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Access and care: reports from Canadian dental education and care agencies.

https://arctichealth.org/en/permalink/ahliterature173771
Source
J Can Dent Assoc. 2005 Jul-Aug;71(7):469-71
Publication Type
Article
Author
James L Leake
Author Affiliation
Faculty of Dentistry, University of Toronto, Toronto, Ontario. james.leake@utoronto.ca
Source
J Can Dent Assoc. 2005 Jul-Aug;71(7):469-71
Language
English
Publication Type
Article
Keywords
Aged
Canada
Dental Care for Aged - organization & administration
Dental Clinics - economics
Dental Health Services - economics - utilization
Education, Dental - economics
Health Services Accessibility
Humans
Indians, North American
Poverty
Abstract
Representatives of faculties of dentistry and agencies working to improve the oral health of groups with restricted access to dental care were invited to address the access and care symposium held in Toronto in May 2004. They told of their clients" sometimes desperate needs in graphic terms. The agencies" response ranged from simple documentation of the need, to expression of frustration with current trends and the apparent indifference of policy makers, to the achievement of some success in arranging alternative models of care. The presenters consistently identified the need to change methods of financing dental education and both the financing and models of care delivery to meet the needs of those with restricted access to oral health care.
PubMed ID
16026632 View in PubMed
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Developing management information from an administrative database of dental services: identifying factors that influence costs.

https://arctichealth.org/en/permalink/ahliterature6616
Source
J Public Health Dent. 2005;65(3):153-9
Publication Type
Article
Date
2005
Author
James L Leake
Stephen Birch
Patricia A Main
Elsa Ho
Author Affiliation
Faculty of Dentistry, University of Toronto, 124 Edward St., Toronto ON, Canada. james.leake@utoronto.ca
Source
J Public Health Dent. 2005;65(3):153-9
Date
2005
Language
English
Publication Type
Article
Keywords
Canada
Databases, Factual
Dental Health Services - economics
Health Care Costs
Health Expenditures
Humans
Indians, North American
Inuits
Management Information Systems
National Health Programs - economics
Research Support, Non-U.S. Gov't
Utilization Review - economics
Abstract
OBJECTIVE: We describe service patterns and compare changes in program expenditures with the Consumer Price Index over eight years in a dental program with a controlled-fee schedule offered to Canadian First Nations and Inuit people. METHODS: We obtained the computerized records of dental services for the period from 1994 to 2001. Each record identified the date and type of service, region and type of provider, age of the client and encrypted identifying information on clients, bands, and providers. We classified the individual services into related types (diagnostic, preventive, etc.). We aggregated the records by client and developed indices for the numbers of clients, mean numbers of services per client, cost per service, and prices. FINDINGS: Over the 8 years, 16.0 million procedures, totaling 811.8 million dollars, were provided to 538,034 different individuals, approximately 76% of the eligible population. Restorative procedures accounted for 36% of all expenditures followed by diagnostic (12.7%), preventive (12.2%), and orthodontic (8.9%) services. For much of the period, increases in program expenditures were exceeded by increases in the Consumer Price Index. This was consistent with fewer services per client, a less expensive mix of services, and relatively flat prices. However, in 2000 and 2001 higher prices and more clients resulted in increasing expenditures. CONCLUSIONS: Program expenditures were influenced by different factors over the study period. In the final two years, increasing expenditures were driven by price increases and increasing numbers of clients, but not by increasing numbers of services per client, nor a 'richer' mix of services.
PubMed ID
16171260 View in PubMed
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The effect of dental insurance on the ranking of dental treatment needs in older residents of Durham Region's homes for the aged.

