were actively engaged in full-time clinical practice in private dental offices. Indigenous dental therapists were significantly more likely to work outside of private dental offices providing care for Indigenous communities. Just over half of respondents were compensated by an annual salary, with the highest proportion of full-time practitioners earning between $75,000 and $99,000 per year. Dental therapists who were active in clinical practice performed a wide range of preventive, diagnostic, and treatment services consistent with their scope of practice. This research demonstrates that Canadian dental therapists are highly engaged and satisfied with their profession. Dental therapists can facilitate improved access to oral health care in less accessible areas of Canada; however, compensation packages and incentives to work in these less accessible areas must be addressed, as well as legal and regulatory requirements to ensure that dental therapists are licenced providers throughout Canada.

The oral health-related quality of life of children with fetal alcohol spectrum disorder

INTRODUCTION

A child's oral health impacts their development and quality of life. Children who live with fetal alcohol spectrum disorder (FASD) face barriers to dental care combined with poorer oral health outcomes. However, how this affects their oral health-related quality of life (OHRQoL) is largely unknown. Thus, the aim of this study is to examine the OHRQoL of children living with FASD.

METHODS

This cross-sectional survey used the Child Oral Health Impact Profile-Short Form-19 (COHIP-SF-19) to evaluate the OHRQoL quality of life of children (aged 8 to 15) living with FASD, compared to healthy controls.

RESULTS

A total of 332 children (or their caregivers) completed the survey. The survey results showed that children living with FASD reported significantly more untreated dental conditions. The majority of children in the control group experienced a low impact across the majority of COHIP-SF-19 domains. However, children living with FASD experienced significantly higher impact scores related to oral health, functional well-being, and social-emotional well-being.

CONCLUSION

The results demonstrated that children who live with FASD have a poorer OHRQoL. Overall, more investigation is necessary to identify the best ways to improve the OHRQoL of children living with FASD.

An evaluation of dental continuing professional development programs in the USA and Canada

PURPOSE

This research explores continuing professional development (CPD) requirements for dental regulatory/licensing authorities located in the USA/Canada and their preferences toward different learning and assessment strategies.

METHODS

Data were first retrieved through an environmental scan of CPD requirements posted on the websites for the 62 regulatory/licensing authorities located in the USA/Canada. Subsequently, an electronic questionnaire was distributed to the appropriate contact at each regulatory authority to capture additional data related to knowledge and preferences.

RESULTS

The environmental scan revealed that Canadian CPD programs had a significantly higher (p < 0.05) average of required CPD hours (26.67 ± 5.44) when compared to the USA (18.20 ± 4.23). For the survey component, 35 completed responses were received (response rate 56%). A total of 54% of respondents selected from a Likert scale that they "rarely" incorporate formative assessments, and 68% only "sometimes" or "often" incorporate summative assessments into their CPD programs. Additionally, 63% of respondents "never" incorporated predisposing activities, and 57% "never" incorporated reinforcing activities. It was perceived that renewal fees were insufficient to finance ongoing CPD costs (60%) and external industry sponsorships were required to sustain programs (43%). Respondents indicated that there is an insufficient number of evidence-based courses available in a variety of dental disciplines.

CONCLUSIONS

Formative and summative assessments and predisposing and reinforcing learning activities were not viewed as essential tools in CPD programs. Costs and human resources could be possible obstacles in incorporating learning activities and assessments. Future studies can build from the initial results of this study to improve the quality of learning in CPD programs.

Technology-Based Interventions to Reduce Sugar-Sweetened Beverages among Adolescents: A Scoping Review

This scoping review investigates the effectiveness of technology-based interventions in reducing sugar-sweetened beverage (SSB) consumption among adolescents. The rise in SSB consumption among young individuals has become a global public health concern due to its association with obesity, diabetes, and various other health problems. The purpose of this scoping review is to map out and examine the various technology-based interventions used in reducing sugar-sweetened beverages among children and adolescents. A systematic search of three databases using the PRISMA guideline was followed, and 474 articles were retrieved. Seven articles met the inclusion criteria and the critical appraisal using the critical appraisal skill program (CASP). The seven articles underwent both descriptive and thematic analysis. Four technology-based interventions were identified from the selected articles, which include smartphone apps, online or web-based tools, text messages, and social marketing strategies. Our findings suggest that these interventions hold promise in improving adolescents' eating patterns and health outcomes associated with SSB intake, highlighting their potential as useful strategies in resolving this urgent public health concern.

