MASTERS OF PUBLIC
HEALTH (MPH) PRACTICUM
PROJECT, 2010
Presented by: Genevieve Braganza H.BSc, MPH(c)
OUTLINE


Two Projects:




Cost of Treating Early Childhood Caries(ECC) in the
Saskatoon Health Region (SHR) and Provi...
COST OF TREATING EARLY CHILDHOOD
CARIES (ECC) IN THE SASKATOON
HEALTH REGION (SHR) AND PROVINCE OF
SASKATCHEWAN

Reference...
BACKGROUND


What is Early Childhood Caries (ECC)?


the presence of one or more decayed, missing (due to
caries), or fi...
TREATMENT




Dental treatment or dental surgery under
General Anaesthetic (GA) is most common.
Advantages:

Safe*
 Eff...
TREATMENT


Disadvantages:


Non-life threatening




nausea and vomiting, fever, pharyngitis and swollen lips

Life t...
WHY ARE WE INTERESTED?


In Canada the prevalence of ECC is 6% to 8%






Disadvantaged populations: 25%- 72%

In 200...
OBJECTIVES
1.

2.

3.

To compare children under age 6 receiving
dental surgery under GA versus all other
pediatric surger...
DATA SOURCES






CIHI Portal Discharge Abstract Database,
collected April 1, 2008 to March 31, 2009.
The 2008-09 In-P...
RESULTS: PEDIATRIC SURGERIES
In Saskatchewan, of the
4858 provisions, 2105
cases (43%) were dental
related cases & 57%
wer...
RESULTS: COST


Estimated average treatment for ECC under GA:


Exam, 2 bitewing x-rays, 4 two-surface amalgam
fillings,...
RESULTS: COST


In Saskatchewan:




In 2008- 009, the cost of treating ECC for children
under age 6 was approximately ...
RESULTS: COST COMPARISON


In British Columbia:




In 2001- 02, the cost of treating ECC for 5000
children under age 4...
RESULTS: PLACE OF RESIDENCE
Saskatoon
Health
Region
resident

Northern
Health
Region
resident

Other Health
Region
residen...
SUMMARY


In Saskatchewan (2008-09), 43% of pediatric
surgeries were dental related and 57% were nondental related.



...
SUMMARY (CONT’D)


In 2008-09, 398 children were Saskatoon
residents versus 345 were from Northern Health
regions.
LIMITATIONS






Limitation of data i.e. dental related surgeries
may not all be ECC related
Limitations with data for...
KEY RECOMMENDATIONS




Establishment of a “dental home” or dental
check-up for children at age 1, as recommended
by the...
KEY RECOMMENDATIONS




To encompass oral health messaging and
screening as part of primary health care,
whereby non-den...
ACKNOWLEDGEMENTS


Leslie Topola- Supervisor, Public Health Services- Oral Health Program



Dr. Gerry Uswak- Dean, Univ...
DENTAL HEALTH HUMOUR..

Reference: onedentalcenter.com
ORAL HEALTH AND DENTAL SERVICE
NEEDS FOR THE VULNERABLE
POPULATION IN SASKATOON
(QUALITY IMPROVEMENT QUESTIONNAIRE)

Refer...
BACKGROUND




In the last 3 decades in Canada, there have been
vast improvements in oral health, however
vulnerable pop...
BACKGROUND


Barriers to accessing oral health care:
Financial
 Geographic
 Social/ Cultural
 Legislative.


Source- ...
THE PROJECT




Quality Improvement Project
A Dental Health Questionnaire was conducted in
the core neighbourhoods of Sa...
THE PROJECT


Organizations:

AIDS Saskatoon
 Mobile Health Bus- Primary Health Clinic
 Westside Community Clinic
 Riv...
THE PROJECT






Dental Health Questionnaire was advertised at
multiple locations throughout core city of
Saskatoon.
S...
OBJECTIVES
1.

2.

3.

4.

