caphd annual conference common risk factors approach: … · common risk factors approach: the role...

CAPHDANNUALCONFERENCE2017ConferenceCommonRiskFactorsApproach:TheRoleofPolicy,ProgramsandResearchScientificSession–OralPresentations

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FridaySeptember22,20179:15-10:15AMScientificSession(EpicRoom)Dr.HereniaLawrenceDr.AliaElMowafyDr.RobertSchrothDr.MichaelJamieMoellerFridaySeptember22,201711:30AM-12:10PMDr.JamesLeakeStudentBursaryAbstracts(EpicRoom)Ms.KaminiKauraMs.ElizabethChisholmSaturdaySeptember23,20179:00-10:20AMScientificSessions(EpicRoom)Ms.KelliSteinDr.NohaGomaaDr.RachelMartinDr.SonicaSinghalDr.KudiratJimohSaturdaySeptember23,201710:40AM-12:00PMScientificSessions(EpicRoom)Ms.KatrinaFundytusDr.ArwaGazzazDr.RichaShrivastavaDr.LindsayMcLarenDr.MichaelJamieMoellerSaturdaySeptember23,20171:00-2:00PMScientificSessions(EpicRoom)Ms.LeslieParkDr.RobertSchrothMs.PaulaBenbowDr.CynthiaWeijs


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Effectivenessofamulti-prongedinterventionforthepreventionofearlychildhoodcaries(ECC)amongCanadianAboriginalchildrenLawrenceHP1,SchrothRJ2,PeressiniS1,MaarM3,CidroJ4,GordonJ5,BrarR6,BroughtonJR7,JamiesonL8,andtheBabyTeethTalkStudyTeam1FacultyofDentistry,UniversityofToronto2CollegeofDentistryandPediatricsandChildHealth,MaxRadyCollegeofMedicine,RadyFacultyofHealthSciences,UniversityofManitoba3NorthernOntarioSchoolofMedicine4UniversityofWinnipeg5SiouxLookoutFirstNationsHealthAuthority6NorwayHouseCreeNation7DunedinSchoolofMedicine,UniversityofOtago8AdelaideDentalSchool,UniversityofAdelaideObjective:Totestacombinationofevidence-basedECCpreventiveandbehaviouralinterventionsamongAboriginalmothersandtheirchildreninOntarioandManitoba,hypothesizingareductioninECC.Methods:Atbaseline,544pregnantFirstNations(93%)andMétis(7%)womenwererecruitedfortheBabyTeethTalkStudy,acommunity-basedrandomizedcontrolledtrial.Theinterventionincluded:(1)dentalcareforpregnantmothers,(2)oralhealthAnticipatoryGuidance,deliveredbytrainedcommunity-basedresearchersusing(3)MotivationalInterviewing,and(4)fluoridevarnishfortheirchildrenatages6,12and18months.Cariesincidencewasassessedbythemeannumberofprimaryteeth/surfaceswithcavitatedandnon-cavitatedenamel/dentinlesionsorfilled(d1-3ftandd1-3fs)perchildagedtwoyears.Effectivenesswasmeasuredbythedifferenceinleastsquaresmeansbetweentheinterventionandcontrolgroupsandbycomputingthepreventivefraction(PF).Results:Atage2years,344mother-childdyadswereassessed(178interventionand166control).Meand1-3ftwas8.9(95%CI8.1to9.6)forthoseonreserves(n=229)andprevalencewas86.5%.Forthoseincities/towns(n=115)meand1-3ftwas3.1(95%CI2.3to3.8)at58.3%prevalence.Onreserves,meand1-3ftwas7.9(95%CI6.9to9.0)fortheinterventiongroupand9.9(95%CI8.7to11.0)forthecontrols;differencewasstatisticallysignificant(p=0.014)andPFwas20%.PFwashighestforthemeannumberofnon-cavitatedcarioussurfacesat49%(p<0.001)forthoseon-reserve.Theinterventionalsoreducedreferralratesfornon-urgentcareby53%on-reserve(OR=0.47;95%CI0.23to0.95;p=0.036).Conclusion:SignificantcariesreductionatagetwowasnotedinFirstNationschildrenresidingonreservewithintheinterventiongroup.Thefindingssupportscaling-upthemulti-componentinterventiontoincreasethebenefitfortheseCanadianFirstNationschildren.


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Mortalityandmorbidityinoffice-baseddeepsedationandgeneralanaesthesiafordentistryinOntarioEl-MowafyA,QuiñonezC,HaasD,YarascavitchCFacultyofDentistry,UniversityofTorontoObjectives:Toestablishtheprevalenceofmortalityandseriousmorbidityforoffice-basedDS/GAfordentistryinOntariosince1996.Methods:Datawillbecollectedretrospectivelyfromtwosources:1)reviewofcases;and2)surveyofDS/GAproviders.CasereviewwillincludeallseriousinjuryordeathinvolvingDS/GA,sourcedfromtheOfficeoftheChiefCoronerofOntarioandfromtheRoyalCollegeofDentalSurgeonsofOntario(RCDSO)Inquiries,Complaints,andReportsCommittee,DisciplineCommittee,andProfessionalLiabilityProgram.ThesurveyofproviderswillincludeallRCDSOregisteredprovidersofDS/GA.ClinicianswillreportthenumberofDS/GAadministeredin2015andthenumberofyearsinpracticesince1996,whichwastheyearofthelastsuchsurveyofmortality.Foreachclinician,thenumberofDS/GAwillbemultipliedbynumberofpracticeyearstoestimatetheirtotalnumberadministeredfrom1996-2015.CliniciandatawillbepooledtoestablishanoverallnumberofDS/GAadministeredindentalofficesinOntariofrom1996-2015.Prevalencewillbedeterminedbydividingthenumerator(casesofseriousmorbidityormortality)bythedenominator(numberofDS/GAadministered).Results:Theprevalenceofmortalityinthe20-yearperiodfrom1996-2015was4deathsin3,742,068cases.Thisadjuststoamortalityrateof1.07deathsin1millioncases.Theprevalenceofseriousmorbiditywas1casein3,742,068caseswhichadjuststoaseriousmorbidityrateof0.25in1millioncases.Conclusion:ThemortalityratefoundinthisstudywasslightlylowerthanthosepublishedbyearlierstudiesconductedinOntario.Theriskofseriousmorbiditywasfoundtobelowandsimilartootherstudiesexaminingmorbidityinoffice-baseddentalanaesthesia.


