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Purpose: This study aimed to explore UBC’s part time sessional instructors’ knowledge of the principles of minimal intervention dentistry (MID). Methods: A qualitative exploratory approach of inquiry was used, and purposeful selection identified sessional instructors for semi-structured interviews. The interview guide presented 3 clinical caries management scenarios with questions exploring the participants’ knowledge of the five domains of cariology and minimal intervention management: knowledge base, risk assessment, diagnosis, synthesis, and choice of surgical/non-surgical therapy. Interviews were conducted over Zoom, audio recorded, and transcribed verbatim. Thematic analysis was conducted with an interpretive deductive-inductive approach. Results: Nine interviews were completed. The participants consisted of 6 males and 3 females between 55-76 years of age, with 32-45 years of private practice experience, and who had taught anywhere between 3-19 years. The thematic analysis led to the identification of two themes and their respective categories: Foundational knowledge - caries detection methods, caries detection limitations, evaluating lesion activity, categorizing caries risk, selective versus complete dentin removal, and pulpal diagnosis; and Caries management decision making - adherence to oral health measures, diagnostic uncertainty and assessment of cavitation, patient cooperation, and economics. Conclusions: There has been a paradigm shift in managing caries from traditionally being invasive to one that is less invasive and has been coined as MID. Participants had varying favorable knowledge of MID. Uncertainties and inconsistencies arose when applying the principles of MID to manage carious lesions that were non-cavitated and cavitated. As dental schools depend upon community dentists to support clinical teaching programs, it would be advisable to consider providing continuing education for sessional instructors to help ensure consistent, evidence-based clinical teaching of caries management.
Objective: The aim of this study was to determine what strategies Canadian pediatric dentists recommend to parents/caregivers for the management of teething signs and symptoms presenting in infants/toddlers and to explore Canadian pediatric dentists’ knowledge (data-related), opinion (perspective-related), and behavior (action-related) regarding teething management strategies.Methods: An online, 29-item cross-sectional census survey was distributed to 385 certified pediatric dentists who were registered across Canada, as verified by either directly contacting or accessing provincial/territorial dental regulatory authorities. The data was first explored employing descriptive statistics. The differences in the knowledge (mechanism of action, regulation) and opinions (safety, effectiveness) were analyzed using either Chi square test or alternatively with Fisher’s Exact test when conditions for Chi square test were not met.Results: The response rate was 34% (n=107). Pediatric dentists typically recommended multiple strategies to parents, with the most recommended strategies being the use of cold objects (79%; n=84). Among those who recommended the use of cold objects, 55% (n=46) of pediatric dentists knew its mechanism of action and most (86%; n=72) considered this option to be safe. Systemic analgesics were also highly recommended (64%; n=69) by pediatric dentists as an alternative strategy in the management of teething when the use of cold was not effective. Pressure in the form of either teething toys (59%; n=63), or massage/compression of the gums (58%; n=62) was the third most common teething management strategy. Among pediatric dentists who recommended teething toys in the management of teething, 46% (n=29) knew its mechanism ofaction, 19% (n=12) knew how teething toys were regulated, 87% (n=55) considered teething toys to be a safe option. Ninety percent (n=96) of pediatric dentists did not recommend homeopathic remedies to manage teething symptoms.Conclusion: Canadian pediatric dentists are more likely to recommend teething management strategies to parents/caregivers when they consider them safe and not necessarily because of how knowledgeable they are in its mechanism of action or its regulation. More education is needed among pediatric dentists about the mechanism of action and regulation for commercially available teething products to decrease the potential for adverse outcomes among teething infants.
Objective: Obtaining informed consent for dental rehabilitation under general anesthesia (GA) for young children with extensive treatment needs is a patient-centered process involving shared decision-making with the family. However, due to intercultural differences, this may present challenges with immigrant families who may not be familiar with North American consent processes and standards of care. This study aimed to explore the barriers and facilitators to immigrant Chinese parents’ provision of informed consent for the use of GA to manage the behaviour of pre-cooperative children with extensive dental treatment needs.Methods: A semi-structured, open-ended questionnaire utilizing vignettes was developed to guide the interview process with immigrant Chinese parents of young children presenting for dental care in Vancouver, Canada. Interviews were conducted in Mandarin and subsequently transcribed, translated, and coded; thematic analysis determined emerging themes. Results: Six major themes emerged from 12 interviews: parental expectations of young children’s ability to cooperate for extensive dental treatment; differences in intercultural perspectives around the need to protect a child’s developing psyche; parental concerns about safety and possible adverse impacts on neurodevelopment; influence of parental knowledge of oral health in the primary dentition; influence of economic factors on providing informed consent; influence of ethnic Chinese cultural values on the informed consent process.Conclusion: The results of this study suggests that differing intercultural expectations related to oral health care for children may present significant barriers to obtaining informed consent for dental rehabilitation under GA for Chinese-Canadian parents. It also emphasizes the importance to discuss potential adverse outcomes associated with GA at the parent consultation appointment. In order to empower the family to make the best informed decision, dentists should consider the acculturation discrepancy of immigrant families to ensure the optimal overall health of the child/family.