https://arctichealth.org/en/permalink/ahliterature189369
Source
J Can Dent Assoc. 2002 Jul-Aug;68(7):412
Publication Type
Article
Author
Albert O Adegbembo
James L Leake
Patricia A Main
Herenia L Lawrence
Mary L Chipman
Author Affiliation
Department of Biomaterials, Faculty of Dentistry, University of Toronto, Toronto, Ontario. albert.adegbembo@utoronto.ca
Source
J Can Dent Assoc. 2002 Jul-Aug;68(7):412
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Analysis of Variance
Attitude to Health
Chi-Square Distribution
Cross-Sectional Studies
Dental Care for Aged - economics - psychology - utilization
Female
Health services needs and demand - economics - statistics & numerical data
Homes for the Aged
Humans
Insurance Coverage
Insurance, Dental - statistics & numerical data
Interviews as Topic
Logistic Models
Male
Ontario
Sensitivity and specificity
Statistics, nonparametric
Abstract
The effect of dental insurance on the ranking of dental needs in older adults has not been reported previously. We examined this effect using data obtained from a cross-sectional survey of older adults living in homes for the aged in Durham Region, Ontario. History of dental insurance was obtained during interviews. Dental needs, assessed during clinical examinations, were ranked from no need to urgent need according to the guideline of the American Dental Association. The associations between the rank of dental needs, dental insurance and other factors were analyzed with the Kruskal Wallis test, chi-square test, analysis of variance and multiple logistic regression. Of the 252 participants, 80 (31.7%) had been insured continuously since 1974, 69 (27.4%) had no need for dental treatment and 59 (23.4%) needed urgent dental care. More of the continuously insured than the uninsured residents were dentate (46/80 [57.5%] vs. 75/172 [43.6%], p = 0.04). Ranking of the need for care was not significantly influenced by dental insurance; need of any kind was explained by being dentate (odds ratio 12.3, 95% confidence interval 5.6 27.3).
PubMed ID
12119091 View in PubMed
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The influence of dental insurance on institutionalized older adults in ranking their oral health status.

https://arctichealth.org/en/permalink/ahliterature170801
Source
Spec Care Dentist. 2005 Nov-Dec;25(6):275-85
Publication Type
Article
Author
Albert O Adegbembo
James L Leake
Patricia A Main
Herenia P Lawrence
Mary L Chipman
Author Affiliation
Division of Public Health Services and Research, College of Dentistry University of Florida, Gainesville, USA. aadegbembo@dental.ufl.edu
Source
Spec Care Dentist. 2005 Nov-Dec;25(6):275-85
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Age Factors
Aged
Aged, 80 and over
Attitude to Health
Canada
Dental Care
Dentition
Female
Health Behavior
Health status
Homes for the Aged
Humans
Institutionalization
Insurance Coverage
Insurance, Dental
Male
Mouth, Edentulous - psychology
Oral Health
Personal Satisfaction
Social Class
Abstract
To assess whether dental insurance influences how institutionalized older adults ages 65 and older rank their oral health status, a census survey was designed for residents of Durham's (Canada) Municipal Homes for the Aged. The odds ratio (OR) and the Cochran & Mantel-Haenszel's OR were used to estimate the crude and adjusted effect of dental insurance on oral health status, respectively. Overall, 64 percent participated in the interview. Oral health status was ranked as "good," "very good" or "excellent" by 57 percent of the participants. This ranking was clearly unrelated to the residents having dental insurance, as only 28 percent had dental coverage. Significant effect modifiers included age, dental status and whether the participant had visited the dentist within the last year. Dental insurance positively influenced how dentate participants ranked their oral health status (OR = 2.26; 95 percent CI = 1.19; 4.28). In edentulous participants, age and visiting the dentist within the last year modified the effect of dental insurance on oral health status. Having dental insurance reduced the odds of reporting "good," "very good" or "excellent" oral health (OR = 0.20; 95 percent CI = 0.08; 0.49) among the participants ages 85 and older who did not visit the dentist within the last year; however, the opposite was true for their younger counterparts who visited the dentist within the last year (OR = 7.20; 95 percent CI = 1.08; 47.96). In this population, therefore, dental insurance was associated with higher oral health status rank among the dentate, but its effect on the edentulous population depended on age and the pattern of visiting the dentist.
PubMed ID
16463599 View in PubMed
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Investigating the potential for students to provide dental services in community settings.