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Canearlychildhoodandprenatalfactorspredictwhetherchildrenundergopediatricdentalsurgerytotreatsevereearlychildhoodcaries?SchrothRJ1,2,3,MittermullerB1,2,AuW1,4,MartinH1,2,Hai-SantiagoK5,MartensP1,4,BrownellM1,41UniversityofManitoba2Children’sHospitalResearchInstituteofManitoba3WinnipegRegionalHealthAuthority4ManitobaCentreforHealthPolicy5ManitobaHealthObjectives:Toidentifyprenatal,maternal,andearlychildhoodfactorsassociatedwithpediatricdentalsurgerytotreatS-ECCinManitoba.Methods:Acase-controlstudyusingadministrativehealthcaredataconsideredwhetherfactorscapturedbypopulation-levelhealthandsocialregistriescontainedintheManitobaCentreforHealthPolicydataRepositorywereassociatedwithsurgeryundergeneralanesthesia(GA).Caseswerechildren<72monthsofage,whounderwentaGAforcaries(fromICD-10codingorGAtariff)between2005/06and2010/11.Controlswererandomlychosenfromthegeneralpopulation.Prenatalandbirthcharacteristics(prenatalbenefit,sizeforgestationalage,five-minuteApgar,breastfeedinginitiation,maternalage),childcharacteristics(surgeryyear,sex,age),maternalandfamilycharacteristics(completedhighschool,incomeassistance,area-levelincome,urbanicity,healthregion,isolationandsmoking),anduseofhealthservices(physicianandhospitalvisits)wereconsidered.Adjustedoddsratios(OR)and95%confidenceintervalswerecalculated.Results:16,015children(meanage44.6±12.7months)underwentGA.FemaleshadlowerOR(0.96),whileincreasingagehadhigherOR(1.02).Large-for-gestational-agewasassociatedwithincreasedOR(1.24)whileinitiatingbreastfeedingbeforedischargeand5minuteApgarscoreof0-7hadlowerOR(0.44and0.88,respectively).Youngmaternalageatbirthwasassociatedwithincreasedodds,whilemothers≥30yearsofagehadloweroddsofhavingachildundergoGA(0.86).ChildreninlowerincomequintileshadhigheroddsofaGAaswerethosewhosemotherswereonincomeassistance(1.63),whileurbandwellershadlowerodds(0.47).Childrenwhovisitedtheirphysicianmorehaddecreasedodds(1.0).Allwerestatisticallysignificant.Conclusion:UnderstandingwhichriskfactorsareassociatedwithdentalsurgeryforS-ECCisimportantandmaygivecluesaboutpromisingprenatalandearlychildhoodinterventionsthatmayhelptosetchildrenonthebestpossibleoralhealthtrajectory.


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Toothpain:ImplicationsforCanada’sopioidcrisisMoellerJ,FarmerJ,QuiñonezC

FacultyofDentistry,UniversityofTorontoObjective:TheuseofprescriptionopioidshasincreaseddramaticallyinCanadainrecentdecades,accompaniedbyincreasingratesofopioid-relatedabuseandaddiction.ThishascreatedseriouspublichealthchallengesthroughoutCanada,includinginBritishColumbia.Thisstudyattemptstoidentifywhichsocioeconomicandoralhealth-relatedfactorsareassociatedwithopioidanalgesicuseinthepresenceoftoothpain,andtoquantifythemagnitudeofsocio-economicfactorsasasourceofinequalitiesamongthosewhousedifferenttypesofanalgesicmedicationstorelievetoothpain.Methods:Thisanalysisuseddatafromthe2003CanadianCommunityHealthSurvey(CCHS),whichaskedrespondentsabouttheiruseofspecificanalgesicmedications,includingopioids,andtheirhistoryoftoothpaininthepastmonth.Weusedlogisticregressiontoidentifythepredictivevalueofsocioeconomic,dentalcareutilization,andoralhealth-relatedindicators.TheRelativeIndexofInequality(RII)wascalculatedbyusingincome-derivedriditvaluesintoabinarylogisticregressionmodel.Results:Conventionalanalgesics(suchasaspirinorTylenol)andopioidsweremorelikelytobeusedbythosewhohadexperiencedatoothacheinthepastmonththanthosewhodidnotexperienceatoothache.Theuseofnon-opioidpainkillerstorelievetoothpainwasassociatedwithmorerecentandmorefrequentdentalvisits,betterself-reportedoralhealth,andagreaterincome.Alowerhouseholdincomewasassociatedwithopioidusetorelievetoothpain.TheRIIforrecentopioiduseandconventionalpainkillerusewere2.06(95%CI:1.75–2.37)and0.62(95%CI:0.35–0.91),respectively,amongthosewhoexperiencedrecenttoothpain.Conclusion:Adversesocioeconomicconditionsmayinfluencetheuseofandneedforopioidanalgesicstorelievedentalpain.Programsandpoliciestargetedatimprovingthedentalhealthofthepoormayhelptoreducetheuseofprescriptionopioids,therebynarrowinghealthinequalitieswithinthebroadersociety.


