Volume 9 • 2022 • Issue 6

The Canadian Dental Association Magazine 2022 • Volume 9 • Issue 6 PM40064661 Dental Schools in Canada: Cross-Country Check Up Page 22

CDABoardofDirectors President Dr. Lynn Tomkins Dr. Marc Mollot Manitoba CDAMissionStatement The Canadian Dental Association (CDA) is the national voice for dentistry dedicated to the promotion of optimal oral health, an essential component of general health, and to the advancement and leadership of a unified profession. is the official print publication of CDA, providing dialogue between the national association and the dental community. It is dedicated to keeping dentists informed about news, issues and clinically relevant information. Dr. Brian Baker Saskatchewan President-Elect Dr. Heather Carr Vice-President Dr. Joel Antel Dr. Mark Bochinski Alberta Dr. Dana Coles Prince Edward Island Dr. Viktor Dorokhine NWT/Nunavut/Yukon Dr. Stuart MacDonald Nova Scotia Dr. Bruce Ward British Columbia Dr. Jason Noel Newfoundland/Labrador Dr. Kirk Preston New Brunswick Dr. LouAnn Visconti Ontario 2022 • Volume 9 • Issue 6 Head of Communications Zelda Burt Managing Editor Sean McNamara Writer/Editor Sierra Bellows Gabriel Fulcher Pauline Mérindol Publications & Electronic Media Associate Rachel Galipeau Graphic Designer Carlos Castro Advertising: All matters pertaining to advertising should be directed to: Peter Greenhough Media Partners Inc. 15 Wade Road Ancaster, ON L9G 4G1 Display or web advertising: Peter Greenhough pgreenhough@pgmpi.ca 647-955-0060, ext. 101 Classified advertising: John Reid jreid@pgmpi.ca 647-955-0060, ext. 102 Contact: Rachel Galipeau rgalipeau@cda-adc.ca Call CDA for information and assistance toll-free (Canada) at: 1-800-267-6354 Outside Canada: 613-523-1770 CDA email: publications@cda-adc.ca @CdnDentalAssoc @jcdaoasis @CDAOasisLive Canadian Dental Association CDAOasis cdndentalassoc cdaoasis cda-adc.ca CDA Essentials is published by the Canadian Dental Association in both official languages. Publications Mail Agreement no. 40064661. Return undeliverable Canadian addresses to: Canadian Dental Association at 1815 Alta Vista Drive, Ottawa, ON K1G 3Y6. Postage paid at Ottawa, ON. Notice of change of address should be sent to CDA: reception@cda-adc.ca ISSN 2292-7360 (Print) ISSN 2292-7379 (Online) © Canadian Dental Association 2022 Editorial Disclaimer All statements of opinion and supposed fact are published on the authority of the author who submits them and do not necessarily express the views of the Canadian Dental Association (CDA). Publication of an advertisement does not necessarily imply that CDA agrees with or supports the claims therein. The editorial department reserves the right to edit all copy submitted to CDA Essentials. Furthermore, CDA is not responsible for typographical errors, grammatical errors, misspelled words or syntax that is unclear, or for errors in translations. Sponsored content is produced by Peter Greenhough Media Partners Inc., in consultation with its clients. The CDA Essentials editorial department is not involved in its creation. 3 Issue 6 | 2022 |

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Contents The Canadian Dental Association Magazine 2022 • Volume 9 • Issue 6 9 17 22 32 CDA atWork 7 Responsive Dental Schools, Resilient Profession 9 Update on Federal Investment in Dental Care News and Events 11 Abacus Survey Gauges Public Opinion on Federal Dental Care 14 To the Bone: University of Alberta Faculty Developing a 3D UIltrasound System for the Dental Office Issues and People 17 Workforce Challenges: The Dental Assistant Perspective 22 Dental Education in Canada: A Cross-Country Checkup with Canada’s Dental Schools Classifieds 42 Offices and Practices, Positions Available, Miscellaneous, Advertisers’ Index Supporting Your Practice 32 Bell’s Palsy and the Dental Practice 37 Maybe You Don’t Need Life Insurance 39 Seasonal Affective Disorder: Surviving the Winter Blues Obituaries 46 Dr. Thomas Raddall II 5 Issue 6 | 2022 |

