There has been a great deal of research describing the risk factors and determinants that impact on the health and well being of Aboriginal Canadians that has revealed tremendous oral health inequalities between these groups and their non-Aboriginal counterparts. Building on this research, culturally-based preventive interventions are now needed to address the significantly higher rates of oral disease among Aboriginals across Canada. Included in this article is an overview of oral health interventions targeted at First Nations, Inuit and Métis peoples in Canada, offering a glimpse of some of the innovative research initiatives originating from within Aboriginal communities that are being used to develop new health programmes and policies to improve the health and well being of this population. Particular emphasis is placed upon community-based and national initiatives to prevent dental caries in young Indigenous children that begin by improving the oral and general health of young women and mothers through pre-conception interventions. In addition, recently developed and implemented national First Nations- and Inuit-led oral health surveys are set to provide new evidence to inform future programmes and policy initiatives that will help to reduce dental disease burden and inequalities affecting Indigenous Canadians.
This ecologic study compared school-level oral health outcomes in schools participating in Ontario's "Healthy Schools" program and nonparticipating schools in York Region, Ontario in 2007-2008 and examined the effect of neighbourhood socio-economic factors.
School-aggregated data were obtained for all 243 elementary schools. York Region Public Health Unit provided oral health data from school dental screenings. We obtained information about schools participating in the Ontario's "Healthy Schools" program from publicly accessible websites. Neighbourhood socio-economic data based on school postcodes were extracted from Statistics Canada (2006) census databases. School oral health outcomes included the percentage of children in each school requiring preventive care, non-urgent dental treatment, urgent dental treatment and children with > or = two decayed teeth.
One hundred and six elementary schools (42%) participated in Ontario's "Healthy Schools" program in 2007-2008. Schools participating in the "Healthy Schools" program had a significantly lower percentage of children with > or = two decayed teeth (p or = two decayed teeth than in low-income non-participating schools (p
To test the hypothesis that, controlling for age, Canadians with Down syndrome (DS) have dental care that is different to that of their siblings without DS.
A cross-sectional survey of parents of children with DS among members of the Canadian Down Syndrome Society (CDSS), using a validated questionnaire. Parents were asked to complete two versions of the questionnaire: one for their child with DS and another for the sibling closest in age without DS. A total of 2327 questionnaires were distributed; 1221 questionnaires for people with DS and 950 for siblings without DS were returned. A paired analysis (McNemar test) of dental care indicators was performed on data from 938 family pairs, stratifying for age.
For all the dental care indicators and age groups, many respondents indicated the same behaviours or experiences in their child with DS and a sibling without DS. However, depending on the particular form of dental care and the age group, 0-47% of families reported discordant dental care experiences for their child with DS and a sibling without DS. The greatest differences were observed for yearly consults (P = 0.029), restorations (P
The purpose of this study was to investigate the prevalence of early childhood caries (ECC) in a population of maltreated children in Toronto, Ontario, Canada.
The sample consisted of preschool-aged children (2 to 6 years) admitted to the care of the Children's Aid Society of Toronto (CAST) between 1991 and 2004. Data were collected by reviewing the dental and social workers' records of CAST ECC was determined using the decayed, missing, and filled deciduous teeth (dmft) index. The type and severity of maltreatment were obtained from the Eligibility Spectrum.
The study included 66 children: 37 (56 percent) boys and 29 (44 percent) girls, with an average age of 4.1 years [standard deviation (SD) = 1.2]. Four (6 percent) children had evidence of dental injury, and none had teeth filled or extracted as a result of decay ECC was observed in 58 percent of the abused children. Of these, the mean decayed teeth ("dt") value was 5.63 (SD = 4.17, n = 38) and 3.24 (SD= 4.21) for the whole sample (n = 66). The proportion of children with untreated caries was 57 percent among "neglected" children (n = 53) and 62 percent in physically/sexually abused cases (n = 13). Logistic regression revealed that children in permanent CAST care and those in its care more than once were significantly less likely to have experienced caries.
Abused and neglected young children had higher levels of tooth decay than the general population of 5-year-olds in Toronto (30 percent prevalence, mean dt= 0.42, SD = 1.20, n = 3185). However, this study did not find any difference in ECC prevalence between children with different types of maltreatment. The study did find that CAST services had a protective effect on children's oral health, which supports the recommendation that child protection services should investigate possible dental neglect in physical/sexual abuse and neglect cases.
