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

Background: When compared to national averages in Canada, Saskatchewan has one of the highest rates of dental treatment under general anesthesia (GA) and average costs per child. Thus, the purpose of this cross-sectional study is to explore the risk indicators and treatment needs of children receiving dental treatment under GA in Saskatchewan. Methods: In this cross-sectional study, we recruited caregivers of children between 24 and 71 months of age in Saskatoon, Canada. Caregivers completed a 40-item questionnaire, which was supplemented with clinical data and then subject to statistical analysis (independent t-tests and one-way ANOVA). Results: A total of 90 caregiver/child dyads were enrolled with the mean age for children being 49.5 ± 12.3 months. The mean age of a child’s first dental visit was 34.7 ± 15.3 months with only 37.9% of children having a dental home. The mean deft index was 11.7 ± 3.4, with an average of 10.9 ± 3.5 teeth receiving treatment. Additionally, location of primary residence (p = 0.03), family income (p = 0.04), family size (p = 0.01), parental education (p = 0.03), dental home (p = 0.04), and body mass index (p = 0.04) had a statistically significant association with a higher mean deft. Conclusions: Our cross-sectional study confirms that children who require dental treatment under GA have a high burden of disease. While individual risk indicators such as diet and oral hygiene play a role in the progression of early childhood caries (ECC), we also demonstrate that children who do not have access to early preventive visits or a dental home are at a higher risk. In addition to improving motivation for oral hygiene at home and nutritional education, improving access to oral health care should be addressed in strategies to reduce ECC.

Guardian Reports of Children's Sub-optimal Oral Health Are Associated With Clinically Determined Early Childhood Caries, Unrestored Caries Lesions, and History of Toothaches

Background: Parents'/guardians' perceptions of their children's oral health are useful proxies of their clinically determined caries status and are known to influence dental care-seeking behavior. In this study, we sought to examine (1) the social and behavioral correlates of fair/poor child oral health reported by guardians and (2) quantify the association of these reports with the prevalence of early childhood caries (ECC), unrestored caries lesions and toothaches.Methods: We used guardian-reported child oral health information (dichotomized as fair/poor vs. excellent/very good/good) obtained via a parent questionnaire that was completed for n = 7,965 participants (mean age = 52 months; range = 36-71 months) of a community-based, cross-sectional epidemiologic study of early childhood oral health in North Carolina between 2016 and 2019. Social, demographic, oral health-related behavioral data, and reports on children's history of toothaches (excluding teething) were collected in the same questionnaire. Unrestored ECC (i.e., caries lesions) was measured via clinical examinations in a subset of n = 6,328 children and was defined as the presence of one or more tooth surfaces with an ICDAS ≥ 3 caries lesion. Analyses relied on descriptive and bivariate methods, and multivariate modeling with average marginal effect (A.M.E.) estimation accounting for the clustered nature of the data. Estimates of association [prevalence ratios (PR) and adjusted marginal effects (AME) with 95% confidence intervals (CI)] were obtained via multilevel generalized linear models using Stata's svy function and accounting for the clustered nature of the data.Results: The prevalence of fair/poor oral health in this sample was 15%–it increased monotonically with children's age, was inversely associated with parents' educational attainment, and was higher among Hispanics (21%) and African Americans (15%) compared to non-Hispanic whites (11%). Brushing less than twice a day, not having a dental home, and frequently consuming sugar-containing snacks and beverages were significantly associated with worse reports (P < 0.0005). Children with fair/poor reported oral health were twice as likely to have unrestored caries lesions [prevalence ratio (PR) = 2.0; 95% confidence interval (CI) = 1.8-2.1] and 3.5 times as likely to have experienced toothaches [PR = 3.5; 95% CI = 3.1-3.9] compared to those with better reported oral health.Conclusions: Guardian reports of their children's oral health are valuable indicators of clinical and public health-important child oral health status. Those with fair/poor guardian-reported child oral health have distinguishing characteristics spanning socio-demographics, oral-health related practices, diet, and presence of a dental home.

