2017 Abstracts, Winnipeg, Manitoba

Tila Bahri Iraei  Oral-Health Status of Children and Adolescents with Adverse Childhood Experiences: A Pilot Study with the Elizabeth Fry Society of Greater Vancouver.

Eugénie Caron Paré, Oral manifestations of Beckwith-Wiedemann syndrome

Cameron GrantOral-Health Related Quality of Life of Preschoolers with Severe Caries

Anne-Marie Moreau

Oral Health Status of Refugee Children in Canada

Poonam Sekhon, Analysis of temporal trends and presenting characteristics of severe permanent tooth injuries at a pediatric hospital over a 5-year period: preliminary results.

Oral-Health Status of Children and Adolescents with Adverse Childhood Experiences: A Pilot Study with the Elizabeth Fry Society of Greater Vancouver.

Dr. Tila Bahri Iraei, University of British Columbia

Objectives: Adverse childhood experiences (ACE) such as poverty, parental substance use and parental incarceration can have negative influences on the physical and mental growth and development of children. The Elizabeth Fry (EFry) Society of Greater Vancouver, which provides a variety of services to children impacted by ACE in British Columbia, expressed interest in knowing about the oral health status of the clients they serve, so that appropriate support and services could be developed as needed. The objectives of this study were to document oral-health-related behaviours of children and youth who receive services from EFry, asses and describe their current oral-health status and explore relationships between a variety of study variables including demographics (age, gender, ethnicity), social characteristics (parent in justice system), and health behaviours and oral health status.

Methods: Children and adolescents from a summer camp operated by EFry completed socio-demographic and oral- health -behaviour questionnaires. A clinical examination including an assessment of dental status (dmft/DMFT), oral hygiene status (DI-S) and gingival status (GI) was conducted on each participant. Analysis included descriptive statistics, as well as bivariate tests to determine relationships between dental health status and a variety of study variables.

Results: The 67 participants of this study, aged 6 to 16 years of age, had a mean dmft /DMFT of 3.64 with 78% having at least one decayed, missed or filled tooth. About one-fifth (19%) of children and one-third of adolescents (35%) had received fissure sealants. Of the participants, 21% and 75% had mild or moderate gingival inflammation respectively. The majority of children and adolescents (69%) had minimal tooth debris and 28% had moderate debris. No statistically significant relationship was found between dmft/DMFT and any of the study variables, including oral health behaviours.

Conclusion: For this limited small volunteer sample of EFry children and adolescents, no relationship was found between any participant characteristics and oral health status. The participants appear to be receiving needed definitive dental care however, preventive measures, specifically fissure sealants were lacking. A greater emphasis on preventive care for these children may help to ensure future oral health.

Oral manifestations of Beckwith-Wiedemann syndrome

Dr. Eugénie Caron Paré, M.Sc. Candidate, Faculty of Dentistry, University of Montreal

Objectives: The objectives of this cross-sectional study were to describe the oral health status and to evaluate the occlusion of patients with Beckwith-Wiedemann syndrome (BWS), a rare entity with an important intra-oral feature, macroglossia.

Methods: All patients between 2 and 18 years followed for a diagnosis of BWS at the Montreal Children's Hospital or Sainte-Justine Hospital were contacted to participate in this study. Patients who agreed to participate had a complete dental examination. Data collected included: presence of dental anomalies, DMFS (decayed, missing or filled surfaces) score, gingival and periodontal health, salivary pH and dietary habits. An orthodontic evaluation was done when cooperation was acceptable. Molar occlusion classification (Angle classification), midline deviation, crossbite, open bite, overbite, overjet, symmetry, diastema and crowding were recorded on patients. The control group was composed of healthy children matched for age and sex.

Results: Fifteen children with BWS were included in the study, six males and nine females with a mean age of 7.07 years old. Three patients had been treated surgically by partial glossectomy. All patients had macroglossia except two. The median value of the DMFS was 0, the mean value of the plaque index was 0.81, while the mean value of the gingival index was 0.51. Seven patients showed dental ankylosis, shape or structural anomalies. Patients had a predominantly straight profile (9/15) and eight patients showed asymmetries. Six patients had ankyloglossia and all patients had a tongue-thrust swallowing habits except one. Most patients had a spaced dentition with anterior diastemas (12/15). Nine patients had an anterior openbite and six patients had unilateral posterior cross bite or were end to end on the molars. Data comparing to the control group is in process.

Conclusion: This study, which is the first to be interested in the oral manifestations of BWS, demonstrates that these patients had good hygiene, good gingival health and a low caries risk despite the macroglossia. However, they tend to have an anterior open bite and a trend towards a Class III malocclusion.

Oral-Health Related Quality of Life of Preschoolers with Severe Caries

Dr. Cameron Grant, University of Manitoba, Winnipeg, Manitoba

Cameron Grant (1, 2), Carrie Daymont (1, 2), Celia Rodd (1, 2), Mike Moffatt (1, 2), Andrew Pierce (2), Betty-Anne Mittermuller (1, 2), Alexandra Letellier (1, 2), Monica Gusmini (1, 2) , Bob Schroth (1, 2, 3)

1) University of Manitoba

2) CHRIM (Children’s Hospital Research Institute of Manitoba)

3) WRHA (Winnipeg Regional Health Authority)

Objective: To determine the oral-health related quality of life (OHRQL) of preschool-aged children before dental rehabilitation surgery under general anesthesia (GA) to treat severe early childhood caries (S-ECC) in Manitoba, Canada. S-ECC can affect children’s health and well-being. Little Canadian data exist on its impact on OHRQL.

Method: Children participating in this study were recruited into a larger prospective investigation examining changes in nutritional status and well-being following dental surgery to treat S-ECC. All participating parents/caregivers provided written informed consent and completed a questionnaire via interview. The questionnaire included the validated Early Childhood Oral Health Impact Scale (ECOHIS), a 13-item tool to measure the OHRQL of preschoolers and their families. The study was approved by the University of Manitoba’s Health Research Ethics Board. Data analysis included descriptive statistics (frequencies, means ± Standard Deviations (SD)) and bivariate analyses (Chi Square, t tests, correlation). A p value ≤ 0.05 was significant.

Results: 150 children and their parent/caregiver completed the baseline phase. The mean age was 47.8±14.1 months and 52% were female. Overall, 12.7% of the children often/very often experienced mouth pain while 10% often/very often reported having difficulty eating some foods. Overall, 11.3% often/very often showed signs of irritation/frustration because of dental problems, while 8.0% of parents/caregivers reported often/very often having feelings of guilt related to a child’s dental problem. The mean ECOHIS score was 6.8±5.41 (range 0-30). There was no apparent difference in scores by sex (female 6.24±4.8 vs male 7.3±6.0, p=0.24) and whether the family received government assistance (p=0.12), or dental insurance (p=0.41); but, lower household income was associated with higher ECOHIS scores (p=0.01).

Conclusion: Baseline data reveals that some children with S-ECC and their families express ongoing decreased OHRQL. ECOHIS could be used as an adjunctive tool along with clinical and radiographic exam to help determine urgency of dental treatment and placement of patients on dental GA wait-lists.

Acknowledgements: External funding was provided from Children’s Hospital Research Institute of Manitoba and the University of Manitoba College of Dentistry Research Fund and Endowment Fund.

Oral Health Status of Refugee Children in Canada

Dr. Anne-Marie Moreau, University of Montreal, Montreal, Quebec

A-M. Moreau, F. Hennous, B. Dabbagh & B. Ferraz dos Santos

Objectives: In Canada, immigrants represent up to 20% of the total population of which 10 % are

refugees. A few studies have shown that immigrants and refugee populations have poorer oral

health than their native counterparts. However, in Canada, there is sparse information on the oral

health status and needs of refugees, especially in the pediatric population. The aims of this study

were to assess the oral health status of refugee children in Montreal, Quebec, in comparison with

their Canadian-born counterparts; and to determine the association between demographic factors

and oral health status among refugee children.

Methods: This cross-sectional retrospective study was conducted at the Division of Dentistry of

the Montreal Children’s Hospital (MCH). Charts of children with a confirmed refugee status who

presented for a complete dental examination between January 2013 and June 2016 were included

in the study. Charts of Canadian-born children attending the dental clinic were randomly matched

for age and gender and composed the control group. Demographic data including age, gender,

country of origin and time since arrival to Canada was collected. Dental forms of all children

included in this study were reviewed to assess caries experience [decayed, missing and filled teeth

(dmft)], oral hygiene, gingival health status and presence of malocclusion.

Results: Fifty-eight percent of refugee children had never seen a dentist before their arrival to

Canada. Refugee children had significant higher decayed, missing and filled teeth (DMFT) scores

(mean dmft/DMFT score 7.29 ± 5.1) than Canadian children (mean dmft/DMFT score 4.47 ± 5)

(p<0.001). Additionally, an increased incidence of malocclusion was found, with the most common

trait being anterior crossbite (p<0.001). Compared to Canadian-born children, refugees were 5

times more likely to have caries incidence [adjusted OR 5.08, 95% CI (2.31 – 11.1), p< 0.0001].

