Jolanta Aleksejuniene
Relevant Thesis-Based Degree Programs
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Dr. Jolanta is a hard-working faculty member at UBC. She supervises many masters and PhD students and a committee member of many research committees. She is able to handle all of that and give each student enough attention. She follows up with each student to make sure that the research projects are on track. She suggests continuously reading materials to students to expand their knowledge. She's special for her resilience & cooperation to make the research experience as smooth as possible.
Graduate Student Supervision
Doctoral Student Supervision
Dissertations completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest dissertations.
Socioeconomic status (SES)- and disability-based inequalities in oral health are well documented, but the pathways underlying these relationships are not fully understood. To understand these pathways, this dissertation includes three research projects focusing on psychosocial factors and their associations with oral health inequalities in children and adolescents. Several hypotheses guided by the Stress Process Model were tested using data from nationally representative Canadian and United States (US) surveys.The first study analyzed the 2012 US National Survey of Children Health (NSCH) (n=21,596 children and n=23,584 adolescents) and found that (a) parents with lower income and lower educational levels reported greater parenting stress; (b) parenting stress was associated with worse child oral health, but not child preventive dental visits; and (c) child/adolescent age-related differences were observed in the association between household SES and parenting stress, but not in the association between parenting stress and child oral health-related outcomes.The second study analyzed data from the Canadian 2014 Health Behaviour in School‐aged Children study (n=20,357 adolescents) and revealed the following: (a) adolescents from lower affluence families were less likely to have family and peer social support, (b) family social support was associated with lower probability of oral health-risk behaviours, and (c) peer social support was associated with frequent toothbrushing and high sugar-sweetened beverage consumption.The third study analyzed the US NSCH (n=27,874 children and n=31,328 adolescents) and showed that (a) parents of children and adolescents with (versus without) special health care needs were more likely to report high parenting stress and low social support (instrumental or emotional), (b) parental instrumental social support was associated with unmet child dental needs, and (c) parental instrumental social support mitigated some of the negative associations between parenting stress and child dental care.Altogether, these studies highlight the importance of the interplay between social and psychosocial factors on the oral health of children and adolescents. The findings contribute to knowledge gaps for understanding oral health inequalities, such as the importance of family and peer support in promoting oral health behaviours and the broader role of parental psychosocial factors in shaping oral health inequalities.
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The current thesis includes three projects that covered several aspects of periodontitis epidemiology. The first project focused on studying the prevalence, extent, and associations with untreated periodontitis. A purposive sample of 431 subjects never treated for periodontal conditions was clinically examined at screening dental school clinics. Background data were collected using questionnaires. The prevalence, extent, and associations with untreated periodontitis were evaluated. Our findings showed that the prevalence and extent of untreated periodontitis were high in untreated subjects. Significant exposures associated with untreated periodontitis included age ≥35 years, male sex, lower education, lower income, uncontrolled diabetes mellitus, current cigarette smoking, and lower perceived stress. The second thesis project compared the performance of partial-mouth recording protocols (PRP) with the full-mouth recording protocol (FRP) to estimate the prevalence, extent, and associations of untreated periodontitis. Three PRPs were selected: full-mouth at the mesiobuccal and distolingual sites [(FM)MB-DL], half-mouth at mesiobuccal and distolingual [(HM)MB-DL] and random-half-mouth (RHM) protocol. The accuracy of PRPs was compared with that of FRP by calculating the sensitivity, negative predictive value, and absolute bias. Our findings showed that PRPs had the highest overall accuracy in estimating the untreated periodontitis prevalence, extent, and associations were the (FM)MB-DL and RHM. The third project focused on studying the accuracy of using PRPs in estimating the prevalence, extent, severity, and associations of periodontitis for population-based studies using a systematic review and meta-analyses. A systematic literature search was conducted to retrieve the studies that examined the accuracy of PRP toward estimating the periodontitis prevalence, its extent, severity, and its associations. Data selection, extraction, synthesis, and meta-analyses were performed for 14 studies that matched the eligibility criteria. Our findings include the following: the PRPs that had the highest overall accuracy in studying the periodontitis prevalence, its extent and severity were the (FM)MB-B-DL, (FM)MB-DL, full-mouth at Mesiobuccal-Midbuccal-Distobuccal [(FM)MB-B-DB] sites, (FM)MB-DB, a total of 84 sites using random site selection method, and RHM. Based on a limited number of studies, estimating the associations with periodontitis using PRPs resulted in marginal bias.
