Sonica Singhal

Does cessation of community water fluoridation lead to an increase in tooth decay? A systematic review of published studies

Background Cessation of community water fluoridation (CWF) appears to be occurring with increasing frequency in some regions. Our objective was to comprehensively review published research on the impact of CWF cessation on dental caries. Methods We searched 13 multidisciplinary databases. Results were synthesised qualitatively and quantitatively. Results We identified 15 instances of CWF cessation (‘intervention’) in 13 countries, which covered a broad time frame (1956–2003) and diverse geographical and political/economic contexts. Overall, results were mixed, but pointed more to an increase in caries postcessation than otherwise. For example, of the 9 studies with at least moderate methodological quality based on criteria we developed for this review, 5 showed an increase in caries postcessation. 3 studies did not show an increase in caries postcessation; however, important postcessation changes (eg, implementation of alternative fluoride delivery programmes) and/or large-scale social change may have contributed to those effects. Of the 3 study groupings that permitted quantitative synthesis, 2 showed statistically significant mean overall increase in caries postcessation; however, quantitative synthesis results must be interpreted cautiously. Conclusions Overall, the published research points more to an increase in dental caries post-CWF cessation than otherwise. However, the literature is highly diverse and variable in methodological quality. To build this literature, it is important to exploit research opportunities presented by CWF cessation. Remaining knowledge gaps include the impact of CWF cessation on the distribution of dental caries (ie, equitable or not) and understanding the decision-making circumstances around CWF cessation.

The impact of dental treatment on employment outcomes: A systematic review

OBJECTIVE Policy advocates in North America argue that access to dental care for low income and unemployed populations can help improve the chances of acquiring a job or attaining a better job, thus having positive economic and social benefits. Our objective is to review the evidence in support of the policy hypothesis that timely access to dental care can improve employment outcomes. METHODS A systematic review was conducted by searching various scientific databases and search engines. Key words included Dental Care, Dental Intervention, Social Welfare, Unemployment, Employment, and Job. RESULTS Seven articles were considered eligible for this review. They varied in study design, target population and intervention studied. Overall, they presented low levels of evidence due to small sample sizes, lack of control groups, combined interventions or being based on anecdotal reports. CONCLUSIONS There is a limited amount of evidence concerning the assumption that dental care can improve employment outcomes. The scarcity of well-conducted studies and the poor quality of evidence makes it difficult to judge the effect of dental care on employment outcomes. More studies need to be conducted in order to confirm or dismiss this generalized assumption.

The accuracy of International Classification of Diseases coding for dental problems not associated with trauma in a hospital emergency department.

OBJECTIVES Emergency department (ED) visits for nontraumatic dental conditions (NTDCs) may be a sign of unmet need for dental care. The objective of this study was to determine the accuracy of the International Classification of Diseases codes (ICD-10-CA) for ED visits for NTDC. METHODS ED visits in 2008-2099 at one hospital in Toronto were identified if the discharge diagnosis in the administrative database system was an ICD-10-CA code for a NTDC (K00-K14). A random sample of 100 visits was selected, and the medical records for these visits were reviewed by a dentist. The description of the clinical signs and symptoms were evaluated, and a diagnosis was assigned. This diagnosis was compared with the diagnosis assigned by the physician and the code assigned to the visit. RESULTS The 100 ED visits reviewed were associated with 16 different ICD-10-CA codes for NTDC. Only 2 percent of these visits were clearly caused by trauma. The code K0887 (toothache) was the most frequent diagnostic code (31 percent). We found 43.3 percent disagreement on the discharge diagnosis reported by the physician, and 58.0 percent disagreement on the code in the administrative database assigned by the abstractor, compared with what it was suggested by the dentist reviewing the chart. CONCLUSION There are substantial discrepancies between the ICD-10-CA diagnosis assigned in administrative databases and the diagnosis assigned by a dentist reviewing the chart retrospectively. However, ICD-10-CA codes can be used to accurately identify ED visits for NTDC.

