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. 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. 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. 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.
To investigate, among Ontario dentists, (1) self-reported barriers to access to sedation and general anesthesia (GA) services and (2) their current use of sedation and GA. Of Ontario dentists practising, 3001 were randomly selected to complete a 16-question survey by mail or online in 2011. Mixed analysis of variance (ANOVA) followed by independent-sample t tests or 1-way ANOVA evaluated the relation between dentists' views and demographic variables including sex, clinical experience and size of primary practice. Of the participants (n = 1076; 37.9% response rate), 69.7% were male, 84.4% were general practitioners, mean time in practice was 20.6 years (0.5-42 years) and 42.2% were in cities of over 500 000 people. Most dentists (60.2%) provided anesthesia services, although 38.2% indicated lack of training and the belief that there is no patient demand (25.3%) as reasons not to use anesthesia in their offices. Nitrous oxide was used 17.5% of the time for all dental procedures except implants. Barriers to referral of patients for anesthesia services included high costs associated with sedation/GA (72.2%) and patient fear of anesthesia (33.5%). This study identified a perceived lack of patient demand, lack of dentist training, high costs of sedation/GA and patient fear of sedation/GA as primary barriers to use of sedation/GA in Ontario dental practices. The use of various anesthesia modalities is diverse, with 60.2% of dentists providing sedation/GA.
Social media have emerged as valuable tools for dentists to connect with patients; however, their misuse may adversely affect the patient-dentist relationship. Given the trend toward commercialized, cosmetically oriented values within the general population, this study examined how dentists use the LinkedIn social network to promote themselves as cosmetic dentists. It also assessed whether dentists' social media practices align with the professional and ethical obligations of dentistry's social contract, given that cosmetic dentistry is not a recognized specialty. A cross-sectional, convenience sampling method was used to retrieve LinkedIn profiles of dentists from 6 Canadian provinces: British Columbia, Ontario, New Brunswick, Nova Scotia, Prince Edward Island, and Newfoundland and Labrador. Profiles were screened for the term "cosmetic" in the headline, position title and/or company name fields to determine whether dentists promoted themselves as cosmetic dentists or appropriately represented themselves as dentists with skills in cosmetic dentistry. A total of 896 dentists had LinkedIn profiles, of whom 612 were registered with their respective dental regulatory authorities and were eligible for screening, after which 527 profiles were subjected to content analysis. Overall, 469 (89%) of the 527 profiles included in the content analysis did not misrepresent their credentials. Ontario dentists had the highest frequency of misrepresentation, followed by British Columbia and Nova Scotia; for all 3 provinces, misrepresentation was most prevalent in LinkedIn headlines. Profiles of dentists in the other 3 Atlantic provinces (New Brunswick, Newfoundland and Labrador, and Prince Edward Island) had no mentions of the term "cosmetic." No significant relationship was found between the province of practice and the distribution of misrepresentation across the different sections of the LinkedIn profile (p = 0.84). These findings offer insight into the potential of social media to jeopardize dentistry's social contract and highlight the importance of professionalism as dentistry evolves.
Regular dental visits are crucial for maintaining optimal oral health, yet adequate access to oral healthcare services remains a significant challenge for refugee populations, including resettled Syrian refugees in Ontario. This study aimed to assess the factors associated with visiting the dentist only for emergency care among resettled Syrian refugee parents in Ontario. A cross-sectional study of 540 Syrian refugee parents, who had resided in Ontario for an average of four years and had at least one child less than 18 years of age, was conducted from March 2021 to March 2022. Information about visiting the dentist only for emergency reasons was gathered through the question, "How often do you usually visit the dentist?" Respondents who indicated that they visit the dentist only for emergency care were categorized as "yes." Multivariable logistic regression was performed to examine the relationship between each of the sociodemographic-, migration-, and health-related factors with the primary outcome of visiting the dentist only for emergency. 73% of respondents reported visiting the dentist only for emergencies. Factors associated with emergency dental visits included dental insurance, number of children, and self-rated oral health. Individuals without dental insurance, higher number of children, and poorer self-rated oral health were more likely to seek emergency dental care. These findings highlight the barriers to regular dental visits among Syrian refugees in Ontario and underscore the need for more inclusive and accessible dental care services for such vulnerable population to enhance their oral health outcomes.