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Introduction: The cleft lip and palate congenital malformation is a common condition, which poses a large burden of care on the young patients and their caregivers. The World Health Organization reported the prevalence of cleft lip with or without cleft palate to be 10 in 10,000 births in the United States and worldwide and 12 in 10,000 births in Canada (IPDTOC, 2011). Post-operative palatal fistula is frequently encountered after the surgical repair of a cleft lip and palate deformity. A wide range of fistula occurrence rates, have been reported in the literature with significant variability. After conducting a systematic scoping review of the cleft palate literature we found that high quality studies were needed in this field. Additionally there were very few Canadian studies available on this subject. We recognized the need to investigate the incidence of palatal fistula at British Columbia’s Children’s Hospital (BCCH) to be able to compare our rates with other centers worldwide. As a result of our research, we realized a gap in the literature, which was the lack of a standardized assessment protocol for the follow up of cleft lip and palate patients.Methods: A retrospective chart review was performed at British Columbia’s Children’s Hospital to examine the incidence of palatal fistula in children with non-syndromic clefts and to identify determinants associated with higher fistula rates.In preparation for the protocol development we conducted electronic database searches and contacted 13 major cleft centers worldwide.Conclusion: The systematic review concluded that the research mainly focused on surgeries and fistula-related risk determinants. The level of evidence was low and the quality was poor. No consistent pattern was detected between fistula occurrence and any of the studied risk determinants. The medical chart audit determined that almost a quarter of patients at BCCH presented with a palatal fistula. The significant risk determinants were severity of the cleft, less experienced surgeons, and the time period in which surgeries were performed. The structured protocol was developed and it will help facilitate data collection of cleft patients prospectively and prevent deficiencies in current medical reporting.
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Master's Student Supervision
Theses completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest theses.
The full abstract for this thesis is available in the body of the thesis, and will be available when the embargo expires.
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Introduction: COVID-19 invoked many restrictions on graduate orthodontic programs. This may have impacted the development of required competencies for the graduation of orthodontic residents. We hypothesized orthodontic graduates in the COVID-19 era (2020-2022) feel less competent as compared to pre-COVID-19 graduates (2019).Objectives: The aims of this study were to develop a list of competencies for orthodontic graduates, use this list to assess perceived competence, and identify common challenges among orthodontic programs due to COVID-19, and how these challenges were overcome. Methods: An orthodontic competency list was based on available information from Canada, USA, and Europe. Part A Qualtrics® survey included information about the perceived competencies of orthodontic graduates (2019-2022) from accredited Canadian and American programs. Graduates were also asked about the importance of achieving these competencies, and the best modes of learning for them. Part B survey asked program directors/faculty from each program to identify COVID-19-imposed challenges in achieving specific competencies, and the accommodations made to overcome them. Results: Pre-COVID-19 graduates (2019) had higher levels of perceived competencies as compared to COVID-19 graduates (2020-2022), and significant differences were found for 8 Competencies out of 21. There were no significant differences in perceived competencies between Canadian and American graduates. Major COVID-19-imposed challenges as identified by the faculty included having fewer patients/patient visits/less of a variety of malocclusions to treat, and less instructor feedback. Few significant differences were observed between Canadian and American programs. Limited accommodations were needed to overcome COVID-19-imposed challenges, with the most common need to introduce additional clinics/seminars, reducing aerosols, and teleorthodontics. Conclusions: Restrictions on orthodontic education due to COVID-19 impacted the perceived competencies of graduates, where pre-COVID-19 graduates felt more competent than graduates during COVID-19. There were no significant differences between Canadian and American graduates. Graduate programs identified a few COVID-19-imposed challenges in achieving competencies, however, little accommodations were needed to overcome them.