Purpose: This study aimed to determine the effectiveness of Biodentine, a calcium-silicate material, as a pulpal medicament for primary molars requiring a pulpotomy procedure.Methods: A retrospective chart review was conducted on children who received a Biodentine pulpotomy procedure on one or more primary molar(s) while receiving dental rehabilitation under general anesthesia from January 1, 2013 to May 1, 2018. Five clinical and radiographic outcomes were used to determine the success of the pulpotomy. The teeth were evaluated at intermittent recalls for up to 30 months post-treatment. Survival curves of the Biodentine pulpotomized teeth were estimated by nonparametric maximum likelihood methods for interval censored data.Results: A total of 608 teeth from 208 children were evaluated over a 30-month post-treatment period. There was a total of twenty teeth with a failed pulpotomy procedure over the study period. Six teeth were identified as having both a clinical and radiographic failure. The remaining 14 failures were either a clinical or a radiographic failure – three were clinical failures, while eleven radiographic failures exclusively. A survival analysis curve indicated that the overall cumulative probability of survival at 30 months was 97.3% (95% CI = 83.7-99.2%) clinically, and 85.6% (95% CI = 76.3-93.7%) radiographically.Conclusions: Pulpotomy procedures on primary molars utilizing Biodentine as the pulpal medicament had favourable clinical and radiographic results up to 30 months.
Purpose: This study aimed to determine whether an audiovisual intervention was more effective than verbal instructions at reducing preoperative anxiety levels for parents whose children were having their first experience of dental treatment with the use of oral sedation.Methods: A prospective clinical trial was conducted. Parents were assigned to either view a video (intervention group), or to receive standardized verbal instructions (control group). Questionnaires modified from the Amsterdam Preoperative Anxiety and Information Scale were distributed to parents at the assessment appointment before the preoperative information was given (T0), and again at the subsequent sedation appointment (T1). The change in parental anxiety levels between T0 and T1 was measured (∆=T0-T1). Results: A total of 40 subjects comprised of 20 individuals each in the control and intervention group were included in the final analytical data set. There were no significant differences in the effectiveness of reducing preoperative parental anxiety between the audiovisual intervention and the verbal instructions. Conclusion: The audiovisual intervention was effective in reducing preoperative parental anxiety, but the reduction was not significantly different from using verbal instructions. Dentists may wish to incorporate audiovisual aids to supplement verbal instructions during the sedation preoperative consultation.
Objectives: The UBC Graduate Pediatric Dentistry Program’s oral sedation clinic has evolved since it began in 2011. The study aimed to evaluate the effectiveness and safety of the various sedation regimens used, and to assess how regimens were influenced by the experience and opinions of clinical instructors.Methods: A retrospective chart review of all oral sedation appointments that took place between March 2011 and May 2014 was completed. The outcome variables of interest were effectiveness and safety. Descriptive and comparative statistics were applied to analyze quantitative data. Six UBC Pediatric Dentistry clinical instructors were invited for interviews through a purposive sampling technique to further understand both their views toward sedation regimens and teaching sedation to graduate students. Thematic analysis was applied to code interview transcripts. Results: There were 195 oral sedation appointments during the study period. The three most commonly used regimens were: midazolam and hydroxyzine (MZH) (45%); midazolam (MZ) (24%); and meperidine, chloral hydrate, hydroxyzine, and dimenhydrinate (MCHHD) (17%). With respect to safety, vital signs and level of sedation were examined. Children undergoing MZH sedations were rated to be in “deep” sedation 1.4% of the time, compared to 12.5% in the MCHHD group. MZH sedations were rated “effective/very effective” 90% of the time, compared with 88% for MCHHD sedations. Data for sedation level and effectiveness of the MZ group was limited. Domains that emerged from the interviews were safety, effectiveness, preparation, and preferences; with risk tolerance as the overarching theme. Conclusion: MZH and MCHHD have similar effectiveness however MZH has a better safety profile. Clinicians with higher risk tolerance tended to practice sedation more frequently than those with low risk tolerance. Accordingly, high risk tolerance clinicians felt students should learn sedation more extensively than did those with low risk tolerance. Two main recommendations emerged from the study: (1) complete and inclusive sedation records are critical to fully understanding the effectiveness and safety of sedation regimens; 2) clinicians may desire to have self-awareness regarding their risk tolerances in the context of both practicing and teaching oral sedation in pediatric dentistry.
Objective: The aim of this study was to determine whether scientific (knowledge base), practical (clinical infra-structure) or personal (sense of social justice) sources of uncertainty among British Columbia general dentists posed the greatest barriers to their ability to treat children with special health care needs (CSHCN). Methods: A 74-item self-administered electronic questionnaire was distributed to a random sample of 1200 general dentists registered with the British Columbia Dental Association. Variability in clinical practice (examine, examine and refer, refer) was assessed using three case scenarios featuring CSHCN with a 1) behavioral difficulty (autism spectrum disorder), 2) physical disability (bleeding disorder) or 3) combination (cerebral palsy). Respondents were asked to use a five-point Likert-type scale to rate uncertainty levels from scientific, practical and personal sources in each case scenario. One-sample t-tests were used to compare differences between examination/refer for examination and treat/refer for treatment group pairs. All items in the scientific, practical and personal domains were tested using multivariate analyses (logistic regression) for all three cases. Data was analyzed and classified based on a novel taxonomical approach.Results: The response rate was 20.2% (n=226). A higher percentage of dentists were willing to examine and treat a child with a bleeding disorder (59.7%) or cerebral palsy (63.0%) compared to a child with autism (54.5%). Among those who would refer, the most significant reported sources of uncertainty in general are scientific (knowledge of management, ability to diagnose disease) and practical sources (staff training, inadequate facilities, busy practice).Conclusions: While the majority of general dentists showed interest and desire to provide care for CSHCN, scientific and practical uncertainty are significant factors affecting their ability to provide care. Recognizing the presence of uncertainty in dental care can inform policy changes to help dentists either decrease reducible uncertainties or cope with those that are irreducible. Implementation of increased undergraduate curriculum hours and hands on experience with CSHCN as well as expanded coverage of public and private dental benefits may help reduce barriers to care for CSHCN, in particular for those with conditions such as autism spectrum disorder.