To examine mouthguard usage, hygiene practices, and oral health status of youth ice hockey players in Ontario. Cross-sectional survey study. Ontario, Canada; recruitment conducted online in collaboration with the Ontario Minor Hockey Association. Youth ice hockey players in Ontario who reported mouthguard use. Participants voluntarily completed an anonymous online questionnaire administered using REDCap. Frequency and consistency of mouthguard use, mouthguard cleaning practices, receipt of hygiene instructions, oral hygiene behaviors, and self-reported caries experience and oral health status. Complete responses were obtained from 214 players using mouthguards. Approximately 47% reported wearing mouthguards during both games and practices, with majority (59%) wearing boil-and-bite type. Among custom mouthguard users, 64% reported never receiving care instructions from a dentist, whereas 29% of stock or boil-and-bite users reported no manufacturer guidance. Overall, 52% reported cleaning their mouthguards, and 38% of these did so after every game or practice. Most participants brushed twice daily (71%), whereas fewer flossed daily (28%). Consistent mouthguard use was associated with significantly lower odds of self-reported caries (OR = 0.49; 95% CI: 0.28-0.85). Higher motivation toward oral health was associated with positive self-rated oral health (OR = 3.45; 95% CI: 1.20-9.97). Youth ice hockey players in Ontario demonstrated inconsistent mouthguard use and suboptimal hygiene practices, compounded by limited guidance from dental professionals and manufacturers. Improved education, clinical engagement, and policy initiatives are needed to enhance mouthguard effectiveness and oral health outcomes among youth athletes.
Dentists serve a crucial role in managing treatment complications for patients with head and neck cancer, including post-radiation caries and oral infection. To date, dental services for head and neck cancer patients in Ontario, Canada have not been well characterized and considerable disparities in allocation, availability, and funding are thought to exist. The current study aims to describe and assess the provision of dental services for head and neck cancer patients in Ontario. A mixed methods scoping assessment was conducted. A purposive sample of dentist-in-chiefs at each of Ontario's 9 designated head and neck cancer centres (tertiary centres which meet provincially-set quality and safety standards) was invited to participate. Participants completed a 36-item online survey and 60-minute semi-structured interview which explored perceptions of dental services for head and neck cancer patients at their respective centres, including strengths, gaps, and inequities. If a centre did not have a dentist-in-chief, an alternative stakeholder who was knowledgeable on that centre's dental services participated instead. Thematic analysis of the interview data was completed using a mixed deductive-inductive approach. Survey questionnaires were completed at 7 of 9 designated centres. A publicly funded dental clinic was present at 5 centres, but only 2 centres provided automatic dental assessment for all patients. Survey data from 2 centres were not captured due to these centres' lack of active dental services. Qualitative interviews were conducted at 9 of 9 designated centres and elicited 3 themes: (1) lack of financial resources; (2) heterogeneity in dentistry care provision; and (3) gaps in the continuity of care. Participants noted concerning under-resourcing and limitations/restrictions in funding for dental services across Ontario, resulting in worse health outcomes for vulnerable patients. Extensive advocacy efforts by champions of dental services who have sought to mitigate current disparities in dentistry care were also described. Inequities exist in the provision of dental services for head and neck cancer patients in Ontario. Data from the current study will broaden the foundation for evidence-based decision-making on the allocation and funding of dental services by government health care agencies.
Tele-dentistry can be useful for dental caries screening of children, especially in lower-middle-income countries (LMICs). To evaluate the diagnostic accuracy of mobile phone photographs taken by a community health worker (CHW) for caries detection in Iran. Children aged 6-12 years were visually examined by a paediatric dentist. Following dental examinations, intraoral photographs were taken by a trained CHW. Two remote dentists assessed intraoral photographs for dental caries. Diagnostic accuracy of tele-dentistry for caries detection was evaluated. In addition, the questionnaire about oral health and parents' views towards tele-dentistry was prepared. One hundred thirty-one children aged 8.74 ± 1.62 years participated. The caries prevalence was 30% for the whole dentition. Tele-dentistry demonstrated high accuracy, with a sensitivity exceeding 80% and specificity exceeding 90%. The inter-rater reliability for remote dentists' assessments to the gold standard dental examination ranged from substantial to almost perfect (kappa: 75%-93%). Additionally, 80% of parents whose children participated in this study had positive views towards tele-dentistry. Tele-dentistry was shown to be an alternative approach to clinical examinations for caries detection among school children. Employing non-dental care professionals in tele-dentistry has been emerged as a reliable and cost-effective approach, especially in LMICs.
