Impact of community and individual social capital during early childhood on oral health-related quality of life: a 10-year prospective cohort study

Author's accepted manuscriptAim: To evaluate the impact of community and individual social capital during early childhood on oral healthrelated quality of life (OHRQoL) over a 10-year follow-up period. Methods: A prospective cohort study was conducted in the southern Brazil. Baseline (T1) data collection occurred in 2010 with preschool children aged 1-5 years. Participants were assessed in 2012 (T2), 2017 (T3), and 2020 (T4). OHRQoL was assessed using the B-ECOHIS at T1 and T2 and through CPQ8-10 at T3 and CPQ11-14 at T4. Community social capital was evaluated through the presence of formal institutions in the neighbourhood and individual social capital by social networks, both at T1. Demographic and socioeconomic characteristics were also evaluated. Multilevel Poisson regression analysis was performed to estimate the impact of social capital measures on OHRQoL. Results: Of the 639 children assessed at T1, 469 were followed at T2 (73.3% response rate), 449 at T3 (70.3% response rate), and 429 at T4 (67.1% response rate). Individuals living in neighbourhoods with the presence of social class associations at T1 had higher OHRQoL at T3 and T4. Individuals whose families visit friends and neighbours less than once a month or never at T1 had lower OHRQoL at T1, T3 and T4. Attending religious meetings less than once a month or never at T1 was associated with lower OHRQoL at T2 and T4. Conclusion: Social capital at the community level had a long-term effect on OHRQoL, especially during adolescence, while individual social capital levels impacted OHRQoL across the assessments. Clinical Significance: The findings indicate that psychosocial variables can impact OHRQoL, a fundamental aspect of clinical practice.acceptedVersio

Health Technology Assessment Fireside: Antibiotic Prophylaxis and Dental Treatment in Canada

Objectives. This paper discusses the controversies surrounding the antibiotic prophylaxis preceding dental interventions within the following research question: how effective is dental antibiotic prophylaxis in preventing comorbidity and complications in those at risk? Methods. A synthesis of the available literature regarding antibiotic prophylaxis in dentistry was conducted under the lenses of Kazanjian’s framework for health technology assessment with a focus on economic concerns, population impact, social context, population at risk, and the effectiveness of the evidence to support its use. Results. The papers reviewed show that we have been using antibiotic prophylaxis without a clear and full understanding of its benefits. Although the first guideline for antibiotic prophylaxis was introduced in 1990, it has been revised on several occasions, from 1991 to 2011. Evidence-based clinical guidelines are yet to be seen. Conclusions. Any perceived potential benefit from administering antibiotic prophylaxis before dental procedures must be weighed against the known risks of lethal toxicity, allergy, and development, selection, and transmission of microbial resistance. The implications of guideline changes and lack of evidence for the full use of antibiotic prophylaxis for the teaching of dentistry have to be further discussed

Sociodental indicators and a re(de)fined model for oral health in old age

Objectives. To review and appraise the validity of psychometric instruments used in dentistry, to report on the use of a written vignette and focus groups among older adults, and to evaluate and if necessary refine a model of oral health in old age under the scopes of framework analysis. Methods. A systematic search was performed to find and compare the psychometric instruments for structure, content and method of validation. In six focus groups, 42 participants (30 women, 12 men), discussed their own experiences of oral health, and how they relate to a vignette and a current model of oral health. Participants focused on the completeness, relevance and interdependency of the model's components. Results. 16 instruments were identified, and most of them were based conceptually on a negative and functionalist perspective of disability. The validation approach to test these instruments has been focused on how well they reflect their theoretical framework, how clear and relevant is the content of their questions, and how accurately they predict a given criteria. The participants of the focus groups reiterated that not everyone gets limited and impaired when oral health is disturbed. The participants confirmed the relevance of the essential components of the model, and added diet, expectations, economic priorities, and health values and beliefs as new components in a different graphic arrangement. Conclusions. The validation approach used to validate the psychometric instruments needs a broader scope of attention to evaluate continuously the content of the questions, the predictive potential of the scores, and their theoretical framework. The graphic changes of the model represent an overlapping and non-hierarchical elliptical rather than a concentric-circular portrayal of oral health as originally presented to remain relevant to older adults.Dentistry, Faculty ofGraduat

A preparedness model for the provision of oral health care during unfolding threats: the case of the covid-19 pandemic

