The use of panoramic radiographs to address the oral health needs of vulnerable Canadian populations.

Background: The high demand for oral health care services among vulnerable individuals combined with limited available resources requires a rethinking of the provision of oral health services. This study aimed to determine the usefulness of the dental panoramic radiograph (DPR) as an imaging tool to assess oral health and prioritize dental interventions in vulnerable patients. Methods: This observational and retrospective study evaluated charts of patients who attended Public Health Dental Clinics (PHDC), Alberta Health Services (AHS), in Calgary, Canada, between January 2018 and December 2019. Data collected included sex and age at the time of image acquisition. The following radiographic findings were gathered: the number of missing, present, decayed, restored, and impacted teeth; periapical lesions; retained root; periodontal bone loss; odontogenic and non-odontogenic lesions in the jaws; carotid calcification; and incidental radiographic findings with clinical relevance. Results: Of the 526 DPRs evaluated, 57.4% were from male patients and 42.6% were from female patients, with a mean age of 38.5 years. The average number of present teeth in females and males was 23.7 and 22.6, respectively. The most prevalent dental-related finding was periodontal bone loss (81.5%), followed by periapical lesions (59.6%) and impacted teeth (27%). Among non-dental findings, osseous lesions of the jaws were found in 10.4% of the patients, and carotid atheroma had a frequency of 3.2%. Conclusion: The DPR is a useful adjunct to the clinical exam in this specific population. It provides an opportunistic overview of their oral health and necessary support to establish priorities in oral health care in a public health setting.

Contexte : La forte demande de services de santé buccodentaire chez les personnes vulnérables, combinée aux ressources limitées disponibles, nécessite de repenser la prestation des services de santé buccodentaire. Cette étude vise à déterminer l'utilité de la radiographie panoramique comme outil d'imagerie pour évaluer la santé buccodentaire et prioriser les interventions dentaires chez les patients vulnérables. Méthodes : Cette étude observationnelle et rétrospective a évalué les dossiers des patients qui ont fréquenté les cliniques dentaires de santé publique d'Alberta Health Services (AHS) à Calgary, au Canada, entre janvier 2018 et décembre 2019. Les données recueillies comprenaient le sexe et l'âge au moment de l'acquisition de l'image. Les résultats radiographiques suivants ont été recueillis : nombre de dents manquantes, présentes, cariées, réparées et incluses; lésions périapicales; racine résiduelle; perte osseuse parodontale; lésions odontogéniques et non odontogéniques dans les mâchoires; calcification carotidienne; et résultats radiographiques accessoires pertinents sur le plan clinique. Résultats : Parmi les 526 radiographies panoramiques évaluées, 57,4 % provenaient d'hommes et 42,6 % de femmes, avec un âge moyen de 38,5 ans. Le nombre moyen de dents présentes chez les femmes et les hommes était de 23,7 et 22,6, respectivement. La découverte la plus courante liée aux soins dentaires était la perte osseuse parodontale (81,5 %), suivie des lésions périapicales (59,6 %) et des dents incluses (27 %). En ce qui concerne les résultats non liés aux soins dentaires, des lésions osseuses des mâchoires ont été repérées chez 10,4 % des patients, et l'athérome carotidien avait une fréquence de 3,2 %. Conclusion : La radiographie panoramique est un complément utile à l'examen clinique dans cette population particulière. Elle donne un aperçu de leur santé buccodentaire et le soutien nécessaire pour établir les priorités en matière de soins buccodentaires dans un contexte de santé publique.

Provision of dental care by public health dental clinics during the COVID-19 pandemic in Alberta, Canada.