https://arctichealth.org/en/permalink/ahliterature189370
Source
J Can Dent Assoc. 2002 Jul-Aug;68(7):408-11
Publication Type
Article
Author
Linda Huynh-Vo
Joel M Rosenbloom
Garry Aslanyan
James L Leake
Author Affiliation
Policy Branch of the Canadian International Development Agency.
Source
J Can Dent Assoc. 2002 Jul-Aug;68(7):408-11
Language
English
Publication Type
Article
Keywords
Administrative Personnel
Clinical Competence
Community Dentistry - economics - manpower
Dental Hygienists - education - utilization
Financing, Organized
Humans
Interviews as Topic
Ontario
Preceptorship - economics
Program Evaluation
Questionnaires
Students, Dental
Abstract
Some dental educational institutions in North America have incorporated community-oriented programs into their curriculum. The purpose of this study was to investigate the potential for the clinical placement of Ontario's dental and dental hygiene students in community-based settings. Key informant interviews were used to collect data. The study group consisted of 15 key informants from 9 potential placement sites and 4 educational institutions in Toronto and London, Ontario. The textual data were analyzed qualitatively to identify important issues regarding a clinical placement program. Results showed that there is strong support for the placement of students in community-based clinics; however, the degree to which health centres can accommodate students varies. The majority would not set any limit on the types of dental services that students could provide as long as the services were within the students' competencies. Funding was identified as a barrier to the implementation of such a program, with most of the organizations not able to contribute financially. None would be able to provide sufficient supervision without additional funding. These results indicate that a clinical placement program would be a welcome addition to the training of dental and dental hygiene students, but that external funding for supervision and operational expenses must be available before a program can be instituted.
PubMed ID
12119090 View in PubMed
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Lack of oral care policies in Toronto daycares.

https://arctichealth.org/en/permalink/ahliterature150884
Source
J Public Health Dent. 2009;69(3):190-6
Publication Type
Article
Date
2009
Author
Elena Gartsbein
Herenia P Lawrence
James L Leake
Hazel Stewart
Gajanan Kulkarni
Author Affiliation
Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada, M5G 1G6.
Source
J Public Health Dent. 2009;69(3):190-6
Date
2009
Language
English
Publication Type
Article
Keywords
Chi-Square Distribution
Child Day Care Centers - organization & administration - statistics & numerical data
Child, Preschool
Dental Caries - prevention & control
Health Policy
Health Resources
Humans
Infant
Ontario
Oral Health
Organizational Policy
Questionnaires
Social Class
Toothbrushing
Abstract
Currently, there is a deficit of information on policies regarding oral hygiene practices in Toronto daycares. It is unknown if any tooth-brushing programs are in existence and if children are permitted to follow professional advice on oral hygiene. The main objectives of this investigation were to a) determine the prevalence of oral care policies in daycares and b) examine the availability of resources.
Telephone interviews were conducted with daycare supervisors using a pretested questionnaire. Summary statistics and the chi-square test were used to analyze the results.
Two hundred forty-nine questionnaires were completed (response rate of 99.6 percent), representing 38 percent of the total daycare population (650) in Toronto. Eighty-three percent did not have a policy on oral care and 11 percent would not cede to requests from parents or medical professionals to brush teeth. However, 50 daycares indicated that their centers used to have a tooth-brushing program, and most (79 percent) were open to establishing an oral care policy. Fifteen percent reported not having proper sinks for tooth brushing.
Many daycares do not have a policy regarding oral hygiene. A policy that encourages and provides guidance on safe tooth-brushing procedures is needed and may improve the oral health of preschool children.
PubMed ID
19453870 View in PubMed
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A macroeconomic review of dentistry in Canada in the 1990s.