Dentists experience barriers of applying knowledge at point of care. In recent years, integrated knowledge translation (IKT) efforts, such as dental practice research networks, have been established in the US and other countries to overcome the potential barriers to dental clinicians being involved in research. In Canada, there is no formal network. The objective of this study was to explore the perceptions of dental clinicians and academics in building a network in Ontario that would encourage research collaboration. Semi-structured interviews were conducted to collect data from dental clinicians and academics in Ontario dental schools. Purposeful sampling was used to recruit participants from the Faculty of Dentistry at the University of Toronto and Schulich School of Dentistry at Western University. Interviews were conducted via Zoom meetings between July and November 2023. Interviews were recorded, de-identified, transcribed, and analyzed using thematic analysis. Strategies to promote rigour were applied throughout the research process. Twenty-six interviews were conducted (twelve dental clinicians and fourteen academics). Most participants described a divide impacting many aspects of oral health research. This divide appeared to be originating from historical cultural norms rooted in the development of organized dentistry in Ontario, current financial strains faced by dentists, and misalignment of values that resulted in miscommunications between dental clinicians and academics. Despite the divide, there appeared to be a strong desire among participants to "bridge the divide". Suggestions included starting a small network of interested individuals, enforcing existing collaborations within the universities, identifying champions in organized dentistry to advocate for establishing a formal network in Ontario, and exploring opportunities to support such a network in Canada. Despite the divide between dental clinicians and academics in oral health research, there appeared to be a strong desire to bridge the divide. This study is novel in that it reports dental clinicians' and academics' perceptions and experiences with IKT partnerships in dentistry. We offer recommendations for oral health professional leaders to build a new network.
This study aims to determine the reasons for disciplinary action, the consequences and any associations with demographic factors for Canadian dentists. Publicly available regulatory body disciplinary action cases from 10 Canadian provinces were coded. Demographic factors were also coded. There were 344 dentist cases from five provinces between January 2010 and December 2020. The rate of disciplinary action was low (1.38 cases/1,000 practitioners/year). Clinical incompetence was the most common category of disciplinary action, followed by professional misconduct and dishonest business practices. Male dentists were overrepresented in the disciplinary action cases compared to the rest of the workforce. This study is the first, to our knowledge, to describe the outcomes of regulatory body disciplinary action for Canadian dentists. Cette étude vise à déterminer les raisons pour lesquelles sont prises des mesures disciplinaires envers les dentistes canadiens et les conséquences qui en résultent ainsi que toute association avec des facteurs démographiques. Les cas, publiquement accessibles, de sanctions disciplinaires d'organismes de réglementation de 10 provinces canadiennes ont été codés. Les facteurs démographiques ont également été codés. Il y a eu 344 cas de sanctions disciplinaires envers des dentistes provenant de cinq provinces entre janvier 2010 et décembre 2020. Le taux de mesures disciplinaires est faible (1,38 cas/1 000 dentistes/an). L'incompétence clinique constitue la catégorie la plus courante liée aux mesures disciplinaires, suivie des fautes professionnelles et des pratiques commerciales malhonnêtes. Les hommes dentistes sont surreprésentés dans les cas de mesures discipli­naires par rapport au reste de la main-d'oeuvre. Cette étude est la première, à notre connaissance, à décrire les résultats des mesures disciplinaires prises par les organismes de réglementation à l'encontre des dentistes canadiens.