Understand the specific needs of this population
based on self-reported dental health.
Determin...
DEMOGRAPHICS:








Income (n= 236): 53% identified an income of
$12,000 or less per year.
Education (n= 246): 70% i...
OBJECTIVE #1: SELF- REPORTED
DENTAL HEALTH & SPECIFIC DENTAL
NEEDS
Self- reported dental health (n= 263):

Approximately 3...
OBJECTIVE #1: SELF- REPORTED
DENTAL HEALTH & SPECIFIC DENTAL
NEEDS


Approximately 70% of participants (n= 262) were
worr...
OBJECTIVE #1: SELF- REPORTED
DENTAL HEALTH & SPECIFIC DENTAL
NEEDS
Dental Health Concerns identified by vulnerable
populat...
OBJECTIVE #2: GOOD DENTAL
HEALTH HABITS


Brush teeth (n= 262): 70% of participants
identified brushing their teeth
38% i...
OBJECTIVE #2: GOOD DENTAL
HEALTH HABITS


Dental Office Visits (n= 263):


Approximately 65 % identified visiting a dent...
OBJECTIVE #3: BARRIERS TO
ACCESSING DENTAL CARE


Barriers (n= 92):

Fear of Bad
Experience: 28%
 Transportation:27%
 C...
OBJECTIVE #3: BARRIERS TO
ACCESSING DENTAL CARE


Of 90 participants that did not visit dental office:
60% had dental cov...
OBJECTIVE #3: BARRIERS TO
ACCESSING DENTAL CARE


Preferred dental services (n= 70):
Cleanings and check-ups :40%
 Good/...
OBJECTIVE #3: BARRIERS TO
ACCESSING DENTAL CARE


Participants identified what they needed to have
good dental health:
Re...
OBJECTIVE #4: HEALTH RISKS
(TOBACCO USE)


Tobacco use among
participants (n= 261):

Approximately 75% of
participants id...
OBJECTIVE #4: HEALTH RISKS
(TOBACCO USE)


Number of years smoked or use of spit tobacco
(n= 174):




Approximately 78...
OBJECTIVE #4: HEALTH RISKS
(TOBACCO USE)


Prevalence of smoking among participants by
location:

Riversdale: approximate...
OBJECTIVE #4: HEALTH RISKS
(STRESS RELATED HABITS)




Stress related habits (n= 257) were noted by 55% of
the sample po...
SUMMARY
 Objective

Health



#1: Self- Reported Dental

Overall the vulnerable population had a poor
perception of the...
SUMMARY
 Objective



#2: Good Dental Health Habits

High prevalence of brushing , flossing and
dental visits among the...
SUMMARY
 Objective

#3: Barriers to Accessing Oral
healthcare



Fear or bad experience, transportation and
cost
Dental...
SUMMARY
 Objective




#4: Health Risks

High prevalence of tobacco use among the
sample population (75%), however, Riv...
LIMITATIONS
1.

Bias based on location dental health
questionnaire was conducted.

2.

Healthy Volunteer Effect.

3.

Gene...
RECOMMENDATIONS






Implement a monthly Dental Health Q&A
outside the Mobile Health bus.
Dental office(s) should be l...
RECOMMENDATIONS






Expand 5 A’s of Brief Tobacco Intervention to other
organizations within the Saskatoon Health Reg...
ACKNOWLEDGEMENTS
Supervisors and Colleagues:


Leslie Topola- Supervisor, Public Health Services - Oral Health Program

...
QUESTIONS?

