A scoping assessment of dental services at designated head and neck cancer centres in Ontario, Canada.

BACKGROUND: Dentists serve a crucial role in managing treatment complications for patients with head and neck cancer, including post-radiation caries and oral infection. To date, dental services for head and neck cancer patients in Ontario, Canada have not been well characterized and considerable disparities in allocation, availability, and funding are thought to exist. The current study aims to describe and assess the provision of dental services for head and neck cancer patients in Ontario. METHODS: A mixed methods scoping assessment was conducted. A purposive sample of dentist-in-chiefs at each of Ontario's 9 designated head and neck cancer centres (tertiary centres which meet provincially-set quality and safety standards) was invited to participate. Participants completed a 36-item online survey and 60-minute semi-structured interview which explored perceptions of dental services for head and neck cancer patients at their respective centres, including strengths, gaps, and inequities. If a centre did not have a dentist-in-chief, an alternative stakeholder who was knowledgeable on that centre's dental services participated instead. Thematic analysis of the interview data was completed using a mixed deductive-inductive approach. RESULTS: Survey questionnaires were completed at 7 of 9 designated centres. A publicly funded dental clinic was present at 5 centres, but only 2 centres provided automatic dental assessment for all patients. Survey data from 2 centres were not captured due to these centres' lack of active dental services. Qualitative interviews were conducted at 9 of 9 designated centres and elicited 3 themes: (1) lack of financial resources; (2) heterogeneity in dentistry care provision; and (3) gaps in the continuity of care. Participants noted concerning under-resourcing and limitations/restrictions in funding for dental services across Ontario, resulting in worse health outcomes for vulnerable patients. Extensive advocacy efforts by champions of dental services who have sought to mitigate current disparities in dentistry care were also described. CONCLUSIONS: Inequities exist in the provision of dental services for head and neck cancer patients in Ontario. Data from the current study will broaden the foundation for evidence-based decision-making on the allocation and funding of dental services by government health care agencies.

Oral cancer screening knowledge and practices among dental professionals at the University of Toronto.

INTRODUCTION: Opportunistic oral cancer screening during visits to the dentist is a non-invasive and accessible option for detection of pre-malignant lesions and early-stage malignancies. The objective of this study was to investigate the knowledge, practices, and attitudes towards oral cancer screening among dentists. METHODS: A 42-item survey was sent to 650 dental professionals affiliated with the University of Toronto. Data regarding training/practice characteristics, knowledge of oral cavity cancer, current screening practices, attitudes towards screening, and remuneration were collected. RESULTS: Ninety-one dentists responded. Most obtained their dental degree from Canada (71.4%) and were practicing in large urban centers (87.9%). Most dentists correctly identified the oral tongue (87.8%) and floor of mouth (80%) as the two of most common sites of oral cavity cancer but only 56% correctly identified the most common presentation. 91% performed intra/extra oral examinations at every patient visit. Only 9.9% of dentists discussed the risk factors of oral cancer and 33% were not familiar with resources for smoking cessation and alcohol abuse. International medical graduates were more likely to discuss risk factor management than Canadian medical graduates (p < 0.01). Over 80% of dentists referred to a specialist when a suspected lesion was found. The greatest barrier for oral cancer screening was lack of time. Almost all dentists (98.8%) reported that their screening practices do not differ depending on the patient's insurance status and 63.8% reported compensation would not influence their decision to perform oral examinations. CONCLUSION: Most dentists have a good knowledge of the presentation and risk factors associated with oral cavity cancer. Most dentists perform screening with every patient, with no influence from compensation and insurance status. Dentists are therefore an excellent first contact for oral cavity cancer screening for the general public and for high-risk populations.

Oral healthcare disparities in Canada: filling in the gaps.

As a key component of overall health and quality of life, oral health is recognized by public health organizations globally as a basic human right. Dentists are oral health experts involved in the primary prevention of oral injury and the detection and management of oral diseases. As regulated healthcare professionals, dentists identify and treat dental caries, gum disease, oral cancers, and edentulism, among other conditions. Oral diseases that go undetected and/or untreated burden patients with increased severity of disease and worse health outcomes. The Canadian Dental Association (CDA) recommends routinely scheduled reexamination and preventive care as an essential component of maintaining optimal oral health. Investments by the federal government into dental services for high-risk groups have failed to resolve pervasive oral health disparities among Canadians related to dental care affordability, accessibility, and availability. Vulnerable groups across Canada, including children, seniors in long-term care, Indigenous peoples, new immigrants with refugee status, people with special needs, and the low-income population, have been identified as having challenges accessing regular dental care. Herein, an equity-focused commentary on the current climate of oral healthcare in Canada is presented. We outline how addressing disparities in Canadian dental care will require the engagement of physicians on multiple levels of care, negotiation with both dentists and policymakers, as well as sustained oral health data collection to inform provincial and national decision-making/strategies.

RéSUMé: Élément clé de la santé globale et de la qualité de vie, la santé buccodentaire est reconnue par les organismes de santé publique du monde entier comme un droit humain fondamental. Les dentistes sont des spécialistes de la santé buccodentaire qui s'occupent de la prévention primaire des lésions buccodentaires et de la détection et de la prise en charge des maladies buccodentaires. Ce sont des professionnels de santé réglementés qui détectent et qui traitent les caries dentaires, les maladies des gencives, les cancers buccaux et l'édentement, entre autres affections. Les maladies buccodentaires non détectées ou non traitées s'aggravent et conduisent à de plus mauvais résultats cliniques pour les patients. L'Association dentaire canadienne (ADC) recommande des examens dentaires périodiques et des soins préventifs, car elle les juge essentiels au maintien d'une santé buccodentaire optimale. Les investissements du gouvernement fédéral dans les soins dentaires des groupes fortement exposés n'ont pas permis de résoudre les disparités d'état de santé buccodentaire omniprésentes liées à l'abordabilité, à l'accessibilité et à la disponibilité des soins dentaires. On sait que les groupes vulnérables au Canada, dont les enfants, les aînés résidant dans des établissements de soins de longue durée, les peuples autochtones, les nouveaux immigrants ayant le statut de réfugiés, les personnes ayant des besoins particuliers et la population à faible revenu, ont des problèmes d'accès aux soins dentaires réguliers. Nous commentons ici dans une optique d'équité le climat actuel des soins de santé buccodentaires au Canada. Nous expliquons que pour aborder les disparités dans les soins dentaires canadiens, il faudra mobiliser les médecins de multiples niveaux de soins, négocier à la fois avec les dentistes et les responsables des politiques et assurer une collecte soutenue de données sur la santé buccodentaire pour éclairer les décisions et stratégies provinciales et nationales.

The relationship between early life stress and working memory in adulthood: A systematic review and meta-analysis.

Exposure to early life stress has been linked to impairment in cognitive functioning in adulthood. The aim of this study was to systematically review the literature on the relationship between early life stress and working memory, a central component of cognitive functioning. Database searches yielded 358 abstracts matching the search terms. Abstract screening followed by full-text review resulted in 26 publications suitable for inclusion, of which 23 were included in the meta-analysis. Results of the meta-analysis suggested exposure to early life stress was associated with poorer working memory. Even though there were a wide variety of working memory tasks used, this effect was significant for both phonological and visuospatial working memory tasks, and both visual and aural task presentation modalities. The effect was also found in samples with and without clinical psychopathology. This review provides recommendations for future research and implications for clinical practice.