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Dr. Lynn Tomkins president@cda-adc.ca Responsive Dental Schools, Resilient Profession Since becoming CDA president in April, the announcement of an increased federal investment in dental care has been the primary focus of my work with the CDA board. Like many in our profession, we’ve been considering some significant questions about the future of dentistry. How can our oral health care system better care for underserved Canadians? How will our work as dentists evolve in response to this federal investment, but also to the social, technological and economic changes that are shaping our nation? In times like these, I often think of a quote attributed to Charles Darwin, “It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.” Our profession has a proud history of transformation and expansion of our knowledge and treatments as science and technology advance and the needs of patients change. I believe that our ability to be responsive is rooted in our university education, our grounding in critical thinking and scientific skepticism. Our dental schools are the incubators of the dental and oral surgeons of the future and forge new ideas through innovative research. University-based research produces the scientific data that help us decide which materials have the properties we need and empowers us to make objective treatment recommendations to our patients. More than 90% of oral health research, which is the core of the evidence-based clinical knowledge on which our profession is based, takes place in our dental schools. Universities are producing new treatments in gene therapy, biomaterials, cell cultures and tissue growth that will, in time, become everyday dentistry. A strong dental profession requires strong dental schools. Our 10 schools have been innovating their educational models, improving their facilities, and rethinking the student experience, while navigating considerable funding and staffing challenges (p. 22). I’ve seen this first-hand at the University of Toronto, where I’ve had the privilege of being a clinical instructor since 1990. The new federal funding for dental care will require graduating students to be well rounded and confident in working with a more diverse patient population and a broader range of needs. CDA’s Future of the Profession Task Force recommended that extending the educational process with a PGY1 (a “post graduate year one” during which new graduates would work in a variety of settings) could help build confidence and enhance clinical skills, while also exposing them to different models of delivery. At the same time, a PGY1 could increase the capacity of university dental clinics to provide care to the underserved Canadians that the new federal funding will reach. We have an opportunity to think about the future of our profession and what an optimal oral health care system that serves all Canadians could look like. It’s an important moment to support our dental schools so that they can continue their outstanding work educating the next generation of dental researchers, educators as well as well-rounded, frontline oral physicians that can interact knowledgeably and comfortably with the medical systemwhile providing excellent patient care. Our universities need our support, whether we provide it by remaining active in alumni associations, mentoring dental students, contributing financially or teaching. We owe a great deal to our alma maters; indeed, I believe that our continued status as a respected profession is dependent on them. From the President 7 Issue 6 | 2022 | CDA atWork

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Update on Federal Investment in Dental Care On September 22, Dr. Lynn Tomkins, CDA president, addressed the House of Commons Standing Committee on Health as part of its study on children’s health. She outlined recommendations to improve the oral health outcomes of Canadian children. “Poor oral health strains other parts of the health care system, whether throughhospital visits for dental emergencies ormanaging the long-term impacts of poor oral health on systemic disease,” Dr. Tomkins said. “This is particularly the case with children, as good childhood oral health serves as a foundation for the rest of a person’s lifetime.” Other issues CDA raised with the health committee included measures that restrict marketing of unhealthy foods and beverages to children; the promotion of community water fluoridation; improving access to surgical suites for high needs patients; and the inclusion of oral health in future health research on COVID-19. Dr. Tomkins also reiterated that CDA welcomed the federal government’s commitment in Budget 2022 of a multi-billion dollar ongoing investment, in enhancing Canadians’ access to oral health. CDA supports the federal government on the first phase of its plan, which will allow time to consult and collaborate with dentists and all relevant stakeholders on a long-term solution that is a well-informed, targeted, comprehensive and effective approach to improving access to oral health care. Bill C-31, AnAct respecting cost of living relief measures related to dental care and rental housing, includes an interim benefit program that will allow the federal government to provide direct, up-front financial support to families who qualify, while work continues on a longer-term solution. The proposed Canada Dental Benefit (CDB) would provide eligible parents or guardians with up to $650 to cover dental expenses for their children under age 12, helping them better afford some out-of-pocket costs. On October 26, Dr. Tomkins addressed the Standing Senate Committee on National Finance as part of its study of Bill C-31. “While Canada compares favourably to many other countries, too many people—including children—still do not receive the dental care they need,” Dr. Tomkins said. “More than six million Canadians each year avoid visiting the dentist because of the cost; particularly those in low income families. While every province and territory in Canada has some sort of publicly funded dental program for children, these vary from jurisdiction to jurisdiction, leaving significant gaps.” The target implementation for the CDB is December 1, 2022, if it is passes through the Senate and receives Royal Assent. The CDB would be retroactive for eligible participants to October 1, 2022. Dental offices can expect to see an increase in requests for pediatric visits in 2022 and beyond, and should continue to issue receipts for services rendered. The government is targeting full implementation of a dental care program for households with incomes under $90,000 to be in place by 2025. In late October the federal government launched the next step in a process towards a potential federally delivered Canadian Dental Care Program. Public Services and Procurement Canada invited companies with experience in processing dental claims to apply for pre-qualification to bid on delivering such a program. Health Canada officials suggested that the new program could be similar to other federally managed dental care programs. While Canada compares favourably to many other countries, too many people— including children—still do not receive the dental care they need. More than six million Canadians each year avoid visiting the dentist because of the cost. 9 Issue 6 | 2022 |