Conclusion: Refugee children have higher rates of dental caries and poorer oral health status. The

disparity in dental caries highlight the need for dental care in the pediatric refugee population.

Dental needs should be aimed at treating active decay before pain or infection sets in for this

vulnerable population.

Analysis of temporal trends and presenting characteristics of severe permanent tooth injuries at a pediatric hospital over a 5-year period: preliminary results.

Dr. Poonam Sekhon, University of Toronto, Toronto, Ontario

Sekhon P, Barrett EJ and Casas, MJ

Objectives: To determine if the incidence of severe permanent tooth trauma presenting to an emergency department (ED) in a pediatric hospital has changed over a 5-year period in addition to investigating seasonal variations, etiology and location of injury.

Methods: This study includes a retrospective chart review of patients under 18 years of age that presented for permanent tooth trauma to SickKids ED after Department of Dentistry clinic hours, between January 1, 2011 and December 31, 2015. Information regarding patient demographics, date of visit, registration time, injury time, location of injury, etiology, tooth number, diagnosis and treatment rendered were collected for patients with severe permanent tooth injury. Severe permanent tooth injury was defined based on diagnosis and treatment rendered and includes: complicated crown fractures requiring pulpal intervention, horizontal root fractures requiring a splint, lateral luxations and extrusions requiring a splint, intrusions (requiring extraction, surgical repositioning with a splint or orthodontic intervention) and avulsions (no treatment or replantation with splinting). Time series analysis will be conducted to look for trends and seasonal patterns in data.

Results: Statistical analysis is currently underway so results are preliminary. A total of 2080 patients presented to the ED for dental concerns over the 5-year period. 371 (18%) had permanent tooth trauma, and 199 (9.6%) severe trauma. Males were more commonly affected with a ratio of 2:1 and the patients average age was 11.6+/- 3.10 years. Maxillary central incisors were the most affected teeth. Avulsions comprised majority of the injuries (30%), followed by complicated crown fractures (25%), lateral luxations (18%), extrusions (15%), intrusions (9%) and horizontal root fractures (3%). When looking at trends, permanent tooth trauma shows a slight decrease over the 5-year period (Figure 1), however the subset of severe injuries appear to be stable (Figure 2). Seasonal variations were noted in time, etiology and location of injury over the 5-year period.

Conclusions: Preliminary overview of trends in severe permanent tooth trauma presenting to the ED shows no change over the 5-year period, implying that EDs are often relied upon to evaluate and treat complex dental injuries. Completion of the time series analysis will allow a closer assessment of the trends in the data set.

Funding provided by the Department of Dentistry, SickKids.

2016 Abstracts, Toronto, Ontario

Edwin Chan, Regenerative endodontic treatment of immature necrotic permanent teeth: 30-month follow-up
Kunal Chander, Effects of Aging on Dentin Bonding and Mechanical Properties of Restorative Glass Ionomer Cements.
Anne-Sophie Fortin Pagé, Breastfeeding improvement in young infants diagnosed with ankyloglossia after a lingual frenotomy
Shuang Liu, Canadian pediatric residents’ perceptions, training and knowledge of infant oral health
Simrit Nijjar, Comparison of Manitoban general and pediatric dentists behaviour guidance technique usage and preference
Becky Olacke, The Effect of Biophysical Characteristics and Dosing on Pediatric Oral Sedation Outcome

Regenerative endodontic treatment of immature necrotic permanent teeth: 30-month follow-up

Dr. Edwin Chan, University of Toronto, Toronto, Ontario

Introduction: The treatment of immature necrotic permanent teeth presents several clinical challenges in endodontics. Regenerative endodontic procedures (REPs) permit root development, increase in canal wall thickness and apical closure.

Objective: The purpose of this study was to evaluate the long-term clinical and radiographical outcomes of REPs over a 30-month period.

Methods: This longitudinal cohort study was carried out at the Division of Dentistry of the Montreal Children’s Hospital. Twenty-eight immature necrotic permanent teeth from 22 patients were included in this study. All teeth were treated with a standardized REP protocol. Patients had follow-up appointments at 1, 2, 3, 6, 12, 18, 24 and 30 months. At each appointment, clinical examination was performed to monitor signs and symptoms. Radiographic evaluation was also performed by a calibrated endodontist in order to analyze different parameters.

Results: Our results demonstrate a high survival rate (96.4%), clinical success (92.8%) and resolution of apical pathology (100%). Significant increases in the average root length (8.1%; p<0.0001) and radiographic root area (11.6%; p=0.03) were observed after an average of 30 months follow-up. In the study period, a considerable decrease in apical diameter was also noted (p<0.0001), with 30.8% of the cases showing a complete apical closure. Teeth with more immature stages of root development had a higher percentage of change in root thickness, length and apical diameter; however, these results were not statistically significant.

Conclusion: REPs showed high resolution of apical pathology and clinical success without significant complications in treating immature necrotic permanent teeth over a 30-month period. An increased root thickness, root length and apical closure was observed, although a clinically significant change was not achieved in all cases.

Effects of Aging on Dentin Bonding and Mechanical Properties of Restorative Glass Ionomer Cements.

Dr. Kunal Chander, University of British Columbia, Vancouver, British Columbia

Objectives: To examine the effects of artificial aging on shear bond strength to dentin (SBS), flexural strength (FS) and diametral tensile strength (DTS) of four restorative glass ionomer cements.

Methods: Sound extracted human permanent molars were ground to flat occlusal dentin surface and fixed in a circular mold with an auto-cured acrylic resin for the shear bond strength test. The teeth were randomly divided into four groups: (1) Fuji II LC (FLC), (2) Equia (EQ), (3) Ketac Nano (KN), and (4) Ketac Molar (KM). For each dentin surface, two glass-ionomer cylinders were bonded. Specimens were stored in artificial saliva (37°C) and tested at 24-hour and 6-month period. Flexural strength bars (25mm x 2mm x 2mm) and diametral tensile strength discs (4mm x 2mm) for each material were fabricated, stored in artificial saliva (37°C), and tested after 24-hour and 6-month period. An additional flexural strength study was conducted with glass ionomer specimens stored either in distilled water or artificial saliva (37°C), and tested at 24-hour and 2-month periods. Data were analyzed in a two-way ANOVA (p<0.05) with post-hoc Tukey’s tests to compare interactions.

Results: Dentin-glass ionomer bond strengths (SBS) were stable after 6-month storage, however a significant decrease was observed for KN (Table 1). There were no significant differences in SBS among the four glass ionomers. The DTS did not change significantly after aging except for FLC group (Table 1). The FS increased significantly after aging in all groups (Tables 1 & 2) regardless of the storage media (water or saliva). Storage media did not affect flexural strength of materials (Table 2). FLC group presented significantly higher diametral and flexural strength compared to other groups (Tables 1 & 2).

Conclusions: Restorative glass ionomer cements presented stable dentin bonds, except for KN. Flexural strength improved over time for all glass ionomers, regardless of the storage media. DTS did not change over time, except for FLC. Overall, FLC demonstrated superior mechanical properties compared to the other materials studied.

Acknowledgements: UBC Faculty of Dentistry (Start Up Funds and Graduate Program Research Funds), GC America and 3M/ESPE.

Breastfeeding improvement in young infants diagnosed with ankyloglossia after a lingual frenotomy

Dr. Anne-Sophie Fortin Pagé, CHU Sainte-Justine, Department of Pediatric Dentistry, Montreal, Quebec

Objectives: To assess the outcomes of lingual frenotomy on breastfeeding efficacy and mother's pain among infants diagnosed with ankyloglossia. The secondary objective is to assess whether the timing of the frenotomy has an impact on the outcome.

Methods: Infants referred to the Montreal Children’s Hospital by a health professional or a certified lactation consultant for a frenotomy were evaluated for enrollment in this cohort study. Healthy infants under 3 months of age, who had difficulty breastfeeding, a poor score on the Hazelbacker Assessment Tool for Lingual Frenulum Function (HATLFF) and whose parents accepted the frenotomy were included. Ankyloglossia was classified into four types according to Coryllos classification. Mothers’ complaints, weight gain since birth and feeding methods were noted. Infant Breastfeeding Assessment Tool (IBAT) and Numerical Pain Rating Scale (NRS) were completed by the mothers at baseline evaluation, 7 days and 31 days after the frenotomy. A 6-month telephone follow-up was done to assess continuation of breastfeeding.

