2023 • Volume 10 • Issue 3 The Canadian Dental Association Magazine PM40064661 Dr. Heather Carr of Nova Scotia New CDA President Page 12 + IN THIS ISSUE Should Parents be in the Operatory? P. 26 The Potential of Teledentistry in Canada P. 29 HPV Vaccinations at the Dental Office P. 37 Photo: A view of Lake Fletcher from the dock at Dr. Heather Carr’s house, located in Fall River, NS.
CDABoardofDirectors President Dr. Heather Carr Dr. Lesli Hapak Ontario 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. Joel Antel Vice-President Dr. Bruce Ward Dr. Mark Bochinski Alberta Dr. Dana Coles Prince Edward Island Dr. Viktor Dorokhine NWT/Nunavut/Yukon Dr. Raymon Grewal British Columbia Dr. Kirk Preston New Brunswick Dr. Stuart MacDonald Nova Scotia Dr. Marc Mollot Manitoba Dr. Jason Noel Newfoundland/Labrador 2023 • Volume 10 • Issue 3 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 @JCDATweets @CDAOasisLive canadian-dentalassociation CanadianDental 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 2023 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 3 | 2023 |
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Contents The Canadian Dental Association Magazine 2023 • Volume 10 • Issue 3 12 26 29 37 CDA atWork 7 The Strength of Relationships 9 First Wave of 2023 Public Opinion Survey Data 12 Dr. Heather Carr: New CDA President News and Events 24 Dental Digest Issues and People 26 Should Parents be in the Operatory? 29 The Potential of Teledentistry Classifieds 41 Offices and Practices, Positions Available, Advertisers’ Index Supporting Your Practice 33 Single versus Multiple Visits for Endodontic Treatment of Permanent Teeth 37 HPVVaccinations at the Dental Office Obituaries 45 Dr. Roch St-Aubin | Dr. Randal Balcom 46 Dr. George S. Beagrie 5 Issue 3 | 2023 |
Invisalign Smile Architect™ is a first-of-its-kind smile-design software integrated with ClinCheck that allows for ortho-restorative treatment planning in a single platform. Learnmore: invisalign.ca/smilearchitect ©2023 Align Technology, Inc. All rights reserved. Invisalign, the Invisalign logo, SmartTrack, SmartForce, SmartStage, among others, are trademarks and/or servicemarks of Align Technology, Inc. or one of its subsidiaries or affiliated companies andmay be registered in the U.S. and/or other countries. | A010805-Rev-A Invisalign Smile Architect™ is not intended to recommend any restorative treatment or replace the need for dental CAD software to complete restoration design and fabrication. Any restorative steps subsequent to the Invisalign driven toothmovement are completed by the doctor independent to ClinCheck and Invisalign. Invisalign Smile Architect™ planning filesmade available through case export functionality are not intended for direct fabrication. The future of ortho-restorative care is here. Invisalign Smile Architect treatment planning software. TM Exclusively available in ClinCheck® Pro 6.0 software
Dr. Heather Carr president@cda-adc.ca The Strengthof Relationships This spring, representatives from many of Canada’s dental organizations came together at the CDA Annual General Meeting in Winnipeg, Manitoba, hosted in-person for the first time since 2019. Connecting with these colleagues and friends again made me realize how important it is to gather as a professional community. The best connections and most successful exchanges happen when we assemble and share our ideas and perspectives. The past few years have presented all of us with unprecedented change, which has created both challenges and opportunities for dentistry. I’m a practising dentist in Nova Scotia; the pandemic and its aftermath have been by far the most complicated time of my career. New federal funding for dental care is another historical change that has the potential to improve the lives of millions of Canadians, but it also presents risks and benefits to the oral health care system at large. For instance, many dental practices are experiencing staff shortages that could impede their ability to provide care for their patients, including those who qualify for the new Canada Dental Benefit. As CDA navigates this ever-changing landscape, we know that every decision made by the CDA Board of Directors can have repercussions on dentists across the country. Ultimately, these dentists must be the focus of our efforts and we try to recognize that dentists’ needs are unique and reflective of regional differences. As my installation as CDA president was approaching, I reflected on how CDA, as the national voice of dentistry, can best represent and support such a diverse profession. I believe one of the most important steps is to come together and work as one. We know that we are stronger together and that we have many common goals. Along these lines, CDA will continue to strengthen relationships with our provincial and territorial partners along with our global colleagues, while holding true to our principles. Like the meetings in Winnipeg, coming together and sharing our individual perspectives and experiences can help strengthen the profession as a whole. During my career, I have found that there are very few problems that can’t be solved by good communication, respect and a commitment to a mutually beneficial result. As CDA has worked closely with the federal government over the past year, we bring this spirit of collaboration with our corporate members to the discussions. Our profession has unique expertise and data that the federal government will need to help design an effective and sustainable program. The program’s success also needs a strong and efficient oral health care