Is it time to update your post-op care sheets? When it comes to dental procedures, the patient’s adherence to the post-op instructions helps to ensure proper healing with minimal discomfort. Often, the problem is that many patients are either confused about the instructions or forget them. Properly delivered postoperative instructions have been proven to help reduce side effects that may occur after dental procedures, including pain and stress. In a study of 120 participants, patients who received both verbal and written instructions reported the least pain and greatest satisfaction.1 The Canadian Dental Association website states that ibuprofen and acetaminophen used in combination can be very effective for pain relief.2 If it is time to update your post-op care sheet, consider adding Combogesic® to it in the pain management section. Combogesic® is a non-opioid pain reliever. It combines a fixed dose of acetaminophen 325 mg and ibuprofen 97.5 mg, eliminating the need to alternate between the two pain relievers individually. If your clinic is prescribing Combogesic® to your post-op patients, it should be included as part of your post-op instruction sheet. Considering that over three-quarters of Canadians aged 18 years or older report being aware that there is an opioid issue in Canada3, it may be reassuring for patients to learn that Combogesic® is a non-opioid pain reliever. Combogesic® also has a simple dosing schedule of up to 3 tablets every 6 hours.4 When studied against comparable doses of acetaminophen or ibuprofen, the combination of acetaminophen and ibuprofen has been shown to provide greater and more rapid relief in patients experiencing moderate to severe pain after the surgical removal of at least 2 impacted third molars. The patients who received Combogesic® experienced significantly less pain within the first 6 hours and 48 hours after taking the first dose. It only took one dose for patients to report feeling significantly less pain intensity with Combogesic® compared to the individual analgesics or the placebo. Moreover, approximately 50% fewer patients taking Combogesic® needed a rescue analgesic compared to those taking a single analgesic. Efficacy is important, but so is tolerability. The combination of acetaminophen and ibuprofen did not compromise the tolerability of the individual pain relievers. There was no statistical difference in adverse events reported by the patients on Combogesic® compared to those taking acetaminophen, ibuprofen, or placebo.5 I have found that Combogesic® is not only effective for the management of pain in endodontics, extractions, and crown and bridges, but also for more invasive procedures such as bone grafting, socket preservation and soft tissue grafting, particularly where a donor site is involved. Combogesic® is a behind-the-counter pain reliever, so your patient should be instructed to ask the pharmacist for it. The dosing schedule is up to 3 tablets every 6 hours, making it easy for most patients to manage. References: 1. Gheisari R, Resalati F, Mahmoudi S, Golkari A, Mosaddad SA. Do different modes of delivering postoperative instructions to patients help reduce the side-effects of tooth extraction? A randomized clinical trial. J Oral Maxillofac Surg. 2018 Aug;76(8):1652.e1-1652.e7. 2. Canadian Dental Association. Pain Management. Available at: www.cda-adc.ca/en/oral_health/talk/complications/pain_management (accessed 2022 Oct 1) 3. Statistics Canada. Results of the Survey on Opioid Awareness, November 2017. (2018). Available at: www150.statcan.gc.ca/n1/dailyquotidien/180109/dq180109a-eng.htm (accessed 2022 Oct 1) 4. Combogesic® product monograph. BioSyent Pharma Inc. May 25, 2020. 5. Daniels SE, Atkinson HC, Stanescu I, Frampton C. Analgesic efficacy of an acetaminophen/ibuprofen fixed-dose combination in moderate to severe postoperative dental pain: a randomized, double-blind, parallel group, placebo-controlled trial. Clin Ther. 2018;40(10):1765-76. Content sponsored by BioSyent Pharma Inc. Dr. Alan Jeroff, Clinical Instructor, Faculty of Dentistry, University of British Columbia

Abacus Survey Gauges Public Opinion on Federal Dental Care After more than two years of public opinion surveys on the impact of COVID-19 on dentistry, CDA and Abacus Data looked at opinions and behavioural trends on broader issues affecting dentistry in Canada, namely the federal investment in access to dental care. Following announcements of increased federal funding for dental care for children under age 12 in low-income families, Abacus Data’s Wave 11 survey showed a strong public awareness of the proposed federal program. Much of this survey, conducted in August 2022, explored Canadians’ views on a federal dental care program and how it would affect their own dental care preferences. The following article includes some key takeaways from theWave 11 survey. Is cost a factor in seeking dental care? If 6% of respondents declare themselves as “dental phobic,” the main reason for not going to the dentist remains the cost, which is still the primary driver of dental absenteeism. A little over half of the population (53%) who haven’t visited the dentist recently consider the cost too high to seek dental care. Do Canadians support a federal dental plan? A large majority of Canadians (78%), across all political parties, support a proposed program coverage for families with <$90,000 household income and no other forms of health insurance. Support only drops when there’s a suggestion that employer-sponsored benefits might be affected, with most then saying they are neutral or their support depends on the specifics of the program. In either case, total opposition to a federal program is only the view of 1 in 10 respondents. “I believe that those who have sufficient coverage and aren’t feeling the financial pressures also recognize that oral health is important, and that every Canadian should be able to access it,” says David Coletto, CEO of Abacus Data. “So there is a real alignment in public opinion around action on this from the federal government’s perspective.” Do Canadians consider a federal dental plan a priority? Dental care was identified as the most important issue for the federal government by about 1 in 3 Canadians (31%) and a large majority support the federal intervention. They even consider it a higher priority than pharmacare or childcare, and some Canadians would even consider it a priority over a more general increase in health transfers to the provinces. CONTINUEDP. 12 11 Issue 6 | 2022 | News and Events