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ContributionsofstructureandagencytotheoralsystemiclinkinanOntariopopulation:across-sectionalanalysisKauraK,FarmerJ,QuiñonezCFacultyofDentistry,UniversityofTorontoObjectives:Todeterminetheextenttowhichstructureandagencyattenuatetherelationshipbetweenoraldiseaseandchronicdisease.Methods:Across-sectional,secondarydataanalysiswasundertakenonanOntariosample(n=23,701)fromtheCanadianCommunityHealthSurvey2013/2014.Aseriesoflogisticregressionmodelswereconstructedtoexaminetheoddsofchronicdiseaseoutcomes,includingarthritis,cancer,diabetes,hypertension,heartdisease,chronicobstructivepulmonarydisorder(COPD),andstroke,amongthosewhoreportedpoororalhealth.UsinganadaptationofCockerham’sHealthLifestyleTheory,logisticregressionmodelswereadjustedsequentiallyforstructural(income,education,jobstatus,ethnicity,countryofbirth)andagency(lifestress,foodsecurity,andoralhealthbehaviours)relatedvariables.Apercentagereductioninoddsratios(OR)wasusedtocalculatetheattenuationbetweenpoororalhealthandchronicdiseaseafteradjustingforstructureandagency.Separateanalyseswereconductedforindividuals35-59yearsoldand60yearsorolder.Results:For35-59yearolds,associationsbetweenpoororalhealthandchronicdiseaseweregreatestforstroke(OR=8.23)andheartdisease(4.00).Theseassociationswerelessforindividuals60yearsorolder,withthegreatestassociationfoundforCOPD(2.75)andheartdisease(2.65).Forallassociationsbetweenoraldiseaseandchronicdiseaseoutcomes,structuralvariablesexplainedoneto48percentoftheassociationbetweenoraldiseaseandchronicdiseaseoutcomesin35-59yearolds,and21to55percentoftheassociationwasfurtherexplainedbyagencyvariables.Thepercentattenuationforindividuals60yearsandolderwas20to55percentforstructuralvariables,and15to65percentforagencyvariables.Conclusion:Poorself-reportedoralhealthisassociatedwithchronicdiseasesandthislinkcanbeexplainedbystructureandagencyrelatedvariables.


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GenderdifferencesindentalvisitingbehavioursinanOntariopopulation:Theroleofeconomic,human,andsocialcapitalChisholmE,FarmerJ,QuiñonezCFacultyofDentistry,UniversityofTorontoObjectives:Toassessthecontributionsofeconomic,human,andsocialcapitalongenderdifferencesindentalvisitingbehavioursinanOntariopopulation.Methods:AsampleofOntarioadultsaged25-74years(n=21,378)fromthe2013-2014CanadianCommunityHealthSurveywasusedtoexaminegenderdifferencesinvisitingthedentistinthepast12monthsandvisitingthedentistonlyforemergencies.Bivariateproportionsandoddsratioswereproducedtodeterminethedistributionandassociationbetweeneconomic(income,insurance,foodsecurity,homeownership),human(yearsofeducation,employment,healthstatus),andsocial(livingarrangements,socialparticipation,senseofbelonging)capitalvariablesandtheseoutcomesformalesandfemales.Fairlienon-lineardecompositionmethodsusingfemale,male,andpooledcoefficientswereperformedtodeterminethecontributionsofeconomic,human,andsocialcapitaltothegendergapindentalvisitingbehaviours.Results:Differencesindentalvisitingbehavioursbetweenmalesandfemalesweregreaterforvisitingthedentistinthepast12months(males=73.1%;females=80.0%)comparedtoonlyvisitingforemergencies(males=19.6%;females13.8%).Theassociationbetweeneconomicandhumancapitalvariablesondentalvisitingbehavioursweregreaterinfemalesthaninmales,withnosubstantialdifferenceinsocialcapitalvariables.Overall,approximately15.0to20.0%ofthegendergapindentalvisitingbehaviourswasexplainedbydifferencesinthedistributionofeconomic,human,andsocialcapitalvariablesbetweenmalesandfemales;thesecontributionswerestatisticallysignificantformosteconomicandhumancapitalvariablesbutonlyforsomesocialcapitalvariables.Conclusion:Findingssuggestthatdifferencesineconomicandhumancapitalcontributestronglytotheexplainedportionofthegendergapindentalvisitingbehaviours.


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Theuseandmisuseofantibioticsindentistry:asystematicreviewSteinK1,SinghalS1,LaljiF2,SutherlandS3,QuiñonezC11FacultyofDentistry,UniversityofToronto2FacultyofPharmaceuticalSciences,UniversityofBritishColumbia3SunnybrookHealthSciencesCentre,SunnybrookHospital

Objectives:Theaimofthissystematicreviewwastoinvestigatetheantibioticprescriptionhabitsofdentists.Weexploredthetype,dose,durationandfrequencyofantibioticsprescribed,thereasonfortheirprescriptionandiftheyareinaccordancewithevidence-basedguidelinesaswellasthechangeabilityofthesepractices.Methods:AsystematicreviewofpublishedliteraturewasconductedbysearchingEMBASE,PubMed,OvidMEDLINE,Scopus,andGoogleScholar.Keysearchtermsincluded:Dentist,Antibiotic,Antimicrobial,Antibacterial,Prophylaxis,Prescription,Pattern,Habits,Knowledge,andPractice.StudieswerequalitativelyassessedusingamodifiedversionoftheCenterforEvidence-BasedMedicine’s(CEBM)checklistforthecriticalappraisalofsurveys.Results:Weidentified1,496studiesbutonly99studieswereconsideredeligibleforreview.Themajorityofstudieswerecross-sectionalsurveysandprescriptionauditsfromvariousgeographicjurisdictions.Moststudiesdidnotassessstatisticalsignificance.Onbalance,theliteraturesuggeststhatdentistsareover-prescribingbothprophylacticandtherapeuticantibiotics.Possiblereasonsforthisinclude:theincreaseduseofantibioticprophylaxiswithsurgicaldentalprocedures,slowadoptionofnewguidelines,externalpressures,alackofknowledge,andclinicalbarriersinthedentaloffice.Conclusion:Publichealthandprofessionally-driveninitiativesshouldbeimplementedtoimprovetheantibioticprescriptionpracticesofdentistsinordertolimittheoveruseofantibioticsindentistry.