Descriptive statistics and Related-Samples Wilcoxon Signed Rank Test were performed to evaluate differences in IBAT scores and NRS scores before and after frenotomy. Additionally, Independent-Samples Mann-Whitney U Test was used to compare the timing of frenotomy (<14 days old vs. ≥ 15 days old).

Results: Sixty-nine infants diagnosed with ankyloglossia were included in the study. Frenotomy were more performed on males (61%) than females (39%) and the average age was 17 days. The majority of infants presented with ankyloglossia type 2 (41%), followed by type 3 (38%), type 1 (17%) and type 4 (4%). In all types, IBAT and NRS scores improved significantly between the baseline and 7 days (p<.001) and between 7 days and 1 month (p<.001). Fifty-five percent of infants were 14 days or less and forty-five percent were 15 days and more at the time of the procedure. Infant age at the time of frenotomy was not significantly correlated to breastfeeding scores or pain rating.

Conclusions: Frenotomy procedure may significantly improve IBAT and mothers's NRS in infants presenting with ankyloglossia and breastfeeding difficulties, regardless of the timing of the procedure. Ankyloglossia should always be examined in infants presenting with breastfeeding difficulties, and if detected, frenotomy may be considered by healthcare providers.

Canadian pediatric residents’ perceptions, training and knowledge of infant oral health

Dr. Shuang Liu, Interfaith Medical Center, Brooklyn, New York

Objectives: The purpose of this survey was to assess the current perceptions of Canadian medical

pediatric residents regarding their education in infant oral health.

Methods: Data was collected in collaboration with the Canadian Pediatric Program Directors’ (CPPD) research group. The CPPD relayed the survey electronically to all 625 Canadian medical pediatric residents in June of 2015.The questionnaire was an anonymous self-administered 17 question survey asking respondents the number of hours they received in oral health training, perceptions on their training, and comfort levels in assessing infant oral health. Five knowledge questions were included. Responses were analyzed using descriptive statistics in addition to statistical testing. Analysis was performed to determine whether demographic variables had an effect on whether

knowledge questions were answered correctly.

Results: 187 surveys were completed out of a total 625, achieving a response rate of 29.9%. 70.6% residents indicated receiving less than 1 hour of training on the oral health exam, 22.5% received between 1 to 2 hours of training, 5.3% received 2 to 4 hours of training and 1.1% residents received more than 4 hours of training. In response to the question of respondent’s perception of adequate training on the infant oral health examination, 4.8% agreed that they received adequate training. No respondents strongly

agreed with the statement, 11.2% strongly disagreed with the statement, 57.2% disagreed and 26.7% were neutral.

Residents comfort levels in performing an infant oral health exam were as follows: 10.1% very uncomfortable; 57.8% uncomfortable, 4.3% neutral; 5.9% comfortable; and 0.5% very comfortable. In response to the question of residents’ perception that oral health is an important component of overall health, 66.8% strongly agreed, 31.6% agreed, 1.1% were neutral, and 0.5% disagreed. Responses to whether the pediatrician plays an important role in ensuring adequate oral health were: 22.5% strongly agreed, 64.2% agreed, 11.8% neutral and 1.6% disagreed. Of those surveyed, 6.4% respondents correctly answered all five knowledge questions. The results to the knowledge questions are listed in Table 2. To allow for a better summary and analysis of data, demographic variables were placed into 2 groups and the mean of the coded scores in response to the 5 questions were compared.

Conclusion: There is a disconnect between the training currently received by pediatric residents and the knowledge base required to adequately aid in insurance of satisfactory oral health amongst the Canadian pediatric population.

Comparison of Manitoban general and pediatric dentists behaviour guidance technique usage and preference

Dr. Simrit Nijjar, University of Manitoba, Winnipeg, Manitoba

Objective: To examine differences in the usages and otherwise preferences of behaviour guidance techniques between Manitoban general and pediatric dentists when considering year of graduation, training locations, and source of training.

Methods: Surveys using SurveyMonkey were emailed via the Manitoba Dental Association to a random 25% sample of general dentists and all pediatric dentists (145 general dentists, 19 pediatric dentists) in Manitoba. Questions regarding type of dentist, year of graduation, place of undergraduate/graduate training, ranking of pharmacological and non-pharmacological behaviour guidance techniques, and sources of training of the techniques were created. Statistical analysis was performed using the statistical software in SAS 9.3 (SAS Institute Inc., Cary, NC, USA). The nonparametric test Wilcoxon Mann-Whitney test was performed on all data by considering all behaviour guidance techniques as continuous variables. Significance levels were considered at alpha <0.05 and at 95% confidence interval (CI).

Results: A total of 87 completed responses were collected (72 general dentists, 15 pediatric dentists). Statistically significant differences were found in voice control and oral sedation overall. In those that graduated before 1998, tell-show-do and oral sedation had statistically significant differences. For those that graduated after 1998, oral sedation and general anesthesia had statistically significant differences. The usage of voice control and the otherwise preference of oral sedation for those trained within Manitoba were found to be statistically significant between the general dentists and pediatric dentists. These findings although statistically significant were judged not to be of clinical significance as the rankings were usually within one number. For the source of training, pediatric dentists mainly chose undergraduate and graduate training as their main source for most behaviour guidance techniques while general dentists mainly chose undergraduate only as theirs. For both the general and pediatric dentists, the most favoured non-pharmacological technique was tell-show-do and the least favoured was protective stabilization. In the pharmacological groups, nitrous oxide sedation was most favoured and IV sedation was least favoured.

Conclusions: In general, there were few statistically significant differences in the usage and otherwise preference of behaviour guidance techniques between both general and pediatric dentists when considering the year, source, and location of training; however, there were some clinically significant findings. Overall, tell-show-do and nitrous oxide sedation were found to be the most favoured in their respective categories while protective stabilization and IV sedation were the least favoured in their respective categories for both general and pediatric dentists of Manitoba.

The Effect of Biophysical Characteristics and Dosing on Pediatric Oral Sedation Outcome

Dr. Becky Olacke, University of Washington Center for Pediatric Dentistry, Seattle, Washington

Objectives: Overweight and obese patients require special consideration because of physiologic differences. For such patients dosing sedation medications at actual weight may result in a relative overdose. Currently, there is no recognized dosing scalar for pediatric procedural sedation. This study examined the biophysical characteristics of pediatric dental sedation patients to determine the effect of child weight and the impact of medication dose on sedation success.

Methods: Records of pediatric dental sedations performed at a university-based dental clinic from Feb 2 2011 through Feb 1 2016 were reviewed. Healthy children aged 24 -144 months, who received an oral preparation of meperidine (1.5mg/kg), midazolam (0.3mg/kg), and hydroxyzine (1.0mg/kg) and whose treatment was supervised by the same attending pediatric dentist were included. Sedation dose was calculated using a simplified IBW dosing scalar, the lesser of actual weight or the Centers for Disease Control and Prevention (CDC) 50th weight for age percentile. Patient demographics and biophysical characteristics were recorded and used to calculate body mass index (BMI) percentiles. The sedation dose was compared with the child’s actual weight to determine if the dose delivered was therapeutic or sub-therapeutic. Sedation success was analyzed to determine association with dose received.

Results: The sample population consisted of 427 children (mean age = 76.8 months, SD = 21.6 months). The overall success rate, measured by the Houpt scale, was 74% (N=315). There was not a significant difference in success rate by gender, ASA status, insurance status, CDC BMI percentile for age, CDC weight for age percentile, or dose delivered. Older age category and simple treatment type were significantly associated with sedation success (P = 0.036 and P = 0.045 respectively). Chi-squared tests were used to evaluate the association between categorical variables and sedation outcome. The calculated ideal and lean body weights of the study participants were significantly greater than the dosing weight used (P < 0.001 and P < 0.001 respectively) and several patients in the upper quartile received sedation during the study period.

Conclusions: Patients in this study were on average heavier than the CDC 50th weight for age percentile. The results suggest that to avoid inadvertent sedation of overweight and obese patients BMI percentile should be considered in sedation case selection and dosing.

2015 Abstracts, Halifax, Nova Scotia

Investigation of Accessory Canals in Primary Molars, A Micro-Computed Tomography Study

Dr. Mark Berscheid, University of Manitoba

Objectives: This study was designed to examine accessory canals in the furcation area of extracted primary molar teeth using micro-computed tomography.

Material and Methods: Extracted primary maxillary and mandibular molars (n=65) were scanned at a resolution of 9.0 µm in a micro-CT scanner (Skyscan 1176). The patient age, as well as type of tooth (maxillary versus mandibular, first versus second molar) were recorded for each tooth and DataViewer v. 1.5.1 was used to interpret scanned images. Presence or absence of canals, canal patency, number of canals, and size of canals was recorded for each tooth. Collected data was analyzed using SPSS 20.0 for Windows. Fisher’s Exact and Kruskal-Wallis tests were used to identify association between variables.