The oral health-related quality of life for individuals with fetal alcohol spectrum disorder - a cross-sectional study

BACKGROUND

The oral health status of an individual can dramatically influence quality of life. Most individuals in Canada report having good oral health, however, this is not true for individuals with developmental disabilities such as fetal alcohol spectrum disorder (FASD). The purpose of this study is to compare the oral health-related quality of life (OHRQoL) of individuals with FASD and the general population in Saskatoon, Saskatchewan. Additionally, it aims to suggest ways to improve the oral health status and OHRQoL of these individuals.

METHODS

For this cross-sectional study, the Oral Health Impact Profile-14 (OHIP-14) survey was used to assess the impact that oral health related problems can have on an individual's quality life. This study used a cross-sectional cohort study design with a survey methodology. The sample population compromised of 154 individuals with FASD along with a separate control group of 154 otherwise healthy adults.

RESULTS

The results of the study showed that most of the individuals in the FASD group experienced pain in the past month. In both groups, cost was most frequently cited as a barrier to accessing care. The majority of individuals in the control group experienced a low impact across all OHIP-14 domains except for physical disabilities. However, in the FASD group, most individuals experienced higher impact scores in some of the categories including functional limitation, psychological discomfort, psychological disability and handicap.

CONCLUSION

The findings clearly demonstrate that there is a discernible effect on an individual's quality of life if they have poor oral health. In conclusion, further research is required to determine the most effective methods to improve the OHRQoL of individuals with disabilities.

Access to oral health care for children with fetal alcohol spectrum disorder: a cross-sectional study

Background

Individuals with developmental disabilities, including Fetal Alcohol Spectrum Disorder (FASD), often suffer from poorer oral health than the general population as they experience challenges with accessing care. However, few studies have investigated access to oral health care specific to children diagnosed with FASD. Thus, the objective of this cross-sectional study is to examine the use of oral health care services by children diagnosed with FASD in Saskatchewan, Canada, and to identify perceived barriers that affect their access to oral health care.

Methods

Parents or caregivers for children with FASD under the age of 16 were recruited through community organizations. Between July 2020 and January 2021, 189 participants completed a 64-item questionnaire that assessed sociodemographic characteristics, oral health care utilization, and perceived barriers to care.

Results

Most children (85%) had visited the dentist within the last 24 months. 55% of children had required sedation for some treatment. 43% of caregivers experienced frustration trying to access care for their child. Common barriers were cost (63%), location (55%), the child’s behaviour (78%) and caregiver anxiety (60%). 35% of caregivers believed their dentist lacked adequate knowledge of FASD. Univariate analysis reveals that income, caregiver education, residence location, and insurance status were significantly associated with reporting barriers. Multivariate logistic regression analysis reveals that caregivers who reported a high school education (OR=1.23; 95% CI 1.03 – 1.38); or public insurance (OR=1.33; 95% CI 1.24 – 1.42) or out-of-pocket payments (OR=1.37, 95% CI 1.20 – 1.46); or rural (OR=1.19, 95% CI 1.07 – 1.26) or remote (OR=1.23; 95% CI=1.12 – 1.31) residences were more likely to report difficulties accessing oral health care.

Conclusion

Our findings indicate that children with FASD experience various barriers to accessing oral health care. Social determinants of health were significant variables that increased likelihood of barriers. Like other vulnerable populations, cost and clinic location are notable barriers. Oral health care providers’ assessment and management of children with FASD are noteworthy for future research.

The Use of General Anesthesia for Pediatric Dentistry in Saskatchewan: A Retrospective Study

INTRODUCTION

The rate of general anesthesia (GA) use for pediatric dental treatment in Saskatchewan is among the highest in Canada. Although the prevalence of and risk factors for early childhood caries (ECC) has been reviewed nationally, few studies have focused on Saskatchewan. The objective of this study was to determine the prevalence of and predictive factors for dental treatment under GA in Saskatchewan.

METHODS

This retrospective review focused on pediatric patients who required dental treatment under GA in Saskatchewan between 2015 and 2018. Demographic, dental diagnostic and treatment data and number of previous exposures to GA were collected and analyzed.

