Fluoridation cessation and oral health equity: a 7-year post-cessation study of Grade 2 schoolchildren in Alberta, Canada.

OBJECTIVE: Community water fluoridation, because of its universal scope and passive mechanism of uptake, is one component of a multifaceted approach to promoting equity in dental health. The objective of this study was to examine social inequities in children's dental health in the Canadian cities of Calgary (fluoridation cessation in 2011) and Edmonton (still fluoridated). METHODS: We analyzed data from surveys of population-based samples of Grade 2 (approx. age 7) children in Calgary in 2009/2010 (pre-cessation; n=557) and in both Calgary and Edmonton in 2013/2014 (Calgary, n=3230; Edmonton, n=2304) and 2018/2019 (Calgary, n=2649; Edmonton, n=2600) (post-cessation). We estimated associations between several socioeconomic indicators and dental caries indicators (i.e., dental caries experience [deft, DMFT] and untreated decay in two or more teeth [untreated decay]) using zero-inflated Poisson, binary logistic regression, and the concentration index of inequality. We compared those associations over time (between survey waves) and between cities at post-cessation. RESULTS: Persistent social inequities in deft and untreated decay were evident; for example, having no dental insurance was significantly associated with higher odds of untreated decay across city and survey wave. In most (but not all) cases, differences between cities and survey waves were consistent with an adverse effect of fluoridation cessation on dental health inequities. For example, the association between no dental insurance and higher odds of untreated decay in Calgary was greater in 2018/2019 (later post-cessation) than in 2009/2010 (pre-cessation; odds ratio [OR] for comparison of coefficients = 1.89 [1.36-2.63], p<0.001) and 2013/2014 (early post-cessation; OR for comparison of coefficients = 1.67 [1.22-2.28], p=0.001); that same association in 2018/2019 was greater in Calgary (fluoridation cessation) than in Edmonton (still fluoridated) (OR for comparison of coefficients = 1.44 [1.03-2.02], p=0.033). CONCLUSION: Social inequities in dental caries were present in both Calgary and Edmonton. Those inequities tended to be worse in Calgary where fluoridation was ceased. Our findings may be relevant to other settings where income inequality is high, dental services are costly, and dental public health infrastructure is limited.

RéSUMé: OBJECTIF: En raison de sa portée universelle et de son mécanisme de réception passif, la fluoration de l'eau des communautés s'inscrit dans une démarche multidimensionnelle de promotion de l'équité en santé dentaire. Notre étude visait à examiner les iniquités sociales en santé dentaire chez les enfants dans les villes canadiennes de Calgary (où la fluoration a cessé en 2011) et d'Edmonton (où l'eau est encore enrichie en fluor). MéTHODE: Nous avons analysé les données d'enquêtes menées auprès d'échantillons populationnels d'élèves de 2e année (environ 7 ans) à Calgary en 2009-2010 (avant l'arrêt; n = 557), et à Calgary et Edmonton en 2013-2014 (Calgary, n = 3 230; Edmonton, n = 2 304) et en 2018-2019 (Calgary, n = 2 649; Edmonton, n = 2 600) (après l'arrêt). Nous avons estimé les associations entre plusieurs indicateurs socioéconomiques et indicateurs de caries dentaires (c.-à-d. l'expérience de caries dentaires [dceo, DCMO] et de dégradation non traitée dans deux dents ou plus [dégradation non traitée]) à l'aide de la régression de Poisson à surreprésentation de zéros, de la régression logistique binaire et de l'indice de concentration des inégalités. Nous avons comparé ces associations dans le temps (entre les cycles de l'enquête) et entre les deux villes après l'arrêt de la fluoration. RéSULTATS: Des iniquités sociales persistantes selon l'indice dceo [dents cariées, extraites et obturées] et la dégradation non traitée étaient manifestes; par exemple, l'absence d'assurance dentaire présentait une corrélation significative avec une probabilité accrue de dégradation non traitée d'une ville à l'autre et d'un cycle à l'autre de l'enquête. Dans la plupart des cas (mais pas tous), les différences entre les villes et entre les cycles de l'enquête correspondaient à un effet indésirable de l'arrêt de la fluoration sur les iniquités en santé dentaire. Par exemple, l'association entre l'absence d'assurance dentaire et la probabilité accrue de dégradation non traitée à Calgary était plus importante en 2018-2019 (longtemps après l'arrêt) qu'en 2009-2010 (avant l'arrêt; rapport de cotes [RC] pour comparaison des coefficients = 1,89 [1,36-2,63], p < 0,001) et qu'en 2013-2014 (peu après l'arrêt; RC pour comparaison des coefficients = 1,67 [1,22-2,28], p = 0,001); cette même association en 2018-2019 était plus importante à Calgary (où la fluoration a cessé) qu'à Edmonton (où l'eau est encore enrichie en fluor) (RC pour comparaison des coefficients = 1,44 [1,03-2,02], p = 0,033). CONCLUSION: Des iniquités sociales relativement aux caries dentaires étaient présentes tant à Calgary qu'à Edmonton. Ces iniquités avaient tendance à être plus importantes à Calgary, où la fluoration a cessé. Nos constatations pourraient être pertinentes dans les autres endroits où l'inégalité des revenus est élevée, où les soins dentaires coûtent cher et où les infrastructures en santé publique dentaire sont limitées.