To develop a Core Outcome Set suitable for adults and children for use in studies of Dental Behaviour Support (DBS) techniques, including non-pharmacological DBS, sedation and General Anaesthesia research. Two systematic reviews generated a preliminary list of candidate outcomes that were shared with Key Stakeholders (KSG) and Public Patient Involvement (PPI) groups, who shortlisted outcomes for further exploration. Patients, carers, clinicians, and researchers were invited to participate in a Delphi panel. A modified e-Delphi was used to generate prioritisation and consensus across outcomes. A subsequent series of consensus meetings with panellists, patient groups and professional stakeholder groups determined the final outcomes within the COS. Twenty-three candidate outcomes were rated by 88 panellists in Round 1. The attrition rate between Rounds 1 and 3 was 21.6%. Thirty-four to 32 panellists attended the consensus meetings. The BeSiDe core outcome set for Dental Behaviour Support consisted of nine outcomes: acceptability, adverse effect, anxiety, behavioural response, cost, pain, therapeutic alliance, time and treatment completion. An additional subset of three core outcomes for use in pharmacological DBS studies was agreed upon: recovery, sedation effect and physiological monitoring. Each outcome was presented with a plain-language label and description to support consistent interpretation across stakeholders. A core outcome set to be used across all DBS studies was produced covering both adults and children, with supplementary additional outcomes available to use in studies exploring only pharmacological DBS approaches. The list is for use in research, though there is obvious transferability to clinical practice. COMET Initiative database (Study ID: 2101), registered September 2022.
Patients with special care needs (developmental disabilities) have unique and complex needs regarding their oral health and care. This qualitative study aimed to identify the experiences, preferences and challenges of dentists and caregivers regarding behavior guidance techniques for dental care in persons with special care needs. Relying on qualitative description as articulated by Sandelowski, we conducted telephone interviews with a purposeful sample of five special care dentists and seven caregivers. We analyzed the data using thematic analysis. Four themes were highlighted: (1) Neither pharmacological or non-pharmacological behavior guidance techniques was universally suitable, (2) A patient-centered approach was critical, (3) The dental environment triggered patients' behaviors and anxiety levels, (4) There was more demand for, than supply of, qualified dentists to treat patients with special care needs. Persons with special care needs are heterogeneous and respond to various behavioral techniques required to deliver their treatment. Behavior guidance planning should be negotiated carefully with patients and caregivers and then individualized based on patients' capabilities and needs for treatment. The necessity to manage complex behaviors has contributed to the limitation of access to dental care for persons with special care needs. Dentistry as a profession has the obligation to uphold the social contract and meet its responsibility to the dental care needs of this population.
Despite guideline recommendations discouraging routine antibiotic use for localized endodontic infections, antibiotics continue to be prescribed after non-surgical root canal therapy (RCT). This study evaluated antibiotic prescribing patterns among general dentists and endodontists across a range of practice settings in the United States National Dental Practice-Based Research Network. A total of 153 dentists enrolled 1,723 patients requiring RCT. Dentists collected clinical, radiographic, and demographic data. The primary outcome was whether systemic antibiotics were prescribed after treatment. Generalized estimating equations were used to assess associations between antibiotic prescribing patterns and dentist, patient, and clinical characteristics. A secondary analysis was restricted to teeth with vital pulp and no swelling-clinical situations where antibiotics are not indicated. Antibiotics were prescribed to 322 (19%) patients. In adjusted models, patients with teeth with tenderness to palpation (OR=1.40; p=.046) or apical periodontitis (OR=1.56; p=.004) were more likely to receive antibiotics. Dentists younger than 45 years (OR=0.47; p=.02), non-Hispanic White (OR=0.40; p=.01), and those affiliated with large group or academic practices (OR=0.25; p=.007) were significantly less likely to prescribe antibiotics. Patients with only a high school education or racial-ethnic minority backgrounds were more frequently prescribed antibiotics (p<.05). Nearly one in five patients undergoing RCT were prescribed antibiotics, often without clear clinical indications. Prescribing varied by dentist, patient, and clinical characteristics. These findings highlight persistent gaps between guideline-based recommendations and real-world practice, underscoring the need for targeted antibiotic stewardship interventions.