RESULTS

We reviewed 570 patient records. Dental treatment needs among the sample were complex; children had 10.85 ± 3.56 (mean ± standard deviation) teeth treated, for an average cost of $3231.72 ± $898.95 per child. Children who lived in less accessible or remote locations had a significantly higher caries experience, number of teeth treated and cost of treatment. In addition, children who lived in such locations were more likely to have had previous dental treatment under GA (odds ratio [OR] 1.29, 95% CI 1.029-1.645) compared with those who lived in easily accessible/accessible areas (OR 0.81, 95% CI 0.700-0.953).

CONCLUSION

Our findings confirm previous research that children who require dental treatment under GA have extensive caries and treatment needs. Our results suggest that children who live in less accessible and more remote areas of the province have a higher burden of disease and are more likely to require repeated GA exposures for dental treatment.

Risk Indicators and Treatment Needs of Children 2-5 Years of Age Receiving Dental Treatment under General Anesthesia in Saskatchewan

BACKGROUND

When compared to national averages in Canada, Saskatchewan has one of the highest rates of dental treatment under general anesthesia (GA) and average costs per child. Thus, the purpose of this cross-sectional study is to explore the risk indicators and treatment needs of children receiving dental treatment under GA in Saskatchewan.

METHODS

In this cross-sectional study, we recruited caregivers of children between 24 and 71 months of age in Saskatoon, Canada. Caregivers completed a 40-item questionnaire, which was supplemented with clinical data and then subject to statistical analysis (independent t-tests and one-way ANOVA).

RESULTS

A total of 90 caregiver/child dyads were enrolled with the mean age for children being 49.5 ± 12.3 months. The mean age of a child's first dental visit was 34.7 ± 15.3 months with only 37.9% of children having a dental home. The mean deft index was 11.7 ± 3.4, with an average of 10.9 ± 3.5 teeth receiving treatment. Additionally, location of primary residence (p = 0.03), family income (p = 0.04), family size (p = 0.01), parental education (p = 0.03), dental home (p = 0.04), and body mass index (p = 0.04) had a statistically significant association with a higher mean deft.

CONCLUSIONS

Our cross-sectional study confirms that children who require dental treatment under GA have a high burden of disease. While individual risk indicators such as diet and oral hygiene play a role in the progression of early childhood caries (ECC), we also demonstrate that children who do not have access to early preventive visits or a dental home are at a higher risk. In addition to improving motivation for oral hygiene at home and nutritional education, improving access to oral health care should be addressed in strategies to reduce ECC.

The oral health status and treatment needs of children with fetal alcohol spectrum disorder

OBJECTIVE

To investigate the oral health status and treatment needs of children with fetal alcohol spectrum disorder (FASD).

METHODS

In this retrospective study, the records of children between the ages of 6 and 14 who attended the College of Dentistry, University of Saskatchewan between 2016 and 2019 were reviewed. Demographic and clinical data was collected and compared for children who were identified as having FASD and a healthy control group.

RESULTS

From our total sample of 252 dental records, 68 children were identified with FASD. When compared to controls, children with FASD were significantly older at their first dental visit, and more dependent on public dental insurance. Children with FASD also had a significantly higher caries experience (97% vs 64.7%) and severity (DMFT/dmft score = 7.18 ± 1.79 vs 2.93 ± 0.98). Additionally, the results of our logistic regression model indicate that children with FASD were 4.71 times more likely (OR 4.71, 95% CI 1.58 -14.03) to be referred for treatment under general anesthesia (GA) when all other factors were controlled.

CONCLUSIONS

Children with FASD may be at a higher risk for poor oral health outcomes and have more extensive treatment needs. Our results indicate that they may also be at a higher risk for treatment under GA.

CLINICAL RELEVANCE

Oral healthcare providers need to be award of the unique needs of children with FASD to better prevent and manage their oral disease.

The Use of Fluoride Varnish in Primary Care in Ontario: A Qualitative Study

OBJECTIVES

Fluoride varnish (FV) has been shown to prevent dental caries. Physicians and nurses may be ideally situated to apply FV during well-child visits. Currently, public health units across Ontario have been successfully piloting this intervention. Yet, challenges remain at both the political and practice levels. The objectives of this research were to understand the perspectives of key stakeholders on making FV application a routine primary care practice in Ontario and to consider the potential enabling factors and barriers to implementation.