Fluoridation cessation and children's dental caries: A 7-year follow-up evaluation of Grade 2 schoolchildren in Calgary and Edmonton, Canada.

OBJECTIVES: We examined the effect of fluoridation cessation on children's dental caries experience in the Canadian cities of Calgary (cessation in 2011) and Edmonton (still fluoridated). METHODS: We used a pre-post cross-sectional design with comparison group. We studied Grade 2 schoolchildren (approximately 7 years old) 7-8 years after fluoridation cessation in Calgary, thus capturing children born after cessation occurred. Data collection included a dental examination conducted in school by calibrated dental hygienists, a questionnaire completed by parents, and fingernail clippings for a small subsample. Our overall analytic approach was twofold. We first examined differences in dental caries experience (deft and DMFT, and smooth surface caries based on defs and DMFS) between Calgary and Edmonton and over time (comparing 2018/2019 data to pre-cessation and early post-cessation surveys in our setting). Second, we evaluated whether differences were likely to reflect fluoridation cessation in Calgary, rather than other factors. RESULTS: The prevalence of caries in the primary dentition was significantly higher (P < .05) in Calgary (fluoridation cessation) than in Edmonton (still fluoridated). For example, crude deft prevalence in 2018/2019 was 64.8% (95% CI 62.3-67.3), n = 2649 in Calgary and 55.1% (95% CI 52.3-57.8), n = 2600 in Edmonton. These differences were consistent and robust: they persisted with adjustment for potential confounders and in the subset of respondents who were lifelong residents and reported usually drinking tap water; they had widened over time since cessation; and they were corroborated by assessments of dental fluorosis and estimates of total fluoride intake from fingernail clippings. Findings for permanent teeth were less consistent, which likely reflects that 7-year-olds have not had the time to accumulate enough permanent dentition caries experience for differences to have become apparent. CONCLUSIONS: Our findings are consistent with an adverse impact of fluoridation cessation on children's dental health in Calgary and point to the need for universal, publicly funded prevention activities-including but not limited to fluoridation.

The Relation Between Exposure to Intimate Partner Violence and Childhood Dental Decay: A Scoping Review to Identify Novel Public Health Approaches to Early Intervention.

BACKGROUND: Early childhood dental decay or caries (ECC) is common, often painful and costly to the health care system, yet it is largely preventable. A public health approach is needed, especially as socially vulnerable children most at risk for ECC are less likely to access conventional treatment. Exposure to intimate partner violence (IPV) in the family represents an important social vulnerability for children, yet little is known about ECC in this context. We explored the relation between ECC and exposure to IPV as well as opportunities for community-based early interventions to prevent ECC. METHODS: We searched 5 electronic databases. All primary research and reviews that focused on childhood decay and exposure to IPV or that referred to community settings (specifically women's shelters) for oral health service delivery were included. RESULTS: Of 198 unique documents identified, 12 were included in the analysis. Although limited, our findings suggest a positive relation between exposure to IPV and ECC, the mechanisms of which are not well studied. Women's-shelter-based prevention programs may hold promise in terms of detecting and addressing ECC. Over the time frame of the literature reviewed, we observed a subtle shift in emphasis away from individual behaviours and biological models toward upstream societal structures. CONCLUSIONS: The available literature suggests that the issue of ECC and IPV may be poised to embrace a public health approach to early intervention, characterized by community collaboration, interprofessional cooperation between dentistry and social work and an equitable approach to ECC in a socially vulnerable group.

