Volume 11 • 2024 • Issue 2

2024 • Volume 11 • Issue 2 The Canadian Dental Association Magazine PM40064661 Dr. Ashley Lindsay: The Father of Modern Dentistry in China Page 30

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. 2024 • Volume 11 • Issue 2 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 canadian-dentalassociation CanadianDental Association 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 2024 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. CDABoardofDirectors President Dr. Heather Carr Dr. Raymon Grewal British Columbia Dr. Brian Baker Saskatchewan President-Elect Dr. Joel Antel Vice-President Dr. Bruce Ward Dr. Dana Coles Prince Edward Island Dr. Jerrold Diamond Alberta Dr. Mélissa Gagnon-Grenier NWT/Nunavut/Yukon Dr. Lesli Hapak Ontario Dr. Stuart MacDonald Nova Scotia Dr. Marc Mollot Manitoba Dr. Jason Noel Newfoundland/Labrador Dr. Kirk Preston New Brunswick Cover Photo: University of Toronto, Dentistry Museum Collection 3 Issue 2 | 2024 |

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Contents The Canadian Dental Association Magazine 2024 • Volume 11 • Issue 2 12 19 24 37 CDA atWork 7 Bringing the Profession Together in a Time of Change 9 Update on the Canadian Dental Care Plan 12 CDA Reader Survey Results News and Events 16 Dental Digest 19 Statistics Canada Numbers: Access to Dental Care in Canada 23 The Pandemic’s Impact on Oral Health Care Issues and People 24 Jean-Pierre Picard Honoured to Serve as Canadian Armed Forces Brigadier-General 30 Dr. Ashley Lindsay: The Father of Modern Dentistry in China Did You Know? 43 Dentists in Cultural History Supporting Your Practice 37 Managing a Patient with High Blood Pressure 40 Navigating Dental Malpractice Claims: Insights from Industry Experts Classifieds 44 Offices and Practices, Positions Available, Miscellaneous, Advertisers’ Index Obituaries 46 Dr. Arthur John (Jack) Harris 5 Issue 2 | 2024 |

Dr. Heather Carr president@cda-adc.ca Bringing the Profession Together in a Time of Change As I began my CDA presidency last April, I focused on the importance of working together to ensure the continued success of our profession. I promised to collaborate with the provincial and territorial dental associations to strengthen the relationships between our organizations and to look for solutions to the obstacles facing our profession. As individuals I respect and admire from across Canada united, we were able to accomplish much during a year of challenge and change. My colleagues and I made strong connections as we worked long hours, met on late-night Zoom calls, and committed ourselves to advocate for those who need us most. Together, we’ve done everything we could to influence the Canadian Dental Care Plan (CDCP) to give it the best chance to meet its potential for improved access to oral health care. In my role, I’ve aimed to be an honest and passionate, but measured, national voice for dentistry, while considering the potential impact on dentists and the importance of a strong oral health care system for all. I was fortunate to be in attendance when the program announced the start of patient applications in December 2023. I was there on your behalf to listen and express dentistry’s perspective during many media interviews. In every interview, I’ve stressed the importance of getting the CDCP right so we can take care of the patients who need it most. When Health Minister Mark Holland visited my practice in Halifax shortly after the announcement, I approached the conversation as a practising Canadian dentist. We had a clear and candid conversation about what it will take to provide care to our most vulnerable patients and how the CDCP can best achieve its goals. At times, the expertise of dentists and our contribution to the health of Canadians was not fully understood or properly appreciated. But we’ve persisted and have significantly improved the parameters of the CDCP. Have all our recommendations for an improved plan been implemented? Absolutely not! But we will continue to work towards a program that is fair to dentists and helps patients get the treatment they need and deserve. It’s been a pleasure and honour to meet fellow dedicated and caring oral health professionals from across Canada. I’ve been inspired by the unique perspectives each dentist brings and enjoyed every opportunity to share our professional and personal experiences. Through it all, I drew on my East Coast sensibility, passion, and humour to bring our national community together. I had the opportunity to get to know my colleagues, not only as respected professionals but as compassionate people. The CDA team, under the leadership of Dr. Aaron Burry, played a critical role and the CDA Board worked as a cohesive group to make tough decisions. I am grateful to all for their contributions. I’ve always believed that each one of us can make a difference by becoming involved in organized dentistry. As my presidency draws to a close, I know this to be true. I’ve done my very best to represent dentistry with integrity and honour. This year has been the highlight of my career and I want to thank you all for your passion and commitment to our profession. I also want to sincerely thank my family who made all of this possible for me with their love and support. From the President 7 Issue 2 | 2024 | CDA atWork