Antibiotic resistance is a growing threat to public health. Improper use of antibiotics can potentially lead to previously curable infections becoming unmanageable. Rampant unnecessary use of antibiotics is a serious problem within developing countries like Pakistan, and dental practices can often be traced as a major cause. Through the widespread implementation of antibiotic stewardship programs (ASP), medical and dental practitioners can be guided to appropriate prescribing practices and better patient education. To gauge current antimicrobial prescribing practices of dentists and their engagement with ASPs. 13 dental practitioners were interviewed using a semi-structured interview template. Interviews were recorded, transcribed, and subjected to thematic analysis. The subjects were selected from various dental hospitals within Punjab, using a convenient sampling approach. The sample size was based on the point of saturation of emerging themes. Many factors were highlighted as causative for the current state of misinformation regarding antibiotic prescription practices among dental practitioners and patients. Awareness regarding ASP was severely lacking; however, most participants showed a positive perception regarding ASP and their impact. Institutional support and the need for implementation of such programs within the educational curriculum were noted as important steps for ASP implementation within dental hospitals of Pakistan. This study found that knowledge regarding ASP was insufficient among dental practitioners, owing to a lack of institutional policies and awareness among the practitioners. The outcome of the lack of these programs and misinformation among both patients and dentists is widely contributing to the current state of antibiotic resistance in Pakistan. Die Antibiotikaresistenz stellt eine wachsende Bedrohung für die öffentliche Gesundheit dar. Der unsachgemäße Einsatz von Antibiotika kann dazu führen, dass zuvor heilbare Infektionen unbeherrschbar werden. Der übermäßige, unnötige Einsatz von Antibiotika ist in Entwicklungsländern wie Pakistan ein ernstes Problem, und die zahnärztliche Praxis kann oft als eine der Hauptursachen angesehen werden. Durch die flächendeckende Einführung von Antibiotic-Stewardship-Programmen (ASP) können Ärzte und Zahnärzte zu einer angemessenen Verschreibungspraxis und einer besseren Patientenaufklärung angeleitet werden. Beurteilung der derzeitigen Verschreibungspraxis von antimikrobiellen Mitteln durch Zahnärzte und deren Engagement für ASP. 13 Zahnärzte wurden anhand einer halbstrukturierten Interviewvorlage befragt. Die Interviews wurden aufgezeichnet, transkribiert und thematisch analysiert. Die Probanden wurden aus verschiedenen Zahnkliniken im Punjab nach dem Prinzip der Zufallsstichprobe ausgewählt. Die Stichprobengröße wurde auf der Grundlage des Sättigungsgrades der sich ergebenden Themen festgelegt. Viele Faktoren wurden als Ursache für den gegenwärtigen Zustand der Fehlinformation in Bezug auf die Verschreibungspraxis von Antibiotika unter Zahnärzten und Patienten hervorgehoben. Das Bewusstsein für ASP war sehr schwach ausgeprägt; die meisten Teilnehmer zeigten jedoch eine positive Einstellung zu ASP und deren Auswirkungen. Die institutionelle Unterstützung und die Notwendigkeit der Implementierung solcher Programme in den Lehrplan wurden als wichtige Schritte für die Implementierung von ASP in pakistanischen Zahnkliniken genannt. Die Studie ergab, dass das Wissen über ASP bei Zahnärzten unzureichend ist, was auf fehlende institutionelle Maßnahmen und mangelndes Bewusstsein bei den Ärzten zurückzuführen ist. Das Fehlen dieser Programme und die Fehlinformation sowohl der Patienten als auch der Zahnärzte tragen in hohem Maße zur derzeitigen Situation der Antibiotikaresistenz in Pakistan bei.
Patients with Huntington's Disease (HD) seeking dental care often present with poor oral health. Dentists often report that few protocols exist and there is a lack of understanding on how to manage these patients in the dental office. The aim of this review is to discuss the etiology and pathophysiology, clinical presentation, and management of this condition primarily from the dental perspective. A detailed literature review was conducted including articles searched on PubMed and Google Scholar using relevant keywords. Inclusion criteria prioritized studies based on relevance to oral care and HD with topics including caregiver-assisted oral hygiene, fluoride, dental preventative approaches, and case studies. Research reveals the significant oral health issues patients with HD suffer from including dysphagia, xerostomia, and a high caries risk. Studies illustrate the need for tailored care emphasizing long term treatment planning, preventive, and clinically relevant approaches. This review presents the importance of a proactive, multidisciplinary strategy to dental care in HD patients. Early preventive strategies can greatly postpone the decline of oral health in this population. Future studies should focus on a conclusive dental care guideline, caregiver education initiatives, and improving access to care in this patient population.