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Thebiopsychosocialpathwaytooralhealth:Understandingthesynergisticrolesofincome,stressandimmunityGomaaN1,GlogauerM1,TenenbaumH1,SiddiqiA2,NicolauB3,QuiñonezC11FacultyofDentistry,UniversityofToronto2DallaLanaSchoolofPublicHealth,UniversityofToronto3FacultyofDentistry,McGillUniversityObjectives:Toassesstheextentofassociationbetweensocioeconomicposition(SEP)andoralinnateimmunefunctioninperiodontaldisease(PD),andwhetherself-reportedstressandneuroendocrinestressbiomarkersexplainedthisrelationship.Methods:Utilizingaconveniencesample(n=85),participantsundergoafull-mouthperiodontalexaminationtomeasurepocketdepths,lossofattachmentandbleedingonprobingonsixsitespertooth.SEPisoperationalizedasthehighesthouseholdincomeandlevelofeducation.Stressisassessedpsychometricallyusingvalidatedquestionnaires(perceivedandfinancialstress).Immunoassaysareusedtomeasurecortisol(aneuroendocrinestressbiomarker)inhairsamples.Oralrinsesamplesarecollectedtoassessoralneutrophilcounts(oralinflammatoryload)andfunctionusingapanelofclusterofdifferentiation(CD)markers,followedbymulti-colourflow-cytometryanalysis.Univariateandmultipleregressionstatisticalanalysisareappliedtoassesstheassociationsofinterest.Results:IncomeandeducationaresignificantlyandinverselyassociatedwithPDandthepro-inflammatoryneutrophilmarkersCD66,CD63andCD11b,indicatinghyperactiveneutrophilsthatareconducivetoperiodontaltissuebreakdown.Individualsabovetheincomethreshold(≥$20,000)show3.5timesreductioninoralinflammatoryload(95%CI-4.8to-2.2).HaircortisolandfinancialstressattenuatedtheassociationsbetweenlevelsofhyperactiveneutrophilsandSEP,indicatingtheroleofstressinthisrelationship.Conclusion:Socioeconomicfactorscanbecomebiologicallyembodiedtoimpactoralimmunitythroughstress,thusaffectingthebiologicalprocessestakingpartinoraldisease.Extendingbeyondtraditionalexplanations,thisworkhelpsdevelopanunderstandingofhowthesocialandlivingconditionsimpactperiodontalhealth.


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Wherethemindmeetsthemouth–anintegratedcollaborativeprogramfrom“downunder”MartinR1,CalacheH1,2,HallMJ1,3,RichardsonJ1,KrouskosD1,BettegaA1,Chalmers-RobinsonA1,ChristianB1,41NorthRichmondCommunityHealthLtd2DeakinUniversity3DentalHealthServicesVictoria,4

LaTrobeRuralHealthSchool,LaTrobeUniversityObjectives:Topresentaninnovativeapproachtoprimaryoralhealthcarefocussedonpatientcentredcare,workforcereorientation,healthpromotionandpreventionandtheintegrationoforalandgeneralhealth.Methods:NorthRichmondCommunityHealth(NRCH),aninnerurbancommunityhealthservice,inVictoria,Australia,throughdevelopinganinnovativeoralhealthprogram,hasalsodevelopedaconferenceseriesWheretheMindMeetstheMouthWMMM(www.wheremindmeetsmouth.com.au)toinformtheintegrationoforalhealthandgeneralhealth.In2015theinauguralconferenceexploredsignificantsocialdeterminantsinoralandgeneralhealth,suchassubstanceuse,mentalillnessandfamilyviolence.In2016,thesecondconference,PuttingtheMouthbackintotheBody,examinedcommonriskfactorsfororalandgeneraldiseases,andworkingwithotherhealthprofessionals(eg.doctors,pharmacists,nurses).Results:WMMMhasraisedawarenessamongsthealthprofessionalsoftheimpactoforalhealthongeneralhealthandviceversa.Anationalresearchnetworkcommittedtointegrationoforalandgeneralhealthhasbeenestablished,andamodelofdiabetesmanagementthatincludesoralhealthhasbeenproposedfortrial.ConversationsaboutCare,2018,placestheconsumeratthecentreofinformingintegratedhealthcareprovision.Conclusion:Byrespondingtothecommunityneeds,encouragingdialogueandsharingbetweenconsumers,healthprofessionalsandcarers,itispossibletofindinnovative,cost-effectivewaysofdeliveringprimarypreventiveintegratedoralhealthcare.


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Canadiandentists’antibioticprophylaxisprescribingpractices:findingsfromanationalsurveySinghalS1,2,FarmerJ1,SteinK1,SutherlandS1,3,PatrickD4,5,LaljiF6,SoucyB7,QuiñonezC11FacultyofDentistry,UniversityofToronto2PublicHealthOntario3SunnybrookHealthSciencesCentre4BritishColumbiaCentreforDiseaseControl5SchoolofPopulationandPublicHealth,UniversityofBritishColumbia6FacultyofPharmaceuticalScience,UniversityofBritishColumbia7CanadianDentalAssociationObjectives:Todeterminecurrentantibioticprophylaxis(AP)prescribingpracticesamongCanadiandentistsinregardstothepreventionofinfectiveendocarditis(IE)andprostheticjointinfection.AndtoassessthedegreetowhichprescribingpracticesareinaccordancewiththeAmericanHeartAssociation(AHA)guidelinesandTotalJointReplacementConsensus(TJRC)statement.Methods:Across-sectionalweb-basedsurveywasconductedamongasampleofCanadiandentists(approximately6,300),whohavegrantedconsenttotheCanadianDentalAssociationtobecontactedforanysurveypurposes.A26-itemquestionnairewasdevelopedbasedonthekeyfindingsofasystematicreviewofprescribingpracticesamongdentistsinternationallyandinputfromexpertsinthefield.STATAwasusedfordatacodingandanalysis.Results:Overall,16.4%ofdentists(n=1,035)participatedintheweb-basedsurvey.AlargeproportionofdentistsprescribeAPtopreventIEforinvasiveproceduressuchastoothextraction(79.2%),periodontalsurgery(77.8%),scalingandrootplaning(72.5%),anddentalimplantplacement(71.4%)(aspertheAHAguidelines);however,somealsoprescribefornon-invasiveproceduressuchasclassVrestorations(16.1%),placingrubberdam(13.5%),oradministeringanestheticinjectionsthroughnon-infectedtissue(12.3%)(whichisnotrecommendedbytheAHAguidelines).ThemajorityprescribeAPbeforeinvasivedentalproceduresforpatientswithpreviousinfectiveendocarditis(87.2%)orprostheticheartvalve(81.0%)(againaspertheAHAguidelines);butsomealsoprescribeformitralvalveprolapse(25.4%)(nolongerrecommendedbytheAHAguidelines).Forpatientswithatotaljointprosthesis,themajorityofdentists(9.0%alwaysand57.0%sometimes)administerAPpriortoinvasivedentalprocedures(whichisnotrecommendedbyTJRCstatement).Conclusion:Findingssuggestthat,ingeneral,dentistsdoadheretoexistingguidelines;however,morecompleteadherencetoguidelineswouldsubstantiallyreducetheburdenofdentalantibioticprescribing.Antibioticstewardshipcampaignsindentistry,inpartnershipwithotherorganizedhealthprofessionalgroups,couldsupporthealthpractitionersinreducinginappropriateantibioticprescribing.