Effects of Mock Facebook Workday Comments on Public Perception of Professional Credibility: A Field Study in Canada.

BACKGROUND: There is considerable discussion of risks to health professionals' reputations and employment from personal social media use, though its impacts on professional credibility and the health professional-client relationship are unknown. OBJECTIVE: The aim of this study was to test the extent to which workday comments posted to health professionals' personal Facebook profiles influence their credibility and affect the professional-client relationship. METHODS: In a controlled field study, participants (members of the public) reviewed randomly assigned mock Facebook profiles of health professionals. The 2×2×2 factorial design of mock profiles included gender (female/male), health profession (physician/veterinarian), and workday comment type (evident frustration/ambiguous). Participants then rated the profile owner's credibility on a visual analog scale. An analysis of variance test compared ratings. Mediation analyses tested the importance of credibility ratings on participants' willingness to become a client of the mock health professional. RESULTS: Participants (N=357) rated health professionals whose personal Facebook profile showed a comment with evident frustration rather than an ambiguous workday comment as less credible (P<.001; mean difference 11.18 [SE 1.28]; 95% CI 8.66 to 13.70). Furthermore, participants indicated they were less likely to become clients of the former when they considered credibility (standardized beta=.69; P<.001). Credibility explained 86% of the variation in the relationship between the type of workday comment and the participant's willingness to become a client of the health professional. CONCLUSIONS: This study provides the first evidence of the impact of health professionals' personal online disclosures on credibility and the health relationship. Public perceptions about professionalism and credibility are integral to developing the evidence base for e-professionalism guidelines and encouraging best practices in social media use.

Strengthening the health system through novel population and public health fellowships in Canada.

This commentary provides a response to the call for papers that explore why public health matters today. We present our thoughts and experiences as members of the inaugural (2017) cohort of Canadian Institutes of Health Research (CIHR) Health System Impact Fellows, focused on population and public health projects within our respective health organizations. One year in, we understand our fellowships as uniquely integrating population and public health attributes toward enhancing health system learning and impact. Despite references to the weakening of public health in the call, we are encouraged by our fellowship experiences that promote a focus on prevention and upstream factors that impact health. We are hopeful that a continued focus on population and public health in future fellowship cohorts will in time demonstrate positive health system change for Canadians.

Identifying and critically examining government legislation relevant to children's dental caries in Calgary, Alberta, Canada: a health inequities lens.

OBJECTIVES: Children's dental caries is an important and urgent public health concern that is largely preventable. Using a social equity framework, our objectives were to identify and critically examine government legislation relevant to the issue of children's dental health in Calgary, Alberta, Canada. METHODS: We conducted a systematic, gray literature search of federal, provincial (Alberta), and municipal (Calgary) statutes and bylaws related to children's dental caries, through the relevant law databases. Eligibility criteria were applied for document screening and selection. Data extraction and synthesis pertained to objectives of the legislation (policy task), relevant agent or actor (level of government), and upstream or downstream focus, in terms of potential impact on social inequities in health. RESULTS: Legislation (n = 114) was retrieved and grouped into eight policy tasks. Most legislation fit under the policy tasks: protection of public safety and health promotion (n = 40) and benefits and compensation (n = 27). Federal and provincial governments have greater involvement in children's dental caries than municipal (Calgary) government. The majority of legislation was classified as upstream in orientation (e.g., improving living and working conditions; macro-level policies). CONCLUSIONS: Analysis of legislation relevant to children's dental caries reveals policies that are more often upstream in nature, and unsurprisingly are multijurisdictional. Despite this, there remains a high prevalence and inequitable distribution of children's dental caries in Canada. This suggests that the nature of upstream involvement and fragmented government involvement is ineffective in tackling this pervasive and urgent public health issue. Implications for children's dental health are discussed.