https://arctichealth.org/en/permalink/ahliterature178029
Source
J Can Dent Assoc. 2004 Oct;70(9):604-9
Publication Type
Article
Date
Oct-2004
Author
Kalyani K Baldota
James L Leake
Author Affiliation
University of Toronto, Ontario.
Source
J Can Dent Assoc. 2004 Oct;70(9):604-9
Date
Oct-2004
Language
English
Publication Type
Article
Keywords
Canada
Cost of Illness
Dental Auxiliaries - supply & distribution
Dental Care - economics
Dentists - supply & distribution
Economics, Dental - statistics & numerical data
Financing, Government - statistics & numerical data - trends
Health Care Costs - statistics & numerical data
Health Expenditures - statistics & numerical data
Humans
Abstract
To document the trends in expenditures on dental health care services and the number of dental health care professionals in Canada from 1990 to 1999.
Information on dental and health expenditures, numbers of dentists, hygienists and dental therapists, and the population of Canada and the provinces were obtained from the Canadian Institute for Health Information; data on numbers of denturists were obtained from regional bodies and from Health Canada. Information on the costs of other disease categories was taken from studies by Health Canada (1993 and 1998). International comparisons were made on the basis of data published by the Organisation for Economic Co-operation and Development (OECD). Indices of change over the decade (in which the 1990 value served as the baseline [100]) were calculated.
By 1999, the supply of all types of dental care providers had increased to 1 for every 904 people. Dental expenditures during the 1990s increased by 64% overall and by 49% per capita, a rate of increase that exceeded both inflation and costs of health care. Although the public share of dental costs decreased from 9.2% to 5.8%, the direct costs of dental care increased to rank second (6.30 billion dollars) after those for cardiovascular diseases (6.82 billion dollars). Among the OECD nations, Canada had the fourth highest per capita dental expenditures and the second lowest per capita public dental expenditures.
The direct economic costs of dental conditions increased during the 1990s from 4.13 billion dollars to 6.77 billion dollars. Over the same period, the public share for expenditures on dental health care services declined.
PubMed ID
15473944 View in PubMed
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The prevalence and risks of early childhood caries (ECC) in Toronto, Canada.

https://arctichealth.org/en/permalink/ahliterature139788
Source
J Contemp Dent Pract. 2010;11(5):001-8
Publication Type
Article
Date
2010
Author
Thikriat S Al-Jewair
James L Leake
Author Affiliation
taljewair@gmail.com
Source
J Contemp Dent Pract. 2010;11(5):001-8
Date
2010
Language
English
Publication Type
Article
Keywords
Age Factors
Breast Feeding - statistics & numerical data
Chi-Square Distribution
Child
Child, Preschool
Data Collection
Dental Caries - epidemiology
Depression - epidemiology
Emigrants and Immigrants - statistics & numerical data
Family Health
Female
Health Behavior
Humans
Infant
Language
Logistic Models
Male
Odds Ratio
Ontario - epidemiology
Oral Hygiene - utilization
Parents - psychology
Prevalence
Risk factors
Self Report
Socioeconomic Factors
Telephone
Abstract
To determine the prevalence and risks of early childhood caries (ECC) among children less than 71 months of age in Toronto, Canada, and to evaluate the association between parental/caregiver depression and ECC.
A secondary analysis of data previously collected by the Toronto Public Health as part of the 2003 Toronto Perinatal and Child Health Survey was performed. The 90-item survey was conducted over the telephone to 1,000 families with children from zero years (birth) to six years of age. Parents/caregivers were asked about factors related to the development and health of their children. For this study, only children younger than six years of age (less than 71 months) were included (n=833). The primary outcome of interest was self-reported and measured by the response to the question of whether a physician/dentist had ever told the parent/caregiver his/her child had ECC.
The prevalence of ECC was 4.7 percent (37 of 791 children). The child's age, his/her history of dental visits, teeth brushing, the use of fluoridated toothpaste, the parent's/caregiver's depressive tendencies, the language spoken at home, and the household annual income were all significant in the bivariate analysis. Multiple logistic regression identified four factors associated with ECC: the child's age (being three years of age or older), having at least one parent/caregiver with depression, not speaking English at home, and having an annual household income less than $40,000 in Canadian dollars (CAD).
While a child's age, home language, and household income are known risks for ECC, the finding that parental/caregiver depression may be related to ECC is new.
Multiple risk factors are involved in the development of early childhood caries. Of particular importance are demographic (e.g., child's age), social (e.g., annual household income), and psychosocial factors (e.g., parental/caregiver depression) that are indirectly linked to ECC. More attention needs to be placed on understanding the role and process by which these factors influence the development of ECC.
PubMed ID
20978718 View in PubMed
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Prevalence of dental caries among 7- and 13-year-old First Nations children, District of Manitoulin, Ontario.