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PatternofopioidanalgesicprescriptionforadultsbydentistsinCanadaJimohK1,MatthewsD1,BrillantM1,SketrisI21FacultyofDentistry,DalhousieUniversity2CollegeofPharmacy,DalhousieUniversityObjectives:Between2009and2011,dentistsintheUSAprescribed8to12%ofopioidanalgesicsdispensed.ThepatternofopioidanalgesicprescriptionbydentistsinCanadaisunknown.TheaimofthisstudywastoexaminethepatternofopioidanalgesicsprescriptionbydentistsinNovaScotia(NS),Canadaasmeasuredbydispensationsfromcommunitypharmacies.Methods:Thisstudyusedtheprovincialprescriptionmonitoringprogram’srecordoforalopioidanalgesicsandcombinationsdispensedtopersons16yearsandolderatcommunitypharmaciesthatwereprescribedbydentistsfromJanuary2011toDecember2015.Results:Duringthestudyperiod,morethan70%oflicenseddentistswroteaprescriptionfordispensedopioidanalgesicsbutthiswaslessthan4%ofallprescriptionsfordispensedopioidanalgesicsinNovaScotia.Wefoundthatdentistscomprisedabout17%ofallopioidanalgesicsprescribersandtheyprescribedlessthan0.5%ofthetotalmorphinemilligramequivalent(MMEq)ofopioidanalgesicsdispensedoverthefiveyears.TherewasasignificantdownwardtrendintotalMMEqofdispensedopioidanalgesicsprescribedbydentistsfromabout2.2millionMMEqin2011to1.9millionMMEqin2015(r=-0.97;p=0.006).Conclusion:OpioidprescriptioniscommonamongdentistsinNovaScotia,buttheircontributiontooverallavailabilityofopioidanalgesicsislow.Further,therehasbeenadownwardtrendintotalandmeanMMEqofopioidanalgesicsprescribedbydentists.Futureresearchmayinformhowguidelinesonappropriateprescribingcouldimpactdentists’prescribingpatterns.


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Quantifyingpopulationexposuretocommunitywaterfluoridationoverhistoricaltime:harderthanitlooks?FundytusK1,ThawerS1,2,McLarenL11DepartmentofCommunityHealthSciences,UniversityofCalgary2SchoolofDentistry,UniversityofAlbertaObjectives:Communitywaterfluoridation(CWF)isoneimportantcomponentofamultifactorialapproachtopreventingdentalcaries.RecentinstancesofCanadianmunicipalitiesoptingtodiscontinuethepracticesuggestthatCWFisindecline.However,thisisuncertain,becauseestimatesofCWFexposureareusuallybasedonincompletelistsofcommunities.Ourobjectivewastoascertainwhether,andtheextenttowhich,CWFisdeclininginAlberta,bycomprehensivelyquantifyingpopulationexposuretoCWFovertime,from1950-2016.Methods:WefirstcompiledapartiallistofAlbertacommunitiesandtheirCWFstatusfromvarioussources.Toroundoutthisinformation,weacquiredalistofallmunicipalitiesinAlberta,whichweattemptedtopopulatewithdenominators(populationcountsovertime)andnumerators(fluoridatedornot),1950-2016.Results:TrackingCWFexposureinAlbertaprovedtobealabor-intensiveandcumbersomeprocess.Thetaskdemandedvariousinformationsources:AlbertaMunicipalAffairs;AlbertaEnvironment;municipalitywebsites;utilityproviders,watercommissions,orwaterplantwebsites;Wikipedia;directcontactwithcommunities;andinputfromprovincialdentalpublichealthleaders.Keychallengeswere:(1)municipalitieschangedovertime;(2)incompleteinformationaboutspecialcommunities(e.g.,FirstNations);and(3)datarecordingprocessesandformatchangedovertime.Overall,sinceCWFspansvariousprovincialministries,ourtaskinvolvedcompilinginformationfromindependentsources.OurfindingsaboutthefluctuationofCWFexposureinAlbertafrom1950-2016,arepending.Conclusion:Asidefromitseffectsontoothdecay,CWFisalynchpinforexaminingthelong-termviabilityofauniversalpreventivepolicyindentalpublichealth.Todothat,however,itisnecessarytohaveacomprehensiveandaccuratepictureofpopulationexposureovertime.Ourexperiencehasimplicationsforpublichealthsurveillance,andinparticularelucidatesthevalueofacentralrepositoryforreadilyavailableinformationonCWFexposure.