Information regarding differences between general dentists (GDs) and endodontists in their daily practices is limited. The aim of this prospective cohort clinical study was to compare the details of clinical approaches of GDs and endodontists when performing non-surgical root canal treatments (NSRCT). The study was conducted among 153 practitioners (104 GDs and 49 endodontists) in the National Dental Practice-Based Research Network in the United States who performed NSRCT on at least one of 1705 patients. Practitioners completed postoperative forms to document procedural data. Bivariate and multivariable analyses were performed to adjust for the potential effect of confounders. Two different multivariable models were tested to eliminate the impact of unstable variables. Overall, after adjusting for the tooth type, multivariable models showed that endodontists were significantly more likely than GDs to use magnifications >5×, rubber dam isolation, NaOCl irrigation, EDTA or H2O2 or chlorhexidine irrigations, ultrasonic/sonic irrigant activation, electronic apex locator and radiographs for working length determination, warm vertical condensation and lateral condensation techniques for obturation, report adequately dense obturation without voids, and to complete NSRCT in a single visit (p ≤ .01). Endodontists were significantly less likely to use lubricants and to report unacceptable obturation length (≥2 mm short or extended beyond the radiographic apex) (p ≤ .01). Based on actual clinical data, this study observed major differences between GDs and endodontists in their clinical approaches when performing NSRCTs. Further studies are needed to assess the effect of these differences on the outcome of NSRCTs.
This study aimed to identify dentist, patient, and pre-treatment clinical characteristics associated with local anaesthesia failure during non-surgical endodontic treatment. Data were collected from the National Dental Practice-Based Research Network study entitled "Predicting Outcomes of Root Canal Treatment (PREDICT)", which included 1723 patients. Local anaesthesia failure during treatment was defined as patient-reported pain of 3 or greater on a 0-to-10-point scale. Pre-treatment factors included patient demographics, psychosocial constructs, and pre-treatment clinical findings (e.g., abnormal sensitivity to cold, biting, percussion, palpation). Characteristics with p < 0.1 (after adjustment for clustering with generalized estimating equations) were entered into a model to identify independent associations with failed anaesthesia, and odds ratios were calculated to measure the strength of these associations. A total of 16% of patients reported intra-operative local anaesthesia failure. Failure was associated with patient age < 55 years (p = 0.05), dental treatment fear ("some" to "extremely afraid") (p = 0.005), mandibular teeth (p = 0.005), and greater numbers of abnormal pre-treatment diagnostic findings (p = 0.02). Protective factors included having treatment done by an endodontist (p = 0.002), and the patient being non-Hispanic White (p = 0.007). Comparisons of local anaesthetic techniques by dentist type (general dentist vs. endodontist) showed statistically significant differences in the bivariate analysis, but none remained significant after adjustment for clustering of patients within dentist. Local anaesthesia failed in 16% of cases. Pre-treatment fear was the only significant psychosocial predictor of intra-operative pain. Failure was more likely in mandibular teeth and when multiple abnormal tests were present pre-operatively (e.g., cold sensitivity, percussion tenderness). Younger patients reported more pain, and endodontists had lower pain rates than general dentists.
Canada has been hosting Syrian refugees since early 2015. Almost half of the Syrian refugee population lives in Ontario, with dental health being at the top of the list of important immediate needs. The objective of the study was to evaluate self-rated oral health and its associated factors among Syrian refugee parents residing in Ontario. This was a cross-sectional study where 540 Syrian refugee parents, residing in Ontario and with at least one child less than 18 years of age, were interviewed. Information about self-rated oral health was collected based on the question "In general, how would you rate the health of your teeth and mouth?" with answers ranging from 1 representing "excellent" and 5 representing "very poor." Multiple linear regression analysis was performed to assess the independent relationship between each of the sociodemographic-, migration-, health-, dental-related factors, and self-rated oral health. The overall prevalence of poor and very poor self-rated oral health was 43.5%. The results showed that the presence of dental health insurance, private sponsorship, improved physical and mental health, and regular visits to the dentist were factors related to improved oral health. Discussion. To achieve better oral health outcomes among refugee populations, including Syrian refugees, efforts should be focused on improving dental care and dental insurance for vulnerable populations.