Results: Canals were observed in the furcation area of 83% of molars scanned, and patent canals were found in the furcation area of 8% of molars. The mean number of canals per tooth was found to be 2.6. Second molars were observed to have a significantly higher number of canals than first molars (p<0.05). No significant association was found between patient age and the number of canals present. Also, no significant relation was found between tooth type or patient age and diameter of canals.

Conclusions: The following conclusions can be made based on the results of this study:

1.   While the majority of primary molar teeth have accessory canals in the furcation area, only a minority of primary molar teeth have accessory canals that are patent.

2.   Micro-computed tomography is an effective tool for analyzing accessory canals in the furcation region of extracted primary molars.

3.   Other factors besides accessory canals may be responsible for the interradicular pathological bone resorption observed following pulpal necrosis in primary molars.


Survey of Professional Burnout and Depression among Pediatric Dentists in the United States

Dr. Leena Chohan, MSc Candidate, Faculty of Dentistry, University of Toronto

Committee Members: Dr. H Nainar, Dr. C Dewa, Dr. W El-Badrawy

Objectives: 1) To assess the prevalence of occupational burnout and depression among pediatric dentists in the United States and 2) To explore for differences in the prevalence of burnout and/or depression by gender, age, marital status, practice type, geographical location, number of years in practice, and number of hours worked per week.


Methods: A self-administered online anonymous survey was sent to all active members of the American Academy of Pediatric Dentistry residing in the United States. Survey Monkey® was used to administer the 37-item online survey. Questionnaire items consisted of three domains: demographic information (7 items); the Maslach Burnout Inventory (MBI) (22 items), including the three dimensions of Emotional Exhaustion, Depersonalization and Personal Accomplishment; and lastly the Patient Health Questionnaire 8 (PHQ-8) (8 items).


Results:  A total of 4739 surveys were sent and resulted in 785 responses (response rate = 17%). Nine percent of respondents had occupational burnout based on high scores in 2 dimensions of the MBI, Emotional Exhaustion and Depersonalization. Seven percent of the sample had PHQ-8 scores indicative of depression. Preliminary analyses indicated that those practicing in a group practice were less likely to have Emotional Exhaustion. Those who practiced for 40 or more hours per week were more likely to have Emotional Exhaustion (p<0.05). Prevalence of burnout and depression were correlated.


Conclusions: A small but notable number of U.S. pediatric dentists had occupational burnout and depression.

Trends in Caries-Related Emergency Visits to a Paediatric Hospital

M.Sc. candidate: Dr. Molly Ehrlich, DMD

Committee Members: Drs. Edward Barrett, Michael Casas and Carlos Quiñonez

Objectives: The aim of this study was to determine the annual frequency of children who presented to a tertiary care pediatric hospital with a caries-related emergency complaint over a ten-year period. The secondary aims of this study were to determine the demographic characteristics of the families that presented, the types of caries-related emergency complaints, treatment provided and costs associated with treatment.


Methods: A retrospective review of the health records of all children who presented to SickKids with caries-related emergency complaints and were seen by a dental resident from January 1, 2003 to December 31, 2012 was completed. A visit for an emergency dental complaint seen within the ED was identified as a registration where the principal diagnosis at discharge was coded using the International Classification of Disease block code equal to K00-K14 (diseases of oral cavity, salivary glands and jaws). Eligibility was determined by reviewing the corresponding health. Records were reviewed and data abstracted on: patient demographics, presenting complaints, co-morbidity, dental treatments, final diagnosis and patient disposition. A cost analysis was provided by SickKids Decision Support Services.


Results: During the ten-year period, 2,020 children with caries-related complaints presented to the ED. Visit rates for caries-related complaints increased by 48% (P= 0.0049) over the study period. 68% of the patients were younger than 6 years. Of the 2,020 patients, 1,217 were seen by the dental resident. There were 276 admissions and 85 were treated under general anaesthetic. The mean cost of care within the ED was $248 (CND).  


Conclusions: Over the study period there was an increasing trend in caries-related ED visits to a pediatric hospital. EDs have become an important site for people with caries-related sequelae to seek urgent care, particularly for pre-elementary school age group. These visits utilize hospital resources with an average per visit cost of $248.


The “W5” of pediatric hospital dental emergencies: A quantitative and qualitative analysis

Dr. Jennifer Park 1*, Campbell, K2


1MSc. Candidate, Faculty of Dentistry, University of British Columbia, Vancouver, Canada; 2Faculty of Dentistry, University of British Columbia; Dept. of Dentistry, BC Children’s Hospital, Vancouver, Canada



Objective:  To explore factors contributing to a reported increase in emergencies presenting to the Department of Dentistry at BC Children’s Hospital over recent years by investigating the “who, what, when, where and why” of their hospital management.


Methods: A two-phase study incorporated quantitative (retrospective chart review) and qualitative (personal interview) elements. Phase 1 - Records of 300 emergencies from 2009 to 2013 were systematically selected and reviewed. Patient demographics; source of referral; time/day of visit; nature, scope and management of emergency; and follow-up care were analyzed (Pearson’s Chi-squared Tests and Odds Ratios). Phase 2 - Twenty-five interviews with parents of children who recently experienced dental emergencies were recorded and analyzed for common themes in reported factors/circumstances.


Results: Emergencies included dentoalveolar trauma (56.7%), dental pain (20%), swelling from advanced dental disease (13.3%), and ‘other’, unrelated to trauma or caries (10%). Common patients characteristics were: healthy, male, young age (<7 years old), proximity of residence to the hospital and low socioeconomic status. Primary source of referral was the emergency department; emergencies presented equally throughout the week. No immediate intervention was necessary for the majority of cases and follow-up with a community dentist was advised. Factors contributing to a parent’s decision to seek emergent dental care in a hospital included: perception of urgency; concern for their child’s well being; desire for reliable care by a reputable institution; limited understanding of dental disease and consequences of poor oral care; and financial and access to care barriers.


Conclusion: Dentoalveolar trauma and untreated advanced dental caries compel families to seek hospital-based dental emergency services. More aggressive efforts to improve awareness of the importance of early dental visits; development of curricula emphasizing management of anxious children and exposure to pediatric emergencies; and reinforcing the ethical responsibility of dentists to provide after-hours emergency care may help to reduce burden on hospital resources.


Acknowledgements: Project funding provided by British Columbia’s Children’s Hospital 2012 Telethon Projects Award.

A Retrospective Study of Stainless Steel Crowns as a Posterior Permanent Tooth Restoration Option

Dr. Alison Sigal

Year of Convocation: 2016

Degree: Master of Science, Department of Paediatric Dentistry, University of Toronto

Objectives: This retrospective cohort study was performed to assess the long-term clinical and radiographic outcomes of the stainless steel crown (SSC) as a posterior permanent tooth restoration option.

Methods: Study included 271 patients with at least one SSC restoration of their permanent posterior dentitions registered at the Mount Sinai Hospital’s Dentistry Clinic for Persons with Special Needs. All posterior permanent tooth restorations were documented accounting for 2623 restorations: 766 SSC, 1651 Amalgam, 204 Composite Resin, and 2 Glass Ionomer.

Radiographic analysis of SSC restorations included 61 patients, 127 bitewing (BW) and 118 periapical (PA) radiographs (59 pre and post SSC placement). BW films permitted electronic measurement of interproximal bone levels. Pre/Post-SSC PA films permitted assessment of periapical status utilizing the Periapical Index (PAI) Scoring Scale.

Results: The 10-year survival rate (95% CI) for SSC restorations was 82.6% (78.8%, 86.0%). The median follow-up was 5.1 years with a range of 0-33.1 years. 675 recorded as intact at final chart assessment with 91-recorded true failures (Recementation: 2, Replacement: 33, Extraction: 56). Breakdown of diagnoses at time of failure included: Caries: 8, Loose/Lost SSC: 2, Pulpal Necrosis/pathology: 21 and Other: 25.

The average alveolar bone height recorded from distal and mesial sites of SSC restorations respectively were 1.40mm (0.53 – 3.78mm) and 1.36mm (0.53 – 2.84mm). 92.1% (117/127) of distal and 93.7% (119/127) of mesial sites recorded as healthy, non-resorbed. All 59 Pre-SSC PA had healthy periapical scores (fifty: 1, nine: 2). Post-SSC PA; 13 SSC restorations had PAI score changes recorded over an average duration of 8.4 years (1 – 29.1 years);seven changed from 1 to 2, six from 2 to 1, all consistently representing healthy periapical structure.

Conclusion: A stainless steel crown restoration is an effective long-term treatment option for the permanent posterior dentition with negligible effects on the surrounding periodontal alveolar bone heights and periapical status.