Reference: http://1.bp.blogspot.com/_a3MDthA0QU/SxQVt2LjViI/AAAAAAAAABU/aDEwkQXtpAg/s1600/GuyThinkingRight.gif
REFERENCES






















Surgeon General (2000). Oral Health in America. A Report of the Surgeon Genera...
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Masters of public health practicum project

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November 3rd 2010

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Masters of public health practicum project

  1. 1. MASTERS OF PUBLIC HEALTH (MPH) PRACTICUM PROJECT, 2010 Presented by: Genevieve Braganza H.BSc, MPH(c)
  2. 2. OUTLINE  Two Projects:   Cost of Treating Early Childhood Caries(ECC) in the Saskatoon Health Region (SHR) and Province of Saskatchewan Oral health and Dental Service Needs for the Vulnerable Population in Saskatoon (Quality Improvement Questionnaire)  Key Findings  Recommendations
  3. 3. COST OF TREATING EARLY CHILDHOOD CARIES (ECC) IN THE SASKATOON HEALTH REGION (SHR) AND PROVINCE OF SASKATCHEWAN Reference: http://www.pediatricdentist.com/images/pagePhotos/early.jpg
  4. 4. BACKGROUND  What is Early Childhood Caries (ECC)?  the presence of one or more decayed, missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months or younger. http://health.state.tn.us/images/oralhealth/caries.gif Source- Canadian Dental Association (CDA), April 2010
  5. 5. TREATMENT   Dental treatment or dental surgery under General Anaesthetic (GA) is most common. Advantages: Safe*  Efficient  Less physical and mental stress on the child and dental professionals  Source: Anderson H K, Drummond B K. Thomson W M 2004
  6. 6. TREATMENT  Disadvantages:  Non-life threatening   nausea and vomiting, fever, pharyngitis and swollen lips Life threatening:  bronchospasms, anaphylaxis, cardiac arrest and respiratory failure Source: Anderson H K, Drummond B K. Thomson W M 2004
  7. 7. WHY ARE WE INTERESTED?  In Canada the prevalence of ECC is 6% to 8%    Disadvantaged populations: 25%- 72% In 2007, Prime Minister Stephen Harper announced a Wait Times Guarantee, to reduce waiting lists for children awaiting surgery in pediatric hospitals, identified as one of the priorities was dental treatment under GA. ECC is almost 100% preventable disease. Source: Schroth RJ, Brothwell DJ, 2004
  8. 8. OBJECTIVES 1. 2. 3. To compare children under age 6 receiving dental surgery under GA versus all other pediatric surgeries. To determine the cost associated with treating preschool children with ECC under GA in Saskatchewan, specifically focusing on the Saskatoon Health Region. Identifying if majority of children treated for ECC under GA are from northern/remote communities.
  9. 9. DATA SOURCES    CIHI Portal Discharge Abstract Database, collected April 1, 2008 to March 31, 2009. The 2008-09 In-Province General Anesthesia costs obtained from Medical Health Service Branch (April 2010). Cost estimation: The College of Dental Surgeons of Saskatchewan (Fee Guide)  NHIB Regional Dental Benefit Grid  Supplementary Health & Family Health Benefits Program. 
  10. 10. RESULTS: PEDIATRIC SURGERIES In Saskatchewan, of the 4858 provisions, 2105 cases (43%) were dental related cases & 57% were non- dental related cases. All pediatric surgeries for children under age 6 compared to dental related surgeries by health region (April 2008- March 2009) 3000 Number of cases  2500 2000 1500 1000 All Services 500 0  Dental (incl Oral Surgery) In Saskatoon Health Region:  Of 2636 provisions, 1104 cases (42%) were dental related cases & 58% were non-dental related. Health Regions
  11. 11. RESULTS: COST  Estimated average treatment for ECC under GA:  Exam, 2 bitewing x-rays, 4 two-surface amalgam fillings, 4 Stainless Steel Crowns, 2 pulpotomies and 4 extractions-deciduous teeth.  Dental Fee Guides to determine average cost.  Cost of General Anaesthetic (GA): $ 324
