- ItemOpen AccessA 30-year retrospective study of single-unit and splinted implant supported crowns and their effects upon adjacent tissues and teeth in a Canadian Dental School Environment(2022-07-07) Sarzynski, IsabellaObjective: A retrospective study at a Canadian dental school evaluated the survivability of single-unit and splinted implant supported crowns and their effects on adjacent tissues. Methods: Data from patients of all ages was collected from the institution’s computer patient management software (AxiUm) and physical charts. Results: A total of 678 implant supported crowns (586 single-unit and 92 splinted) were placed at the University of Manitoba Dr. Gerald Niznick College of Dentistry between September 10, 1989 to January 1, 2020. Of the implant cases, 249 (36.7%) of them were smokers, 64 (9.44%) were diabetic and 96 (14.2%) were reported to experience bruxism. Within the duration of the study, 17 (2.90%) single-unit crowns and 5 (5.43%) splinted crowns failed and warranted a replacement. Furthermore, 371 single-unit (63.3%) and 46 splinted (50.0%) implant crowns were a complete success as they had no complications with the crown itself or adjacent tissues. Therefore, 215 single-unit (36.7%) and 46 splinted (50.0%) crowns endured some type of complication with the crown or adjacent tissues which may have led to its failure. Overall, 96.8% of cases experienced no failure as of the study end date and a log rank test was performed to determine if there were differences in the survival distribution for the single-unit and splinted implant supported crowns (χ2(2) = 1.285, p = 0.257). Conclusion: The survival distribution of single-unit and splinted implant supported crowns was not statistically significant as they both presented with high success rates and minimal complications. Although some limitations and challenges were present, this study highlights the longevity and complications of implant supported crowns in order to improve their functionality and lifespan as well as to maintain the health of adjacent teeth.
- ItemOpen AccessNutritional status and feeding practices of First Nations and Metis children and their association with early childhood caries(2022-06-06) Grover, Ramneek SObjective – To investigate the baseline nutritional status and feeding practices of First Nations and Metis children in Manitoba participating in a community-based participatory oral health study and whether there were any associations with early childhood caries (ECC). Methods – This cross-sectional study assessed the oral health status of Indigenous children <72 months of age while their parent(s)/caregiver(s) completed a questionnaire, which included the Nutrition Screening Tool for Every Preschooler (NutriSTEP) and questions on children’s dietary practices. The analysis included descriptive statistics, bivariate analyses, and linear regression. A p value ≤0.05 was significant. Results – Overall, 146 children were recruited at a mean age of 40.8±20.4 months, and 59.6% had ECC. The mean decayed, missing, and filled primary teeth (dmft) score was 4.9±5.3 (range 0–20). While the mean NutriSTEP score was 19.9±6.2 (median 19.5) suggesting a low risk for impaired nutritional status, 50.0% of children were at moderate or high risk for impaired nutritional status. There was no significant difference in NutriSTEP scores between First Nations and Metis children (p=0.29), and no association was found between NutriSTEP risk categories and ECC (p=0.77). Children who frequently ate meat, fish, poultry, or alternatives (NutriSTEP Q5) were significantly more likely to have ECC (p=0.032). Children who never received nutritional supplements (NutriSTEP Q13, p=0.05) were significantly more likely to have ECC. Children who used a pacifier were less likely to have ECC than children who did not (p<0.01). Conclusions – Although half of the children classified using the NutriSTEP were at low risk, the other half were at moderate and high risk. Children classified as high risk were not shown to have a statistically significant association with ECC. Specific NutriSTEP questions, however, were shown to be significant for ECC. In addition, numerous childhood feeding practices were found to play a significant role in the prevalence of ECC.
- ItemOpen AccessPopulation-based Assessment of Antibiotics Prescribing by Dentists in Manitoba – A Longitudinal Analysis(2021-09-26) Quach, AaronBackground: Antibiotic surveillance/stewardship programs have become important tools to promote optimal antibiotic use. Dental prescribing of antibiotics is a significant contributor to overall antibiotic use but has received limited assessment and review at the population level. Methods: Antibiotic prescriptions dispensed from 2014-2019 were evaluated in this longitudinal population–based study conducted in Manitoba, Canada. Antibiotic rates were adjusted for population numbers (per 1000 persons). Linear regression was used to assess trends over time for dentists and physicians. Results: Over the study period, 405,124 antibiotic prescriptions written by dentists were dispensed, representing 9.1% of all antibiotic prescriptions. Physician antibiotic prescribing dropped over time while dentist prescribing remained unchanged (60.1 prescriptions/1000 persons). More than a quarter (27.0%) had potentially inappropriate durations longer than a week. Penicillins were most commonly prescribed (amoxicillin (64.1%), penicillin V (15.0%)). While limited prescriptions were written for the broader spectrum amoxicillin/clavulanate (1.9%), there was a modest increase over time of 12.5% per year (p<0.0015). Analysis by region and income showed relatively consistent results except for northern remote regions where higher rates of dental prescribing were seen. Conclusions: Dental prescribing of antibiotics in Manitoba is stable but higher than national averages with some indications of increased use of broad-spectrum antibiotics. This is in contrast to a significant decline of overall antibiotic prescribing by physicians. Practical Implications: Current data suggest that limiting prescription duration, evaluating the need for a prescription, and increasing scrutiny of the need for broad-spectrum antibiotics may improve the overall quality of dental antibiotic prescribing.