Background: The aim of this study was to appraise a recently developed preparedness model for the provision of oral health care during a threat such as the COVID-19 pandemic from the perspectives of oral health care providers, administrators/staff, and patients. Methods: An exploratory qualitative inquiry via at-a-distance semi-structured interviews and group discussions engaged a purposefully selected sample of oral health care workers and patients in British Columbia (BC), Canada. Participants were asked to appraise a preparedness model by considering how to prepare for oral care during a pandemic, while answering open-ended questions about the model content and visual presentation. Interviews and group discussions occurred between April 2020 and January 2021, were audio recorded, and transcribed verbatim. An inductive coding process was used to identify themes, subthemes, and categories of information until saturation was achieved. Results: Seventy-four participants, including 19 dentists, 15 dental hygienists, 10 certified dental assistants, 9 administrators, and 21 patients, suggested modifications to the recently developed preparedness model. Individual interviews (41 participants) and group discussions (33 participants in groups ranging from 2 to 9 attendees each) lasted for an average of 53 min. Eighty-four hours of audio recordings led to more than 1110 single-spaced pages of transcripts. The thematic analysis identified 82 codes, 12 categories, and four main themes: life-long learning, critical thinking, personal and professional risk, and patient-centred care. These themes were understood within provider characteristics and social and environmental contexts. Participants highlighted the need for the model to focus on information and communication, developing awareness and understanding, inferring risks, and performing oral health care during a threat such as a pandemic or disease outbreak. A modified portrayal of the model was suggested to better represent participants’ perspectives. Conclusion: A recently developed preparedness model for the provision of dental care during an unfolding threat like the COVID-19 pandemic was appraised and modified by oral health care workers. Future studies are warranted to evaluate the modified model for use in the event of another unfolding threat collaboratively with providers, patients and stakeholders.Dentistry, Faculty ofOral Health Sciences (OHS), Department ofReviewedFacult

COVID-19 pandemic : Students’ perspectives on dental geriatric care and education

Objectives: With the emergence of the COVID-19 pandemic in Canada and the curtailment of clinical and face-to-face university instruction in British Columbia on March 16, 2020, the opportunity arose to explore how third- and fourth-year undergraduate dental students critically considered the impact of the pandemic on education and the practice of dental geriatrics. Methods: All third- and fourth-year undergraduate dental students within a dental geriatric module were asked to provide a written guided reflection on the question: “In your opinion, what factors make outbreaks (or pandemics) like COVID-19 relevant to the practice of dental geriatrics?” Reflections were gathered from March 12 to May 8, 2020. Thematic analysis was conducted to identify and interpret patterns of meaning within the reflections by means of an interactive coding process. Results: A total of 115 reflections, between 291 and 710 words each, were received from 56 third-year (62.5% male) and 59 fourth-year (42.6% male) students. Five main themes emerged: experiencing uncertainties, frailty as a moderator, constraints in accessing care, preparedness protocol, and redefining care. The frequency in which the same codes, categories, and themes were assigned varied from 16 to 140 times. Conclusions: Students’ reflections highlighted the effects of the pandemic, not only on their education but also on frail older adults themselves and the profession of dentistry in general. Further studies are warranted to explore how this curtailment might impact educators’ approaches to geriatric education, as well as the way graduating students will set up their practices and approach geriatric care in the future.Dentistry, Faculty ofReviewedFacult

Assessing patients’ attitudes to opt-out HIV rapid screening in community dental clinics: a cross-sectional Canadian experience

Background: As a public health initiative, provided-initiated HIV screening test in dental settings has long been available in the U.S.; it was only in 2011 that such setting was used in Canada. The objective of this paper was to assess patients’ response to, and attitudes towards, an opt-out rapid HIV screening test in a dental setting in Vancouver, Canada. Methods A cross-sectional evaluation design using a self-complete survey questionnaire on self-perceived values and benefits of an opt-out rapid HIV screening was employed. An anonymous 10-item questionnaire was developed to explore reasons for accepting or declining the HIV rapid screening test, and barriers and facilitators for the HIV screening in dental settings. Eligible participants were male and female older than 19 years attending community dental clinics and who were offered the HIV screening test between June 2010 and February 2015. Results From the 1552 age-eligible patients, 519 completed the survey and 155 (10 %) accepted the HIV screening due to its convenience, and/or free cost, and/or instant results. From the 458 respondents who did not accept the screening, 362 (79 %) were between the ages of 25 and 45 years; 246 (53.7 %) had identifiable risk factors for contracting HIV; and 189 (41.3 %) reported having been tested within the last 3 months. Those tested in less than 3 months had 3.5 times higher odds to decline the HIV screening compared to those who have been tested between 3 months and 1 year. Conclusions Convenience, cost-free and readily available results are factors influencing rapid HIV screening uptake. Although dental settings remain an alternative venue for HIV screening from the patients’ perspectives, dental hygiene settings might offer a better option.Dentistry, Faculty ofNon UBCOral Health Sciences (OHS), Department ofReviewedFacult