  12. 12. RESULTS: COST  In Saskatchewan:   In 2008- 009, the cost of treating ECC for children under age 6 was approximately 3.4 million* In the Saskatoon Health Region:  Saskatoon had the highest number of cases and therefore highest cost of approximately 1.9 million (accounting for cases by postal code/ residence) Reference: www.energeticforum.com/general-discusion/460...
  13. 13. RESULTS: COST COMPARISON  In British Columbia:   In 2001- 02, the cost of treating ECC for 5000 children under age 4 was approximately 10 million. In Toronto, Ontario:  In 1996, the cost of treating ECC for children between 1 and 4 years was approximately 3 million. Reference: www.energeticforum.com/general-discusion/460...
  14. 14. RESULTS: PLACE OF RESIDENCE Saskatoon Health Region resident Northern Health Region resident Other Health Region resident Saskatoon Health Region (Total) Dental treatment $1,236.40 $1,236.40 $1,236.40 $1,236.40 General Anaesthetic $323.48 $323.48 $323.48 $323.48 Additional Cost ($) -- $568.03 -- -- Total cost per child $1,559.88 $2,127.91 $1,559.88 $1,559.88 Number of children that received treatment (under age 6) 398 345 361 1104 Total Cost (2008-09) $620,832.24 $734,128.95 $563,116.68 $1,918,077.87
  15. 15. SUMMARY  In Saskatchewan (2008-09), 43% of pediatric surgeries were dental related and 57% were nondental related.   Saskatoon Health Region: 42% dental related surgeries & 58% non-dental related. In 2008-09, the cost associated with treatment of ECC under GA in Saskatchewan & SHR was approximately 3.4 million & 1.9 million respectively.
  16. 16. SUMMARY (CONT’D)  In 2008-09, 398 children were Saskatoon residents versus 345 were from Northern Health regions.
  17. 17. LIMITATIONS    Limitation of data i.e. dental related surgeries may not all be ECC related Limitations with data for disability code i.e. unaware if disability code is a mandatory field in the database or an optional code. Identification of provincial versus federal funds.
  18. 18. KEY RECOMMENDATIONS   Establishment of a “dental home” or dental check-up for children at age 1, as recommended by the Canadian Dental Association (CDA). Parents and guardians with poor oral health to have access to dental insurance and dental providers to be willing to provide care, in order to prevent poor oral health in families. Source- Canadian Dental Association, 2005
  19. 19. KEY RECOMMENDATIONS   To encompass oral health messaging and screening as part of primary health care, whereby non-dental health providers ensure good oral health practices. Develop new multidisciplinary follow-up strategies between clinical team and parent/guardian and child, as current follow-up processes following treatment for ECC do not exist. Reference: http://archive.student.bmj.com/issues/08/07/education/images/view_1.jpg
  20. 20. ACKNOWLEDGEMENTS  Leslie Topola- Supervisor, Public Health Services- Oral Health Program  Dr. Gerry Uswak- Dean, University of Saskatchewan, College of Dentistry      Lisa Dietrich- Program Manager, Data and Statistical Services, Medical Health Services Branch Janet Gray- Technical Dental Consultant/Dental Health Educator (DHE), Population Health Unit Shirley Schweighardt- Health Information Analyst, Strategic Health Information and Planning Systems (SHIPS) Lynne Warren- Library Technician, Public Health Services- Public Health Observatory Cynthia Ostafie- Dental Health Educator, Public Health Services- Oral Health Program
  21. 21. DENTAL HEALTH HUMOUR.. Reference: onedentalcenter.com
  22. 22. ORAL HEALTH AND DENTAL SERVICE NEEDS FOR THE VULNERABLE POPULATION IN SASKATOON (QUALITY IMPROVEMENT QUESTIONNAIRE) Reference: http://3.bp.blogspot.com/_kO5SLwNlPr8/SiWzBOHn-gI/AAAAAAAAAAc/VpoJp3IJNb8/s400/cartoon_dentist_things.gif