https://arctichealth.org/en/permalink/ahliterature179871
Source
J Can Dent Assoc. 2004 Jun;70(6):382
Publication Type
Article
Date
Jun-2004
Author
Sabrina Peressini
James L Leake
John T Mayhall
Marion Maar
Ray Trudeau
Author Affiliation
Department of Community Dentistry, Faculty of Dentisty, University of Toronto, Toronto, Ontario, Canada. s.peressini@utoronto.ca
Source
J Can Dent Assoc. 2004 Jun;70(6):382
Date
Jun-2004
Language
English
Publication Type
Article
Keywords
Adolescent
Analysis of Variance
Child
DMF Index
Dental Caries - epidemiology
Female
Humans
Indians, North American - statistics & numerical data
Male
Ontario - epidemiology
Prevalence
Abstract
Dental caries is a disease that, although decreasing in the non-Aboriginal child population, remains high for Canadian Aboriginal and Native American children and adolescents. To address dental health issues in First Nations in the District of Manitoulin, Noojmowin Teg Health Centre initiated a multiphase collaborative research project with the department of community dentistry at the University of Toronto. The purpose of this paper was to identify the prevalence of dental caries in children 7 or 13 years of age and to compare these data with published data for the same age groups from other First Nations communities in Canada.
All children 7 or 13 years of age who were in elementary schools on a reserve in 7 First Nations communities were eligible for a dental health examination as part of the survey. Children attending school off the reserve in 6 of the communities were also eligible.
A total of 66 children (56% 7-year-old children, 62% girls) were examined. The mean caries score (deft+ DMFT) for 7-year-old children was 6.2; the mean decayed, extracted, filled permanent teeth (DMFT) score for 13-year-old children was 4.1. Overall, 96% of children had 1 or more past or active carious lesion.
Results indicate that dental caries is highly prevalent and increasing in severity in this population.
PubMed ID
15175117 View in PubMed
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Prions in dentistry--what are they, should we be concerned, and what can we do?

https://arctichealth.org/en/permalink/ahliterature170683
Source
J Can Dent Assoc. 2006 Feb;72(1):53-60
Publication Type
Article
Date
Feb-2006
Author
Amir Azarpazhooh
James L Leake
Author Affiliation
Department of Community Dentistry, Faculty of Dentistry, University of Toronto, Toronto, Ontario. amir.azarpazhooh@utoronto.ca
Source
J Can Dent Assoc. 2006 Feb;72(1):53-60
Date
Feb-2006
Language
English
Publication Type
Article
Keywords
Animals
Blood Transfusion
Canada
Dental Care for Chronically Ill
Dental Instruments
Disease Transmission, Infectious - prevention & control
Equipment Contamination - prevention & control
Guidelines as Topic
Humans
Infection Control, Dental - methods
Prion Diseases - transmission
Risk factors
World Health Organization
Abstract
To briefly review the characteristics of prions, the risk of transmission and implications for infection control in dentistry.
The literature on prion disease in the context of dentistry up to March 2005 was reviewed using the PubMed, MEDLINE, Cumulative Index to Nursing & Allied Health Literature, Google Scholar databases and the Web sites of the departments of health of countries affected by the disease.
The sporadic form of Creutzfeldt-Jakob disease (CJD) is the most common human prion disease; the mean age of those affected to date is 68 years, the mortality rate is 85% within 1 year, and the average death rate is 1 per million persons. Variant CJD (vCJD) affects people (mean age 26 years) with a history of previous extended periods of residence in certain countries, mainly in the United Kingdom. Currently, there is no evidence of human-to-human transmission of CJD or vCJD following casual or intimate contact or blood transfusion, nor is there evidence of iatrogenic transmission of vCJD in a health care setting. Furthermore, there is no evidence indicating increased occupational risk of CJD or vCJD among health workers or clustering of vCJD among people associated with a dental practice. The risk of transmission of prions through dentistry is unknown but is thought to be very low if appropriate infection control measures are taken.
The theoretical risk of transmission of prion disease through dental treatment emphasizes the need to maintain optimal standards of infection control and decontamination procedures for all infectious agents, including prions.
Notes
ReprintIn: Tex Dent J. 2006 May;123(5):421-816967690
PubMed ID
16480606 View in PubMed
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12 records – page 1 of 2.