An exploratory pilot study to assess self-perceived changes among social assistance recipients regarding employment prospects after receiving dental treatment

BackgroundStrengthening self-efficacy in job-seeking among individuals with dental problems has been identified as an important factor in facilitating job procurement and maintenance. There is no knowledge about whether receiving dental treatment improves someone’s self-efficacy in seeking a job. This work explores this relationship.MethodsAn exploratory pilot study of a convenience sample of 30 social assistance recipients of Ontario, Canada, was conducted using a pre- and post-dental treatment survey, which included both quantitative and qualitative components. The survey included two validated instruments Oral Health Impact Profile (OHIP-14) and Job-Seeking Self-efficacy scale (JSS). Changes in scores of both scales following dental treatment were calculated. Pearson correlation was performed between OHIP-14 and JSS scores. Qualitative data were transcribed and interrelated ideas were grouped together to generate themes.ResultsMean scores for OHIP-14 (23.4 to 6.7, p < 0.001, effect size: 1.75) and median scores for JSS (4.9 to 5.5, p = 0.002, effect size: 0.40) changed significantly after receiving dental treatment. A significant negative correlation (−0.56, p = 0.001) was observed between OHIP-14 and JSS scores indicating that job-seeking self-efficacy improves with improvement in oral health related quality of life (OHRQoL). Qualitative analysis reveals participants’ physical and psychosocial impacts of dental problems; barriers experienced in accessing dental care and seeking a job; and changes perceived after receiving dental care.ConclusionResults of our survey indicate that social assistance recipients experience negative impacts of dental problems and perceive improvements in OHRQoL and job-seeking self-efficacy after receiving dental treatment.

Addressing health inequities in Ontario, Canada: what solutions do the public support?

BackgroundAs public opinion is an important part of the health equity policy agenda, it is important to assess public opinion around potential policy interventions to address health inequities. We report on public opinion in Ontario about health equity interventions that address the social determinants of health. We also examine Ontarians’ support and predictors for targeted health equity interventions versus universal interventions.MethodsWe surveyed 2,006 adult Ontarians through a telephone survey using random digit dialing. Descriptive statistics assessed Ontarians’ support for various health equity solutions, and a multinomial logistic regression model was built to examine predictors of this support across specific targeted and broader health equity interventions focused on nutrition, welfare, and housing.ResultsThere appears to be mixed opinions among Ontarians regarding the importance of addressing health inequities and related solutions. Nevertheless, Ontarians were willing to support a wide range of interventions to address health inequities. The three most supported interventions were more subsidized nutritious food for children (89%), encouraging more volunteers in the community (89%), and more healthcare treatment programs (85%). Respondents who attributed health inequities to the plight of the poor were generally more likely to support both targeted and broader health equity interventions, than neither type. Political affiliation was a strong predictor of support with expected patterns, with left-leaning voters more likely to support both targeted and broader health equity interventions, and right-leaning voters less likely to support both types of interventions.ConclusionsFindings indicate that the Ontario public is more supportive of targeted health equity interventions, but that attributions of inequities and political affiliation are important predictors of support. The Ontario public may be accepting of messaging around health inequities and the social determinants of health depending on how the message is framed (e.g., plight of the poor vs. privilege of the rich). These findings may be instructive for advocates looking to raise awareness of health inequities.

Assessing the relationship between dental appearance and the potential for discrimination in Ontario, Canada

Poor oral health is influenced by a variety of individual and structural factors. It disproportionately impacts socially marginalized people, and has implications for how one is perceived by others. This study assesses the degree to which residents of Canada’s most populated province, Ontario, recognize income-related oral health inequalities and the degree to which Ontarians blame the poor for these differences in health, thus providing an indirect assessment of the potential for prejudicial treatment of the poor for having bad teeth. Data were used from a provincially representative survey conducted in Ontario, Canada in 2010 (n=2006). The survey asked participants questions about fifteen specific conditions (e.g. dental decay, heart disease, cancer) for which inequalities have been described in Ontario, and whether participants agreed or disagreed with various statements asserting blame for differences in health between social groups. Binary logistic regression was used to determine whether assertions of blame for differences in health are related to perceptions of oral health conditions. Oral health conditions are more commonly perceived as a problem of the poor when compared to other diseases and conditions. Among those who recognize that oral conditions more commonly affect the poor, particular socioeconomic and demographic characteristics predict the blaming of the poor for these differences in health, including sex, age, education, income, and political voting intention. Social and economic gradients exist in the recognition of, and blame for, oral health conditions among the poor, suggesting a potential for discrimination amongst socially marginalized groups relative to dental appearance. Expanding and improving programs that are targeted at improving the oral and dental health of the poor may create a context that mitigates discrimination.