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Socioeconomicstatus,socialsupportandco-occurrenceofhealth-compromisingbehavioursinadolescentsGazzazA,AleksejūnienėJ

FacultyofDentistry,UniversityofBritishColumbiaObjectives:1)Toassesstheco-occurrencesofhealth-compromisingbehaviours(Co-HCBs)amongasampleofCanadianadolescents;2)todeterminethevariationinCo-HCBsbysocioeconomicstatus(SES);and3)toexaminehowsocialsupportinfluencestherelationshipbetweenSESandCo-HCBs.Methods:Dataon11,13,and15years-oldwereobtainedfromtheHealthBehavioursinSchool-agedChildrenSurvey,collectedintheschoolyear2009-2010.MultipleHealth-compromisingbehaviourswereselectedinthestudy,namelyinfrequenttoothbrushing,highsweetsandsoftdrinkconsumption,smoking,alcoholconsumption,lowfruitandvegetableconsumption,physicalinactivity,andscreentime.Factoranalysiswasconductedtoexploretheco-occurrenceofhealth-compromisingbehaviours.HierarchicallogisticregressionmodelswereusedtoassessthevariationinCo-HCBsbySEScrudelyandadjustedforage,genderandsocialsupport(familyandfriends).Results:Thehealth-compromisingbehavioursclusteredintofourdistinctclustersamongthesample,thefirstclusterreflected‘non-adherencetoprevention’(toothbrushing,fruit/vegetableconsumption),thesecondcluster‘sugarconsumption’(sweets/softdrink),thethirdcluster‘risktaking’(smoking/alcoholconsumption)andthefourthcluster‘sedentarylifestyle’(physicalinactivity/screentime).TheprevalenceofCo-HCBs,indescendingorder,wasasfollows:clusterfour(98.6%),clusterone(59.2%),clusterthree(32.2%)andclustertwo(22.4%).TherewasasignificantdifferencebetweenlowandhighSESgroupsinclustersoneandtwoaftercontrollingfordemographicandsocialsupportvariables.Conclusion:FourCo-HCBswereidentified.SESassociatedwithCo-HCBsonlyinthe‘non-adherencetoprevention’andthe‘sugarconsumption’clusters.SocialsupportdidnotinfluencethelinkbetweenSESandanyoftheCo-HCBs.


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Worldwideuniversity-basedinitiativestowardsbetteraccesstooralhealthcareforruralandremotepopulation-AscopingreviewShrivastavaR1,PowerF2,EmamiE11UniversitédeMontréal2McGillUniversityObjectives:Thepresentscopingreviewmapsthelargebodyofliteraturetoidentifytheglobalacademicprogramsthathavebeendevelopedtoenhancetheoralhealthcareforruralandremotepopulationsandtogiveanoverviewontheiroutcomes.Methods:ArkseyandO’Malley’s5-stagescopingreviewframeworkhassteeredthisreview.Weconductedaliteraturesearchwithdefinedeligibilitycriteriathroughelectronicdatabases,websitesofacademic,professionalandruralandremoteoralhealthcareorganizationaswellasgreyliteraturespanningthetimeintervalfromlate1960’sto2016.Thecharteddatawassummarizedpergeographiccontinentsandreportedbyutilizinganarrativeapproach.Results:Atotalof74citations(67publicationsand7websites)wereselectedforthefinalreview.Thereviewidentified60Universitiestakinginitiativestowardsimprovingtheaccesstooralhealthcareinruralandremotecommunities.Theseinitiativeswereclassifiedintoruralplacementprogramsfordentalstudents,trainingprogramsfornon-dentalhealthcareproviders,trainingofruralschoolteachers,ruraloutreachprograms,e-oralhealthbasedprograms,andphilanthropicorganizationprograms.Theoutcomesreportedprograms’successintheformofpositiveperception,enhancedconfidenceandcompetenceamongdentalstudents,improvedchancesofadoptionofruralpracticesbystudents,improvedoralhealthknowledgeandselfefficacyofnon-dentalhealthcareproviders,improvedruraloralhealthservices,fulfilledoralneeds,andimprovedoralhealthofruralpopulation,andcosteffectiveness.Conclusion:Theresultssuggestthattheseinnovativeprogramscanactasavehicletoaddressdisparitiesinruralandremoteoralhealthcareandmayserveasthespringboardtootheracademicinstitutionsthathavenotyetimplementedsuchprograms.


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AhistoryofdentalpublichealthinAlbertathroughthelensoftheAlbertaPublicHealthAssociation:awindowintotheroleofthenon-profitsectorinpublichealthMcLarenL1,2,LucykK1,MendozaR3,StahnischF1,2,31DepartmentofCommunityHealthSciences,UniversityofCalgary2O’BrienInstituteforPublicHealth,UniversityofCalgary3DepartmentofHistory,UniversityofCalgaryObjectives:Ahallmarkofpublichealthistheinvolvementofdiversesectors,includinggovernment,privatesector,andcivilsociety(i.e.,non-governmentalorganizationsandcitizens).OurobjectivewastoexaminedentalpublichealthhistoryinAlbertathroughthelensofonenon-governmentalorganization,theAlbertaPublicHealthAssociation(APHA).TheAPHAisanon-profitassociationrepresentingpublichealthinAlberta,which,sinceits1943foundation,hasprovidedanindependentvoiceforpublichealthadvocacy,servedasahubforpublichealthworkers,andengagedincollaboration.Weaimedtoshedlightontheroleofthenon-governmentalsectorinpublichealth,usingdentalpublichealthasafocaltopic.Methods:Thispaperissituatedwithinalargerproject,titledPublichealthadvocacy:lessonslearnedfromthehistoryoftheAlbertaPublicHealthAssociation,fundedbytheAlbertaHistoricalResourcesFoundation.DatasourcesincludeAPHAarchivalmaterials(e.g.,annualreports,conferenceprograms,andresolutions),whichwecontextualizedusingpublishedandgreyliterature.Results:WedescribethishistoryusingfiveoverlappingperiodscorrespondingtokeyemphasesindentalpublichealthinAlberta:1940s-1959(introductionanduptakeofcommunitywaterfluoridation),1960-1969(establishmentofdentalhygienetraining),1970-1999(dental-relatedsurveysandresearch),and2000s-present(the“cessationera”offluoridation).AlthoughtheprominenceofdentalpublichealthamongstAPHA’sactivitiesebbedandflowed,itmaintainedastrongpresencethroughresolutionsforadvocacy,anactiveDentalPublicHealthsection,andpresentationsattheannualconference.Conclusion:Asgovernmentinfrastructureforpublichealthdeclines,itbecomesincreasinglyimportanttounderstandandleverageothersectors.Ourfindingssuggestthat,againstachanginggovernmentlandscape,provincialnon-governmentalpublichealthassociationsofferoneavenueformaintainingvisibilityofdentalpublichealth.Thoughpromising,ourfindingsmustbetemperedbyfinancial,ideological,andsocio-culturalchallengesfacingnon-governmentalassociationscontemporarily.