Data set and methodology involving pedagogical approaches to teach mental health and substance use in dental education

Objective In this Data note, we provide a raw data set in the form of brief self-guided reflections. We also present the methodological approach to generate these reflections including an educational vignette so that other dental schools can plan for their teaching activities involving mental health and substance use topics. Data description Between 2015/16 and 2018/19, the University of British Columbia’s (UBC) undergraduate dental and dental hygiene students submitted optional written guided reflections to address ‘how can an educational vignette, depicting a patient with a history of substance use and mental health disorders accessing dental care, promote an open dialogue about stigma?’ From a total of 323 undergraduate students, 148 anonymous reflections between 200 and 400 characters each were received. The main ideas that may emerge from the reflections include ‘exploring power relations’ and ‘patient-centered care approach to counteract stigma’.Dentistry, Faculty ofNon UBCOral Biological and Medical Sciences (OBMS), Department ofOral Health Sciences (OHS), Department ofReviewedFacultyResearcherOthe

Oral sex and oral cancer in the context of human papillomavirus infection: lay public understanding

Human papillomavirus (HPV) is a risk factor for ano-genital and cervical cancers and has been associated with head and neck malignancies in the context of oral sex for the transmission of the virus. However, the level of knowledge that lay people have in terms of HPV transmission through oral sex and oral cancer development remains unknown. A pilot sample of 150 questionnaires was distributed at specific non-profit health organizations in Vancouver, Canada. Questions included perceived risks for oral sex in terms of HPV infection and oral cancer development, and the frequency with which respondents were asked about oral sexual practices by physicians and dentists. Data were analysed statistically by age group (19– 30, 31–50, 50\), gender (male, female), and sexual orientation (queer, straight). 110 questionnaires were returned fully completed. For the transmission of HPV, 58% of the participants believed that oral sex is an activity of no or low risk, whereas 72% considered the same activity to be of no risk for the development of oral cancer. There was no statistical difference between gender and sexual orientation. Participants never discussed related health risks in regard to oral sex with their physicians or dentists. In conclusion, although recent attention has been given to the potential links between HPV infection and oral cancer, such links remain mostly unknown by the public. Physicians and dentists could discuss oral sex practices to raise awareness with their patients. This is a small sample size study and the results should be interpreted with caution

The role of an educational vignette to teach dental students on issues of substance use and mental health disorders in patients at the University of British Columbia: an exploratory qualitative study

Background Inverted classroom approaches and the use of vignettes have been suggested in health care education. The objective of this study was to use an educational vignette to discuss issues of stigma around substance use and mental disorders within undergraduate Doctor of Medicine in Dentistry (DMD) and Bachelor of Dental Science in Dental Hygiene (BDSc-DH) students at the University of British Columbia, Canada. Our research question was “how can an educational vignette, depicting a fictitious patient with a history of substance use and mental health disorders accessing dental care, promote an open dialogue about stigma?” Methods An educational vignette was developed based on individuals’ lived-experiences with a variety of substance use and/or mental health disorders. This vignette was used to generate in-class discussion involving all the DMD and BDSc-DH undergraduate students enrolled between 2015/16 and 2018/19 who attended a mandatory 2.5 h didactic session using an inverted classroom approach. Students were also encouraged to provide a post-class voluntary written reflection, between 200 and 300 words, around stigma. The authors took written field notes on students’ response to the vignette and used excerpts from students’ de-identified reflections to illustrate the impact of such an educational tool. Results A total of 323 DMD and BDSc-DH students attended the didactic sessions between 2015/16 and 2018/19, and 148 reflections were submitted over the same time period. The inverted classroom approached showed to be engaging and collaborative. The vignette promoted open dialogue and was determined to be a conducive tool to generate in-class discussion and reflection. Major themes from the textual data included ‘exploring power relations’ and ‘patient-centered care approach to counteract stigma’. The vignette also enabled the discussion of positive experiences characterized by empathy, reassurance and communication, although it might not have prompted all students to participate in class or in writing the reflections. Conclusion The inverted classroom approach and the vignette seemed to be an effective way to facilitate dialogue and reflection for most students. This study highlighted the need to explore innovative ways in which to continuously prepare current and future oral health care providers to professionally address the needs of patients with a history of substance use and/or mental health disorders.Dentistry, Faculty ofNon UBCOral Health Sciences (OHS), Department ofReviewedFacult