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Update on the Canadian Dental Care Plan In early February, the federal government announced further details on the oral health care services that will be covered by the CanadianDental Care Plan (CDCP). The government’s statement included information about how some services, such as crowns, initial placement of partial dentures, and general anesthesia, will require preauthorization and prior evaluation from an oral health provider. The government also released the 2023 established fees for CDCP, for illustrative purposes only, available via Sun Life’s website (sunlife.ca/sl/cdcp/ en/provider/dental-benefit-grids) to inform oral health care providers ahead of the release of the 2024 fees. Later in March, the government published the 2024 CDCP abbreviated fees. Each service covered under the plan will be compensated at 2024 CDCP fees when services can start to be delivered in May 2024. The CDCP will reimburse a percentage of the cost, based on CDCP reimbursement rates, which are not the same as the provincial and territorial dental association (PTDA) suggested fee guides. CDCP fees will be reassessed annually to account for new evidence, inflation, and changes in costs over time. The plan is designed to have oral health providers bill Sun Life directly for eligible CDCP services. The government acknowledged that patients covered under the CDCP may have to pay an outstanding amount, such as a co-payment or additional charges, which would be paid directly to their oral health provider. In early March, the government said that more than one million older adults had successfully applied to participate in the CDCP through Service Canada. On March 11, Sun Life opened an online portal for oral health providers to sign up for participation in the CDCP (sunlife.ca/sl/cdcp/en/provider). What CDA and the PTDAs Have BeenWorking On CDA has been meeting on a regular basis (almost weekly) with senior officials at Health Canada to discuss and provide recommendations to improve the CDCP. CDA and PTDAs met with Minister Holland in early February to discuss specific concerns about the CDCP and how they could be addressed. In February, PTDAs and CDA distributed a survey to a sample of dentists across Canada. Over 4,000 dentists responded, and the results indicated that dentists were not willing to participate in the program The government acknowledged that patients covered under the CDCP may have to pay an outstanding amount, such as a co‑payment or additional charges, which would be paid directly to their oral health provider. 9 Issue 2 | 2024 |

in its current design. About 70% of dentists said they opposed the CDCP, based on the details that had been shared by the government to date. Over 40% of dentists said the main reason they were unlikely to participate in the CDCP was because the fee grids do not match PTDA suggested fee guides. On aggregate, the most common reason cited by dentists about their reluctance to participate in CDCP was the administrative burden that the program creates for dental offices. In early March, CDA sent a letter to Minister Holland, highlighting the results of this dentist survey and reiterated recommendations to help improve the CDCP. Among the input provided, CDA highlighted the need to reduce the administrative processes of CDCP not found in other dental plans, to allow patients the option to be reimbursed directly, removing the provider registration requirement with onerous terms and conditions, and ensuring that patients are fully covered for the full costs of oral health care to mitigate out-of-pocket expenses. “CDA is concerned with the continued signal of low provider participation, which will compromise the success of this plan. Without adequate participation by providers, eligible Canadians cannot receive the care they need,” wrote CDA President Dr. Heather Carr in a March 7 letter to Minister Holland. “The recommendations [we’ve] proposed would go a long way in improving the perceptions of the program among dentists…We hope that the federal government will consider the viewpoints of dentists in finding equitable solutions to these challenges.” On March 14, CDA and PTDAs met with Deputy Health Minister Stephen Lucas to discuss these CDCP recommendations. During the Pacific Dental Conference in Vancouver in early March, Minister Holland met with PTDAs and participated in a fireside chat with BCDA and CDA representatives and heard firsthand from an audience of dentists about their concerns with the CDCP. Meanwhile, Health Canada has established three working groups—Engagement and Communications, Preauthorization and Administrative Efficiencies, and Fee Setting—that brings together representatives from the dental professions to discuss and receive input on aspects of the CDCP’s design. The working groups started meeting in February, and CDA and PTDAs representatives are participating. 10 | 2024 | Issue 2

Supporting your PRACTICES. Supporting your PATIENTS. Go to https://hcp.jnj/3TCNVSj or scan the QR code below to access: • Information about our partnership with the CDA on the Oral Health Literacy Campaign • The LISTERINE® VIP Program, which connects dental healthcare professionals with patient tools for at-home oral care, LISTERINE® samples for patient distribution, member perks and best practices © J&J Inc. 2024. To be sure this product is right for your patient, always read and follow the label. SCAN THE QR CODE

72% 72% CDA Reader Survey Results At the end of 2023, we asked for your thoughts and feedback on CDA Essentials magazine andCDA’s other knowledge products—and what you expect from these communication channels in the future. Almost 300 of you answered our call. Here’s a quick glance at what you had to say. Value Inside the Magazine Topics of Interest 12 | 2024 | Issue 2

Reading Habits CDA READER SURVEY RESULTS 13 Issue 2 | 2024 |

Congratulations! Sincere thanks to the dentists who took time to complete the 2023 CDA Reader Survey. Special congratulations to Dr. Robert Kurio (left) of Lacombe, Alberta, who was randomly selected as our Grand Prize winner of an Apple Watch Series 9. Dr. Jayati Brahmbhatt of Vegreville, Alberta, Dr. Genevieve Lalonde of Courtenay, British Columbia, and Dr. Fel Rocci of Stoney Creek, Ontario, were each recipients of a $50 VISA gift card. CDA Knowledge Products Other Platforms Respondent Demographics z 55%WOMEN 45% MEN z 83% URBAN 17% RURAL CDA READER SURVEY RESULTS z 85%WERE FULL-TIME PRACTISING DENTISTS 15%WERE PART-TIME z 86% PRACTISE GENERAL DENTISTRY z 27%WERE SOLO PRACTITIONERS 63%WERE IN A GROUP PRACTICE— MAJORITY HAD 2–3 FELLOW DENTISTS. 14 | 2024 | Issue 2

