Leeann Donnelly

Objective: It is important that people living with HIV/AIDS (PLWHA) receive routine oral health care due to their increased risk of oral complications. However, PLWHA have difficulty accessing oral health services for various reasons, including having to endure HIV-related stigma and discrimination. In 2011, the University of British Columbia (UBC) Dental Hygiene Degree Program (DHDP) implemented a preventive oral health program at the Positive Living Society of British Columbia (PSLBC), a non-profit organization supporting PLWHA. This study aims to assess the influence this type of service delivery has on access to oral health care for members of PLSBC.Methods: A retrospective chart review of 170 PLSBC members who utilized the program services was conducted with descriptive analysis. Sixty-nine patient satisfaction surveys were also reviewed. Personal interviews with 10 members and one focus group comprised of 12 staff and administrative personnel were conducted. Audio-recordings were transcribed verbatim and coded thematically using N-Vivo® 11 software. Emerging themes were identified using the interpretative phenomenology approach following Penchansky and Thomas’ theory of access.Results: Of the 170 members who utilized the program, the majority (85.9%) were males and most (72.8%) lived where the program was easily accessible and convenient. Eighty-six members were routinely and currently using the services. The program helped members utilize their financial resources to receive other types of dental services. As members are influenced by their past traumatic experiences, they appreciated services were delivered in a safe manner and in a stigma-free setting. Members valued the opportunity to educate future dental professionals to reduce HIV-related stigma. However, unmet dental needs could not be addressed in the program for some members and appear to be influenced by dimensions of access at referral clinics.Conclusion: This community-based preventive dental program had multiple positive influences on access to oral health care for members of PLSBC; however, the referral pathway appeared to need improvement. Findings highlight that there is a need for dental professionals to address the interrelated dimensions of access in order to engage PLWHA in oral health care due to the influence of socioeconomic status, HIV-related stigma, and histories of trauma.

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Objective: Women impacted by the criminal justice system experience barriers accessing oral health care. In 2013, the Elizabeth Fry Society of Greater Vancouver (EFry) and the University of British Columbia implemented a dental hygiene clinic at EFry at which dental hygiene students provide preventive care to women and children. This study aimed to describe the population utilizing the clinic and identify clients’ and EFry staff’s perceptions about how this clinic has influenced access to preventive oral care for women at EFry. Methods: Ninety-nine dental charts were reviewed retrospectively to determine client demographics, oral health status, services and referrals provided, and clinic attendance, and descriptive univariate statistical analyses were performed. Sixty-two satisfaction surveys were reviewed and three focus groups and three interviews with twelve clients and one focus group with four staff were conducted to identify perceptions of access to care. Focus groups and interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. The concept of access proposed by Penchansky and Thomas (1981) and Saurman (2015) was used to organize themes. Results: Ninety-three women and six children attended the clinic over three years. This clinic addressed women’s preventive care needs through the provision of on-site dental hygiene services. The clinic’s close proximity and services offered for which women did not need to pay out-of-pocket allowed women to access preventive care that would otherwise be inaccessible due to costs of care and transportation. The person-centered and trauma-informed care further facilitated access. Thirty-three women were referred for dental care, however access was limited by cost and likely issues of stigmatization from other dental care providers. Clinic aesthetics, communication related to time needed for care, and clinic communication strategies and advertisement precluded access. Conclusion: This clinic facilitated access to preventive oral care for a subset of women at EFry. Findings highlight that oral health care providers should accommodate for clients receiving public dental benefits and be knowledgeable about the trauma and stigmatization faced by this group. Oral health clinics should employ appropriate clinic advertisement and design, and further accommodate for this group through flexible appointment scheduling and guidance navigating the referral process.