system as its foundation, where our dental practices can offer patients access to optimal oral health care. It will remain imperative that patients can choose their own dentist and that new federal funding doesn’t affect the employer-sponsored dental benefits that most Canadians depend on. Dental schools will also need to offer the resources and clinical experiences to continue providing a well-rounded curriculum for the upcoming generation of dentists. As a profession, we are building toward a future where we can provide oral health care equitably to more Canadians; and in doing so, creating a healthier Canada. It is my privilege and pleasure to begin my term as CDA’s 104th president. I am excited to work with individuals that I admire and respect from across Canada. I’m confident that we can work together respectfully to find the best solutions and ensure the continued success of our profession. From the President 7 Issue 3 | 2023 | CDA atWork
CDA continues to work with Abacus Data to track public opinion and behavioural trends related to current issues in dentistry, most notably the Canada Dental Benefit (CDB). The first survey of 2023 aims to get a better sense of the public’s reaction, participation, and issues regarding the interim CDB for children under 12. This survey looks at the impact of the first phase of the federal government’s approach to dental care, as well as the proposed federal dental care plan in general. It also explores other trends in employer-benefits plan coverage and comfort levels related to visiting the dental office. Wave 13 of this national survey was conducted in February/March 2023 and reported separately on Canadians who are parents of children under age 12 and who have household incomes of under $90,000. First Wave of 2023 Public Opinion Survey Data Increasing Awareness of the CDB In the general population, support for the federal dental plan remains high (71%) and even higher among the target group for the dental plan (81%). To the questions: “Had you heard anything in the news about this newly announced first phase for kids under 12 in families with income less than $90,000?”, 58% have or think they have, showing a 9% increase since October 2022. Most importantly, among those who would be eligible, 67% are aware of the program, also showing an increase in the same time frame. Among those aware, 68% would be much more or somewhat more likely to go to the dentist regularly, an increase of 5%. Almost 70% of those eligible for the CDB say they are somewhat or much more likely to go to the dentist regularly because of the new benefit. Parents Applying for and Receiving the CDB As of March 2023, 17% of eligible families have applied to receive the CDB. Of those who hadn’t applied, a little over half just haven’t done so yet, but 41% did plan to apply. More than two-thirds (70%) had already received their dental benefit. The process is rated well by most who have already applied for the CDB, and 84% were satisfied with the process. Speed of receiving dental services was also very well rated by families, 9 Issue 3 | 2023 |
with a total satisfaction rate of 88%, including the majority being “very satisfied” (54%). “Cleanings” and “check ups” were the two main dental treatments used with the CDB. “Of note, about one-third (30%) of Canadians do not have access to a Canada Revenue Agency (CRA) account, which is required to apply for the benefit,” says Costa Papadopoulos, CDA’s principal health policy advisor. Avoiding Appointments due to Affordability Issues To the question: “Has the type of dental treatment you are seeking out changed due to economic climate?,” almost 1 in 10 (9%) answered yes. Among the reasons highlighted, the price of dental care is mentioned by 60% when 44% had to cut their expenses to afford dental care and almost 20% lost their job or went through a cut in their work hours. “Another key finding in this survey is that about onethird of parents of eligible children have delayed a dental appointment waiting for the implementation of the federal dental plan,” says Papadopoulos. “And over half (57%) of this group will wait until funds are actually deposited before going to see a dentist. Less than half (43%) would be willing to pay extra for any dental treatments not covered by the federal dental plan.” The survey was conducted with 3,500 Canadians from February 10 to March 3, 2023. A random sample of panelists were invited to complete the survey from a set of partner panels based on the Lucid exchange platform. These partners are typically double opt-in survey panels, blended to manage out potential skews in the data from a single source. 10 | 2023 | Issue 3
Dental Benefits and Coverage from Employers Many of those surveyed (62%) have some kind of dental insurance and this number is higher among parents of children under age 12 (71%). The vast majority (84%) co-pay less than 40% of the average dental fee for basic dental care they receive. “About 3 in 10 (28%) have a health spending account as part of their dental benefits and this is more likely among those working for larger companies,” explains Papadopoulos. “And half of them (50%) say this account has more value than just regular dental benefits.” Most Canadians say their workplace dental benefit plans have stayed the same in the past few months or are expected to stay the same in the upcoming year. But 10% cited some loss of benefits or other signals from their employers about future changes to coverage related to the federal dental benefit. Although 7% of working Canadians mention the possibility of a decrease or decline in dental