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TherelationshipbetweenoralhealthandincomeinequalityinCanadaMoellerJ,QuiñonezC

FacultyofDentistry,UniversityofTorontoObjectives:Societiesexhibitinghigherlevelsofeconomicinequalityexperiencepoorerhealthoutcomes,andtheproposedpathwaysusedtoexplainthesepatternsarealsorelevanttooralhealth.ThisstudythereforeexaminestherelationshipbetweenthelevelofincomeinequalityandtheoralhealthanddentalcareservicesutilizationofresidentsfromelevenmetropolitanareasintheCanadianprovincesofOntarioandBritishColumbia.Methods:Usingdatafromthe2006Canadiancensusandthe2003CanadianCommunityHealthSurvey(CCHS),wecalculatedPearsoncorrelationcoefficients(r)betweeneachmetropolitanarea'sGinicoefficient(usedasaproxyforincomeinequality),andeacharea'sexperienceofdentalpain,self-reportedoralhealth,anduseofdentalcareservices.Results:Greaterlevelsofincomeinequalityintheselectedmetropolitanareaswererelatedtoanincreasedlikelihoodofresidentsself-reportingtheiroralhealthaspoororfair(r=0.72,p=0.008),andreportingnothavingvisitedadentistwithinthepastyear(r=0.68,p=0.015),orformorethanthreeyears(r=0.78,p=0.003).Therewas,however,nostatisticallysignificantrelationshipbetweenthelevelofincomeinequalityandthelikelihoodrespondentsreportedexperiencingatoothache(r=0.34,p=0.280),toothsensitivity(r=0.11,p=0.734),orjawpain(r=0.25,p=0.433)inthepastmonth.Conclusion:Wefoundastrongassociationbetweenametropolitanarea’slevelofincomeinequalityandthelikelihoodthatrespondentsfromthatmetropolitanareaself-reportpooreroralhealth,orreporthavingnotvisitedadentistforaprolongedperiodoftime.Policiesdesignedtoimprovetheoralhealthofthepopulation,andCanadians’accesstodentalcaregenerally,maythereforeworkbestwhensupportedbypoliciesthatpromotegreatereconomicequalitywithinCanada.


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Socioeconomicinequalitiesinchildren’soralhealth:theroleofallostaticloadParkL,GomaaN,QuiñonezCFacultyofDentistry,UniversityofTorontoObjectives:Toassesstheextentofassociationbetweensocioeconomicposition(SEP)anddentalcariesinchildrenandwhetherallostaticload(ameasureofcumulativestress)explainsthisrelationship.Methods:Weuseddatafromthe2003-2004NationalHealthandNutritionExaminationSurvey(NHANESIV).Childrenwerecategorizedintothreeagegroups(3-7,8-11and12-17years).SEPwasindicatedbyannualhouseholdincomeandpoverty-to-incomeratio.Allostaticloadwasmeasuredasacumulativesumofmetabolicandimmunebiomarkers.Thenumberofdecayed,missing,andfilledteeth(dmft,DMFT)wasusedtomeasuredentalcaries.Covariatesincludedage,sex,race,dentalandmedicalinsuranceandthenumberofdentalvisitsperyear.Weconstructedunivariateandzero-inflatedPoissonregressionmodelstoassesstherelationshipsofinterest.Results:AsignificantinverseassociationwasobservedbetweenSEPandallostaticload.SimilarassociationswereobservedbetweenSEPanddmft,DMFT.Allostaticloadshowedanassociationwithdecayedandmissingteeth,butaninverseassociationwithfilledteeth.AdjustingforallostaticloaddidnotattenuatetheobservedassociationsbetweenSEPanddentalcaries.However,adjustingfordentalinsuranceandthenumberofdentalvisitsfullyattenuatedtheserelationships.Conclusion:Allostaticloadmayplayaroleasanindicatorofpsychosocialstressinchildren’soralhealth.However,behaviouralandhealthsystemfactorswereshowntohaveamoresignificantexplanatoryroleinthisstudy.


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NutritionalstatusofchildrenwithsevereearlychildhoodcariesSchrothRJ1,2,3,PierceA2,DaymontCB4,RoddC1,2,3,MittermullerB1,2,LetellierA1,2,GusminiM1,2,SinghS1,2,GrantC1,MoffattME1,21UniversityofManitoba2Children’sHospitalResearchInstituteofManitoba3WinnipegRegionalHealthAuthority4PennStateHersheyChildren’sHospitalObjectives:Severeearlychildhoodcaries(S-ECC)hasbeenreportedtobeassociatedwithmalnutritionincludinganemia,irondeficiency,irondeficiencyanemia,andvitaminDdeficiency.ThepurposewastodeterminethenutritionalstatusofchildrenwithS-ECConthedayofdentalsurgeryundergeneralanesthesia(GA).Methods:ChildrenwithS-ECCwererecruitedintoalargerprospectivecohortstudyinvestigatingchangesinnutritionalstatusandwell-beingfollowingdentalsurgeryunderGA.Afterprovidinginformedconsent,parentsandcaregiverscompletedabaselinequestionnaireonoralhealth,nutritionalintake,andqualityoflife.ChildrenunderwentavenipuncturewhileunderGA.Bloodanalysismarkersincludedhemoglobin,ferritin,iron,totalironbindingcapacity(TIBC),and25-hydroxyvitaminD(25(OH)D)levels.Statisticalanalysisincludeddescriptive(frequenciesandmeans±StandardDeviation(SD))andbivariate(ttests,ChiSquareanalysis)tests.Apvalue≤0.05wassignificant.Results:150childrenwererecruited.Themeanagewas47.7±14.1monthsand52.0%werefemale.Meanhemoglobin,ferritinandironlevelswere107.5±9.2g/L,27.9±19.2g/L,and12.3±4.3μmol/L,respectively.Overall,53.2%hadanemia,33.8%hadlowferritin,and14.6%hadlowironlevels.Atotalof30.1%wereirondeficientand20.4%hadirondeficiencyanemia(IDA).Femalesweresignificantlymorelikelytohaveanemia(63.2%vs.36.8%,p=0.011),buttherewasnoassociationwithirondeficiencyandIDA.Thosereceivinggovernmentassistancewerenotmorelikelytohaveanemia(p=0.055),irondeficiency(p=0.52),orIDA(p=0.52).Themean25(OH)Dlevelwas50.0±16.8nmol/L(range17-108,median49).Themajority(92.9%)hadsuboptimal25(OH)Dlevels(<75nmol/L),48.9%mettheInstituteofMedicinethresholdforsufficiency(≥50nmol/L),and17.0%weredeficient(<35nmol/L).Conclusion:NutritionalproblemsarecommonamongchildrenwithS-ECC.Primarycareprovidersanddentistsshouldbeawareoftheseoral-systemicrelationships.