Increased risk of coronary heart disease in female smokers

802 www.thelancet.com Vol 379 March 3, 2012 disease (per 100 000 person-years) for non-smokers was 241 for men but only 115 for women. Diff erences in baseline risk highlight the importance of the choice of eff ect measure when considering hetero geneity in risk across populations. The risk diff erence in coronary heart disease mortality between current and never smokers in CPS-II was 167·1 in men but 66·5 in women. Had Huxley and Woodward chosen to focus on absolute rather than relative risk, the study conclusions would probably have been diff erent, and might have directly contradicted their reported fi ndings and interpretation. Given their study design, Huxley and Woodward might not have had access to baseline risks or absolute risk diff erences, since these continue to be seldom reported. Nevertheless, the omission of this issue has important consequences. The risk diff erence is widely regarded as being a more relevant scale by which to quantify the burden of disease, and arguments about the merits of relative risks for aetiological studies have been shown to be fl awed. Although we agree with Huxley and Woodward that the rise of smoking in women has important public health consequences, estimation of its eff ects on the absolute scale would provide important context for assessing potential interventions.

The use and misuse of antibiotics in dentistry

BACKGROUND To describe antibiotic prescribing behaviors in dentistry, including clinical and nonclinical indications for their use, the type and regimen of antibiotics prescribed, and factors influencing their prescription, the authors conducted a scoping review. TYPES OF STUDIES REVIEWED The authors conducted a scoping review of published literature by searching multiple databases. Key search terms included dentist, antibiotic, antimicrobial, antibacterial, prophylaxis, prescription, pattern, habit, knowledge, and practice. Two authors independently reviewed titles and abstracts by using detailed eligibility criteria. The authors placed no restrictions on study design or publication year. The authors qualitatively assessed studies by using a modified version of the Center for Evidence-Based Managements critical appraisal of a survey checklist. RESULTS The authors identified 1,912 studies but considered only 118 studies eligible for review. Most included studies were either cross-sectional surveys (81 studies) or prescription audits (25 studies) from various geographic locations. Publication dates ranged from 1982 through 2017. The authors examined prophylactic and therapeutic antibiotic use in 48 and 29 studies, respectively. Another 29 studies examined the use of both prophylactic and therapeutic antibiotics in dentistry. Overall, dentists prescribed a wide variety of antibiotic regimens for various clinical and nonclinical indications. Dentists have acquired their prescribing knowledge from a variety of sources and have changed their antibiotic prescribing practices throughout their careers for various reasons. CONCLUSIONS AND PRACTICAL IMPLICATIONS Considering the seriousness of antibiotic resistance, the authors highlight trends in antibiotic prescribing practices, characterize factors contributing to the use and misuse of antibiotics in dentistry, provide insight into the importance of antibiotic stewardship in the oral health setting, and encourage dentists to reflect on their antibiotic prescription practices.

Methodological considerations for designing a community water fluoridation cessation study

High-quality, up-to-date research on community water fluoridation (CWF), and especially on the implications of CWF cessation for dental health, is limited. Although CWF cessation studies have been conducted, they are few in number; one of the major reasons is the methodological complexity of conducting such a study. This article draws on a systematic review of existing cessation studies (n=15) to explore methodological considerations of conducting CWF cessation studies in future. We review nine important methodological aspects (study design, comparison community, target population, time frame, sampling strategy, clinical indicators, assessment criteria, covariates and biomarkers) and provide recommendations for planning future CWF cessation studies that examine effects on dental caries. There is no one ideal study design to answer a research question. However, recommendations proposed regarding methodological aspects to conduct an epidemiological study to observe the effects of CWF cessation on dental caries, coupled with our identification of important methodological gaps, will be useful for researchers who are looking to optimize resources to conduct such a study with standards of rigour.

Knowledge, attitude, willingness and readiness of primary health care providers to provide oral health services to children in Niagara, Ontario: a cross-sectional survey

BACKGROUND Most children are exposed to medical, but not dental, care at an early age, making primary health care providers an important player in the reduction of tooth decay. The goal of this research was to understand the feasibility of using primary health care providers in promoting oral health by assessing their knowledge, attitude, willingness and readiness in this regard. METHODS Using the Dillman method, a mail-in cross-sectional survey was conducted among all family physicians and pediatricians in the Niagara region of Ontario who have primary contact with children. A descriptive analysis was performed. RESULTS Close to 70% (181/265) of providers responded. More than 90% know that untreated tooth decay could affect the general health of a child. More than 80% examine the oral cavity for more than 50% of their child patients. However, more than 50% are not aware that white spots or lines on the tooth surface are the first signs of tooth decay. Lack of clinical time was the top reason for not performing oral disease prevention measures. INTERPRETATION Overall, survey responses show a positive attitude and willingness to engage in the oral health of children. To capitalize on this, there is a need to identify mechanisms of providing preventive oral health care services by primary health care providers; including improving their knowledge of oral health and addressing other potential barriers.