Cale, K., Oxner, J., Azarpazhooh, A., Singhal, S.

University of Toronto, Faculty of Dentistry

Background:

With the federal government’s announcement of the Canadian Dental Care Plan (CDCP) to include children from low- and middle-income families, it is essential to determine what needs will be addressed through the new program. Pediatric dentists would be most suitable in understanding the normative oral-health needs of children and subsequently, the services which are essential to be included in the program.

Objectives:

To determine what Canadian pediatric dentists perceive as the essential oral-health services that eligible children should have access to prior to the launch of the CDCP and to compare how much these services align with the CDCP released grids.

Methods:

A cross-sectional survey was administered electronically by the Canadian Association of Pediatric Dentists (CAPD) to eligible members, including certified pediatric dentists working in Canada or retired from practicing, comprising 297 potential respondents. With the funding support from the Canadian Paediatric Society, prize incentivization was offered to ten randomly selected respondents.

Results:

A total of 105 CAPD members participated in the survey (35% response rate); 84 completed the entire survey. More than half of the respondents were females, and the largest participation was from the 30–39-year-old age group, at 33.3%. Most respondents work in a private practice setting, a hospital setting or a combination of the two. Pediatric dentists emphasized through their responses that the health of deciduous teeth are equally as important as permanent teeth. Most of the services that were determined to be essential by respondents were aligned with the CDCP grids apart from a few exceptions. Mouth guards, preformed zirconia crowns, space maintainers, smoking cessation, oral hygiene instruction and nutritional counselling are examples of services that were not included in the CDCP but that respondents believe should be available with limitations or with a pre-authorization for appropriate candidates.

Conclusions:

Though the CDCP dental grids are mostly aligned with the services pediatric dentists perceive to be important for children, some important services are missing, and their inclusion is crucial in reducing the future burden of oral disease on society and the healthcare system. Consultation with pediatric dentists to ensure that normative oral-health needs of Canadian children are being met is necessary as future iterations of the CDCP are released.

Shamira Naik, Joy Richman, Jolanta Aleksejuniene, Ahmed Hieawy

Objectives: In Vancouver, BC Children’s Hospital provides urgent dental services to children referred by dentists or presenting directly to the emergency department. However, their follow-up care is managed by community dentists, resulting in a gap in understanding the success of initial emergency treatments. This study aims to identify prognostic factors affecting the treatment outcomes of luxation injuries in permanent anterior teeth treated at BC Children’s Hospital.

Methods: This retrospective follow-up study was conducted in two stages. The first stage involved collecting data from the electronic health records of patients who presented to BC Children’s Hospital emergency department with traumatic dental injuries to anterior teeth from September 2019 to September 2022. Various prognostic factors influencing clinical and radiographic outcomes were recorded. The second stage involved follow-up visits for children with luxation injuries, including lateral luxation, intrusion, extrusion, and subluxation. Follow-up visits consisted of clinical and radiographic examinations, with outcomes assessed based on healing criteria (healed, non-healed, healing/functional). Associations between prognostic factors and treatment outcomes were examined using a Chi-squared test.

Results: The study included 60 traumatised permanent teeth, of which 40 were luxation injuries. Significant prognostic factors affecting treatment outcomes were the stage of root development (p=0.003) and the time elapsed from trauma to treatment (p=0.01). Injuries treated within five hours of trauma and teeth with closed apices had better outcomes. The health status of the patient showed a trend towards significance, with healthier individuals more likely to have favorable outcomes (p=0.09). Factors such as type of initial treatment, presence of a combination injury, and location of the incident did not have statistically significant associations with treatment outcomes.

Conclusions: Clinical variables such as the stage of root development and the time elapsed from trauma to initial treatment significantly impact the outcomes of luxation injuries. These factors should be considered when triaging patients in hospital emergency departments to ensure optimal prognosis following emergency treatment.

Authors and affiliations: Atyaf Saleh, Jennifer Park and Joy M. Richman, University of British Columbia and British Columbia Children’s Hospital, Vancouver, Canada

Objectives: Dental care for children with autism spectrum disorder (ASD) is challenging for the child, caregiver and dental provider. Several studies assess Oral Health-Related Quality of Life of Children with autism as perceived by the caregiver but do not address the quality of care. Our aim was to carry out a quality improvement/quality assurance survey of caregivers at a tertiary care hospital where many children with autism are referred for dental care.

Methods: A custom survey consisting of multiple-choice questions and free text boxes was distributed between Dec. 1, 2023 and July 5, 2024. After opening the survey and consenting, caregivers were given access to the questions. Anonymous responses were collected using REDCap. Frequency histograms for the survey questions were created using Prism v10. The positivity and negativity of text box responses was measured using word-cloud software. This study was approved by the BCCH Research Data Management committee.

Results: There were 348 caregivers (98% were parents) who completed all 4 sections and 20 who responded to the optional questions about aging-out-of-system. Most families were from the lower mainland of BC (85%), and 66% stated their first language was English reflecting the diversity of the population in BC. The average age of diagnosis of autism was 3.81±2.41 years agreeing with the national average. The main barrier to care was the behaviour of their child (41.67%). Many caregivers favoured in-person visits (85%) over virtual visits, as they felt their child's dental needs cannot be addressed with virtual visits. In contrast, caregivers felt virtual visits were better for their child and were less distracting. There were 615 free-text-boxes completed which provided rich feedback in the following areas 1) physical layout of the clinic, 2) length of visits, 3) sensory stimulation and 4) staff training. Positive comments included overall high satisfaction (88.5%) with the dental providers and the systematic desensitization program. However, a majority of caregivers (75%) felt they are ill-prepared to transition their child out, mainly because they cannot find a suitable dental home.

Conclusions: These results will be used to design a new BCCH dental clinic space. Visits will be shortened and staff training in ASD will be implemented. Our study highlights the significant challenges for caregivers when their child needs to find a dental home in their local community. Since there are relatively few pediatric dentists, better training for general dentists would improve the care for adults with ASD.