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Dental behaviour support (DBS) describes all specific techniques practiced to support patients in their experience of professional oral healthcare. DBS is roughly synonymous with behaviour management, which is an outdated concept. There is no agreed terminology to specify the techniques used to support patients who receive dental care. This lack of specificity may lead to imprecision in describing, understanding, teaching, evaluating and implementing behaviour support techniques in dentistry. Therefore, this e-Delphi study aimed to develop a list of agreed labels and descriptions of DBS techniques used in dentistry and sort them according to underlying principles of behaviour. Following a registered protocol, a modified e-Delphi study was applied over two rounds with a final consensus meeting. The threshold of consensus was set a priori at 75%. Agreed techniques were then categorized by four coders, according to behavioural learning theory, to sort techniques according to their mechanism of action. The panel (n = 35) agreed on 42 DBS techniques from a total of 63 candidate labels and descriptions. Complete agreement was achieved regarding all labels and descriptions, while agreement was not achieved regarding distinctiveness for 17 techniques. In exploring underlying principles of learning, it became clear that multiple and differing principles may apply depending on the specific context and procedure in which the technique may be applied. Experts agreed on what each DBS technique is, what label to use, and their description, but were less likely to agree on what distinguishes one technique from another. All techniques were describable but not comprehensively categorizable according to principles of learning. While objective consistency was not attained, greater clarity and consistency now exists. The resulting list of agreed terminology marks a significant foundation for future efforts towards understanding DBS techniques in research, education and clinical care.
The widespread use of digital imaging can now be combined with additive three-dimensional (3D) printing, changing traditional clinical dentistry, especially in challenging cases. Visualizing the bone and soft tissue anatomy using computed tomography (CT) and intraoral scanning generated digital files that can be further processed for 3D printing. Among the popular 3D printing approaches, fused filament fabrication (FFF) and stereolithography (SLA) are broadly used due to their rapid production, precision, and ease of use. The current case series outlines three challenging clinical scenarios where a combination of CT and intraoral scans were utilized for digital planning. FFF multicolor anatomical models and SLA surgical guides were produced using 3D printing technology. The first case outlines the utility of this approach to place the optimal surgical window at the lateral sinus lift with anticipated difficult access. In the second case, distinct sites for autogenous bone harvesting were identified while preserving critical adjacent structures with surgical simulation. Finally, the third case outlines this strategy for optimal surgical access to expose an impacted second premolar. Both clinicians and patients benefited from the educational use of FFF‒SLA 3D-printed models, and all cases were successfully treated without complications. These cases demonstrate the significant utility of these digital technologies and rapid prototyping for improved pre-surgical planning, patient motivation, and didactic training that contribute to improved quality of clinical care. To the authors' knowledge, this is the first case reports employing both fused filament fabrication (FFF) and stereolithography (SLA) printing techniques in dental surgery. This innovative approach addresses a range of clinically challenging scenarios presented in this report. Computed tomography (CT) and intraoral scanning are essential for three-dimensional (3D) reconstruction. Specialized software is required to design the guide with precise specifications, and FFF and SLA printers are necessary for fabricating the 3D model. Three-dimensional reconstruction can be time-intensive, particularly when manual segmentation is necessary. Acquiring proficiency in the software may require additional time, and multicolor 3D printing also demands extended printing durations. This study explores how digital imaging and three-dimensional (3D) printing can improve complex dental surgeries. Using tools such as computed tomography scans and intraoral scans, dentists can create detailed 3D models of a patient's bone and soft tissues. Two popular 3D printing methods-fused-filament fabrication (FFF) and stereolithography (SLA)-were used to make these models, which help with surgical planning. The study includes three cases where 3D-printed models were used to prepare for difficult dental procedures. In the first case, the 3D model helped plan the best way to access a difficult area for sinus surgery. The second case used the model to identify the best sites for bone harvesting. The third case used the model to plan how to safely expose an impacted tooth. These helped both the dentist and the patient understand the procedure better. All surgeries were successful, demonstrating how FFF and SLA 3D printing enhance planning, making advanced dental surgeries safer and more efficient.