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Halitosis is an unpleasant breath odor; it affects roughly 30-50% of the population. The major compounds that contribute to halitosis that originates from the mouth, typically referred to as oral malodor, are volatile sulfur compounds (VSCs), which are produced by a variety of microorganisms. It has been shown that orthodontic patients with acrylic appliances complain of oral malodor. The source of the odor is in part due to the nature of the appliance, which retains microorganisms that are not removed by mechanical cleaning so typically the addition of an antimicrobial agent, such as Chlorhexidine (CHX) to cleanse the appliances is recommended. However, CHX has some side effects so alternatives need to be explored. Objective: To assess the antimicrobial and the anti-malodor efficacy of a bioflavonoid mouth rinse (BFMR) compared to CHX and water on removable orthodontic appliances. Method: Participants between 8-20 years of age who complained of malodor from their removable orthodontic appliances from the UBC dental clinics and a private orthodontic practice were recruited and blindly randomized into groups in which different mouth rinses were used to soak the appliances for one week (BFMR, Chlorhexidine and water). Baseline and one-week follow-up data collection included the oral hygiene index (OHI), gingival index (GI), tongue coating index (TCI), VSC measurement by gas chromatography, organoleptic assessment, a microbial swab Results: Data was collected from 27 participants ranging in age from 8-16 years old. The baseline measurements of OHI, GI and TCI did not change significantly throughout the study. The organoleptic measurements of odor as well as the aerobic and anaerobic bacterial counts showed a significant reduction in the BFMR group, but for the CHX and water group no significant difference was detected from baseline to follow-up. Conclusion: The BFMR has superior antimicrobial and anti-malodor effect when compared to CHX or to water.

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Objectives: Parental incarceration is an Adverse Childhood Experience (ACE) that can have a negative effect on health related Quality of Life (QOL) outcomes in adulthood. It is unclear how this ACE influences oral health in childhood and in adulthood. This study explores: 1. The oral-health and dental care experiences of men and women whose parents were incarcerated during their childhood;2. How this childhood experience influences current behaviours and perceptions of oral health and dental care in adulthood. Methods: Semi-structured, in-depth interviews were conducted with adults who had one or both parents incarcerated during their childhood. The transcripts were analyzed using Interpretive Phenomenology to identify and describe dominant themes.Results: The eight participants in this study (four males, four females) were found to have experienced more than one ACE. Four themes emerged: 1) Instability; 2) Poverty, stigma and shame; 3) Past dental experiences, and 4) Value of empathetic dental professionals. Conclusion: This study aimed to provide awareness into the concepts that exist about oral health and dental care in adults that have experienced parental incarceration. We found that participants were able to receive dental care on a regular basis during childhood, (urgent and general dental care) however, preventive dental care at home was lacking. The manner in which dental care was delivered in childhood had a strong influence on dental behaviours in adulthood. Financial barriers such as inability to afford dental-care and non-financial barriers such as dental fear, stigma and shame exist for the participants in adulthood in accessing dental care. Perceived poor dental aesthetics made participants feel low self-esteem and social isolation, and restricted their career options. Oral health of their children is given more priority than their own and dental professionals who are empathetic are preferred. The findings of this study highlight that, similar to other vulnerable groups, it is important for dental practitioners to understand and practise Trauma Informed Care universally when working with children, in particular those who may have suffered from ACE, in order to provide experiences that promote their future oral-health.

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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.

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OBJECTIVE: Numerous studies to date have revealed that the oral health status of people living in long-term care (LTC) facilities is poor. As an elderly resident’s ability to perform personal oral care tasks declines, so does their oral health mainly in the form of periodontal disease and caries. Poor oral health also contributes to oral malodour (foul odour emanating from an individual’s breath), which negatively impacts an individual’s verbal interactions and social acceptability. There is evidence suggesting that the geriatric population is more prone to oral malodour. Studies done on oral malodour have looked at aspects such as sources, measurement techniques, management strategies and how malodour impacts the individual suffering from it. However, a deeper understanding of the impact of oral malodour on care givers has yet to be investigated. The following study investigated using an interpretive qualitative approach and a social constructivism interpretive framework the question: what experiences do residential care aides (RCAs) have with individuals living with oral malodour in a LTC facility? METHODS: The study was conducted through face-to-face interviews with RCAs, which were recorded and transcribed verbatim, observations of RCAs in their work environment, as well as RCA personal logs of their daily experiences with odour during caregiving. Thereafter, data was analyzed and coded for emerging themes.RESULTS: Five main themes emerged that described the experiences of RCAs working with residents with odour; challenges of care giving, knowledge of oral malodour management, attitudes and behaviours, attitude and job satisfaction, culture and odour. Collectively these factors affected the quality of interactions the RCA had with the resident.CONCLUSION: Oral malodour among residents was a difficult condition for most of the participants in this study to deal with, and appeared to impact both the quality and quantity of care they provided. Knowledge and understanding of the sources of oral malodour and how to manage it were found to be one of the factors that influenced the provision of care among the participants. Participant attitude, cultural beliefs and organizational beliefs influenced both the importance of oral malodour and how it was managed.

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