Case 5 : Let’s Agree to Agree: Management Techniques in Calibrating Oral Health Screening Systems

In 2014, Lisa Montebello, a Registered Dental Hygienist and Master of Public Health candidate at the Interfaculty program in Public Health, Western University, was working during her practicum with Dr. Mark Gracey, Oral Health Manager of the Middlesex-London Health Unit (MLHU), in London, Ontario, Canada. Her objective was to formulate a clinical calibration assessment and recommendation report. Clinical calibration is a comparison of agreement between clinicians, or against a verified standard, to achieve a clinical gold standard. Dr. Gracey was responsible for following the Ontario Public Health Standards (OPHS) protocols to ensure that all Grade 2 children in the Middlesex-London area were receiving equitable access to oral health care services through oral health screenings. There were over 120 schools with five registered dental hygienists (RDHs), along with five dental assistants (DAs) providing this service through the school screening program. After a calibration review slide session the year before, it was found that the RDHs were rating the oral health care needs of children inconsistently. This posed a dilemma for both Dr. Gracey and Lisa, as vulnerable children with urgent dental care needs may be missed as a result. There was also no standardized recommended statistical analysis in place at MLHU to analyze the data from the calibration sessions. Lisa needed to come up with a best practice guideline for clinical calibration, including statistical analysis recommendations, so that the MLHU could ensure that no child was overlooked due to inconsistent measurement outputs. Lisa had just 8 weeks to observe and assess the entire current calibration system in place, and to formulate a report for the oral health team at the MLHU

Case 8 : iSMILE Project – Improving Seniors’ Mouthcare In Long-term care Establishments

The Ontario universal healthcare coverage through the Ontario Health Insurance Plan (OHIP) was established to provide for the health needs of Ontarians ranging from children to the elderly. However, it does not include oral healthcare. Publicly funded programs that provide dental services are offered to children from low income families, recipients of Ontario works, and Ontario Disability Support with no program for seniors. With most seniors already retired and no longer receiving employment derived dental benefits, those in need of dental services would have to purchase private insurance or pay out-of-pocket. The cost of dental treatment for those who cannot afford it serves as a barrier to accessing dental services and leads to poor oral health. Seniors, especially those at a long-term care establishment (LTCE), are more susceptible to dental diseases. With many seniors retaining their natural teeth compared to previous generations, dental diseases tend to thrive and there is the increased need for dental services. The Vanes Health Unit (VHU) Oral Health Department, under the leadership of Dr. Dawn DaSilva and Dr. Charles Oakswood, identified this vulnerable subgroup and in 2014 decided to take on the challenge to promote seniors’ oral health while working with limited resources. Out of this situation the iSMILE project (improving Seniors’ Mouthcare In Long-term care Establishments) was born. It is a health promotion initiative aimed at improving seniors’ mouthcare by targeting caregivers – personal support workers (PSWs) mainly (in some homes nurses as well). This was done through a needs assessment first to determine what oral health meant to caregivers and their knowledge of its impact on general health, how oral care is carried out in the home, challenges and barriers faced. The project also targeted management staff as a secondary audience. In May 2014, Michaela Josephs, a new member of the VHU-Oral Health Team, was tasked with the responsibility to carry out the iSMILE project and to eventually develop oral health education and promotional resources that could be used by the caregivers in LTCEs. The iSMILE project was a community funded grant. Michaela had a 12-week timeline to carry out the project based on the amount of funding provided. She reviewed the findings from Dr. DaSilva and Dr. Oakswood’s literature review on causes of poor oral health status of seniors in LTCEs. Michaela also conducted several literature searches and consulted with several experts to gather information about the priority population, the different target audiences, and to gain access into the LTCEs. Having done this she then proceeded to the LTCEs where she conducted a series of focus group discussions and interviews with PSWs and management staff

Determinants of dentists' readiness to assess HPV risk and recommend immunization: A transtheoretical model of change-based cross-sectional study of Ontario dentists.

ObjectivesTo evaluate dentists' readiness to assess the history of human papilloma virus (HPV) infections and recommend immunization among their patients.Materials and methodsA link to a self-administered questionnaire was emailed to Ontario dentists. Dentists' readiness and its determinants were assessed based on Transtheoretical Model's 'stages' and 'processes' of change, respectively. Based on their current practices, dentists were either assigned to 'pre-action' or 'action+' stages.ResultsOf the 9,975 dentists contacted, 932 completed the survey; 51.9% participants were in action stage to assess the history of HPV infections and 20.5% to recommend immunization. Internationally-trained and those whose office's physical layout was not a concern to discuss patients' sexual history were more likely to assess the history. Dentists with higher knowledge about HPV vaccines, not concerned about the HPV vaccine safety, comfortable discussing sex-related topics with patients, or willing to exceed their scope of practice were more ready to recommend HPV immunization to their patients.ConclusionImproving Ontario dentists' knowledge and communication skills and changing their self-perceived role regarding HPV infections and vaccination can increase their capacity to minimize the burden of HPV infections