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DENTAL DIGEST The British Columbia provincial government announced new measures in February to make nicotine pouch products only available for sale by a pharmacist behind the counter. The measures were aimed at preventing the sale of flavoured nicotine pouches to youth in the province. “By limiting access to these products and ensuring they are dispensed by trained health care professionals, our goal is to prevent their misuse, especially among young people for recreational purposes,” said Adrian Dix, BC Health Minister. Nicotine pouches were previously available for sale at various retail locations like gas stations and convenience stores. Under the new restrictions, individuals wishing to purchase these products will need to consult a pharmacist, allowing for an opportunity to inform people about the health risks associated with nicotine dependency. BC joins Quebec as provinces placing such restrictions on the sale of nicotine pouches. “BC is taking proactive steps to ensure nicotine cessation products are used for their intended purpose—aiding individuals in quitting smoking and improving their overall health,” said Dix. Buccal nicotine pouches are taken orally and may contain up to 4 mg of nicotine, equivalent to the amount of nicotine BC Restricts Sale of Nicotine Pouches ADA Recommendations on Use of Lead Aprons for Dental X-Rays The American Dental Association (ADA) updated its recommendations in February on the use of lead abdominal aprons or thyroid collars on patients when conducting dental X-rays. After reviewing several published studies on radiography, an expert panel of the ADA Council on Scientific Affairs determined that lead aprons and thyroid collars are not necessary to shield patients from radiation exposure, regardless of a patient’s age or health status. The panel noted that the best available evidence suggests that using modern digital X-ray equipment and restricting the beam size to just the areas that need to be imaged can protect patients against radiation exposure to other parts of the body. The ADA also outlined best practices that dentists can use to help safeguard patients against unnecessary radiation exposure. In Canada, all radiographic equipment, accessories, installation and room design criteria should conform to federal or provincial regulations (such as Radiation Protection Acts). In the absence of existing provincial regulations in a particular jurisdiction, dentists can refer to Health Canada Safety Code 30. The 2022 edition of Safety Code 30 states in part that lead aprons are not required for routine dental X-rays but are still required for other procedures and situations (i.e., those needing to be physically assisted, those assisting them, people potentially vulnerable to radiation, etc). absorbed from 3 to 4 cigarettes. When used as intended, the pouches can be used as a nicotine-replacement therapy tool to help people reduce nicotine dependency. However, public health experts have noticed a trend of youth using nicotinecessation products recreationally. See: bit.ly/3xeqtU1 See: cda-adc.ca/en/about/position_statements/xray See: bit.ly/49X7rQw 16 | 2024 | Issue 2

A group of researchers are developing a sensory array to detect 11 different types of bacteria in saliva and plaque. The sensors employ nanoscopic particles that mimic natural enzymes (called nanozymes) made from iron oxide particles coated in DNA strands. When used to test a sample, bacteria adhere to the DNA, which decreased the nanozyme’s reactivity, resulting in different coloured test strips in the sensor array. The testing process can be completed in 20 minutes. “Dental caries are mainly caused by cariogenic bacteria like S. mutans,” says Ling Zhang, lead author on the article. “The bacteria might be different in a healthy person versus a person with cavities. The sensor array has the potential to quickly discriminate between these two kinds of samples, which could have applications in the dental office.” The researchers also found that the sensor array has antibacterial effects on three bacteria species. Electronic microscopic images suggest that the nanozymes destroy bacterial membranes. Detecting Oral Bacteria See: bit.ly/3IXortV 17 Issue 2 | 2024 | Full product catalog at pulpdent.com The ACTIVA restorative advantage: Secondary caries defense* · Superior handling · Easy dispensing · Esthetic · Durable Moisture friendly · Dual-cure · Everyday versatility · Loved by patients and doctors alike Celebrating Over 10 Years of Clinical Success Activa is the hero of my practice. —Dr. Brittany Bergeron, General and cosmetic dentist ACTIVA™ user since 2019 *ACTIVA™ BioACTIVE physically seals the margin of the material and tooth interface through apatite crystal formation, subsequently protecting against microleakage, the leading cause of secondary caries and recurrent decay.

