PRACTICE PROFILE OF PERIODONTISTS IN CANADA: A NATIONAL SURVEY.

OBJECTIVE: To document the profile of periodontists in private practice in Canada in terms of services provided and referral patterns. METHODS: An online survey consisted on 45 questions in 3 categories: demographics, referral patterns and periodontal procedures performed. The sampling frame consisted of all active members of the Canadian Academy of Periodontology (n= 280). Letters and email containing links to the online survey were used to invite participants and to send reminders to non-respondents on days 7, 21 and 49. RESULTS: The response rate was 164/280 (58.6%); 135 respondents completed the entire survey. Of the respondents who noticed changes in referral dynamics in the last 10 years (68.1%), most (61.9%) perceived an overall decrease in the number of referrals, and 74.0% reported that general dentists were referring patients later in the disease progression. The most common referrals (71.6%) were for limited treatment. Most respondents placed dental implants (93.7%) and performed maxillary sinus lifts (81.6%). All performed surgical debridement, esthetic and prerestorative crown lengthening and connective tissue grafts. Only 13.7% provided photodynamic therapy. Fewer years in practice (<20 years), more recent graduation (after 1990) and younger age (<45 years) were correlated with greater use of single-implant placement, sinus lifts and procedures requiring intravenous sedation. Men were more likely than women to use lasers (p=0.020). CONCLUSION: Periodontal specialists perceived a change in referral dynamics over the last 10 years with most reporting both a decrease in number and delayed timing of referrals. Practice patterns have changed, with younger periodontists performing more advanced surgical procedures. These findings may guide periodontal residency programs and create awareness among general dentists of the role of the periodontist and their repertoire of treatment options.

Success and Survival Rates of Dental Implants Restored at an Undergraduate Dental Clinic: A 13-Year Retrospective Study with a Mean Follow-up of 5.8 Years.

PURPOSE: The purpose of this study was to evaluate the clinical, radiographic, and patient-based outcomes of dental implants placed at an undergraduate student dental clinic. MATERIALS AND METHODS: A retrospective study was performed to determine the success and survival rates of dental implants placed at the undergraduate dental clinic at Dalhousie University between January 1999 and January 2012. Only patients with a minimum of 1-year follow-up were included. Clinical and radiographic assessments determined implant success and survival rates. Questionnaires recorded patients' satisfaction with esthetics, comfort, and ease of hygiene. RESULTS: Of the 352 patients (n = 591 implants) who received implants over 13 years, 165 patients completed the clinical and radiographic examinations. By the end of the study period, demographic information and implant characteristics were collected for 111 (n = 217 implants; 47.5% in the maxilla, 52.6% in the mandible) of these patients. Of those assessed clinically, 36.4% were males and 63.6% females, with a mean age of 56.1 ± 14.15 years (range, 17 to 86 years) at the time of implant placement. The mean follow-up period was 5.8 years (range, 1 to 13 years). The overall implant success and survival rates were 88.0% and 97.2%, respectively. No observable bone loss was evident in 88.0% of the surviving implants. There were no implant fractures. Most patients (91.2%) were very satisfied with the implant restoration appearance, 88.0% were very comfortable with the implant, 92.6% were very satisfied with their ability to chew, and 84.8% reported easy hygiene maintenance at the implant sites. CONCLUSION: Implant success and survival in an undergraduate student clinic were comparable to those reported in the literature. It seems that inexperienced students were able to provide restorations that were very satisfying to the patients.

The oral health status of recent immigrants and refugees in Nova Scotia, Canada.

There are no published reports on the oral health status of adult immigrants and refugees in Canada. An oral health interview and clinical oral examination were conducted on 45 recent immigrants and 41 recent Bhutanese refugees, aged 18-67, in Nova Scotia, Canada. Over half (53%) of the immigrants and 85% of the refugees had untreated decay. Most (89% of immigrants; 98% of refugees) had moderate to severe gingivitis and the majority (73% of immigrants; 85% of refugees) had moderate to severe periodontitis. Despite these, 64% of immigrants and 49% of refugees rated their oral health as good, very good or excellent, and most believed they did not need fillings or periodontal treatment. Oral disease among the study sample was higher than the Canadian average and there was a striking discrepancy between self-reported and clinically determined need for dental care.

Periodontal practice and referral profile of general dentists in Nova Scotia, Canada.

BACKGROUND: In contrast to an expected increase in demand for periodontal services with aging of the population, it appears that referrals to periodontists are declining. OBJECTIVE: To determine the extent to which general dentists in Nova Scotia, Canada, provide periodontal and surgical implant therapies and to determine the factors influencing a dentist's decision to provide treatment or refer patients to a specialist. METHODS: A cross-sectional survey study was performed. The survey questionnaire was mailed to all 443 general dentists practising in Nova Scotia in summer 2009. The questionnaire presented several clinical scenarios and asked respondents whether they would treat the patient in the office or refer to a specialist. The data were analyzed by logistic regression. RESULTS: Of the 279 (63.0%) dentists responding to the survey, 272 (61.4% of the total) were eligible for inclusion in the analysis. The majority of dentists reported rendering nonsurgical periodontal therapy, including scaling (98.5%; 262/266), periodontal maintenance (95.9%; 255/266), and treatment for bruxism (95.1%; 252/265). The most common surgical procedures performed by dentists were frenectomy (29.4%; 78/265), gingivectomy (29.3%; 77/263) and crown-lengthening procedures (17.0%; 46/271). Eleven factors significantly influenced dentists' decisions to treat or refer patients. The most common criteria used in selecting a periodontist were satisfaction of previous patients, previous success with the treatment, and the personality of and good communications with the periodontist. CONCLUSIONS: In this study, dentists reported rendering nonsurgical periodontal therapy on a wide scale, whereas their involvement in oral or periodontal and implant surgical therapies was limited.