Professional Uncertainty in Providing Dental Care for Special Needs Children


Dr. Shan Sun S1*, Bush HM2, Harrison R1, Poon B3, Mathu-Muju KR1


1Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada; 2
Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, U.S.A.; 3School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada


Objective:  The aim of this study was to determine whether scientific (knowledge base), practical (clinical infra-structure) or personal (sense of social justice) sources of uncertainty among British Columbia general dentists posed the greatest barriers to their ability to treat children with special health care needs (CSHCN).


Methods: A 74-item self-administered electronic questionnaire was distributed to a random sample of 1200 general dentists registered with the British Columbia Dental Association. Variability in clinical practice (examine, examine and refer, refer) was assessed using three case scenarios featuring CSHCN with a 1) behavioral difficulty (autism spectrum disorder), 2) physical disability (bleeding disorder) or 3) combination (cerebral palsy). Respondents were asked to use a five-point Likert-type scale to rate uncertainty levels from scientific, practical and personal sources in each case scenario. One-sample t-tests were used to compare differences between examination/refer for examination and treat/refer for treatment group pairs. All items in the scientific, practical and personal domains were tested using multivariate analyses (logistic regression) for all three cases. Data was analyzed and classified based on a novel taxonomical approach.


Results: The response rate was 20.2% (n=226). A higher percentage of dentists were willing to examine and treat a child with a bleeding disorder (59.7%) or cerebral palsy (63.0%) compared to a child with autism (54.5%). Among those who would refer, the most significant reported sources of uncertainty in general are scientific (knowledge of management, ability to diagnose disease) and practical sources (staff training, inadequate facilities, busy practice).


Conclusions: While the majority of general dentists showed interest and desire to provide care for CSHCN, scientific and practical uncertainties are significant factors affecting their ability to provide care.  Recognizing the presence of uncertainty in dental care can inform policy changes to help dentists either decrease reducible uncertainties or cope with those that are irreducible. Implementation of increased undergraduate curriculum hours and hands on experience with CSHCN as well as expanded coverage of public and private dental benefits may help reduce barriers to care for CSHCN, in particular for those with conditions such as autism spectrum disorder.


Acknowledgements: Children with Special Health Care Needs Grant #F13-00854, British Columbia Dental Association.

2014 Abstracts, Montreal, Quebec


Evaluating Parents' and Pediatricians' Awareness of the Cariogenicity of Pediasure                                                                       Emily Lin Jun Chen, D.M.D., Janna Danbe, D.M.D., Nuntiya Kakanantadilok, D.M.D.
Montefiore Medical Center, Bronx, New York, U.S.A.       

1) Determine reasons why parents give Pediasure (nutritional supplement) to their children,
2) Investigate how parents use this product, 
3) Determine what information pediatricians provide to their patients for use of the nutritional supplement,
4) Evaluate pediatricians' knowledge of the cariogenicity of the nutritional supplement.

A survey was administered to the parents of patients at the Montefiore Medical Center Pediatric Dental Clinics, who reported their child’s usage of the nutritional supplement. The goal of the survey was to evaluate the parents’ knowledge of the nutritional supplement as a potential caries risk factor, similar to other sugary beverages. The questionnaire helped determine why patients were using the nutritional supplement and what type of professional anticipatory guidance they had received regarding its use, if any. Similarly, a survey was administered to pediatric medicine residents and pediatricians at Montefiore Medical Center (who treat the same patient population) to determine what information and or instructions were given regarding the consumption of the nutritional supplement.

Results and Conclusions:
This study demonstrated the need to discuss nutritional supplement usage at dental visits as part of routine anticipatory guidance, in an effort to reduce patient’s dental caries risk.  Neither parents nor pediatricians were aware of the relative sugar content of the nutritional supplement compared to other beverages known for their high sugar contents. Parents were unaware that this nutritional supplement is cariogenic, and they were giving the nutritional supplement because they were concerned about their child not eating enough. They did not routinely discuss the usage of the nutritional supplement and caries prevention with their child’s pediatrician. Pediatricians did not routinely provide oral hygiene counseling for patients using the nutritional supplement. Pediatricians should include oral hygiene counseling and discuss the cariogenicity of the nutritional supplement, as part of their routine anticipatory guidance. 73% of parents who purchased the nutritional supplement without the pediatrician’s recommendation, were willing to discontinue product usage, when informed of the cariogenicity.

Changes in parental behavior depend on the pediatric dentist providing anticipatory guidance that includes nutritional counseling.  Dentists must ask about the use of these products.

Trends in Caries-Related Emergency Visits to a Paediatric Hospital

Molly Ehrlich, DMD
Committee Members: Drs. Edward Barrett, Kathy Boutis, Michael Casas and Carlos Quiñonez

The aim of this study was to determine the annual frequency of children who presented to a tertiary care pediatric hospital with a caries-related emergency complaint over a ten-year period. The secondary aims of this study were to determine the demographic characteristics of the families that presented to the hospital, the types of caries-related emergency complaints, the treatment provided and the costs associated with providing this care.

A retrospective review of the health records of all children who presented to SickKids with caries-related emergency complaints from January 1, 2003 to December 31, 2012 was completed. Records were reviewed and data abstracted on: patient demographics, presenting complaints, co-morbidity, dental imaging, dental treatments, final diagnosis and patient disposition.  Patients seen in 2007- 2012 had additional information collected including wait times (total time spent in the emergency department), Comprehensive Ambulatory Classification System (CACS) grouping, Resource Intensity Weight (RIW), catchment area and direct and indirect costs associated with care. Time series analysis will be used to explore trends and patterns within the data. Descriptive statistics will be calculated, including the mean and standard deviation for quantitative measures such as age, neighborhood income quintile and deprivation index quintile. Frequencies of chief complaints, diagnoses and treatments rendered will be calculated and compared by year of presentation. Mean cost of treatment, cumulative total costs and total time spent in the emergency department will be calculated and compared by year of presentation.

The results are pending.  Data collection is currently underway and planned to be completed by August, 2014.

Conclusions are pending.

Oral Inflammatory Load as a Risk Factor for Spontaneous Preterm Birth in Women at Risk of Preterm Delivery

Marie-Lyne Gosselin, DMD
Supervisor: Dr. Michael Sigal, Dr. Howard Tenenbaum, Dr Michael Glogauer
Committee Members: Dr Wendy Whittle, Dr Amir Azarpazhooh, Dr Michael Goldberg
The primary aim of this study was to explore the possible association between oral inflammatory load  (OIL) and spontaneous preterm birth (PTB) in pregnant women who are at risk of preterm delivery by evaluating their exposure to indicators of OIL. This study also aimed to compare oral neutrophils counts in pregnant women at risk of spontaneous preterm delivery with oral neutrophil counts in pregnant women with no foreseeable risk of spontaneous preterm delivery.
Following specific inclusion and exclusion criteria, pregnant women at risk for PTB were recruited to participate in this prospective cohort study. The cells from oral rinse samples provided by the participants were stained with acridine orange, and neutrophil counts (primary exposure variable), were carried out visually by using a fluorescence microscope and a hemocytometer and via spectroscopy. Traditional and non-invasive assessment measures of periodontal health were also recorded and a blood sample was collected to assess the MMP-9 and the fetuin (Ahsg) serum level (secondary exposure variables). Pregnancy outcome along with demographic, dental and medical data were collected using a questionnaire, the antenatal dental chart, the delivery records and a post-delivery phone call questionnaire.

The results are pending. Statistical measures of risk will be calculated to measure the risk of PTB following the exposure to the observed variables. To control for confounders, a multiple logistic regression analysis will be executed.

This study will bring about a deeper understanding of the possible relation between OIL, related to periodontal inflammation that could include either or both periodontitis and gingivitis, in pregnant women at high risk for PTB and overall birth outcomes.  By relying principally on non-invasive, fast and straightforward tools for assessment of OIL, this approach could be used, even by those without dental training, to identify women at  risk for PTB.




Brad Klus, University of Manitoba
The objective of this study was to determine whether the composite bond strength acquired using a single step self-etching bonding system is as or more effective when compared to the two step etch-rinse-bond system at clinically relevant in-vitro standards.

A total of 80 extracted human deciduous with at least one intact smooth surface were collected with parental consent. Collected teeth were randomly assigned to one of four treatment protocols (n=20): single step self-etch (Adper Prompt L-Pop, 3M ESPE), two step etch (15s)-rinse-bond (Optibond Solo Plus, Kerr), single step self etch (Adper Prompt L Pop, 3M ESPE) with 30s pre-etch, and two step etch (30s)-rinse-bond (Optibond Solo Plus, Kerr). A composite cylinder of uniform shape was bonded to each tooth using the designated adhesive system and specimens were tested with a universal testing machine. Descriptive statistics and statistical analysis was performed.

Median shear bond strengths for all specimens, regardless of treatment group, ranged from 3.25 MPa to 43.13 MPa. These values are above suggested minimum clinical required values of 3MPa. A Kruskal-Wallis analysis between treatment groups found statistical significance (p<0.05) for shear bond strength between the groups and both one step system protocols, had higher mean and median shear bond strength values than the two step systems.