Parents' online discussions about children's dental caries: A critical content analysis.

OBJECTIVES: Through an analysis of postings to an online parenting forum, we aimed to explore the many ways in which parents orient to (i.e., take up, challenge, re-articulate) information about child dental health in the context of their online interactions. Our analysis is anchored in Nettleton's theoretical work on dental authority and power, which we apply in a digital context. METHODS: We examined discussion threads from the public online forums on BabyCenter Canada. We identified relevant threads using the site search function and keywords related to dental health, with a focus on dental caries (tooth decay), related care behaviours (e.g., toothbrushing), and the controversial issue of fluoride. Following descriptive content coding, we applied a critical lens to unpack themes related to expert knowledge, gender and parenting online cultures. RESULTS: We analyzed 479 relevant threads. Our findings focus on two central themes: the tension between parents' views and those of dental health professionals; and, the gendered, cultural roles and expectations that position mothers as primarily responsible for the care of children's dental health. Though these themes are not new, our findings show that they persist in the digital context where social divisions (e.g., expert/non-expert) may be blurred. CONCLUSIONS: Our analysis of online discussions provides an opportunity to think critically about ways in which parents engage with public health, in digital contexts. Although some mothers express disconnect when communicating with dental professionals, they are very engaged and concerned with dental health issues for their children. A challenge for dental public health is to find ways to shift perspective towards recognizing that the target population is empowered and already engaged in discussions of research evidence and clinical encounters on their own terms, facilitated by an online context.

Final-Year Students' and Clinical instructors' Experience of Workplace-Based Assessments Used in a Small-Animal Primary-Veterinary-Care Clinical Rotation.

Final-year veterinary students must meet baseline clinical competency upon completion of their training for entry to practice. Workplace-based assessments (WBAs), widely used in human medical training to assess post-graduate students' professionalism and clinical performance, have recently been adopted in undergraduate veterinary clinical teaching environments. WBAs should support veterinary trainees' learning in a clinical teaching environment, though utility of WBAs within veterinary education may differ from that in medical training due to differences in context and in learners' stage of clinical development. We conducted focus groups with final-year veterinary students and clinical instructors following the implementation of three WBAs (Direct Observation of Procedural Skills [DOPS], the Mini-Clinical evaluation exercise [Mini-CEX], and the In-Training Evaluation Report [ITER]) during a small-animal primary-veterinary-care rotation. Students and clinical instructors viewed the DOPS and Mini-CEX as feasible and valuable learning and assessment tools that offered an overall opportunity for timely in-the-moment feedback. Instructors viewed the ITER as less feasible in the context of a service-oriented veterinary clinical teaching environment. Students believed the ITER had potential to be informative, although in its existing application the ITER had limited utility due to time constraints on instructors that prevented them from providing students with individualized and specific feedback. In service-oriented veterinary clinical teaching environments, successful implementation of WBAs requires balancing provision of feedback to students, time demands on clinical instructors, and flexibility of assessment tools.

Reputation management on facebook: awareness is key to protecting yourself, your practice, and the veterinary profession.

From the Social media use by health professionals occurs in a digital environment where etiquette has yet to be solidly defined. The objectives of this study were to explore veterinarians' personal use of Facebook, knowledge of privacy settings, and factors related to sharing personal information online. All American Animal Hospital Association member veterinarians with a valid e-mail address (9469) were invited to complete an online survey about Facebook (e.g., time spent on Facebook, awareness of consequences, types of information posted). Questions assessing personality dimensions including trust, popularity, self-esteem and professional identity were included. The response rate was 17% (1594 of 9469); 72% of respondents (1148 of 1594) had a personal Facebook profile. Veterinarians were more likely to share information on Facebook than they would in general. Trust, need for popularity, and more time spent on Facebook predicted more disclosure of personal information on Facebook. Awareness of consequences and increased veterinary experience predicted lesser disclosure. As veterinary practices use Facebook to improve client services, they need also to manage risks associated with online disclosure by staff. Raising awareness of reputation management and consequences of posting certain types of information to Facebook is integral to protecting the individual, the practice, and the veterinary profession.