METHODS

In this qualitative study, 16 key stakeholders representing medicine, nursing, dentistry, dental hygiene, public health and government were interviewed. Interview data were transcribed and coded, and a conceptual framework for implementing change to daily health care practice was used as a guide for thematic analysis.

RESULTS

Our findings suggest that there is an opportunity for interdisciplinary care when considering children's oral health. There is also motivation and acceptance of this specific intervention across all fields. However, we found that concerns related to funding, knowledge and interprofessional relationships could impede implementation and limit any potential short- or mid-term window for meaningful policy and practice change.

CONCLUSION

With respect to introducing FV into medical practice for children under 5 years of age, the many factors required to implement immediate change are arguably not in alignment. However, policymakers and practitioners are motivated and have identified opportunities for change that may form the foundation for this program in the future.

Effects of initial body mass index on development of gestational diabetes in a rural Sri Lankan population: A case-control study

AIM

High pre-pregnancy body mass index (BMI) and excessive pregnancy weight gain lead to higher incidence of gestational diabetes mellitus (GDM). Aim of the study was to assess the effects of initial BMI and pregnancy weight gain on development of GDM in a rural Sri Lankan population. It was also hypothesized that these effects could be more pronounced in shorter mothers.

METHODS

A case-control study was conducted at two rural hospitals in Sri Lanka. A case was defined as a pregnant mother admitted for the completion of pregnancy and diagnosed to have GDM (n=99). A similar group of mothers without GDM were recruited as controls (n=336). Data were collected through health records and direct interviews.

RESULTS

Mean age of GDM and non-GDM mothers were 32.8 years 28.1 years, respectively. High pre-pregnancy BMI was a significant risk for GDM, with a rising trend with increasing BMI. In contrast to underweight mothers, the risk increases from normal weight [odds ratio (OR)=6.6, 95% confidence interval (CI) 2.2-19.4, p<0.01], overweight (OR=17.1, 95% CI 5.8-49.9, p<0.01) and to obese (OR=32.4, 95% CI 10.0-104.5, p<0.01). There was no significant difference in weight gain across mother's height groups. Height or leg length did not show an association with GDM. Family history of diabetes and past GDM were associated with GDM. GDM mothers had higher likelihood for cesarian deliveries, and babies with higher birth weight.

CONCLUSION

The pre-pregnancy BMI was the most important modifiable risk factor for GDM, and it should be the main preventive measure.

Early loss of primary incisors due to parafunctional tendency--case report

Premature loss of primary teeth associated with a parafunctional habit in a 30-month-old child is reported. Report details, clinically and radiographically, these effects in a very young child and reviews diagnostic possibilities. Early detection and scrutiny by the pediatric dentist is important to determine origin and to rule out periodontal disease as a manifestation of underlying systemic disease.

Early loss of primary incisors due to parafunctional tendency. Case report

Premature loss of primary teeth associated with a parafunctional habit in 30-month-old child is reported. Report details, clinically and radiographically, these effects in a very young child and reviews diagnostic possibilities. Early detection and scrutiny by the pediatric dentist is important to determine origin and to rule out periodontal disease as manifestation of underlying systemic disease.

PROTEIN INHIBITION OF SURFACTANT DURING MECHANICAL VENTILATION OF ISOLATED RAT LUNGS

This study tested the hypothesis that material leaking into the airspace from the vasculature during ventilation interferes with surfactant function and contributes to decreases in lung compliance. Rats were euthanized and the lungs were isolated either with or without flushing of the vasculature, followed by mechanical ventilation and analysis of lung compliance and lung lavage analysis. Flushed lungs had higher lung compliance compared to the non-flushed lungs. This was associated with lower protein concentrations and improved surfactant activity. It is concluded that during mechanical ventilation, leakage of proteins results in surfactant inhibition and thereby contribute to decreased lung compliance.

Cat scratch disease: clinical considerations for the pediatric dentist

Cat scratch disease (CSD), caused by Bartonella henselae, is a self-limited chronic lymphadenopathy. It is transmitted commonly by a scratch or bite from cats or kittens. Diagnosis of CSD is often difficult, as it masquerades as other causes of cervical lymphadenopathy or submandibular gland pathology. The purpose of this paper was to report a unique case of a 6-year old male who had close contact with a domestic dog and developed CSD which progressed to suppuration. After treatment with antibiotics was unsuccessful, the patient was taken to the operating room for definitive care. As CSD children may be seen in the pediatric dental office, on awareness of its symptomatology can prevent unnecessary dental intervention and facilitate early treatment.