An adhesive remnant index (ARI) was analyzed to confirm uniform adhesive fracture between all four treatment groups. Both a Fisher’s exact test, and a Hantel-Haenszel statistic found no significant difference (p<0.05) between the samples.

Based on these findings we concluded that:
1. The ARI score for all treatment groups was not statistically significant, suggesting that the type of bond breakage was consistent regardless of adhesive system used.
2. Both Optibond Solo Plus and Adper Prompt L-Pop systems achieve adequate shear bond strengths as described by current literature.
3. The use of a one-step system to save chair time and aid in patient behavior management may be clinically useful


Effect of anticipatory guidance on the presence of cariogenic bacteria in preschool children

Nick Lekic, University of Manitoba

Objectives: This study was designed to address whether or not the level (high or low) of Streptococcus mutans in the saliva of preschool children can be used as an indicator of caries risk. 

Material and Methods: Levels of Streptococcus mutans was assessed in saliva of 100 preschool children, before and approximately 6-months after receiving a health promotion intervention known as anticipatory guidance. The S. mutans bacterial level was assessed using an immunoassay system (Saliva-Check MUTANS) based on monoclonal antibody technology. Bacterial counts were determined at baseline as well as at a six month recall examination. Obtained data was analyzed using SPSS 20.0 for Windows to report frequencies and to look for trends and associations between the dependent and independent variables. Bivariate analysis (ANOVA, Chi Square/Fishers/McNemar exact test) was used to identify associations between variables. 

Results: The main finding of this study was that higher levels of Streptococcus mutans were associated with higher caries prevalence at baseline, and caries incidence at follow-up. Furthermore following anticipatory guidance, the levels of Streptococcus mutans were reduced at the subsequent follow-up examination, approaching but not reaching statistical significance, and caries incidence was significantly lower in subjects demonstrating low Streptococcus mutans levels.

Conclusions: Results from this study have shown that anticipatory guidance, offered to caregivers and children at an initial examination, led to a reduction in the proportion of children with high Streptococcus mutans levels upon recall six months later. Children with low Streptococcus mutans levels were also less likely to develop new dental caries. These findings suggest that Streptococcus Mutans counts could be used to assess caries risk and encourages clinicians to provide anticipatory guidance to their patients to help avoid the development of new caries.


  “But they stole her teeth.”  Developmentally disabled adults seek dental care


Salmasi A*, Harrison R, Brondani M, Rush J

Department of Oral Health Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver

Objectives: Dental services for children and adolescents with special health care needs, such as developmental disabilities, are reasonably accessible in tertiary care hospital dental departments and in the private offices of pediatric dentists.  However, once these young people become  adults, accessing dental care is often problematic.  This qualitative study explored the experiences of adults with developmental disabilities (AWDD) accessing dental services in metro Vancouver. 

Methods: This research used a qualitative, deductive approach.  Recruitment of participants was facilitated by AWDD service organizations and family support groups. Time was devoted to engaging and building relationships with participants before beginning the research.  Consent was obtained from each participant. The focus groups were guided by open-ended questions, audiotaped and then transcribed.  Each focus group lasted, on average, forty minutes. Participants were either “self-advocates” (AWDD who speak or act on behalf of themselves or others on issues that affect people with disabilities) or caregivers (usually parents). Each transcript was read, re-read and coded.  These codes were organized into categories and finally into domains.

Results: Five focus groups with twenty participants were conducted. Seven main domains relating to the experiences of AWDD self-advocate and their family members with dental care providers were identified. These domains were communication, trust, respect, financial issues, transitional services, waiting times and, finally, what makes for a “positive dental experience”.

Conclusions:  The cost of dental care and the need for enhancing government dental benefits for AWDD were concerns expressed primarily by family members. However, problems with communication between dental professionals and AWDDs and respect for the personal autonomy of AWDD  were identified by self-advocates and their carers as issues of concern in the quest for dental care. Ideas for a more positive dental experience were suggested with the hope that these ideas will eventually be communicated to dental providers.

Acknowledgements:  Project funded by BC Dental Association and Canadian Fund for Dental Education.


Esthetic Crown Options for the Primary Dentition within Post-Doctoral Residency Programs

Bradford Scheideman, DMD, Jacobi Medical Center

Purpose: To compare the attitude, usage and training of esthetic, full-coverage restorative treatment options in the primary dentition among pediatric dentistry residents and program directors.

Methods: Utilizing an email list from the AAPD, two questionnaires were sent to 907 pediatric dentistry residents and 108 pediatric dentistry program directors. Both surveys investigated the utilization, the learning opportunities provided to the residents, the perceived limitations, and the personal experience of different esthetic, full coverage restorative treatment options. Results were analyzed using standard accepted statistical analysis.

Results: Most pediatric dentistry residencies offer a variety of esthetic, full coverage primary restorative options for anterior teeth, while the majority of programs do not offer any esthetic restorative treatment options for posterior teeth. Residents and dentists both agree that esthetics in the primary dentition are important to parents and pediatric dental residents. There are many barriers to new esthetic primary restorative treatment options. Barriers to zirconia crowns (ZC) include cost, retention, lack of research, lack of personal knowledge/experience, fracture, removal of excess tooth structure, and excess time to place. The major barriers of preveneered SSCs (PVSSC) include patient dissatisfaction and risk of fracture.

Conclusion: Pediatric Dentistry Residencies are adapting to a more esthetic approach for full coverage primary dental restorations. There is a discrepancy between what the director’s state the residents are able to offer in terms of esthetic restorations and what the residents provide to the patients. There is also a discrepancy between the residents’ clinical training and the reported clinical experience in esthetic restorations. The majority of residents are able to learn about PVSSC from faculty members but rely on manufacturer prepared material to educate the residents on ZC. There are several barriers to ZC that need to be addressed before they are universally incorporated into routine restorative procedures by pediatric dentists and residencies.

Life-long tooth replacement in the leopard gecko (Eublepharis macularius)
Wong, Andrew C.1 Grieco, Theresa M. 1 Richman, Joy M.1

Life Sciences Institute, Faculty of Dentistry, University of British Columbia, Vancouver, Canada

Background: The tooth replacement pattern of the human dentition is characteristic in terms of timing however the understanding of what controls the transition from primary to permanent dentition is lacking. Moreover it is not clear why humans can only replace their teeth once while other animals such as reptiles can replace their teeth throughout life. One potential pathway involved in tooth replacement is the Wingless signalling pathway (Wnt), which leads to uncontrolled budding of supernumerary teeth Gardner’s syndrome in humans.

Objectives: 1) To develop a reptile model, the leopard gecko, in order to study tooth replacement in real-time in vivo. 2) To measure the effect of LiCl, an activator of Wnt signaling, on tooth replacement in longitudinal studies.

Methods: Upper dental arch wax bites of 3 adult leopard geckos were taken weekly. The present/missing teeth were recorded over an 8 month period. The palate was injected bilaterally with LiCl or the control, Sodium Chloride (NaCl), at certain intervals. Post-euthanization, the upper and lower arches were evaluated using Micro CT imaging and with histology.


Results: The average replacement frequency per tooth was 7 weeks and there were 42 teeth per quadrant. Slower cycling teeth were interspersed between faster cycling teeth. A posterior-to-anterior wave of replacement emerged but was inconsistent. Additionally, there was limited replacement symmetry between right and left sides. LiCl disrupted the replacement pattern at varying times as the posterior-to-anterior waves became irregular.

Conclusions: Posterior-to-anterior waves of replacement present at certain intervals but repeating coordination of replacement is not readily apparent. LiCl caused irregularity in the replacement wave suggesting Wnt signaling may regulated the natural process of  tooth replacement.

Acknowledgements: Supported by Faculty of Dentistry Research funds and an NSERC Discovery grant to JMR (RGPIN 326908)                             
Quantifying facial morphogenesis in 3D using Optical Projection Tomography


Woo, JM2*, Richman, JM1,2
1Life Sciences Institute, 2Faculty of Dentistry, Division of Pediatric Dentistry. University
of British Columbia

Objectives: In order to study abnormal facial development, reference standards of normal development are required. It is challenging to obtain 3D data on early embryos, since they are comprised of non-differentiated tissue. We used optical projection tomography (OPT) (Bioptonics, UK), which images transparent specimens with UV light. Here we used carefully staged chicken embryos to measure facial morphogenesis over time.