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New data from the 2022 Canadian Community Health Survey (CCHS) were released by Statistics Canada in November 2023 that provide a glimpse into the use of dental care services in Canada as well as dental insurance coverage rates. These findings are based on survey data for Canadian residents age 12 and older living in the provinces. In 2022, nearly two-thirds (65%) of Canadians had seen a dental professional in the previous 12 months, which was lower than the 2018 CCHS dental utilization rate of 75%, though methodology for the survey has slightly changed between those years. In 2022, 55% of those surveyed had private dental insurance and 40% of those of who did not have dental insurance said they avoided visiting a dental professional due to cost. The CCHS is conducted every year, but questions about dental care are not always included. 1 This refers to the 20% of Canadian families with the lowest incomes. Highest income refers to the 20% of Canadian families with the highest incomes. Statistics Canada uses quintiles to divide up income groups. In 2019, about 5.1 million Canadians lived in families in the lowest quintile of income. Statistics Canada Numbers: Access to Dental Care in Canada 19 Issue 2 | 2024 |

Statistics Canada Numbers 2 Difficulty in at least one of the functional health components, including vision, hearing, mobility (walking or climbing steps), cognition (memory and concentration), self-care and communication. News and Events

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A Statistics Canada study published in February 2024 explored how COVID-19 interrupted dental care during the first year of the pandemic. The 2021 Survey on Access to Health Care and Pharmaceuticals During the Pandemic collected information from Canadians age 18 years and older. Respondents were asked whether they needed routine dental care in the previous 12 months, whether they received care, whether they experienced any mouth or tooth pain, and whether COVID-19 affected access to care. Data from this study found that during the first year of the pandemic, some Canadians experienced cancelled or delayed dental services or did not receive the oral health care they needed. The Pandemic’s Impact on Oral Health Care Read the full study at: bit.ly/3PjOXRD 23 Issue 2 | 2024 |

Jean-Pierre Picard Honoured to Serve as Canadian Armed Forces Brigadier-General For over a century, Canada’s military dentistry has been dedicated to meeting the oral health needs of Canadian troops at home and abroad in operations across the globe. Collaborative efforts between the Canadian Dental Association (CDA) and the Royal Canadian Dental Corps (RCDC), have prioritized optimal oral health for Canadians, in both military and civilian settings. Serving in the armed forces can sometimes be a demanding task, as is practising dentistry, on occasion; combining these two disciplines can be even more challenging. In June 2023, Dr. Jean-Pierre Picard was promoted to the prestigious rank of Brigadier-General (BGen) of the Canadian Armed Forces (CAF), preceded only by a small yet illustrious group of dentists who have reached the rank in the Canadian Armed Forces. Brigadier-General (BGen) Jean-Pierre Picard and General Wayne Eyre (Chief of Defence Staff) at BGen Picard’s promotion ceremony. 24 | 2024 | Issue 2

© All rights reserved. Canadian Forces badge reproduced with the permission of DND/CAF (2024) When a young Jean-Pierre Picard suffered from the poor outcome of a root canal therapy at age 13, he developed a fascination for dentistry that eventually led him down the path of becoming a dentist himself. Growing up in a non-military family, he still had a profound admiration and respect for the discipline that is represented by wearing a uniform, especially seeing his father in Royal Canadian Mounted Police attire. “I have always been proud and inspired by my father’s service as a police officer in the RCMP,” said BGen Picard. In 1990, during his second year of dentistry studies, the CAF offered him the opportunity to enroll in its Dental Officer Training Plan. He had no hesitation in joining the military and he went on to obtain his DMD degree from l’Université Laval in 1992. as well as operational-level professional technical issues and standards. He was promoted to Colonel in 2016 and assigned command of 1 Dental Unit, the sole organization responsible for all in‑garrison oral health treatment for the CAF in Canada and Europe. In 2018, BGen Picard was appointed Director of Dental Services, Chief Dental Officer of the CAF, and Head of the RCDC. “Throughout my journey in the Canadian Armed Forces, I’ve had the privilege of being part of a community that understands that it requires a collective effort to nurture its members and to develop them,” he says. “The community that we have in the RCDC, the Canadian Forces Health Services and in the CAF in general, the support received from the most inspiring individuals and remarkable team members, the exceptional mentors, colleagues, subordinates, and leaders have lifted me along this path,” says BGen Picard. In 2021, while remaining Chief Dental Officer, he was appointed Director General Health Services—Clinical Services, Since graduation, a steady promotion up the ranks within the CAF dental services has followed. His leadership journey began with his promotion to the rank of Major in 1998, when he assumed the position of Dental Detachment Commander at the Canadian Forces Base (CFB) Trenton, Ontario, culminating with his recent promotion to Brigadier General this past June. BGen Picard earned a Masters of Dentistry in Periodontics from the University of Manitoba in 2003 that led him to be assigned as the Regional Periodontist and Detachment Second-in-Command of the Specialty Care Centre at CFB Edmonton. Promoted to Lieutenant-Colonel in 2005, he served for many years as the RCDC Periodontics Practice Leader while successively commanding two RCDC Specialty Care Centres at CFB Edmonton and Halifax, then working as a Senior Staff Officer at the strategic headquarters of Canadian Forces Health Services (CFHS), overseeing CAF national dental policy and programs. This was followed by serving as Deputy Commanding Officer of 1 Dental Unit, where BGen Picard oversaw day-to-day operations Throughout my journey in CAF, I’ve had the privilege of being part of a community that understands that it requires a collective effort to nurture its members and to develop them. (L. to r.) Major-General Marc Bilodeau (Surgeon General), BGen Picard (Director General Health Services —Clinical Services), Chief Warrant Officer Martin Bédard (Canadian Forces Health Services Group Chief Warrant Officer). BGen Picard received the second clasp for the Canadian Forces’ Decoration, recognizing over 32 years of exemplary military service. 25 Issue 2 | 2024 | Issues and People