Why is a federal plan needed now? Economic concerns are delaying treatments and examinations, as seen by 15% of parents currently delaying their children’s dental care and 25% also report they have delayed oral care in the past. About one-quarter of respondents (27%) say they will be delaying further dental treatments this year because of the current uncertain economic situation. The same proportion will be delaying regular check-ups or cleaning for the same reason. Close to that same number (22%) have delayed their appointments, waiting for the federal dental care program to be implemented. What kind of risks may arise with the implementation of a federal dental plan? Almost 60% of Canadians have heard about the federal government’s proposed investment to enhance dental care access, and 3 in 10 are aware of government dental programs in their province. But the support of a new plan drops from78% to 39%when the potential impact on existing employer-sponsored benefits is mentioned. Also, 80% of the people without dental coverage are less familiar with public programs but the ones accessing those provincial and territorial programs for children and seniors tend to be satisfied with their respective public coverage programs (66% satisfied and 30% neutral). Are staff shortages still impacting care? One in 10 Canadians report a dental appointment cancellation in the previous 2 months that was initiated by the dental office. Having a dentist or dental hygienist being on leave or out of office was the reason of the cancellation for 20% of cases, increasing by 16% since the previous survey. But only 1% of survey respondents were unable to book an appointment in the past 2 months. This AbacusWave 11 survey was conductedwith 3,000Canadians fromAugust 11 to 19, 2022. A random sample of panelists were invited to complete the survey froma set of partner panels based on the Lucid exchange platform.These partners are typically double opt-in survey panels, blended tomanage out potential skews in the data froma single source. Themargin of error for a comparable probability-based random sample of the same size is +/- 1.63%, 19 times out of 20.The data were weighted according to census data to ensure that the samplematchedCanada’s population according to age, gender, educational attainment, and region. 12 | 2022 | Issue 6 News and Events

Watch the interview with David Coletto, CEO of Abacus Data, on these survey results on CDA Oasis: bit.ly/3UWbHYv Are Canadian still concerned about COVID-19 transmission at the dental office? Canadians feel optimistic that the worst of the pandemic is behind them, and they are more comfortable with visiting the dentist than ever before (81%), consistent with results from the last survey. The concerns about the transmission of COVID-19 by a treatment from a dentist continues to drop, with only 3 in 10 (29%) saying they would be concerned. “We are seeing a confluence of factors that are moving us from a pandemic-crisis world to one where economic issues become more important,” adds Coletto. “This will likely increase public support and demand for federal investment because people are more aware of their economic vulnerability and the risks that these issues are having on their ability to afford dental care.” 13 Issue 6 | 2022 | News and Events A-Oss, a xenogeneic bone graft material, was developed by Osstem Implant in Korea, the world's largest dental implant sales company. A-Oss was launched in 2013, and in 2020, it obtained CE Class III certification, which is the highest level of the European MDD (Medical Device Directive). A-Oss' excellence and product competitiveness demands attention from Canada as well. The pore structure of A-Oss is very similar to that of human bone. The three-dimensional connective pore structure helps fluids, blood vessels, and cells, easily flow in, and acts as a canvas that lays the foundation until new bone is regenerated. Extensive testing conducted by Osstem Implant showed that the high porosity and large surface area of A-Oss resulted in increase blood volume in comparison to other products, which resulted with the formation of excellent new bone. A-Oss can be used for all patients who require bone grafting due to insufficient bone mass. This can be advantageous in areas where sufficient bone mass is required and in areas of aesthetics. A-Oss has volume stability, retention to ensure stable, natural, and esthetic results. Osstem Implant's Bone Science R&D Centre, under the Tissue Regeneration Institute, which developed A-Oss, explained, "Based on Osstem Implant's proprietary deproteinizing technology, immunogens and infectious agents have been removed. A-Oss is a safe and pure deproteinized bone graft material with no immunological rejection. In addition, A-Oss promotes excellent new bone formation by optimizing the surface, pore structure, and granular shape to create a favorable environment for bone cell interaction, proliferation and differentiation.” A-Oss will give clinicians high surgical success rates and price satisfaction. www.hiossen.ca | info@hiossen.ca | �.���.���.���� 20220923_CDA Essentials AD_en_8.125x5.4375 inch_print line_FINAL.pdf 1 10/5/22 1:06 AM