Small Animal Veterinarians' Communication With Dog Owners From a Motivational Interviewing Perspective

Veterinary communication skills are fundamentally important in animal practice. Despite client-centered communication being recommended as the optimal medical communication style, a paternalistic approach is still common in veterinary medical encounters with pet owners. Motivational interviewing (MI) is a client-centered, evidence-based counseling method aiming to strengthen a person's motivation and commitment to behavior changes. In this exploratory study, the aim was to investigate Swedish small animal veterinarians' use of client centered communication with dog owners regarding dental home care in dogs. This was achieved by analyzing the use of MI-techniques among veterinarians without previous training or knowledge of the method. Individual telephone calls, reflecting a veterinary clinical scenario, between small animal veterinarians (n = 8) and a trained professional actor playing a dog owner were recorded and coded according to an MI coding protocol (MITI 4.2.1). In the present study, the degree of spontaneously used MI was low. From an MI-communication perspective, with a simulated dog owner, the veterinarians predominantly relied on asking questions, giving information, and persuasive talk. The veterinarians dominated the conversations and made minimal attempts to involve the dog owner resulting in a power imbalance between veterinarian and client. As the degree of spontaneously used MI was found to be low, MI-training may be required in order to apply the method in professional counseling. The veterinarians' communication pattern suggested a paternalistic communication style, when attempting to motivate a client to brush his or her dog's teeth. We suggest that Motivational Interviewing (MI) has a potential to improve veterinary communication and adherence to medical recommendations if introduced and implemented in veterinary practice.

The creation of a specializedmedical-dental clinic for adults with developmental disabilities in Montreal, Canada

Purpose There is inadequate health care for patients with developmental disabilities (DD), due to a number of systemic issues. This case study describes the establishment of a medical-dental clinic in Montréal, Québec for adults with DD. The purpose of this paper is to describe the model of interdisciplinary care based on best practices, as an example to encourage a growing community of trained health professionals to serve this population. Design/methodology/approach Interviews with all the clinic staff and leadership were conducted on-site at the clinic, followed by document review and discussions with an embedded researcher in the organization. Findings The clinic was established through a series of events that led to public and government interest to act, the timely emergence of major donors, and bringing together several dedicated individuals and organizations. The core team engaged in consultation with clinics, followed by extensive billing analyses and iterative process mapping as a learning organization. Prior to patient visits, the clinic conducted detailed intake processes to adequately plan for each patient interaction. Desensitization visits were undertaken to improve patient tolerance for examination and treatment. The continual collection of data fed into an evaluation framework to facilitate continuous improvement and articulate a model for replication. Originality/value To the best of the authors knowledge, there is not a clinic of this nature serving this population in Canada. This work can serve to inform the efforts of other care providers looking to create a medical – dental home for this population.

Improved Oral Health and Adaptation to Treatment in Dogs Using Manual or Ultrasonic Toothbrush or Textile of Nylon or Microfiber for Active Dental Home Care

Poor oral health is a common problem in dogs causing pain and impaired welfare. The gold standard to maintain good oral health and prevent periodontitis is daily tooth brushing. However, many dog owners find it difficult, and dogs often show aversive behavior. There are several different tools available, and in this intra-subject study, four different active dental home care treatment options were examined: manual and ultrasonic toothbrush, a nylon glove, and a microfiber finger cloth. The treatments were evaluated for efficacy against gingivitis, plaque, and calculus in beagle dogs. Each dog received two treatments on the buccal sides of the teeth once daily, either two types of toothbrushes (N = 10) or two types of textiles (N = 11), on separate sides of the mouth. The dogs’ teeth were assessed before and after the five-week treatment period, with the assessor blinded by additional, similar dogs (N = 7). The study also assessed the dogs’ stress levels during treatment using a fear, anxiety, stress (FAS) protocol. All four treatments improved dog oral health, reducing gingivitis and plaque. Furthermore, the amount of calculus also decreased in some individuals. Adaptation to dental care occurred in the dogs over time. This information can be used to encourage dog owners to brush their dogs’ teeth.