the first Dental Officer in the history of the CFHS to be entrusted with this responsibility. In this role, BGen Picard’s responsibilities encompass overseeing the overall clinical health programs and policies of the CFHS. Providing health care services to the CAF is a complex undertaking and in his current position, BGen Picard provides guidance, direction, work prioritization and oversight for all clinical directorates responsible for the development and management of Health Programs that direct health care provision within the CAF. These include Mental Health, Medical Policy, Force Health Protection, Women’s and Diversity Health and Dental Services. He also oversees the Professional Affairs for all clinical occupations in the CFHS and the Health Research portfolio. As a Senior Leader of the CFHS, he participates in all aspects of Health Services, integrated governance framework, fostering an efficient and effective decision-making process within Health Services. Building Bridges For many years, as Chief Dental Officer and head of the RCDC, BGen Picard played a crucial role ensuring that the Dental Corps was delivering quality and operationally focused dental care to its CAF members. “RCDC is home to several military occupations,” says BGen Picard. “We have a complement of military dentists, dental hygienists, and dental technicians, providing in-garrison care in our dental clinics at military bases across Canada and in Europe with military dental specialists offering care in select dental clinics. Our team is also composed of highly professional civilian employes and contractors,” adds BGen Picard. The RCDC also provides support to CAF members that are deployed abroad, contributing to the national interest and international security in that matter. “They all provide an essential role in enabling CAF operations and broader Government of Canada objectives,” he says. Today, the RCDC representation is woven into all levels of governance, and it promotes a unified medical and dental approach within the health services. “Some years ago, we went through a governance review of the entire Canadian Forces Health Services, including the medical and dental branches, and we’ve taken substantial steps to modernize our health care system,” he explains. “These actions served as catalyst to fostering synergy and harmonization between the two vibrant branches as one strong Health Services team.” As a dentist, BGen Picard gave himself one overarching mandate for the CAF health care systems and organized dentistry: put the mouth back into the body. Working more closely with medical colleagues allowed his team to develop stronger bonds and be a key part of the fabric of Canadian military health care. “These bridges are crucial for the betterment of overall health of CAF members and Canadians alike,” he says. “The launch of the Canadian Dental Care Plan by the federal government also sends a clear message that oral health is integral to overall health. I am delighted by this historic investment, which will provide access to comprehensive oral health care and significantly alleviate financial barriers for millions of Canadians.” A Sense of Purpose Dr. Picard’s promotion to the rank of Brigadier General also marks a significant milestone. It demonstrates the CAF’s commitment to modernize CFHS and ensures that the right structure is in place to care for the CAF members and to be prepared toaddress all challenges that lay ahead. “This evolution not only marks an important progression for the organization, but it also sends a message of optimism and hope for Health Services and the future of the RCDC,” he says. I’ve been extremely fortunate. I’ve been surroundedby great rolemodels that believed in me and guided me. They offered me opportunities in clinical and military leadership roles. (L. to r.) Colonel Commandant of the Royal Canadian Dental Corps, Brigadier-General (retired) Victor Lanctis, with BGen Picard on his promotion day. 26 | 2024 | Issue 2 Issues and People

