James L. Leake

Incidence of and Risk Factors for Tooth Loss in a Population of Older Canadians

Data on the incidence of tooth loss in community-dwelling older Canadians have not previously been reported. Since recent US studies of older adults were conducted in predominantly rural communities, their results may not be generalizable to Canada, where the majority of older adults live in major metropolitan or urban settings. This paper describes a study designed to estimate the incidence of tooth loss in older Canadians and to identify factors predictive of that loss. Using personal interviews and clinical examinations, we obtained baseline and three-year follow-up data from 491 dentate subjects. Overall, 23.2% lost one or more teeth between baseline and follow-up. Only six, or 1.2%, became edentulous. Twelve baseline factors were significantly associated with the probability of loss. However, in a logistic regression analysis, only five had significant independent effects. These were gender, marital status, self-rating of oral health status, the number of decayed root surfaces, and a mean periodontal attachment loss of 4 mm or more. The predictive ability of the model was poor, largely because tooth loss is a complex outcome which depends on decisions taken by dentists and patients. Since this decision-making process cannot be captured in epidemiological studies, observational studies are needed to cast further light on tooth loss in this population.

Prevalence of and Factors Associated with Root Decay in Older Adults in Canada

We collected data on the oral health status and treatment needs of a random sample of persons aged 50 years and over. Data on root decay were obtained from the 183 subjects who were dentate. All remaining teeth were examined for root decay and restorations, whether root surfaces were affected by recession or not. Analysis was undertaken by case and root surface, with separate analyses of decayed (DS), and decayed and filled (DFS) root surfaces. One or more root surfaces with untreated decay were found in 37.2% of subjects, while one or more decayed or filled root surfaces were found in 56.8%. The mean number of decayed sutfaces was 1.3 per person, and the mean number of decayed and filled root surfaces was 2.6. Multiple and logistic regression analyses showed that oral health variables were more important predictors of the presence and severity of root decay than demographic, general health, or dental care factors.

Public policy and the market for dental services

Social inequality in access to oral health care is a feature of countries with predominantly privately funded markets for dental services. Private markets for health care have inherent inefficiencies whereby sick and poor people have restricted access compared to their healthy and more affluent compatriots. In the future, access to dental care may worsen as trends in demography, disease and development come to bear on national oral healthcare systems. However, increasing public subsidies for the poor may not increase their access unless availability issues are resolved. Further, increasing public funding runs counter to policies that feature less government involvement in the economy, tax policy on private insurance premiums, tax reductions and, in some instances, free-trade agreements. We discuss these issues and provide international examples to illustrate the consequences of the differing public policies in oral health care. Subsidization of the poor by inclusion of dental care in social health insurance models appears to offer the most potential for equitable access. We further suggest that nations need to develop national systems capable of the surveillance of disease and human resources, and of the monitoring of appropriateness and efficiency of their oral healthcare delivery systems.

A retrospective analysis of referral patterns for oral radiologic consultation over 3 years in Ontario, Canada

OBJECTIVES To determine the types of practitioners who most commonly refer and the film type and diagnostic entities that are most frequently submitted for oral radiologic consultation in Ontario, Canada. STUDY DESIGN A total of 430 referral letters and responses from 2 Ontario oral radiologists from 2003 to 2005 were analyzed. Data collected included the specialty of the referring practitioner, the film type(s) submitted, the radiographic density of the entity of interest, and the interpretation by the radiologist. RESULTS General practitioners (58.9%) and oral surgeons (21.5%) were the most frequently referring practitioner types, representing 1.2% and 17.1% respectively of each group practicing in Ontario. Also, 18.2% of oral pathologists referred. Panoramic radiographs (79.5%) were included in referrals more often than intraoral radiographs (46.0%). Of the entities, 37.0% were radiopacities, 27.4% were radiolucencies, and 13.5% had mixed radiopaque-radiolucent density. The radiologists interpreted normal features (55.6%) most often. CONCLUSION Panoramic radiographs with normal findings were submitted to oral radiologists for consultation most frequently in Ontario.

Lack of Oral Care Policies in Toronto Daycares

OBJECTIVES 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. METHODS Telephone interviews were conducted with daycare supervisors using a pretested questionnaire. Summary statistics and the chi-square test were used to analyze the results. 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. CONCLUSIONS 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.

Structured or Unstructured Personnel Interviews

The challenge for health care managers is finding, hiring and retaining appropriately qualified and motivated employees. One useful method of gaining information about and insight into a candidate is interviewing, which can be classified as structured, unstructured or semi-structured. The disadvantages of unstructured interviews are reviewed; ways to enhance the psychometric properties of interviews by adding structure are reviewed and summarized; and the possible reasons for underutilization of structured interviews are explored.

5000 ppm toothpaste more effective than 1100 ppm in reversing root caries

Design Six-month double-blind randomised trial of 186 adults who each had to least one PRCL.Intervention Verbal and written instructions were given to participants to brush at least once a day with the allocated dentifrice. Toothbrushes and dentifrices were supplied.Outcome measure New lesions were assessed by a single examiner using fixed clinical criteria and an electric caries monitor (ECM).Results After 6 months, significantly more lesions in the 5000 ppm group had reversed (see Table 1). Non-cavitated lesions were more likely to harden. ECM scores in the 5000 ppm group tended to increase during the study.Conclusions The dentifrice containing 5000 ppm fluoride was found to be significantly better at remineralising PRCL than the one containing 1100 ppm fluoride.Acknowledgement This study was supported by a grant from Colgate Palmolive.