To the Bone University of Alberta faculty developing a 3D ultrasound system for the dental office In both orthodontics and periodontics, it’s useful to be able to routinely assess the height and thickness of the bone on the outside surface of teeth. Currently, the standard 3D imaging tool available to measure bone height and thickness is cone-beam computed tomography (CBCT), which requires a large machine that exposes patients to radiation. “Because of the radiation, CBCT can’t be routinely used for children or for repeated imaging to monitor bone level during treatment,” says Dr. Paul Major. (L. to r.) The University of Alberta’s Dr. Lawrence Le, clinical professor, Department of Radiology and Diagnostic Imaging; Dr. Paul Major, orthodontist, professor, and chair of the U of A School of Dentistry. Ultrasound imaging prototype developed by Drs. Major and Le. The first step was creating an ultrasound probe that was small enough to fit comfortably inside the mouth. The team created a working prototype that used ultrasound to create 2D images that showed bone and gum tissue. Eight years ago, Dr. Major and Dr. Lawrence Le, began exploring the use of ultrasound, long used in the imaging of soft tissue, to create images of bone inside the mouth, without radiation. The first step was creating an ultrasound probe that was small enough to fit comfortably inside the mouth. The team created a 14 | 2022 | Issue 6

Drs. Major and Le are interviewed on CDA Oasis: bit.ly/3Ai3QwB working prototype that used ultrasound to create 2D images that showed bone and gum tissue. “We tested it and found that it is reliable and valid in assessing bone levels,” says Dr. Major. Dr. Le says that the ultrasound prototype uses high frequencies to get the level of detail needed to plan orthodontic and periodontal treatment. “On a technical level, the tracking equipment has to be very precise to provide a high level of accuracy,” he says. Now, the team is working toward a device that can create 3D images. “Having a 2D image is like being in the forest with no bearings and no idea what’s happening in the neighbourhood,” says Dr. Le. “By transforming 2D images into 3D images, we will be able to look around at different angles, giving us a good view of the soft tissue, blood flow and bone.” Artificial intelligence (AI) will help non-expert operators use the device and interpret results. “One of the barriers to implementing this technology in clinical practice is having the dentist be able to interpret the images that they’re seeing,” says Dr. Major. “We’ve developed AI algorithms, which use machine learning to identify the biological structures we’re looking at. Those structures will be labeled on the display and different tissues will be displayed in different colours, so images can be quickly interpreted.” The 3D ultrasound will eventually be tested in clinical trials to diagnose periodontal gum disease. The researchers envision the system being used to guide dental implant design, monitor oral lesions and even diagnose cavities in the future. 15 Issue 6 | 2022 | News and Events SINCE 1923 ids-cologne.de 14 March 2023: Trade Dealer Day 40th International Dental Show MARCH 14-18, 2023 COLOGNE, GERMANY inclusive IDSconnect SHAPING THE DENTAL FUTURE 8770 West Bryn Mawr Ave. Suite 1300 Chicago IL 60631 USA Tel. +1 773 326 9920 info@koelnmesse.us

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Workforce Challenges: The Dental Assistant Perspective CDA Essentials interviewed Heather Brownlee, Canadian Dental Assistants’ Association (CDAA) president 2022–23, about the dental assisting workforce and her vision for the future of the dental assisting profession. As the Canadian labour market evolves, building and sustaining excellent dental teams remains a necessity for the oral health of Canadians. CDA and CDAA have been working together to help support the dental team and the invaluable work that each member does. Brownlee shares her insights about what dental assistants value and what support they need to enjoy long and fulfilling careers. As well, she explains some of the initiatives that have been undertaken to support a strong dental assisting workforce in the future. Heather Brownlee received her Phase II Dental Assisting Diploma from Red River College Polytechnic in Winnipeg in 1977. She earned her Orthodontics Module in 1984 and Extended Duties in 2003. Q What have you found most fulfilling in your career as a dental assistant? Heather Brownlee (HB): When I started dental assisting over 40 years ago, I was very lucky to work in an office with a great dentist. The 12 staff members all got along; everybody on the dental team helped each other. The office was 17 Issue 6 | 2022 | Issues and People