The periodontal examination profile of general dentists in Nova Scotia, Canada.

BACKGROUND: In this cross-sectional study we investigate the extent to which general dentists in Nova Scotia carry out periodontal examinations of their patients. In addition, factors that significantly influence performing a periodontal examination by a dentist are identified. METHODS: A survey questionnaire was mailed to all 443 general dentists practicing in the province of Nova Scotia in the summer of 2009. The survey included questions on demographics and the various components of the periodontal examination. Simple and multiple logistic regression tests were used to analyze the results. RESULTS: Of the 279 (63%) responses received, 272 (61%) responses were eligible to be included in the analyses. The majority of responders (94.8%) reported performing periodontal examinations of their patients. However, only 37.8% and 43.3% of the dentists reported performing full-mouth and selective probing depth measurements, respectively. Dentists who practiced in urban locations (P = 0.05), dentists whose practices were situated <5 km from a periodontist (P = 0.08), and dentists who planned to take a continuing education course in periodontal plastic surgery in the next 2 years (P = 0.07) were more likely to perform a periodontal examination. CONCLUSIONS: Although the majority of dentists in our study report performing periodontal examinations of their patients, only a small portion report recording complete probing depth measurements or using appropriate radiographs in their examinations. These practices could lead to an underestimation of diagnosis and treatment of periodontal disease.

Assessment of surgical competence in North American graduate periodontics programs: a survey of current practices.

This cross-sectional study was designed to document the methods utilized by North American graduate periodontics programs in assessing their residents' surgical skills. A survey of clinical skills assessment was mailed to directors of all fifty-eight graduate periodontics programs in Canada and the United States. Thirty-four programs (59 percent) responded. The data collected were analyzed using SPSS version 15.0. The results demonstrate that the most common practice for providing feedback and documenting residents' surgical skills in the programs surveyed was daily one-on-one verbal feedback given by an instructor. The next two most commonly reported methods were a standard checklist developed at program level and a combination of a checklist and verbal comments. The majority of the programs reported that the instructors met collectively once per term to evaluate the residents' progress. The results suggest that graduate periodontics programs provide their residents frequent opportunities for daily practice with verbal feedback from instructors. However, assessment strategies identified in other health professions as beneficial in fostering the integration of clinical skills practices are not employed.

Teaching methods and surgical training in North American graduate periodontics programs: exploring the landscape.

This project aimed at documenting the surgical training curricula offered by North American graduate periodontics programs. A survey consisting of questions on teaching methods employed and the content of the surgical training program was mailed to directors of all fifty-eight graduate periodontics programs in Canada and the United States. The chi-square test was used to assess whether the residents' clinical experience was significantly (P<0.05) influenced by having a) a structured preclinical program or b) another dental residency program in the institution. Thirty-four programs (59 percent) responded to the survey. Twenty-six programs (76 percent of respondents) reported offering a structured preclinical component. Traditional teaching methods such as slides, live demonstration, DVD/CD, and animal cadavers were the most common teaching methods used, whereas online courses, computer simulation, and various surgical mannequins were least commonly used. The most commonly performed surgical procedures were conventional flaps, periodontal plastic procedures, hard tissue grafts, and implants. Furthermore, residents in programs offering a structured preclinical component performed significantly more procedures (P=0.012) using lasers than those in programs not offering a structured preclinical program. Devising new and innovative teaching methods is a clear avenue for future development in North American graduate periodontics programs.

Periodontal health status of the Sandy Bay First Nation in Manitoba, Canada.

OBJECTIVES: To determine the distribution and determinants of periodontal health in adult members of the Sandy Bay First Nation in Manitoba, Canada. STUDY DESIGN: Cross-sectional study based on face-to-face interviews and oral examinations. METHODS: Face-to-face interviews and oral examinations were performed on a convenience sample of 107 individuals to assess Debris Index, Calculus Index, Gingival Index and clinical attachment loss (CAL). Chi-square, Fisher's exact, Mann-Whitney and Kruskal-Wallis tests were used to find variables significantly associated with 2 outcome variables: dichotomous mean CAL (< or = 2.5mm and > 2.5mm) and dichotomous severe periodontitis. Variables found to be significantly associated with either of the outcome variables were entered into logistic regression analysis to look for significant independent effects (P < 0.05). RESULTS: The mean age for the sample was 36.1 (SD 11.6). The mean CAL for the group was 1.44 mm (SD 1.14), with age-specific CAL (SD) values of 1.08 (0.69), 1.18 (0.97), 2.05 (1.57) and 2.10 (0.95) for subjects aged 18-27, 28-37, 38-47 and 48 years or above, respectively. Of the individuals studied, 42.6% suffered from moderate periodontitis, whereas 22.4% suffered from either localized or generalized severe periodontitis. Of the variables tested, tooth brushing frequency (p < 0.05), flossing (p = 0.001), Calculus Index (p = 0.001), Gingival Index (p < 0.05), age (p < 0.05), diabetes (p < 0.05) and DMFS (p < 0.05) were found to be significantly associated with mean CAL, whereas, sex (p < 0.05), tooth brushing frequency (p < 0.05), Calculus Index (p < 0.005), age (p < 0.005) and DMFS (p < 0.05) were found to be significantly associated with severe periodontitis. Age, tooth brushing frequency and flossing were found to have significant independent effects on mean CAL and severe periodontitis using logistic regression analysis. CONCLUSIONS: Considering the high prevalence of periodontitis in this population, expanded availability of community-based dental services is urgently needed.