Facebook use among early-career veterinarians in Ontario, Canada (March to May 2010).

OBJECTIVE: To explore the nature and content of information publicly posted to Facebook by early-career veterinarians. DESIGN: Cross-sectional descriptive study. Sample-352 early-career veterinarians. PROCEDURES: Publicly accessible Facebook profiles were searched online from March to May 2010 for profiles of early-career veterinarians (graduates from 2004 through 2009) registered with the College of Veterinarians of Ontario, Canada. The content of veterinarians' Facebook profiles was evaluated and then categorized as low, medium, or high exposure in terms of the information a veterinarian had publicly posted to Facebook. Through the use of content analysis, high-exposure profiles were further analyzed for publicly posted information that may have posed risks to an individual's or the profession's public image. RESULTS: Facebook profiles for 352 of 494 (71%) registered early-career veterinarians were located. One-quarter (25%) of profiles were categorized as low exposure (ie, high privacy), over half (54%) as medium exposure (i.e., medium privacy), and 21% as high exposure (i.e., low privacy). Content analysis of the high-exposure profiles identified publicly posted information that may pose risks to an individual's or the profession's reputation, including breaches of client confidentiality, evidence of substance abuse, and demeaning comments toward others. CONCLUSIONS AND CLINICAL RELEVANCE: Almost a quarter of veterinarians' Facebook profiles viewed in the present study contained publicly available content of a questionable nature that could pose a risk to the reputation of the individual, his or her practice, or the veterinary profession. The increased use of Facebook and all types of social media points to the need for raised awareness by veterinarians of all ages of how to manage one's personal and professional identities online to minimize reputation risks for individuals and their practices and to protect the reputation and integrity of the veterinary profession.

Understanding veterinary students' use of and attitudes toward the social networking site, Facebook, to assist in developing curricula to address online professionalism.

Social media is an increasingly common form of communication, with Facebook being the preferred social-networking site among post-secondary students. Numerous studies suggest post-secondary students practice high self-disclosure on Facebook. Research evaluating veterinary students' use of social media found a notable proportion of student-posted content deemed inappropriate. Lack of discretion in posting content can have significant repercussions for aspiring veterinary professionals, their college of study, and the veterinary profession they represent. Veterinarians-in-training at three veterinary colleges across Canada were surveyed to explore their use of and attitude toward the social networking site, Facebook. Students were invited to complete an online survey with questions relating to their knowledge of privacy in relation to using Facebook, their views on the acceptability of posting certain types of information, and their level of professional accountability online. Linear regression modeling was used to further examine factors related to veterinary students' disclosure of personal information on Facebook. Need for popularity (p<.01) and awareness of consequences (p<.001) were found to be positively and negatively associated, respectively, with students' personal disclosure of information on Facebook. Understanding veterinary students' use of and attitudes toward social media, such as Facebook, reveals a need, and provides a basis, for developing educational programs to address online professionalism. Educators and administrators at veterinary schools may use this information to assist in developing veterinary curricula that addresses the escalating issue of online professionalism.

Teaching veterinary professionalism in the Face(book) of change.

Facebook has been identified as the preferred social networking site among postsecondary students. Repeated findings in the social networking literature have suggested that postsecondary students practice high personal self-disclosure on Facebook and tend not to use privacy settings that would limit public access. This study identified and reviewed Facebook profiles for 805 veterinarians-in-training enrolled at four veterinary colleges across Canada. Of these, 265 (32.9%) were categorized as having low exposure, 286 (35.5%) were categorized as having medium exposure, and 254 (31.6%) were categorized as having high exposure of information. Content analysis on a sub-sample (n=80) of the high-exposure profiles revealed publicly available unprofessional content, including indications of substance use and abuse, obscene comments, and breaches of client confidentiality. Regression analysis revealed that an increasing number of years to graduation and having a publicly visible wall were both positively associated with having a high-exposure profile. Given the rapid uptake of social media in recent years, veterinary educators should be aware of and begin to educate students on the associated risks and repercussions of blurring one's private life and one's emerging professional identity through personal online disclosures.