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OralhealthinCanada:FillingthegapincareLoveO,BenbowPCDHA-commissionedresearchbyOmniEducationalGroupLtd.CanadianDentalHygienistsAssociationObjectives:OralhealthinequalitiescontinuetopersistinCanada;thosewiththegreatestoralhealthneedshavethegreatestdifficultyaccessingcare.Withtheclosureofthedentaltherapyprogramin2011,theoralhealthneedsofunderservedgroupswillonlyincrease.Thepurposeofthisresearchwastoexploreeducationalpathwaysfordentaltherapyabilitiestosupportcost-effectiveopportunitiestoincreaseaccesstocare.Methods:Apurposefulsamplingwasusedtoinvitekeyinformants(n=71)toparticipateinsemi-structuredinterviewspertainingtodentaltherapyabilities,educationalmodels,enablinganddisablingfactors,andgeneraladviceabouttheideaofamulti-skilledoralhealthproviderincludingthemixofdentalhygieneanddentaltherapyskills.Theresponseratewas74%(n=53).Interviewswerelargelyconductedbytelephonerangingfrom40to90minuteswithanaverageof50minutes.Threecommissionedresearchersanalyzedthedatausinggroundedtheorymethodology.Results:Theframeworkincludedtwostrategies:1)directingattentiontothescopeofdentalhygienepracticetoenhanceaccesstocare,and2)offeringpossibleeducationalmodelsthatincorporatethefullscopeofdentaltherapyabilities.Threeentry-to-practiceeducationalmodelsweredeveloped,twoofwhicharedirectedtoaproviderwithacombinationofdentalhygieneandtherapyabilities,andtheotherdirectedtoaproviderwithdentaltherapyabilities.AfurtheraspectoftheframeworkisdirectedtodeliverystrategiesforIndigenouspeopleandthoselivinginremoteareas.Conclusion:Amulti-skilledproviderwithbothdentaltherapyanddentalhygieneabilitiescouldhelpshiftfromtreatmenttopreventionandhealthpromotionwhilealsohavingcompetencytoprovidebasicrestorativeandsurgicalservices.However,otherelementsneedtobeinplaceforanyeducationalmodeltobeviableandrequiresupportofhealthprofessions,regulators,educatorsandgovernments.


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Onlineparentingforums:drawingimplicationsforcariespreventionfromparents’perspectivesofchildhooddecayandtrustindentalexpertiseWeijsC1,Haines-SaahR1,2,McLarenL1,21DepartmentofCommunityHealthSciences,UniversityofCalgary2O’BrienInstituteforPublicHealth,UniversityofCalgaryObjectives:Onlineparentingforumsareanincreasinglypopularmediumforpeer-to-peerinteractionandadvicearoundhealthissues,includingdentalhealth.Withinthiscontemporarycommunicationlandscape,weareinterestedindiscussionsparentshaveaboutearlychildhoodcaries(ECC),aseriousandprevalenthealthprobleminCanadathaturgentlyneedsimprovedpreventionefforts.Weaimto1)exploreandunderstandhowmothersusevarioussourcesofinformation(experts,family,peers,onlineforums)vis-à-visthetopicsoffluorideandECC;and2)exploreandunderstandonlinemothers’perspectivesabouttrustinparentingforumsrelativetotraditionaltrustedsourcesofexpertise(i.e.,dentalprofessionals).Methods:ParticipantswillberecruitedforfocusgroupsthroughadvertisementsonappropriateonlinevenuesincludingCanadianparentingforumsandFacebookparentinggroups.Focusgroupdiscussionwillcenteronhowmothersuseparentingforums,includingtheirperceptionsoftrustandexpertise,andwhatlevelofinteractionmightbeappropriateforhealthprofessionalsonsuchforums,toenhancepreventionofECC.Datawillbeinductivelycodedandthematicanalysisperformed,incorporatingrelevanttheory.Results:Weexpecttoidentifykeyinsightsandopportunitiesaroundthiscriticaldentalpublichealthissue,toimprovepublichealthcommunicationinthedigitalcontext.FindingswillinformtheroleofpublichealthanddentalprofessionalsinenhancingeffortsatECCpreventioninthedigitalrealm,acrossabroadaudience.Conclusion:Traditionalpublichealthapproachesneedtoaccommodateachangingcommunicationlandscape.Althougha‘digitalgradient’inonlineaccessandusepersists,onlineforumsprovideoneavenuetoreachdiverseaudiences.Thisisimportantbecause1)ECCpreventionisenhancedwhenparentshaveeasyandearlyaccesstorelevantinformation;and2)parentingforumsareimportantsourcesofadviceandsupportaboutchildren’shealth,butnotably,haveanorganic,‘grassroots’appealthatneedstobeunderstoodandrespected.

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