  23. 23. BACKGROUND   In the last 3 decades in Canada, there have been vast improvements in oral health, however vulnerable populations still suffer from poor oral health. There is a strong positive correlation between poor oral health and chronic disease i.e. coronary heart disease. Source- Canadian Health Measures Survey, 2010
  24. 24. BACKGROUND  Barriers to accessing oral health care: Financial  Geographic  Social/ Cultural  Legislative.  Source- Canadian Oral Health Strategy, 2004
  25. 25. THE PROJECT   Quality Improvement Project A Dental Health Questionnaire was conducted in the core neighbourhoods of Saskatoon.   29 mandatory questions & 11 optional questions Timeframe: 10 questionnaire days, June 2010. Reference: http://www.phha.mlanet.org/blog/wp-content/uploads/2010/02/survey.jpg
  26. 26. THE PROJECT  Organizations: AIDS Saskatoon  Mobile Health Bus- Primary Health Clinic  Westside Community Clinic  Riversdale Immunization Clinic   Incentive: dental gift bag & optional dental health consultation with licensed dental therapist.
  27. 27. THE PROJECT    Dental Health Questionnaire was advertised at multiple locations throughout core city of Saskatoon. Sample size: 263 Descriptive statistics & frequency tables were used using the software SPSS 17.0.
  28. 28. OBJECTIVES 1. 2. 3. 4. Understand the specific needs of this population based on self-reported dental health. Determine the prevalence of good dental health habits among the vulnerable population Determine specific barriers that prevent Saskatoon’s vulnerable population from accessing oral health care. Understand specific health risks impacting the dental health of the vulnerable population.
  29. 29. DEMOGRAPHICS:     Income (n= 236): 53% identified an income of $12,000 or less per year. Education (n= 246): 70% identified having an education of high school or elementary school. Housing (i.e. Fixed address) (n= 248): 86% noted fixed address. Ethnicity (n= 252): 82% identified themselves as Aboriginal/ First Nations/ Métis/ Inuit
  30. 30. OBJECTIVE #1: SELF- REPORTED DENTAL HEALTH & SPECIFIC DENTAL NEEDS Self- reported dental health (n= 263): Approximately 32% of participants identified either “excellent” or “good” dental health  68% of participants identified their dental health as “fair” or “poor”.  Self- reported Dental Health in the vulnerable population in Saskatoon (n= 263) Frequency  120 100 80 60 40 20 0 Excellent Good Fair Self- Reported Dental Health Poor
  31. 31. OBJECTIVE #1: SELF- REPORTED DENTAL HEALTH & SPECIFIC DENTAL NEEDS  Approximately 70% of participants (n= 262) were worried or concerned about their dental health: Females: 66%  Males: 69%   Most reported concern (n = 263) and problem (n= 99) by participants were dental caries (or cavities), by 63% and 37% respectively.
  32. 32. OBJECTIVE #1: SELF- REPORTED DENTAL HEALTH & SPECIFIC DENTAL NEEDS Dental Health Concerns identified by vulnerable population in Saskatoon (n= 263)
  33. 33. OBJECTIVE #2: GOOD DENTAL HEALTH HABITS  Brush teeth (n= 262): 70% of participants identified brushing their teeth 38% identified brushing once per day  46% identified brushing twice per day   Floss teeth (n= 262): 45% identified flossing their teeth  Approximately 47% identified flossing once per day Reference: http://1.bp.blogspot.com/_oYgi6XUmHiE/SHbQOXtvBnI/AAAAAAAAA-Q/hCKlyUTqNho/s320/Toothbrush.jpg
  34. 34. OBJECTIVE #2: GOOD DENTAL HEALTH HABITS  Dental Office Visits (n= 263):  Approximately 65 % identified visiting a dental office  Approximately 65% identified visiting dental office once per year
  35. 35. OBJECTIVE #3: BARRIERS TO ACCESSING DENTAL CARE  Barriers (n= 92): Fear of Bad Experience: 28%  Transportation:27%  Cost 26% Reasons for not visiting a dental office (n= 92)  Use dental services if they were free of charge: approximately 95% noted “yes” Frequency  100 90 80 70 60 50 40 30 20 10 0 Barriers to Accessing Oral Healthcare