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Objectives: Lateral Ridge Augmentation (LRA) is a surgical technique to gain bone prior to implant placement. At the UBC graduate dental periodontics clinic specialty residents are trained in the LRA technique. Prior and after the surgery each patient receives cone-beam computed tomography (CBCT) scans allowing quantitatively measures the buccal-lingual width as well as the vertical height of the edentulous ridges. The present study evaluated the outcomes of the surgeries performed by residents during their training. Methods: A 10-year retrospective review was done. A total of 30 cases with quality CBCT images were available for the study. All before and after the surgery bone measurements were taken from the CBCT images and subsequently analyzed by the Microview ABA 2.2 software. Study data included a total of 5 linear measurements (2D) which were obtained from the middle of the edentulous ridge and a volumetric (3D) measure. Results: The intra-examiner agreement (duplicate recordings of 5 randomly selected patients) was excellent as indicated by Intra-Class Coefficient values of 0.974 or higher. There was a significant mean increase from before to after the surgery in linear (2D) and volumetric (3D) values. The linear bone gain ranged from 1.5 mm to 2.5mm and volumetric from 250 mm³ to 750 mm³. However, two patients did not gain any bone. Multivariate regression showed that pre-surgery bone volume and the mandible surgeries were strongest predictors of bone gain post-surgery. In maxillary, particularly anterior areas, the LRA surgeries were the least successful. Conclusions: Lateral ridge augmentation before implant placement performed by periodontics specialty residents at the UBC graduate clinic for the majority of patients helped to increase bone. The CBCT image quantitative analyses showed a high level of intra-examiner agreement. Due to small sample size, the study findings need to be validated in future studies with larger sample sizes.
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Objectives: This study was conducted to examine the rates and potentialpredictors of implant failures and peri-implant condition associated withtreatments provided by the periodontal residents at the graduate dental clinic atthe University of British Columbia (UBC).Materials and methods: A retrospective review of information from dentalcharts of patients who received dental implants at the UBC graduate clinic betweenJanuary 1st, 2009, and December 31st, 2018, by the graduate periodontics residents.Results: During the review period, 597 patients received a total of 1494 dentalimplants. The majority of potential risk indicators we examined did not havestatistically significant associations with either implant failures or peri-implantcondition.Conclusion: The implant failure rate was lower than the failure rate reported in aprevious retrospective study done in the same university setting. To ensure theproper documentation of all cases, the standardized protocol for informationrecording, including follow-ups, should be implemented.
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Objective: Many dental schools contribute to public health through free or reduced-fee treatment for underserved pediatric populations. Since the 1970s, the University of British Columbia (UBC) Faculty of Dentistry’s students provide dental treatment to pediatric patients through a bussing program known as the Children’s Dental Program (CDP), which transports children from areas outside of Vancouver city limits to UBC for free care. The purpose of this study was to quantify the scope of the CDP by reviewing the populations served and the dental treatment provided using digital records of the past twenty-one years. Methods: De-identified data was retrieved from UBC’s axiUm Dental Software database, including demographic information and treatment procedures performed. The twenty-one years were divided into 4 time periods (Period 1 to Period 4). The first three digits of the patients’ postal codes (i.e. their forward sortation area) were used to create choropleth maps using QGIS Software. The treatment procedures were organized into ten categories (including diagnostic, preventive, restorative, and oral surgery), and their proportions and means were calculated. A Standardized Treatment Provision Index (STPI) was also created to facilitate more detailed comparisons. Using SPSS Software, statistical analysis was done at three levels: procedure-, patient-, and student-level.Results: A total of 5,203 patients were treated between April 1997 and March 2018. Their mean age was 7.8 years. A majority were from the Vancouver suburbs of Surrey, Abbotsford, and Burnaby. Over each successive period, the mean number of procedures per patient decreased. All levels of analyses also revealed decreases in restorative and preventive procedures from Periods 1 to 4.Conclusions: The CDP has been providing dental care to children from many disadvantaged communities located in the Vancouver suburbs, with dental students gaining valuable experience working with pediatric patients. The decrease in restorative procedures may be due to decreases in the children’s caries experience. The program should advocate for more preventive procedures such as fluoride applications and fissure sealants. Last but not least, the Standardized Treatment Provision Index (STPI) has great potential in epidemiology as a measure of treatment provision in a population and as a proxy of its treatment needs.