Methods: Chicken eggs (n=32) were incubated for 3.5-6 days (stage 20, 24, 28, 29). Embryo heads were fixed in 10% formaldehyde, embedded in agarose blocks, dehydrated in methanol, and then cleared in Benzyl Alcohol Benzyl Benzoate 2:1. Embryos were scanned with the OPT, images were reconstructed, and then the head was digitally resliced in the frontal plane using NRecon and CTan. Resliced files were imported into Amira software, and facial prominences were outlined, and isosurfaces were created. Volumetric measurements were assessed using Amira. Landmarks were applied to the outer surface of each prominence using Landmark. The landmarks were then superimposed from different embryos using MorphoJ, whereby they underwent Procrustes Superimposition (PS), Principal Component Analysis (PCA), Canonical Variate Analysis (CVA), and Discriminant Function Analaysis (DFA).

Results: Traditional morphometrics revealed that the greatest amount of growth was a 24-fold difference in volume of the lateral nasal prominence between stages 20 and 29, followed by the maxillary, mandibular, and frontonasal mass. The ratio length/width shows that there was a 3-fold difference in the frontonasal mass between stages 20 and 29. Geometric morphometrics revealed that embryonic facial prominences grow isometrically until stage 24 except the maxillary prominence which grows till stage 28. Afterwards, facial prominences grew allometrically. Shape changes were observed in all three axes. The frontonasal mass narrowed mediolaterally, and lengthened superioinferiorly and proximodistally. The lateral nasal and maxillary prominences both grew more proximodistally and mediolaterally, and had minimal growth superioinferiorly. The mandibular prominence grew mainly superioinferiorly, and had minimal growth mediolaterally and proximodistally.

Conclusion: Embryonic chicken facial prominences undergo allometric growth. Each prominence varies in dimensional changes with respective stage, with the frontonasal mass and mandibular prominence having the greatest dimensional change.

Acknowledgements: This work was funded by Faculty of Dentistry research funds and CIHR operating grants to JMR.

2013 Abstracts, Vancouver, British Columbia

2nd Year

3rd Year

2011 3M ESPE Graduate Student Research Presentations

Four Canadian graduate students in pediatric dentistry participated in the 3M ESPE Graduate Student Research Presentations, held during the Canadian Academy of Pediatric Dentistry (CAPD) Annual General Meeting in Edmonton in September, 2011. The graduate students presented their research to a panel of judges, and the winning student was awarded a $1000 cash prize.


Dr. Tabitha Chng, winner of the 3M-ESPE Graduate Student Presentations and Mr. Garrett LeBlanc,

3M-ESPE Representative.


Dr. Tabitha Chng, winner

of the 3M-ESPE Graduate Student Presentations,      
Mr. Garrett Leblanc and Dr. Zahra Kurji, Chair of Scientific Committee

2011 Abstracts, Edmonton, Alberta

  • Dr. Tabitha Chng: GLUT2 and TAS1R2 genotype and risk of dental caries
  • Dr. Sabrina Huda: Novel oral rinse assay for the quantification of oral neutrophils and comparison to the standard periodontal exam in pregnant women
  • Dr. Anita Moosani: Evaluation of an Oral Swab Assay as a Quantitative Measure of Periodontal Inflammation in Patients with Special Needs
  • Dr. Lori Waichenberg: A retrospective analysis of the success of fixed space maintainers in a private pediatric dental setting and a survey of the use of fixed space maintainers among pediatric dentists and orthodontists

The following are condensed versions of the abstracts submitted for the 2011 pediatric dental research event.


Text Box:

Dr. Tabitha Chng


Title:  GLUT2 and TAS1R2 genotype and risk of dental caries

Authors: Tabitha Chng, Ahmed El-Sohemy, Daiva Nielsen, Christine Wessman, Karen Eny, Gajanan Kulkarni


Introduction: The microbiological and environmental contribution to dental caries has been extensively studied. However, the relative contribution of genetic predispositions has not been clearly defined. Genetic polymorphisms in the TAS1R2 (Ile191Val) and GLUT2 (Thr110Ile) genes have recently been associated with habitual sugar consumption with carriers of the Ile allele of GLUT2 having higher sugar consumption and carriers of the Val allele of TAS1R2 having lower sugar consumption. However, the association between these genetic variants and dental caries has not yet been examined.   

Objectives: To determine whether a common polymorphism in the TAS1R2 and GLUT2 genes is associated with dental caries.

Methods: 80 healthy Caucasian individuals, aged 21-31 years old, who were previously genotyped for the TAS1R2 and GLUT2 polymorphisms through the Toronto Nutrigenomics and Health Study, were recruited.  A clinical and radiographic examination was conducted by a single examiner who was blinded to the genotype of the participants.  To assess caries prevalence, three different caries scores were determined: DMFT (Decayed, Missing, and Filled teeth), DMFT+radiographs and ICDAS (International Caries Detection and Assessment System). Associations between genotype and caries incidence were analysed analyzed Student’s t test.

Results: A significant increase in DMFT scores (mean ± SEM) (4.32±0.43 vs. 6.13±1.24, p=0.04) was shown in carriers of the Ile allele of GLUT2. Carriers of the TAS1R2 gene polymorphism consistently demonstrated lower caries scores: DMFT (4.14±0.47 vs. 5.78±0.89, p=0.05), DMFT+radiographs (4.93±0.57 vs. 7.53±0.91, p=0.01), and ICDAS (19.52±2.15 vs. 26.14±2.82, p=0.03).  

Conclusion: The results suggest that variation in the GLUT2 and TAS1R2 genes are associated with risk of dental caries. Further analysis using the genome-wide association study (GWAS) approach is planned next to identify other polymorphisms associated with caries risk. Further studies targeting children with early childhood caries and validation of the current results in a pediatric population are needed.


Dr. Sabrina Huda.jpg

Dr. Sabrina Huda


Title:  Novel oral rinse assay for the quantification of oral neutrophils and comparison to the standard periodontal exam in pregnant women


Authors: Dr. Sabrina Huda, Dr Howard Tenenbaum, Dr Wendy Whittle, Dr Michael Glogauer, Dr Herenia Lawrence, Dr Michael Goldberg


Background:  Current studies suggest that periodontal disease is associated with an increased risk of preterm birth and low birth weight infants. Periodontal diagnosis relies on intraoral visual clinical factors that include redness, bleeding, probing depths, attachment loss and amount of plaque and calculus. A simple test that identifies pregnant women at increased risk of adverse outcome due to periodontal disease would be valuable.

Objectives: To develop a valid and reliable tool to measure periodontal inflammatory disease in pregnant women. To determine the salivary neutrophil counts in pregnant women using a new non-invasive oral rinse assay.  To assess their periodontal health status using this neutrophil quantification assay and conventional methods. To validate the assay as a quantitative measure of periodontal inflammatory disease in pregnant women.

Methods: Periodontal examinations of pregnant women were performed (preliminary n = 36). 10 ml saline rinse for 15 seconds, were collected.  Neutrophils were counted in each rinse.  ABTS, a colour changing redox agent, was added. The intensity of the colour reaction was measured by absorbance. Descriptive statistics and Spearman’s correlation were calculated to assess preliminary results.

Results: Preliminary results showed a significant positive correlation between neutrophils counts and periodontal disease severity as measured by bleeding on probing (rs = 0.70; p <0.01) and the modified gingival index (r = 0.57; p <0.01).

Conclusions: Preliminary results suggest a correlation between neutrophils and periodontal disease in pregnant women. The rinse assay may be used as a screening test for periodontal inflammation in pregnant women.


Text Box:Dr. Anita Moosani


Title:Evaluation of an Oral Swab Assay as a Quantitative Measure of Periodontal Inflammation in Patients with Special Needs



Dr. Anita Moosani, Dr. Michael J. Sigal, Dr. Howard C. Tenenbaum, Dr. Michael Glogauer

Dr. Herenia P. Lawrence, Dr. Michael Goldberg


Patients with special needs have a high prevalence of oral disease, which can be difficult to diagnose with conventional dental instruments due to lack of cooperativity, resulting in the use of subjective measures for periodontal disease, unless patients are examined under general anaesthesia. Measurement of oral neutrophil levels may serve as an objective measure of periodontal health status. This study aims to validate and assess the feasibility of using an oral swab assay of oral neutrophils as a quantitative measure of periodontal inflammation in uncooperative patients with special needs.

Methods: Patients scheduled for comprehensive dental treatment under general anaesthesia at Toronto’s Mount Sinai Hospital Dental Program for Persons with Disabilities were included in this study. A periodontal examination using a periodontal probe was done under general anaesthesia and oral swabs were obtained to show that measurable counts of oral neutrophils could be attained. These measurements were then compared to neutrophil counts taken from the oral swabs done later at the patient’s recall examination. Oral neutrophils obtained from the oral swabs were measured using the FLUOstar Optima software.

Results: Sample size calculations indicated that 44 patients are required for this study, and 49 have been assessed under general anaesthesia thus far. Data collection during recall examinations is still in progress, and will allow statistical comparisons between periodontal parameters and oral neutrophil counts taken during the general anaesthetic and recall examinations. Descriptive statistics will be used to determine the evaluators’ ability to acquire the oral swab data in an ambulatory dental clinic for patients with special needs.