- ItemOpen AccessA retrospective analysis of restorative factors that affect prognosis of endodontically treated teeth(2022-06-02) Lee, Christine HannahAlthough there have been many studies concerning endodontically treated teeth (ETT) and the factors affecting prognosis, many have reported different findings. This retrospective study aimed to support the hypothesis that the initial pulpal diagnosis and restorative factors can help determine the prognosis of ETT. The University of Manitoba’s data collecting software was used to assess 1,360 ETT from January 2011 to June 2021, a period of 10 years. A Kaplan-Meier survival estimate with an associated P value comparing different prognosis, types of posts, and restorations, respectively, was performed using SPSS statistical software. From this data pool, there was a 94.4% survival rate of ETT with only 5.6% failing. A pre-operative necrotic pulp diagnosis was determined to be clinically significant in affecting prognosis. In descending order, a full coverage crown proved to improve prognosis, then permanent restorations, then temporary restorations. Other factors such as the presence of a post, type of post, amalgam vs composite, and type of crown did not affect prognosis. In descending order of causing failure in ETT, reasons were: 33.33% non-restorable crown fractures, 25% vertical root fractures, 14.29% inadequate restorations, 10.71% periodontal reasons, 9.5% endodontic failure, and 7.14% non-restorable caries. Based on these results, it was concluded that just as the quality of endodontic treatment is important, so is the quality/type of restorations that follows. Based on this paper, patients should be recommended full coverage crowns after endodontic treatment to ensure the best prognosis.
- ItemOpen AccessA Review of Dental Outcomes for Infants and Preschool Children Enrolled into a Clinical Trial of Asfotase Alfa for Early Onset Hypophosphatasia(2020) Long, Catherine; Schroth, Robert J.; Rockman-Greenberg, CherylIntroduction: Hypophosphatasia (HPP) is a highly variable genetic disease that impedes the development of teeth and bones. HPP is due to mutations in the ALPL gene which encodes the tissue non-specific form of alkaline phosphatase (TNSALP). Dental manifestations of HPP include painless premature exfoliation of primary teeth with intact roots. Until recently, there was no effective treatment for this disorder. Asfotase alfa is human recombinant bone-targeted ALP (StrensiqTM) (Alexion Pharmaceuticals, Inc. Boston, MA, USA). The purpose of this study was to review the development and exfoliation patterns of primary and permanent teeth in HPP patients with systemic HPP who were enrolled at the Canadian site in Winnipeg in a clinical trial of enzyme replacement therapy (ERT) with asfotase alfa. Methods: Data were collected from a cohort of hypophosphatasia patients ≤ 5 years of age at baseline who were enrolled at the Winnipeg site from locations across North America. Available dental data were recorded from a review of study files of enrolled patients at scheduled visits. In particular, exfoliation patterns and the eruption of deciduous and permanent teeth. Statistical analysis included descriptive and bivariate statistics (T tests and chi square analysis). A p value ≤ 0.05 was significant. Results: Eleven children (7 females, 4 males) with a mean age of 30 ± 27.1 months were enrolled at the Manitoba site in this 72-month clinical trial. Five were recruited in infancy (mean age 3.0 2.3 months) while the other 6 were recruited as preschool children (mean age 52.5 11.3months). Overall, children recruited as preschoolers had lost an average of 10.2 ± 3.9 of primary teeth prematurely due to HPP before enrollment. On average, children lost 2.3 2.9 number of teeth during this clinical trial. Participants recruited as infants prematurely lost significantly fewer teeth to early onset HPP during the trial period where started on ERT in infancy than those who were recruited as preschoolers and started on ERT at a later age (1.9 2.1 teeth vs. 10.2 3.9, p= 0.0043). Conclusion: Results suggest that there were fewer teeth prematurely lost because of HPP among children who began asfotase alfa treatment in infancy compared to those children recruited as preschoolers. This is the first demonstration, albeit on a small number of patients, that the oral health of children with confirmed systemic HPP with onset of signs and symptoms < 6 months of age might be improved with earlier and continued administration of ERT vs. later initiation of ERT.