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Objectives: The study examined whether a relationship exists between self-esteem, self-perception of malocclusion and motivation to seek orthodontic treatment. Methods: 49 patients were recruited from the Graduate Orthodontics Department, Faculty of Dentistry, UBC. An online survey inquired about their self-esteem, motivation to seek orthodontic treatment, and self-perceived esthetics of their malocclusion. The objective severity of malocclusion was assessed by a single examiner. Subjectively and objectively measured malocclusion were compared and subsequently related to patient self-esteem and their motivation to seek orthodontic treatment. Self-esteem was measured by the Rosenberg Self-Esteem Scale; self-perception of malocclusion through the aesthetic component of the Index of Orthodontic Treatment need (IOTN-AC); and the objective malocclusion severity by the IOTN-AC, IOTN-DHC (Dental Health Component) and by the Index of Complexity and Orthodontic Need (ICON). Patients indicated their motivation for treatment on a scale 1-100%. Results: Self-esteem and motivation to seek orthodontic treatment did not differ significantly with age, gender, objectively assessed severity or malocclusion, or self-perceived severity of malocclusion. Self-esteem was not significantly different among participants with different motivations to seek orthodontic treatment. Objective measures of malocclusion (IOTN-AC, ICON, IOTN-DHC) were significantly associated. Higher and lower self-esteem were not significantly related to an underestimation, or overestimation of self- perceived malocclusion severity (self-perception discrepancy). Motivation to seek treatment was significantly higher in participants with severe, as compared to mild treatment need when the severity of malocclusion was measured objectively using the ICON scale. Self-esteem was not significantly related to motivation to seek treatment when compared among objectively assessed malocclusion groups, self-perception groups, or self-perception discrepancy groups. Conclusions: Self-esteem was not related to objectively measured severity of malocclusion, self-perception of malocclusion, or the discrepancy between self-perception and objectively determined malocclusion severity. Motivation to seek treatment was not related to self-esteem or self-perception of the severity of the malocclusion but was related to the objectively measured malocclusion severity.
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Objective: The current study examined differences in treatment planning for space maintenance between pediatric dentists and general dentists.Methods: Two online self-administered electronic questionnaires were developed and administered by the UBC Qualtrics Survey software. One was a 32-question questionnaire that was administered to 1640 general dentists, and the other was a 31-question questionnaire that was administered to 41 pediatric dentists registered with the College of Dental Surgeons of British Columbia, Canada. The questionnaires consisted of three clinical case scenarios regarding space management in pediatric patients. The assessments on space maintenance treatment planning were based on the following cases: 1. Extraction of tooth #7.4 in primary dentition; 2. Extraction of tooth #7.5 in primary dentition; and 3. Premature loss of tooth #7.3 in mixed dentition. The survey also acquired information about the practitioners` demographics and their knowledge, attitudes, and practices towards space maintenance for each specific case. Statistical analysis was conducted using the independent sample t-test, Mann Whitney U test, Chi-square test, and Fischer’s exact test. Results: The response rate for general dentists was 20.3% (n=320), and for the pediatric dentists it was 56.1% (n=23). The majority of general dentists (76.7%, n=244), and all pediatric dentists (100%, n=23) chose to place a band and loop appliance after extraction of tooth #7.4. The majority in both groups selected to place a distal shoe appliance after extraction of tooth #7.5 (59.2%, n=189 of general dentists and 78.3%, n=18 of pediatric dentists), and both general (59.6%, n= 189) and pediatric (69.6%, n=16) dentists selected that they would consider an orthodontic consultation for the case about the premature loss of tooth #7.3. Differences in attitudes about their dental school/residency training were the strongest determinant associated with treatment planning. There were no statistically significant differences in mean total knowledge scores between the pediatric and general dentists. Conclusions: Space maintenance treatment planning is multifactorial; however, differences in attitudes towards the practitioners’ training strongly associated with their decision making.