Conclusions: Oral neutrophil counts derived from swabs are expected to correlate significantly with conventional parameters of gingival inflammation and provide a standardized method for clinical measurement, thus overcoming the problem of subjectivity encountered with conventional measures in the special needs population.



Text Box:Dr.  Lori Waichenberg

Title: A retrospective analysis of the success of fixed space maintainers in a private pediatric dental setting and a survey of the use of fixed space maintainers among pediatric dentists and orthodontists


Dr. Lori Waichenberg, Dr. Paul Andrews; Dr. Michael Sigal; Dr. Keith Titley; and Dr. Bryan Tompson


Space management of the developing dentition is an important part of interceptive and preventive dental care.  Though the published success rates are generally low, many of these studies are based on data from multiple student operators As such, it would be beneficial to present data from a single practitioner on the success and longevity of fixed space maintainers (spms) under a strict protocol in a private practice setting. Furthermore, it would be informative to document the prevailing attitudes of a representative sample of North American pediatric dentists and orthodontists regarding their personal experience with fixed spms.  

Objectives: To evaluate the success and longevity of fixed space maintainers placed by a sole dental practitioner in a private pediatric dental office. To evaluate the use of, attitudes toward, and perceived difficulties with fixed space maintainers by a representative sample of North American pediatric dentists and orthodontists.

Experimental Methods: A retrospective chart review of patients who had fixed space maintainers placed between 2000-2010 at a private pediatric dental practice was conducted.  A total of 898 appliances were included in the study.  A web-based online survey was sent out to a random sample of 1000 pediatric dentists and 1000 orthodontists regarding their use of fixed spms.

Statistical Analyses: For the chart review, descriptive statistics, a Cox regression analysis, and survival curves were generated.  A log-rank test was used to assess the equality of the survival distributions. For the survey study, the results were compiled and analyzed and visual summaries of the responses were generated.

Results: The overall success rate for the spms studied was 86.7%.  The overall survival time for the spms was 205 days, with the band and loop showing the longest survival. The response rate for the survey for the pediatric dentist was 42%, but for the orthodontists was only 6.9%.  The vast majority of pediatric dentists and orthodontists place fixed spms in their practice (99.8% and 97%, respectively). The most common reason for failure was cited as cement loss by the pediatric dentists (47.3%) and breakage was cited as the most common reason by the orthodontists (30.4% ).

Conclusions: Fixed spms had a high success rate and were used by the vast majority of pediatric dentists and orthodontists.  They should be recommended for use in patients whenever indicated.

2009 Abstracts, Victoria, British Columbia

  • Dr. Tim Seto:  Dental Cleanings and pneumonia incidence among Children with Cerebral Palsy
  • Dr. Evan Zaretsky:  Pediatric Dentists' Behaviour Management of Patients with Autism Spectrum Disorder
  • Dr. Ngoc Luong:  Assessment of Parental Satisfaction with Dental Treatment under General Anesthesia in Pediatric Dentistry
  • Dr. Michael Park:  Oral Disease Prevalence and Relationship to Oral Neutrophil Levels and Function in Neutropenia



Student: Tim Seto (University of Michigan, Ann Arbor, MI)


Objectives: Investigate the relationship between pneumonia and dental cleanings in a pediatric population with cerebral palsy (CP) and test the null hypothesis that children with CP are not at increased risk for pneumonia when receiving dental cleanings.


Methods: Analyzed pneumonia claims from Michigan State's Medicaid database for a 5-year period (January 2001-December 2005).  Patients aged 3 to 18 years with CP were included.  Outcome of interest was the presence of greater than or equal to 1 claim for pneumonia (International Classification of Disease, Clinical Modification 9th edition - 480 to 486 or 487.0) within 14 days of a prior dental cleaning (Current Dental Terminology 1110, 1120, 4341, 4355).  Multivariate time-dependent logistic regression was used to determine factors associated with pneumonia events.  Potential risk factors evaluated in the regression model include demographic variables: age at entry of study, area of residence (i.e. urban vs. rural), and, the presence of medical conditions: esophagogastric fundoplasty, gastroesophageal reflux, asthma, gastrostomy feeding tube, dysphagia, epilepsy.


Results: 7079 children were eligible for this study with the mean age at entry of study of 7.75 years old.  Among these children, 871 (12%) had greater than or equal to 1 claim for pneumonia during the study period.  Only 17 children reported claims of pneumonia within 14 days and 37 children after 30 days of a dental cleaning.  Regression analysis revealed significant risk factors for pneumonia, including dysphagia (OR 2.26), asthma (OR 2.19), gastrosophageal reflux (OR 1.58) and epilepsy (OR 1.43).  Significant non-medical associations with pneumonia include age at entry of study (OR 0.95) and rural area of residence (OR 1.35).


Conclusions: No association between dental cleanings and pneumonia events could be demonstrated in CP children aged 3 to 18.  Dysphagia, asthma, gastrosophageal reflux, and epilepsy are more important risk factors than dental cleanings for pneumonia.


(Dr. Seto was the first place winner of the 2009 3MESPE prize)



zaretskyStudent: Dr. Evan Zaretsky (University of Toronto)


Objectives:  The purpose of the present study was to asses which specific behaviour management skills pediatric dentists are using and find effective in working with their patients with Autism Spectrum Disorders, ASD, and to highlight specific influences whether educational, environmental or experiential which contribute to their skills in advanced behaviour management.


Methods: Surveys were mailed to all Canadian and select American members of the AAPD, with an invitation to participate in the research either via direct mailing or online.  The survey tool had two sections: Personal and Professional Background; and the Behaviour Management Technique Rating Scale, BMTRS. The BMTRS asks respondents to indicate their frequency of use, and perceived effectiveness of 23 different behaviour management techniques. Responses were collected over 10 weeks and will subsequently be analyzed to describe the previously noted relationships.


Results: A total of 837, subjects replied to the survey, a response rate of 50.1%. Although statistical analysis is still pending, several trends were noted. Over 60% of the subjects see autistic patients weekly or more often. Over 40% of respondents say that they use inhalation sedation often or regularly, and more than 2/3 felt it was at best, somewhat useful. Conversely, traditional approaches, such as Tell-Show-Do, are used regularly by 60%, but only 43% considered it useful. Meanwhile, modern techniques, such as filmed modelling, are untried by over 90% of respondents. A resounding 71% believe that more continuing education with regards to ASD would be valuable.


Conclusions: Pediatric dentists recognize a need for further education in the field of behaviour management, specifically in regards to ASD. Pharmacologic and traditional techniques, like voice modulation, are widely used, but may not be effective. Many new approaches, such as sensory stimulation, have been documented in the literature, yet remain largely unutilized for reasons, such as time and costs involved.




luongStudent: Dr. Ngoc Luong (University of Toronto)

Supervisors: Dr. B. Saltzman, Dr. M. Sigal, Dr. D. Haas, Dr. M. Casas


Objectives: To identify and compare pre-treatment and post-treatment parental expectations and satisfaction concerning their child's dental care under general anaesthesia. Participant characteristics were also investigated.


Methods: Questionnaires were administered to 100 parents who had attended the pre-operative anaesthesia consultation (pre-treatment group) and to 100 parents who had returned for post-operative reassessment (post-treatment group). Participants were asked to rate the importance and frequency of each event on a four point Likert Scale. Parents were also asked to complete a participant character information form. A score was calculated for each item in the questionnaires by multiplying the item's mean "importance rating" and the item's mean "expectation rating" and the items were ranked by scores.


Results: To date, complete responses were obtained from 69 parents in the pre-treatment group and 77 parents in the post-treatment group. In each group, the highest ranked elements were those representing information and communication. (Additional data and statistical analyses will be reported in the future)



Our initial results reinforce the value that parents place in adequate communication and provision of information in dental treatment under general anaesthesia. 



parkStudent: Dr. Michael Park (University of Toronto)

Primary Supervisor: Dr. Michael Glogauer

Supervisory Committee: Dr. Yigal Dror, Dr Michael Sigal and Dr. Howard Tenenbaum


Historically, case reports and studies that have looked at the oral manifestations of neutropenia have documented advanced periodontal disease, premature loss of teeth and ulcerations upon initial presentation. Patients with neutropenia are treated routinely with granulocyte-colony stimulating factor to increase their levels of circulating neutrophils. However, no follow up studies have been carried out which report on the oral health status of these patients during their active haematological treatment.


Objectives: To assess the oral health of children with neutropenia.


Methods: Children with neutropenia between the ages of 6-18 attending the Hospital for Sick Children were asked to participate in the study. Participants also underwent an oral and radiographic examination.




Preliminary data suggest that oral health and neutrophil function are maintained for most patients receiving CSF therapy.

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