a very respectful and positive workplace. After I had my children, I went to work at the University of Manitoba (U of M) Dental College where I worked towards my certificate in Human Resources (HR). I started on the clinic floor and eventually transitioned to a career doing administrative work in many departments, ending my career as the office assistant in the graduate prosthodontics program at the U of M. I’ve been involved with dental assisting professional organizations at both the provincial and national level for many years, with the goal of advocating for healthy workplaces for my colleagues—ones that support both the physical and psychological health of the entire team. assistants to leave the profession. A lack of competitive compensation and benefits also act as contributing factors for attrition. The CDAA recognizes that there are also capacity limits for training and, unfortunately, some bottlenecks in the system that we’re planning to address with a new project in partnership with CDA. As we work towards planning for a bright future, I think it is important that we look at some of the factors that have historically shortened dental assisting careers: stress, challenging work environments and a need for more competitive compensation and benefits. Perhaps one of the key areas of focus should be not only to attract more people to the dental assisting profession, but also on giving dental assistants good reasons to stay with the profession longer and addressing workplace environment issues. Q Let’s talk more about why dental assistants are leaving the profession before traditional retirement age. HB: The CDAA did a workplace conditions survey of dental assistants in March 2019. One of the findings was that dental assisting employee turnover and exit from the profession is caused by many factors. In response to the survey findings, we collaborated with CDA and the Canadian Dental Hygienists Association (CDHA) on a Healthy Workplace Matters working group where we developed resources for oral health providers that are available online (oasisdiscussions.ca/ healthy-workplace-matters). In our survey of the mental health status of dental assistants conducted this year, the results showed that nearly 47% of respondents had experienced some form of bullying or harassment from either a dentist, work colleague or patient at some point in their career. The survey also showed that 18% of dental assistants reported that they experienced discrimination in the workplace, 27% said they felt worthless in their job most of the time, and that most dental offices do not provide mental health resources or stress management resources to their staff. These results show that opportunities exist for improvement within the dental workplace; improvements that will benefit all members of the oral health care team. Another factor that could help improve retention is compensation levels. For example, I talked with one dental assistant recently who started a job at a new dental office and was offered the same starting salary that she was offered 17 years ago. So, it is important that wages keep up with inflation and cost of living. Q In the past few years, it seems like the number of people entering the dental assisting profession has decreased. What factors might be causing that change? HB: The oral health profession is not unique in this situation. Working in a health care environment in general is stressful, especially since COVID-19 struck, and some people have left health care altogether because of it. My husband has appointments with a home care worker four times a day. You would not believe how many visits are cancelled because they do not have enough staff. There are news stories about ERs that are shut because there aren’t enough nurses or doctors. Staffing in health care is a sector-wide challenge, one we must all address by working collaboratively across health care professions. When I’ve spoken with representatives from dental assisting training programs, there are wait lists for people who want to enter the programs. So people are still entering the profession, but the demands of today’s dental office are complex and often highly stressful. These are some of the factors that cause dental The oral health profession is not unique in this situation. Working in a health care environment in general is stressful, especially since COVID-19 struck, and some people have left health care altogether because of it. 18 | 2022 | Issue 6 Issues and People

Many dental assistants feel that there is a lack of opportunity for growth in the field. There are a limited number of jobs available to dental assistants outside of a dental office. As well, labour mobility is limited by the inconsistency of the regulatory landscape. Every province has their own regulations for dental assistants and unique training for different areas of practice. We are advocating to make it easier for dental assistants who move to a different province to continue in the profession in their new location. We’re hoping that, through our partnership with CDA and a joint grant application, we can address many of these issues through the development of HR training and mental health resources. Later this year, we will release a study regarding compensation, benefits and other factors that influence the dental assisting profession. CDAA is working on gathering more data about what support dental assistants need in the workplace. We look forward to sharing this information over the coming months. Q How has the pandemic affected the dental assisting profession? Are there both positives and negatives? HB: From a negative perspective, it has heightened our stress levels. In many cases, work takes longer than it used to. Similar to our health care colleagues, wearing enhanced PPE has been draining and stressful. Workloads have increased due to more stringent infection prevention and control (IPC) protocols. It’s stressful when we—or our families—get sick and we have to isolate. It’s hard when you have to miss work as it usually means you don’t get paid. But there are also some positives. The pandemic brought attention to the importance of IPC protocols in general. Dental assistants are highly trained in this area, and it is often one of our primary responsibilities in the dental office. Our IPC diligence matters, and now the general public knows a lot more about this aspect of health care. In our mental health study, we found that 73%of dental assistants felt a strong sense of personal accomplishment in their jobs. Providing patients with quality care during the pandemic has been hard, but it has also been meaningful. Oral health care was an essential service during the pandemic and the continuation of providing care to Canadians could not have happened without the commitment of dental assistants. Q What can be done to support dental assistants so that they can enjoy long and fulfilling careers? HB: Direct care doesn’t offer the same level of freedom as other occupations. This is partly what can make being part of a dental team demanding and stressful, at times. One of the first things to consider is the workplace environment. As a general best practice, it is important to continually focus on improving the workplace and learning how to foster a work culture that is healthy and supportive for all members of the team. Every team member in a dental office can benefit from better team building. Offices can implement policies and procedures that promote a fair, positive, less stressful work environment. Also, having explicit HR policies is important: policies set expectations, delegate who is responsible for what tasks, and create processes to deal with problems that may come up in a respectful and transparent manner. Our joint grant application with CDA will hopefully allow us to collaborate on the creation of HR training targeted for dentists and staff to help offices better understand how to improve employee retention, the salaries and compensations needed to recruit staff in a competitive labour market, and how to improve the workplace environment as a whole. It will also be an opportunity to provide training on As a general best practice, it is important to continually focus on improving the workplace and learning how to foster a work culture that is healthy and supportive for all members of the team. 19 Issue 6 | 2022 | Issues and People