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Objectives: This blinded randomized controlled clinical trial assessed the effectiveness of an authoritative parenting model in improving the oral hygiene skill level of adolescent orthodontic patients. Methods: The sample consisted of patients aged 10-16 years undergoing orthodontic treatment at the UBC’s graduate orthodontic clinic. Patients were randomized into two study groups: an intervention group receiving oral health promotion material and a template of a parent-child contract, and a control group that received conventional dental instructions provided by orthodontic graduate students. Oral hygiene skill levels were assessed by measuring percentage of total plaque (after best brushing) at three observation periods (baseline, 1-3-month follow-up, and 3-7-month follow-up). Plaque scores were calculated from the photographs of teeth with disclosed plaque, employing the manual for the standardized digital estimation of dental plaque scores. Results: Overall, patients had high plaque scores with large within-group variations indicating deficiency in oral self-care skills (OSCS). Although skills improved from the baseline in both study groups, there was no statistically significant difference (p>0.05) between the intervention group and the control group. The parental compliance rate with the intervention was low (~30%); however, within the compliant group, there was a non-significant trend for OSCS improvement. The baseline plaque level was the only significant predictor of future OSCS. Conclusions: The authoritative parenting model did not result in greater improvements of OSCS of orthodontic patients in comparison to the conventional dental instruction. Parental compliance with the intervention was low; therefore, it is important to identify reasons for non-compliance.
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The UBC Children’s Dental Program (CDP) has provided free basic dental treatment for high caries risk children, from marginalized populations, since the mid-1970s. Children are referred to the program by Health Authority Staff in metro Vancouver. Treatment is provided by senior dental students under the supervision of UBC Pediatric Dentistry instructors. However, the students have limited time to provide health education to the accompanying caregivers. Therefore, this project developed a ʺwaiting-room basedʺ dental health education program (DHEP) to engage the caregivers of participating children. Our main objectives were to assess the feasibility and acceptability of the DHEP and its short term effectiveness in changing parental dental health related behaviours.A situational analysis using structured interviews was performed with the caregivers and other stakeholders of the CDP: Health Authority Staff, UBC Pediatric Dentistry instructors and participating dental students. After the assessment of caregivers’ dental knowledge, dental behaviours, attitudes as well as preferences about a dental educational program, the DHEP was developed and implemented in the waiting rooms at UBC’s two children’s dental clinics. Follow-up phone calls with the caregivers assessed their short term self-reports of changes in dental health related behaviours. Comparisons before and after being exposed to our DHEP were made using Chi-square tests; significance was set at P
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Objectives: To describe the oral health-related lifestyle of Vancouver inner city elementary school-aged children and relate different aspects of their oral health-related lifestyle with demographic and socioeconomic factors. Methods: This cross-sectional study used a structured questionnaire with some open-ended items to survey 424 school-aged children in Vancouver inner city elementary schools (53.3% boys and 46.7% girls). There were two versions of the questionnaire: the shortened version was used for grades 1-3 and included only multiple choice questions while the comprehensive version for grade 4-7 comprised both structured and open-ended questions. In the questionnaire, different items were used such as ordinal, interval and qualitative to acquire information about different aspects of oral health-related knowledge, attitudes and behaviours. Results: Overall, there was a deficiency in oral-health related knowledge and corresponding behaviours in all age groups and both genders. Thus awareness about oral health in this cohort of children needs to be improved. The oral health-related lifestyle did not differ between boys and girls except for the interdental cleaning behaviour (P=0.033). Oral health-related lifestyle did not differ according to socio-demographic characteristics except for the difference in consumption of sugar-containing drinks among age groups (P