A role for the family in children's oral health

A large percentage of children from families of low socioeconomic status are still affected by early childhood caries. Barriers to receiving adequate dental care in these populations can include high costs of dental treatment, lack of insurance coverage, an insufficient number of dentists treating these children, as well as parental perceptions and motivation. This paper explores the role of parental perception on oral health and subsequent behaviors and how it ultimately affects the dental care of children. An emphasis is placed on increasing parent education and awareness regarding their children's oral health as well as their own.

Early manifestation of pemphigus vulgaris. A case report

Pemphigus vulgaris (PV) is traditionally viewed as an autoimmune disease of the skin, but it almost always involves the oral cavity. It can be fatal if left untreated and allowed to progress to advanced stages. Early recognition and intervention are essential for a favorable prognosis. Since oral lesions represent an initial manifestation of PV, dentists are in an ideal position to make an early diagnosis and initiate treatment. Here we report a case of PV that was diagnosed in its earliest stage.

Bilateral temporalis muscle hypertrophy: a case report

Although masseteric hypertrophy is common and can be accompanied by temporalis hypertrophy, temporalis hypertrophy by itself is an exceptional finding. A patient, a chronic bruxer who was receiving psychiatric care and psychotherapeutic medications, complained of moderate discomfort and swelling in both temporal areas. It is believed that the patient's long-term stress-related sleeping problem was causing her bruxism. Of great interest was the fact that chronic bruxing had resulted in the rare occurrence of temporalis muscle hypertrophy without a coexisting masseteric hypertrophy.

Bone marrow stem cell and progenitor response to injury

Hematopoietic stem cells represent a long term reservoir of cells to populate blood with multiple formed cells. These hematopoietic stem cells proliferate and mature into lymphoid, erythroid, and myeloid precursor cells, with the balance of these cell populations modulated by major thermal injury, with or without sepsis. Recent studies indicate that thermal injury shifts this balance to favor the monocyte/macrophage lineage at the expense of neutrophil production. The mechanisms for these changes are now being elucidated with the results of clinical importance, because understanding the dynamics of the different precursor pools could be used to identify patients at greater risk for systemic inflammatory sequelae following major thermal injury.

Use of water-miscible retinyl palmitate as markers of chylomicrons gives earlier peak response of plasma retinyl esters compared with oil-soluble retinyl palmitate

Delayed peak response of plasma retinyl esters (RE) relative to plasma triacylglycerols (TAG) and apolipoprotein (Apo) B-48 responses following a fat load supplemented with vitamin A raised doubts about the use of vitamin A to label dietary-derived lipids and lipoproteins. The present study compared the use of water-miscible and oil-soluble retinyl palmitate (RP) as markers of dietary-derived lipoproteins in healthy subjects along with the measurements of postprandial plasma TAG and ApoB-48 responses to investigate whether the delayed peak response observed was due to delayed intestinal output of RE from oil-based solutions. Nine healthy female subjects were given a standard test meal containing a dose (112 mg) of RP in either water-miscible or oil-soluble form in random order, on two separate occasions after a 12 h overnight fast. The results showed that the mean plasma RE concentrations reached a peak significantly later than mean plasma TAG and ApoB-48 concentrations when oil-soluble RP was consumed, whereas plasma RE peaked earlier relative to plasma TAG and ApoB-48 responses when water-miscible RP was used. The results suggested a more rapid absorption with a significantly higher and earlier peak response of plasma RE when water-miscible RP was consumed. This was in contrast to the delayed initial appearance and later sustained higher concentrations of plasma RE during the late postprandial period when oil-soluble RP was consumed. The RE response to the water-miscible RP showed better concordance with plasma TAG response than that of oil-soluble RP.

5,5-Diaryl-2-amino-4-pentenoates as novel, potent, and selective glycine transporter type-2 reuptake inhibitors

A novel series of 5,5-diaryl-2-amino-4-pentenoates was synthesized and found to be potent and selective glycine transporter type-2 reuptake inhibitors.