The rank of BGen has only been held by dentists a few times in CAF history, including Brigadier-General William Thompson, Brigadier-General James Wright, BrigadierGeneral John Federick Begin and Brigadier-General Victor Lanctis, who also served as head of the RCDC between 1993 and 1996. “I am the vehicle by which the dental profession is recognized. You don’t become a Brigadier-General by yourself. I am the product of the environment and the entire community that supported me,” says BGen Picard. Being part of the CAF has always filled BGen Picard with great pride, and he also feels truly grateful for the opportunities he’s been given along the way. “I’ve been extremely fortunate. I’ve been surrounded by great role models that believed in me and guided me,” he says. “They offered me opportunities in clinical and military leadership roles. Throughout my career, I’ve been surrounded by amazing teams and they’ve all made a significant impact on me.” That recognition also contributes to the health and well‑being of the military personnel. For BGen Picard, serving our nation in this role is a privilege that he takes very seriously. “I’ve been surrounded by so many people that inspired me, that gave me the energy to serve and the pride to wear a uniform. Every morning that I get up, I have a sense of purpose, supporting CAF members, people that are prepared to put their lives in harms way. It is extremely gratifying to know that we can make a tangible difference for the people that give so much to their country,” he says. Through many of his civilian professional engagements, either as the current Vice-Chair of the Royal College of Dentists of Canada, or as past President of the Canadian Academy of Periodontology and the Canadian Dental Specialties Association, or as a member of numerous committees, BGen Picard has demonstrated his strong attachment to the dental profession. “Whenever the Canadian Dental Association has asked BGen Picard, he has always been willing to give of his time and expertise,” says Dr. Heather Carr, CDA President. “When BGen Picard has been asked to serve, he serves his country, but he also serves his profession. And the depth of his commitment speaks a lot to his character. He has many other responsibilities, but still, when CDA calls on him, he’s always willing to help out to the best of his abilities.” During the COVID-19 pandemic, BGen Picard participated on a regular basis in the CDA Infection Prevention and Control Working Group, sharing his experiences within the armed forces. This included various innovative measures put in place to further prevent the transmission of the COVID-19 virus and protect CAF members, clinicians and the community. “I’ve always admired him and appreciated his work ethic,” says Dr. Carr. “He is one of those rare people who embodies the best of dentistry and the Royal Canadian Dental Corps.” Today, BGen Picard sees himself as an advocate for the profession both in the dentistry and military fields. To him, nothing is more rewarding than serving. “It’s all about giving and serving and developing skills so that you can better serve people,” he says. (L. to r.) Brigadier-General Scott Malcolm (Commander Heath Services Division), Dr. Dian Lu (Medical Epidemiologist), Major-General Marc Bilodeau (Surgeon General), BGen Picard (Director General Health Services – Clinical Services), Chief Warrant Officer Martin Bédard (Canadian Forces Health Services Group Chief Warrant Officer), Colonel Carlo Rossi (Director Force Health Protection) on the occasion of World Aids Day and the U=U (undetectable HIV = untransmittable HIV) global public health campaign in 2023. 27 Issue 2 | 2024 | Issues and People

Under his leadership, the RCDC continues to focus on developing individuals to build lifelong skills. For instance, the Junior Dental Officers are enrolled in the RCDC Dental Officer Clinical Mentorship Program, covering foundational aspects of comprehensive dentistry, periodontics, prosthodontics and oral surgery. “At the end of this program, Dental Officers can operate effectively in our military clinics and will be better prepared to work independently in some of the more austere or remote environments that we sometimes encounter when serving in the CAF,” he says. Family First BGen Picard is very family-focused. In fact, he credits his family for being the central guiding force in his life. “My wife Rachel is exceptional. And people that know me well, know that it takes somebody special to be so supportive through all of this,” he says. “Sometimes I forget to tell her that I have a last-minute meeting or out of town work commitment and she is always understanding and supportive.” BGen Picard is also extremely proud of his children, Alexandre and Amelia. “They are our greatest accomplishment and what my wife and I are most proud of, and they’re my main source of energy,” he says. “They give me all the strength in the world to keep going and I treasure every moment with them.” BGen Picard is glad that he chose to join the military. “It’s been a phenomenal career,” he says. “The experiences I’ve had, the opportunities, the travel, the training–not only as a dentist, but as an officer–made me grow in both the military and dental professions. The training and developmental opportunities we have are second to none.” The only little twinge of sadness perhaps, as a BrigadierGeneral, is that he is not allowed to wear the RCDC crest anymore. “We have a beautiful crest. I cherish wearing the royal blue beret with the crest of the Royal Canadian Dental Corps, but unfortunately, I can’t wear them now,” he says. “But I still proudly wear the colour of the Dental Corps on my mess dress–this is the pride we develop in the RCDC.” In envisioning the future, BGen Picard highlights the profound shift that emerges. “This year is filled with optimism as oral health is seen as an essential component of overall health in our great nation; the mouth is being put back into the body. These are fantastic times to serve in our wonderful dental profession,” concludes BGen Picard. My wife Rachel is exceptional. And people that know me well, know that it takes somebody special to be so supportive through all of this. Family photo on promotion day. (L. to r.) Betty Cadoret Picard (mother), Amelia Picard (daughter), Rachel Picard (wife), BGen Picard, Alexandre Picard (son), and Jean-Pierre Picard ( father). 28 | 2024 | Issue 2 Issues and People

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Dr. Ashley Lindsay: The Father ofModern Dentistry inChina By HelenY. He In the student services department at the Faculty of Dentistry at the University of Toronto (U of T), there is a bronze bust on display. With a determined look, a noble nose, and his hair swept back, the man honoured by the sculpture appears distinguished and kind. A plaque explains that the bust was donated by a group from a university in China. Who is this man, Dr. Ashley Lindsay? And how did his life connect the U of T dental faculty and China? 30 | 2024 | Issue 2