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Objectives: The aims of the study were: to describe the dental health and treatment needs of inner-city Vancouver elementary-school-aged children and to examine differences in dental health between socioeconomic and ethnic groups. Methods: Principals of all 10 elementary schools in inner-city Vancouver were approached. Principals of 7/10 inner-city Vancouver elementary agreed to have their schools participate in this project. Consent letters were sent to parents/guardians. The clinical data included assessment of dental health and treatment needs. Self-reported data comprised information about ethnicity, gender, place of birth, years lived in Canada, dental insurance, family education and income. Results: A total of 561 children of age 5-12 year were examined (kindergarten and grades 1-7). Of the children from ethnic minorities, 20% were Filipino, 18% south Asia and 14% Vietnamese. Overall, 57% of children had experienced caries. The mean number per child of decayed, missing or filled teeth was 2.67. In total, 32% of children needed dental treatment. Overall, there were no statistically significant differences among different demographic groups regarding dental treatment needs or dental health status, except that children born outside Canada had more decayed teeth as compared to their Canadian born counterparts.Conclusion: With the information from this study it is possible to conclude that there is a difference in dental health status between children born in Canada and foreign born children. On average, foreign born children present with poorer dental health status than their native counterparts. Further research should also aim to determine the cause of the disparity, so that a more targeted approach can be taken to improve dental health status.
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Objectives: To describe the oral health-related lifestyle of Vancouver inner city elementary school-aged children and relate different aspects of their oral health-related lifestyle with demographic and socioeconomic factors. Methods: This cross-sectional study used a structured questionnaire with some open-ended items to survey 424 school-aged children in Vancouver inner city elementary schools (53.3% boys and 46.7% girls). There were two versions of the questionnaire: the shortened version was used for grades 1-3 and included only multiple choice questions while the comprehensive version for grade 4-7 comprised both structured and open-ended questions. In the questionnaire, different items were used such as ordinal, interval and qualitative to acquire information about different aspects of oral health-related knowledge, attitudes and behaviours. Results: Overall, there was a deficiency in oral-health related knowledge and corresponding behaviours in all age groups and both genders. Thus awareness about oral health in this cohort of children needs to be improved. The oral health-related lifestyle did not differ between boys and girls except for the interdental cleaning behaviour (P=0.033). Oral health-related lifestyle did not differ according to socio-demographic characteristics except for the difference in consumption of sugar-containing drinks among age groups (P
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Objectives: The purpose of this randomized controlled experimental study was to examine how the xerostomia products Biotene® Oralbalance moisturizing liquid and MouthKote® oral moisturizer spray influence mineral content of human enamel in vitro. Methods: 104 caries free extracted human teeth were selected and prepared, followed by baseline QLF imaging and exposure to an erosive solution of lactic acid (pH of 4.5) and/or Biotene®, MouthKote®, as well as Oral-B fluoridated rinse. Mineral loss was determined with respect to mean fluorescence loss (ΔF, %), maximum fluorescence loss (ΔQ, %), and lesion area (WS, %/mm²). Within-group and among-group comparisons were made employing independent sample t-tests, paired sample t-tests, and ANOVA for multiple comparisons with Bonferroni post hoc adjustment, or their non-parametric equivalents. For all tests, the threshold for the statistical significance was set at P
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