OBJECTIVES: This study aims to describe dental services provided to a low income population in dental public health settings during the first wave of COVID-19 pandemic in Alberta, Canada. METHODS: Routinely collected clinical data were recorded by dentists in electronic medical record files at Alberta's two Public Health Dental Clinics (PHDCs). Patient contact was via teledentistry or in person, respecting phased provincial pandemic restrictions. A descriptive analysis of data relating to all patients contacting PHDC with dental problems between 17 March - 31 October 2020 was undertaken and compared to equivalent pre-COVID 2019 data. RESULTS: In the period examined, 851 teledentistry consultations and 1031 in person visits were performed. Compared to the same period in 2019, 46% fewer patients were treated, representing a decrease in dental procedures: tooth extractions (17%), silver diamine fluoride applications (17%), endodontic treatments (82%) and fillings (84%). By contrast, prescriptions increased by 66% overall; representing 76%, 121% and 44% in antibiotics, non-opioid analgesics, and opioid analgesics respectively. In both years, antibiotics were the most prescribed drugs (66% in 2019 versus 62% in 2020) followed by non-opioid analgesics (28% in 2019 versus 33% in 2020); opioids accounted for the remainder (6.5% in 2019 and 5% in 2020). The largest drug prescription increases occurred during April-May 2020, when access to care was most restricted: antibiotics and non-opioid analgesics were 300% and 738% higher than the same time in 2019. CONCLUSIONS: Teledentistry and pharmacotherapy were used to triage and organise dental patients accessing care during the early stages of the pandemic. However, teledentistry did not replace definitive in person dental treatment, particularly for low income populations with high incidence of toothache and odontogenic infection. Reduced provision of dental procedures was accompanied by an increase in drug prescribing. Expedient access to care must be provided to address the dental needs of this population avoiding risks of further complications associated with infection and overprescribing antibiotics and opiates.

Factors Associated with Emergency Department Use for Non-traumatic Dental Problems: Scoping Review.

OBJECTIVE: The use of hospital emergency departments (EDs) for non-traumatic dental problems places a significant strain on the health care system and resources. The objective of this scoping review was to identify factors associated with patients' use of EDs for such problems. METHODS: Embase, Medline-Ovid, Scopus and Web of Science databases were searched, and primary studies, systematic reviews and meta-analyses from Canada and the United States, published in English between 2007 and 2017 were selected for inclusion. RESULTS: Of 469 articles, 22 met our inclusion criteria: 6 were conducted in Canada and 16 in the United States. Identified factors associated with ED use for non-traumatic dental problems included patient demographics (age, gender, race/ethnicity, comorbidities, oral health status), accessibility (time of day, day of week, geographic location, access to dental practitioner), economic influences (insurance, inability to afford dental care, income) and social demographics (community language, homelessness, repeat use). CONCLUSION: The factors identified in this review can inform future research studies and program planning to address ED use for non-traumatic dental problems.

Acute dental infections managed in an outpatient parenteral antibiotic program setting: prospective analysis and public health implications.

BACKGROUND: The number of Acute Dental Infections (ADI) presenting for emergency department (ED) care are steadily increasing. Outpatient Parenteral Antibiotic Therapy (OPAT) programs are increasingly utilized as an alternative cost-effective approach to the management of serious infectious diseases but their role in the management of severe ADI is not established. This study aims to address this knowledge gap through evaluation of ADI referrals to a regional OPAT program in a large Canadian center. METHODS: All adult ED and OPAT program ADI referrals from four acute care adult hospitals in Calgary, Alberta, were quantified using ICD diagnosis codes in a regional reporting system. Citywide OPAT program referrals were prospectively enrolled over a five-month period from February to June 2014. Participants completed a questionnaire and OPAT medical records were reviewed upon completion of care. RESULTS: Of 704 adults presenting to acute care facilities with dental infections during the study period 343 (49%) were referred to OPAT for ADI treatment and 110 were included in the study. Participant mean age was 44 years, 55% were women, and a majority of participants had dental insurance (65%), had seen a dentist in the past six months (65%) and reported prior dental infections (77%), 36% reporting the current ADI as a recurrence. Median length of parenteral antibiotic therapy was 3 days, average total course of antibiotics was 15-days, with a cumulative 1326 antibiotic days over the study period. There was no difference in total duration of antibiotics between broad and narrow spectrum regimes. Conservative cost estimate of OPAT care was $120,096, a cost savings of $597,434 (83%) compared with hospitalization. CONCLUSIONS: ADI represent a common preventable cause of recurrent morbidity. Although OPAT programs may offer short-term cost savings compared with hospitalization, risks associated with extended antibiotic exposures and delayed definitive dental management must also be gauged.