obligations to employees under existing provincial and federal regulations. As I’ve mentioned, improving compensation levels and offering an attractive benefits package would help increase the length of the careers of many dental assistants. So would improving labour mobility between the provinces. One thing we haven’t talked a lot about is creating opportunity for advanced training so that dental assistants can improve their skill sets. For most people, a sense of being able to be more, do more and grow more in their work is important. be exploring the required support for dental assistants in response to this survey. We will also have data from our national compensation and job market survey that will be completed later this year. We are advocating for better support for the health sector on a national level, including the oral health sector. And we’re involved in a test project to develop evidence-based initiatives to support the health care workforce. I’m excited for the professional associations of all members of the dental team to work together. If each member of the oral health team recognizes that there are issues that need to be solved and that their individual commitment is vital to improving the workplace experience of all team members, we are more likely to have positive, long-lasting impact. Personally, seeing our professional communities and associations working collaboratively to foster a healthy work environment that values all members’ contributions to oral health care would be one of the most rewarding moments in my 40-year career. CDA, CDAA and CDHA collaborated on a healthy workplace working group and developed online resources to help employers and the whole dental team participate in creating a healthier and more respectful workplace. oasisdiscussions.ca/healthyworkplace-matters Q What about attracting more people to the dental assisting profession? HB: The first step is that the oral health team has to recognize that dental assistants are a key component of the care team. The qualifications, overall range of practice and expertise of dental assistants are essential to providing quality oral health care to Canadians. The oral health professions need to work together to raise awareness with high school academic advisors to present dental assisting as a valuable career in its own right, not just as a stepping-stone to other jobs in the oral health care sector. Q Would you like to share some of the work that CDAA has been doing to help support and sustain the dental assisting profession? HB: In collaboration with CDA, we’ve applied for a ESDC Sectoral Workforce Solutions Program grant that has several components: HR training, mental health resources, an accredited online curriculum for dental assisting, and better labour mobility and integration. We recently finalized our mental health survey and will The oral health professions need to work together to raise awareness with high school academic advisors to present dental assisting as a valuable career in its own right. 20 | 2022 | Issue 6 Issues and People

#1 brand of water losser1 © 2022 Water Pik, Inc. All rights reserved. 1. Data on file. Water Pik, Inc. 2. Rosema NAM et al. The e ect of di erent interdental cleaning devices on gingival bleeding. J Int Acad Periodontol. 2011;13(1):2–10. 3. Barnes CM et al. Comparison of irrigation to floss as an adjunct to toothbrushing: e ect on bleeding, gingivitis and supragingival plaque. J Clin Dent. 2005;16(3):71–77. 4. Gorur A et al. Biofilm removal with a dental water jet. Compend Contin Educ Dent. 2009;30(Suppl 1):1–6. Become a Waterpik® Insider! Rebates on Waterpik® products Educational resources Unique offers Clinical study summaries and data Designed exclusively for dental professionals Sign up to become a Waterpik® Insider at waterpik.ca/sign-up. more effective for reducing gingival bleeding vs. string floss.2 2x Waterpik® was up to more effective for improving gum health vs. string floss.3 50% Waterpik® was up to of plaque biofilm from treated areas.4 99.9% Waterpik® removed up to INSIDER PROGRAM It works because they use it. (And because it's a Waterpik®.) The only water flosser to earn the CDA Seal. The following benefits are validated by the CDA: • Removes up to 99.9% of plaque from treated areas. • Up to 50% more effective for improving gum health vs. string floss. • Up to 2X more effective for improving gum health around implants vs. string floss. • Up to 3X more effective for removing plaque around braces vs. string floss. 25 water flosser models, including countertop products for in-home use and cordless products, in addition to 7 unique tip options to meet all types of oral care needs. Waterpik® has Proven results and over 70 clinical studies.1 Waterpik® has 70+ 25+

Dental Education in Canada: The Deans’ Perspective A Cross-Country Checkup with Canada’s Dental Schools Strong dental schools—which educate students to be outstanding dentists and undertake the research that supports evidence-based oral health care—are the bedrock of an effective oral health care system, a strong profession, and, ultimately, the oral health of Canadians. CDA Essentials reached out to the deans at the 10 dental schools across Canada to ask three questions: 1. What are you most proud of or excited about at your school right now? (“School pride”) 2. What do you feel are the biggest challenges facing dental education in Canada right now? (“Challenges”) 3. How has dental education changed in the last 5–10 years? How do you envision dental education evolving in the next 5–10 years? (“Evolution of dental education”) Here is what the deans had to say about the state of dental education in Canada and their visions of the future as the 2022–23 school year began. Answers have been edited for length and clarity. 22 | 2022 | Issue 6