Missionaries inChengdu in the early1920s.Thebicyclebelonged toDr. Lindsay. Photo: Memory of West China Union University, Sichuan University Press (2006) pg 83. Dentistry had not been established as a profession in China and those who practised it were largely untrained. Dr. Lindsay was not supposed to treat Chinese patients until he developed proficiency in the language. Early Life Between 1903 and 1907, when Dr. Ashley Lindsay was a dental student at the Royal College of Dental Surgeons (which would become the U of T Faculty of Dentistry in 1925), he was actively involved in the YMCA and went on to serve as president of his YMCA chapter during his final year. As a friend of Rev. Edward Wilson Wallace, who was a member of the “Victoria Eight,” who were eight young Victoria College graduates who set out on missionary trips to China and Japan in 1906, Dr. Lindsay also began to dream of becoming a missionary in China and volunteered with the Methodist Church Mission Board. In 1906, Dr. Lindsay applied to the mission board to serve as a dentist in China. He was turned down because, at the time, only ordained men and medical workers could be appointed for mission work. A true fighter, Dr. Lindsay never backed down. In 1907, after securing support from his home church in Quebec, he applied again. This time, he was successfully appointed as a medical missionary, with the understanding that he would practise dentistry. At the mission board’s request, Dr. Lindsay studied post graduate anesthesia and minor surgery at the Toronto Western Hospital for six months in preparation for his posting in China. He was one of the first dentists to take an internship and post-graduate study in any hospital. Aiming to have “his certificate re-printed in Chinese,” with his newly wedded wife, Alice, and a small travelling dental case, he boarded an ocean liner inVancouver in 1907. His voyage to China took five months and involved many challenges and difficulties, including being detained for 10 days at a customs’ barrier as innocent bystanders of a plot among the ship’s captains to smuggle contraband goods. The ocean liner docked in Shanghai, after which Dr. Lindsay and Alice travelled via boat on the Yangtze River to Kiating, and then took a four-day ride on a sedan chair—an enclosed seat borne on two poles by bearers—before arriving in Chengdu in March 1908. Arriving in China Other Canadian missionaries, including Dr. Omar Leslie Kilborn and his wife Dr. Retta G. Kilborn, were already providing medical care and working toward creating medical education for Chinese students in the old Canadian Methodist Mission Hospital in Chengdu. According to the mission board, Dr. Lindsay was expected to dedicate the first two years of his mission to studying the Chinese language. However, dental care was in high demand among the expatriate community in Chengdu and, soon after his arrival, Dr. Lindsay allocated half of each day to treating English-speaking patients. In 1908, dentistry had not been established as a profession in China and those who practised it were largely untrained. Dr. Lindsay was not supposed to treat Chinese patients until he developed proficiency in the language, but soon he was providing care for Dr. Kilborn’s Chinese friends. A public spectacle created by the niece of the Viceroy of Sichuan, Zhao Erxun, who arrived at Dr. Lindsay’s clinic in a grand, red-canopied sedan chair carried by four bearers and accompanied by many servants and soldiers, became an unintentional advertisement for Dr. Lindsay’s dental clinic. 31 Issue 2 | 2024 | Issues and People

Dr. Lindsaywithstudents. Photo: University of Toronto, Dentistry Museum Collection Dr. Lindsay’s vision for dental education focused on preparing students to be medical scientists rather than craftsmen. He emphasized a thorough knowledge of human anatomy, clinical pathology and diagnostics. Soon, peoplewere traveling thousands of miles, which could take up to 2–3 weeks, to seek treatment from Dr. Lindsay. At that time, the working conditions for Dr. Lindsay were extremely challenging, he described in an article that the building where he worked “could hardly have had the status of a third-rate woodshed in Canada.” His first year and a half were spent on temporary fillings and treatments because his dental chair, instruments and supplies, which he had ordered before he left Canada, didn’t arrive in Chengdu until 1909. As the number of dental patients grew, the mission board set aside funds for a more functional building for Dr. Lindsay’s clinic. In 1909, the board passed an assessment for the establishment of a dental hospital but didn’t find a suitable location until 1911. Dr. Lindsay designed the facility and supervised its construction. Sze Shen Tze Dental Hospital was to be the first dental hospital in China. In 1911, the Xinhai revolution ended the Qing dynasty, the last of the monarchies that ruled China for more than 2,000 years. Political turmoil and summer heat interrupted construction intermittently, but the dental hospital was complete by the end of 1911. Just two weeks later, Dr. Lindsay and Alice went back to Canada for their first furlough. On January 1, 1912, when the National Assembly declared the establishment of the Republic of China, Dr. Lindsay was at the University of Toronto conducting post-graduate work. When Dr. Lindsay returned to China in the fall of 1913, he became superintendent of the dental hospital he had built. Dental Education in China In 1910, believing that more meaningful results could be accomplished with the same funds by educating Chinese students to carry out mission work indefinitely, the West China Union University was founded by the union of four missions, including the General Board of Missions of the Methodist Church of Canada. In 1914, under Dr. Kilborn’s leadership, a Faculty of Medicine was established at the university where Dr. Lindsay and another dental missionary, Dr. John Thompson, offered dental courses for students. In 1917, with the addition of Dr. Harrison Mullett, another dental missionary, the university formed a dentistry department within the faculty of medicine and Dr. Lindsay became its head. By 1919, the university had created a College of Dentistry, the first in China. Except for the time he was on sabbatical, Dr. Lindsay was the dean of this college until he left China in 1950. Dr. Lindsay’s vision for dental education focused on preparing students to be medical scientists rather than craftsmen. He emphasized a thorough knowledge of human anatomy, clinical pathology and diagnostics. He believed that dental professionals needed to possess a comprehensive understanding of both economics and health, which should be applied in the context of interpersonal interactions. While acknowledging advancements in oral medicine and science in the Western world, Dr. Lindsay championed the development of a uniquely Chinese dental education and practice system. He argued that importing knowledge without instilling professional ethics and ideals appropriate to the context of Chinese society would be less effective in a rapidly changing world. Dr. Lindsay taught oral physiology and anatomy, oral surgery, anesthesiology, and complete dentures. As a professor, Dr. Lindsay was a great mentor. He inspired the students to embody positive values and principles, becoming role models and advocated for the ideals necessary for the progress of the nation. He cared deeply about his students. When the dental school was established, many students needed their education to be heavily subsidized. Dr. Lindsay invested his personal funds into a student loan program and provided students with access to his library. He kept several typewriters, a multigraph machine, and other office equipment for the students to use to earn money to help cover some of their expenses. Overseas education was considered crucial to evaluate the effectiveness of dental education in China. Dr. Lindsay helped secure grants from different organizations, including the Rockefeller Foundation, to send outstanding dental students from West China Union University to universities in Canada and the U.S. 32 | 2024 | Issue 2 Issues and People