  36. 36. OBJECTIVE #3: BARRIERS TO ACCESSING DENTAL CARE  Of 90 participants that did not visit dental office: 60% had dental coverage  28% noted no dental coverage  12% did not know  Reference: http://fullcoveragedentalinsurancereview.com/wp-content/uploads/2010/08/full1.jpg
  37. 37. OBJECTIVE #3: BARRIERS TO ACCESSING DENTAL CARE  Preferred dental services (n= 70): Cleanings and check-ups :40%  Good/ flexible dentist: 11%  Dentures/ denturist: 11%   Location of services (n= 33):  Approximately 88% identified west side of Saskatoon   Suggestions: 20th/ 22nd street, Ave U, Riversdale area, Westside community clinic etc. Approximately 12% identified any location (east or west side)
  38. 38. OBJECTIVE #3: BARRIERS TO ACCESSING DENTAL CARE  Participants identified what they needed to have good dental health: Reported needs for Good Dental Health (n= 108) 2% 2% Dental Services (i.e. checkups, cavities fixed, extractions, dentures) 6% 27% 9% Tools i.e. tooth brush, tooth paste, floss Better habits (i.e. brush & floss more, stop smoking, eat healthier, more education) 14% 16% 24% A good, respectful dentist (and an appointment) Money
  39. 39. OBJECTIVE #4: HEALTH RISKS (TOBACCO USE)  Tobacco use among participants (n= 261): Approximately 75% of participants identified using tobacco!  Saskatoon Health Regions prevalence: 26%. Frequency of Tobacco Usage among Participants (n= 192)   Frequency of tobacco use (n= 192):  Approximately 52% noted 1- 10 cigarettes smoked per day. Reference: Health Disparity Report, 2006 120 Frequency 100 80 60 40 20 0 1 to 10 11 to 25 More than 25 Number of cigarettes/ cigars/ tobacco used
  40. 40. OBJECTIVE #4: HEALTH RISKS (TOBACCO USE)  Number of years smoked or use of spit tobacco (n= 174):   Approximately 78% identified using tobacco for more than 5 years. Number of participants that (n= 174): Used spit tobacco: 15%  Engaged in both smoking and used spit tobacco: 14%  http://www.usabledt.com/wp-content/uploads/quit-smoking.jpg
  41. 41. OBJECTIVE #4: HEALTH RISKS (TOBACCO USE)  Prevalence of smoking among participants by location: Riversdale: approximately 53% identified tobacco use.  Other locations (AIDS Saskatoon, Mobile Health Bus, Westside Community Clinic): approximately 82% identified tobacco use.   Possible explanations: Demographics of participants  Identified the “correct” answer  Public Health Services provide 5A’s of brief tobacco intervention 
  42. 42. OBJECTIVE #4: HEALTH RISKS (STRESS RELATED HABITS)   Stress related habits (n= 257) were noted by 55% of the sample population. Type of stress related habits (n= 142): Clenching  Grinding  Cheek biting  Nail biting  Stress related habits among participants (n= 142) 34% 21% Clenching your teeth Grinding your teeth Cheek biting 11% 34% Nail biting
  43. 43. SUMMARY  Objective Health   #1: Self- Reported Dental Overall the vulnerable population had a poor perception of their dental health. Large percentage of the sample (70%) identified concerns/ worry with respect to their dental health.
  44. 44. SUMMARY  Objective   #2: Good Dental Health Habits High prevalence of brushing , flossing and dental visits among the sample population. Erroneous results
  45. 45. SUMMARY  Objective #3: Barriers to Accessing Oral healthcare   Fear or bad experience, transportation and cost Dental services and tools were recommended by participants to have good dental health
  46. 46. SUMMARY  Objective   #4: Health Risks High prevalence of tobacco use among the sample population (75%), however, Riversdale participants showed decrease in prevalence of tobacco use (53%). High prevalence of stress related habits (i.e. grinding and nail biting) among vulnerable population.