School pride When the chief medical officer of Nova Scotia closed dental clinics in March 2020, our faculty was one of the first three emergency clinics in the province to treat patients in our new, hospital-grade surgical rooms. The emergency team also developed a set of COVID-19 protocols and procedures, which have been widely shared with clinics across Atlantic Canada and beyond. Our faculty and students quickly made the transition to online teaching and learning, and we had our students back in the clinic as quickly as possible, enabling them to be promoted and graduate successfully throughout the pandemic. We are also proud of the equity, diversity and inclusion (EDI) work our faculty is doing, our highly soughtafter post-graduate programs, and our soon-to-be launched pediatric and special needs clinic. Challenges The biggest challenges facing dental education in Canada are cuts to university funding while trying to increase access to affordable oral health care, the cost of education for students, covering the volume of the curriculum within the allotted time, attracting and retaining faculty and clinical staff, and improving diversity among our students, faculty, and staff. Evolution of dental education Digital dentistry and other technological changes are rapidly transforming many aspects of oral health care and education. The pandemic has accelerated the adoption of virtual and online lectures and other new methods of teaching. There is also a more holistic, patient-focused approach to clinical teaching. Over the next 5–10 years, we expect to see more individualistic learning, greater integration with other health care professions, the expansion and development of outreach initiatives, and more efforts to improve access to oral health care for underserved populations. School pride At the end of two terms as head of the Faculty of Dentistry, hampered by an unprecedented pandemic, we are proud of the completion of a major cycle of renovations and modernization of the physical and material infrastructure of most of the facility. With an investment of more than $10 million, the school is now equipped with modern clinics, simulation labs, research labs and classrooms, all of which are up-to-date and equipped with contemporary multimedia equipment and technology. These facilities will attract the best students and faculty talent and provide a quality training and learning environment that promotes academic excellence and personal well-being. We completed a major overhaul of our DMD program by adopting a program-based approach. This approach aims to develop an integrated program of study based on a common vision among stakeholders, and continuous improvement of the program structure. This project has taken more than six years to build and implement; we recently graduated our second class that has been educated within the new paradigm. The biggest challenges facing dental education in Canada are cuts to university funding while trying to increase access to affordable oral health care. Dalhousie University Université Laval Dr. Benjamin Davis, dean of the Faculty of Dentistry Dr. Fatiha Chandad, vicedean of graduate studies at the Faculty of Dentistry CONTINUEDP. 25 23 Issue 6 | 2022 |

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Challenges Dental education in Canada is currently facing a human resource shortage at many levels, both in terms of faculty and support staff, including dental assistants and dental hygienists. Canadian dental faculties are experiencing a lack of specialized resources in many areas of dentistry. Attracting people to and retaining people in academic careers are major challenges. Dental schools are called upon to create innovative strategies for recruiting future dental educators. In addition, dental practice must be upgraded and evolve at the same pace as the evolution of knowledge and technology. Robotics, AI and communication tools are just a few examples of innovations that will inevitably affect traditional dental practice and require a rethinking of the way we practise dentistry and the accessibility of dental services and care for Canadians. School pride We are very proud of our community service program and our action plan for equity, diversity, and inclusion (EDI). Through our community clinics, we provide free dental care for priority members of the Montreal community who are not always able to afford or access dental care. Our service to the community stands as a model for other dental schools nationwide. Our EDI strategic plan focuses on developing concrete actions for ensuring that all members of our community feel safe, welcomed, valued, and heard, and is part of a larger effort spearheaded by McGill. We have created two admission pathways to establish equitable processes for welcoming students in the DMD program who are members of underrepresented groups. We are excited that the Faculty of Dental Medicine and Oral Health Sciences has been recognized in the top 50 of the 2022 Global Ranking of Academic Subjects. We continue to be a leader in dental and oral health research in Canada and worldwide. Challenges We need to have a sustainable health education ecosystem with a focus on our citizens’ priorities and needs. Canadian universities must address the historic underrepresentation of Indigenous and Black students in dental medicine programs. Unfortunately, many administrators, clinicians and researchers are not familiar with the concept of cultural competency and EDI principles. This should also be addressed quickly by creating an effective strategic plan, which can include free mandatory courses on these topics. All faculties need programs and initiatives to support the mental health and well-being of students and staff. We must also remain on the cutting edge of innovation and adapt our curriculum to keep up with advancements in dental technology. Like many other professional programs, we are facing academic shortages. We need more academic clinicians, especially those who have been trained in providing care to people with special health care needs. Robotics, AI and communication tools are just a few examples of innovations that will inevitably affect traditional dental practice and require a rethinking of theway we practise dentistry. Evolution of dental education Dental education is in a state of constant evolution. It has been affected by new technological tools, and also by the evolution of the main pedagogical principles in the transmission and acquisition of knowledge and the modalities of evaluation of learning. The teaching of different disciplines independently of each other is a thing of the past. Most Canadian faculties are now focusing on teaching by competency or integrating knowledge in a global manner. The teaching of one area of dental knowledge must be integrated with other relevant areas. Teaching modalities have already undergone major changes in recent years, in terms of simulations, the creation of multimedia tools and computer platforms. But the pandemic has accentuated the implementation, mastery and acceptability of new means and modes of learning by the training and regulatory authorities, teachers and learners. Access to dental studies and the parameters for selecting new candidates is another area where dental education stakeholders have been working for several years now. But in light of the new paradigms affecting all spheres of dental practice, the means and parameters of selection of future oral health professionals will also have to be re-imagined. McGill University Dr. Elham Emami, dean of the Faculty of Dental Medicine and Oral Health Sciences CONTINUEDP. 27 25 Issue 6 | 2022 | Issues and People