The Canadian Dental Association (CDA) and the American Academy of Pediatric Dentistry (AAPD) recommend that children visit the dentist by 12 months of age.
To report on how Manitoba"s general dental practitioners and pediatric dentists manage oral health in early childhood.
Mailed surveys that used the modified survey methods of Dillman were sent to 390 Manitoban general dental practitioners and pediatric dentists. The sampling frame was the Manitoba Dental Association"s Membership Registry, but only those dentists who consented to the release of their mailing information were contacted. Survey data were analyzed with Number Cruncher Statistical Software (NCSS 2007). Descriptive statistics, bivariate analyses and multiple regression analyses were done. A p value of
To qualitatively analyse how integration of dental service in long-term care (LTC) impacts residents and their oral health.
Few studies have attempted to merge inductive and deductive data to clarify the significance of the complex psychosocial environment in LTC facilities. Understanding the subjective oral health experience of LTC residents in their social setting is key to uncovering behavioural patterns that may be limiting the oral care provided to LTC residents.
A cross-sectional study was performed involving 61 residents in three Ontario LTC facilities. Observations and reflective notes were recorded during open-ended interviews using a structured questionnaire to stimulate conversation topics. This ensured that each resident received the same prompting during the interview process. Inductive analysis was used to identify common patterns and themes within field notes and transcriptions.
The major themes identified included oral hygiene, oral discomfort, general health, appearance, dental access, and denture related issues. Oral hygiene and discomfort were the dominating categories within the facilities.
Two of the three LTC centres identified in this study failed to provide appropriate oral care for their residents. Future research needs to be directed at prospective studies assessing the effect of oral health education and mandatory dental examinations o entry within LTC centres utilising qualitative and quantitative analyses.
The 4- to 6-yr outcome of initial (first-time) endodontic treatment was assessed for Phase II of the "Toronto Study." In total, 442 teeth were treated by using flared preparation and vertical compaction of warm gutta-percha or step-back preparation and lateral compaction. With 126 teeth excluded (discontinuers: deceased and relocated patients), 163 dropouts, and 31 extracted, 122 (48% recall) were examined for outcome: "healed" (no apical periodontitis [AP], signs, symptoms) or "diseased" (AP, signs, or symptoms). Phase II was analyzed separately and combined with Phase I (n = 242), using Chi-square and Fisher's exact tests (p or = 2-81%), and root-filling length (adequate, 87%; inadequate, 77%). Logistic regression revealed increased risk of disease for preoperative AP (odds ratio = 3.3) and technique (odds ratio = 2.3). This study confirmed AP and highlighted treatment technique as the main predictors of outcome in initial treatment.
The purpose of this study was to assess quality of life and satisfaction in relation to endodontic treatment in two Canadian populations and the association of these outcomes with the treatment providers' level of training (generalist or endodontist). New patients aged 25 to 40, presenting at the dental faculties in Toronto and Saskatoon were screened. Patients with radiographically identifiable endodontic treatment were invited for interviews conducted using a questionnaire that measured changes in quality of life after endodontic treatment and semantic differential scales that measured satisfaction with endodontic treatment. Data were analyzed using Chi-square, multiple and logistic regression (p
To explore trends in access to dental care among middle-income Canadians.
A secondary data analysis of six Canadian surveys that collected information on dental insurance coverage, cost-barriers to dental care, and out-of-pocket expenditures for dental care was conducted for select years from 1978 to 2009. Descriptive analyses were used to outline and compare trends among middle-income Canadians with other levels of income as well as national averages.
By 2009, middle-income Canadians had the lowest levels of dental insurance coverage (48.7%) compared to all other income groups. They reported the greatest increase in cost-barriers to dental care, from 12.6% in 1996 to 34.1% by 2009. Middle-income Canadians had the largest rise in out-of-pocket expenditures for dental care since 1978.
This study suggests that affordability issues in accessing dental care are no longer just a problem for the lowest income groups in Canada, but are now impacting middle-income earners as a consequence of their lack of, or decreased access to, comprehensive dental insurance.
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