  47. 47. LIMITATIONS 1. Bias based on location dental health questionnaire was conducted. 2. Healthy Volunteer Effect. 3. Generalizability of results.
  48. 48. RECOMMENDATIONS    Implement a monthly Dental Health Q&A outside the Mobile Health bus. Dental office(s) should be located on the Westside of Saskatoon. Oral hygiene tools (i.e. toothbrush, toothpaste and floss) and preventative services should be available to the vulnerable population in Saskatoon.
  49. 49. RECOMMENDATIONS    Expand 5 A’s of Brief Tobacco Intervention to other organizations within the Saskatoon Health Region. Parents and guardians with poor oral health to have access to dental insurance in order to treat oral health issues. Present results of the Dental Health Questionnaire to private practice dentists in the Saskatoon Health Region to receive feedback on the results of Quality Improvement Questionnaire i.e. how to link patients with specific dentists.
  50. 50. ACKNOWLEDGEMENTS Supervisors and Colleagues:  Leslie Topola- Supervisor, Public Health Services - Oral Health Program  Dr. Gerry Uswak- Dean, University of Saskatchewan, College of Dentistry  Julie Laberge- Lalonde- Dental Health Educator, Public Health Services- Oral Health Program  Joyce Birchfield – Administrative Assistant, Public Health Services- Oral Health Program  Rhonda Richards- Desktop Publisher, Public Health Services  Josh Marko- Epidemiologist, Public Health Services- Public Health Observatory Contributing Organizations:  AIDS Saskatoon  Mobile Health Bus- Primary Health Clinic  Westside Community Clinic  Riversdale Immunization Clinic Other:  Special thank you to all participants who took time to complete the Dental Health Questionnaire and provide Public Health Services, Oral Health Program with valuable information.
  51. 51. QUESTIONS? Reference: http://1.bp.blogspot.com/_a3MDthA0QU/SxQVt2LjViI/AAAAAAAAABU/aDEwkQXtpAg/s1600/GuyThinkingRight.gif
  52. 52. REFERENCES            Surgeon General (2000). Oral Health in America. A Report of the Surgeon General. Rockville, MD: Department of Health and Human Services- U.S. Public Health Service. Lemstra M, Neudorf C. Health Disparity in Saskatoon: Analysis to Intervention, Executive Summary, June 2010. Retrieved from: http://www.saskatoonhealthregion.ca/your_health/documents/PHO/HealthDisparityExecSummary.pdf Canadian Oral Health Strategy, June 2010. Retrieved from: http://www.fptdwg.ca/assets/PDF/Canadian%20Oral%20Health%20Strategy%20-%20Final.pdf Health Canada, Canadian Health Measures Survey. Oral Health Statistics: 2007-2009, June 2010: http://www.hc-sc.gc.ca/hl-vs/pubs/oral-bucco/fact-fiche-oral-bucco-stat-eng.php Canadian Dental Association. August 2010. Retrieved from: http://www.cdaadc.ca/_files/position_statements/Early_Childhood_Caries_2010-05-18.pdf Canadian Dental Association. August 2010. Retrieved from: http://www.cdaadc.ca/en/oral_health/faqs_resources/faqs/dental_care_faqs.asp#4 Schroth RJ, Brothwell DJ. Prevalence of Early Childhood Caries in 4 Manitoba Communities. Journal of Canadian Dental Association 2005; 71 (8): 567a- 567d. Ismail AI, Sohn W. A Systematic Review of Clinical Diagnostic Criteria of Early Childhood Caries. Journal of Public Health Dentistry 1999 (59) 3: 171-91. Anderson H K, Drummond B K. Thomson W M. Changes in aspects of children’s oral- health- related quality of life following dental treatment under general anesthetic. International Journal of Pediatric Dentistry 2004; 14: 317- 325. Schroth RJ, Morey B. Providing Timely Dental Treatment for Young Children under General Anesthesia is a Government Priority. Journal of Canadian Dental Association, 2007: 73 (3): 241- 243. Association of Dental Surgeons British Columbia. Children’s Dentistry, Task Force Report. Vancouver BC: Association of Dental Surgeons British Columbia, 2001.
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