Dr. Lindsay andhiswifeAlice (front row, 3rdand4th fromright)with colleagues inChengdubefore their return toCanada in1950. Photo: University of Toronto Archives Dr. Lindsay receivinganhonoraryDoctorofLawsdegree fromUofTin1945. Photo: University of Toronto, Dentistry Museum Collection Dr. Lindsay played a significant role in the administration of the university and supported its growth as an educational institution. He took on the role of vice-chancellor. He served as a member of the Board of Governors of the university and as the last chairman of the council. Even with his administrative and teaching duties, Dr. Lindsay still found time to publish books, articles, and editorials on dental education and practise in dental journals in China, Canada, and the US. He also translated Frederick Bogue Noyes’ dental histology textbook into Chinese. Continued Scholarship Each time Dr. Lindsay returned to Canada for sabbaticals, he raised funds to continue the work he was doing in China and invited other dentists to join him there. He also conducted professional research and continued his graduate education. In 1928, he obtained a Bachelor of Dental Science and wrote a thesis called “Direct Approach Mandibular Block,” which revolutionized local anesthesia of the mandible. “He may not have been the first to advocate the direct approach technique, but he was the first to systematically dissect and portray the retro-molar anatomy in clear and readily understood line drawings,” wrote dental historian Dr. P. Ralph Crawford, CDA president 1984–85. The technique is still widely used around the world. In 1936, Dr. Lindsay was awarded an MSc in Dentistry by U of T. Then in 1937, he was recognised as one of the top four aestheticians of the Direct Approach Technique in Mandibular Block Anesthesia by the American Dental Association. The Sino-Japanese war, from 1937 to 1945, was a difficult and chaotic time. There was an exceptionally high inflation rate of approximately 600%. An operating chair and unit, previously priced at NC$850 before the war, skyrocketed to NC$11,000. For Dr. Lindsay and other members of the missionary community in Chengdu, the situation was dire. They sold their clothes and personal possessions to meet their basic needs. In a 1944 interview, Dr. Lindsay recalled, “I sold my old, second-hand bicycle for NC$15,000, only to find that someone was willing to pay NC$20,000 for it the very next day.” At that time, bicycles were rare in China and whenever Dr. Lindsay rode it, he attracted the attention of curious onlookers. In June 1939, West China Union University was badly damaged in an air strike by Japanese bombers. Despite the challenges and suffering they had faced in war-torn China, both Dr. Lindsay and Alice wanted to carry on with their mission in China. The reporter wrote that “his eyes lighted at the thought of returning.” Dr. Lindsay and Alice returned to Canada in 1944, not directly because of the war, but instead because inflation prompted the university to grant furloughs to staff. When students learned of the Lindsays’ departure, they expressed their appreciation in a letter that read in part, “…you have done a lot to benefit us by establishing the Dental Department in the University from this we learn new knowledge and new sciences, which we use … to serve our country. We appreciate so much that we do not even know how to express our gratitude to you, the founder of dentistry in China.” In 1945, U of T conferred the honorary degree of Doctor of Laws on Dr. Lindsay for the study and organization of the system of dental education and practise most suitable to the needs of China. In 1946, Dr. Lindsay founded the Dental Journal of West China Union University, the first dental journal in China. 33 Issue 2 | 2024 | Issues and People