benefits specifically related to the upcoming federal dental plan, two-thirds don’t feel any difference in their coverage and say they would still be able to afford dental care if they lost coverage (66%). Among those who co-pay for their dental insurance, a large majority (88%) declare being currently able to afford dental care, at a similar level as what we saw in the fall. Cost-of-Living Concerns As inflation and the cost-of-living increases, some Canadians find themselves cutting back on healthy foods and activities. About one-third have been going to the dentist less often than they normally do in the last few years, and 29% say they haven’t been going at all. “Among this group, half say this is due to the current economic climate,” says Papadopoulos. Only a small segment (9%) reported that the type of dental treatment they are seeking out has changed due to the economic climate. But about one-third (31%) say they are currently restricting themselves to only dental treatments that are covered by dental benefits or their insurance coverage. Comfort Level withVisiting a Dentist After reaching an historical low point in November 2020, patients’ comfort level visiting a dentist is getting back to prepandemic levels. About half of parents in the eligibility group regularly visit the dentist with their children, and about two-thirds (61%) of all Canadians say they have a dentist that they visit on a regular basis. This compares to the one-quarter (26%) that do not have a dentist that they see regularly or have not been to in a while. David Colletto, CEO of Abacus Data, discusses Wave 13 survey results on CDA Oasis: bit.ly/3BcWf28 The margin 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 sample matched Canada’s population according to age, gender, educational attainment, and region. Totals may not add up to 100 due to rounding. 11 Issue 3 | 2023 |
When Queen Elizabeth II visited Canada to open the 1976 Summer Olympics in Montreal, the Queen and Prince Phillip also visited Nova Scotia and attended a luncheon at the Government House of the Lieutenant Governor. In her blue uniform and sash, a young Heather Carr was seated next to theQueen as a representative of the Girl Guides of Canada. “She asked me about my Canada Cord and how I got involved with guiding,” says Dr. Carr. “She was very good at her job.” Meanwhile, Dr. Carr was nervous about embarrassing herself because smoked salmon and lobster were on the menu, both foods she didn’t like as a child. “When I tell this story of meeting the Queen, my daughter laughs at the fact that my biggest concern that day was trying not to be sick!” Dr. Heather Carr’s high level of achievement, hard work and positive attitude has put her in many situations where she’s been a leader and representative for her profession over the course of her career. She brings a down-to-earth perspective to her work and a knack for finding solutions that benefit everyone involved. Dr. Heather Carr: New CDA President 12 | 2023 | Issue 3
Early Life A lifelong resident of Fall River, Nova Scotia, Dr. Carr grew up as the oldest of four sisters. Her parents were unable to finish high school due to family obligations but earned their GEDs while working and raising kids. Her mother, Sandra, went to secretarial school and became an administrative assistant for Defence Construction. Her father, Bill, founded and ran Vulcan Sheet Metal. Both parents encouraged their daughters to excel. “My parents are some of the smartest people that I’ve ever known,” Dr. Carr says. “They built a business, several houses with their own hands, and contributed a great deal to the community.” Dr. Carr attributes the early death of her gentle giant father with teaching her what is most important in life. “Surround yourself with people you love and really enjoy your time with them, be grateful for them,” she says. “My parents always believed in me and my sisters, they had the attitude that we should pursue our potential and figure out how to succeed. They didn’t write cheques but supported us in every way they could. We learned to be resilient and independent.” All four Carr sisters have names that begin with “H”— Heather, Holly, Heidi, and Hope. “My mother just liked the names Heather and Holly, and then she was kind of on a roll,” says Dr. Carr. “We joke Hope was their last chance for a boy, but my dad always said that wasn’t true. He told us his daughters were better and more accomplished than any sons would have been.” The sisters were nicknamed “the 4H Club” a moniker they are still known by in the community and beyond. “Not that we were ever involved with farming” says Dr. Carr. A newspaper clipping of Dr. Carr meeting Queen Elizabeth II. Dr. Heather Carr (top) with her sisters, Holly, Heidi and Hope. CDA President 2023–24 13 Issue 3 | 2023 |
CONTINUEDP.17 Education Dr. Carr was an excellent student as a child but didn’t have many people in academia or the health professions in her extended family. “But in junior high school, I did a guidance office test about possible careers, and it suggested I become a minister, a teacher or a dental hygienist,” says Dr. Carr. “And then I started thinking, ‘Why couldn’t I be a dentist?’” At that time, there were few female role models in the dental profession, which actually appealed to Dr. Carr because she liked to set high goals and expectations for herself. Dr. Carr earned her first post-secondary degree, in psychology, at King’s College, where she excelled, earning academic scholarships and the Dalhousie University Medal when she graduated. She was accepted to both dental school and to a graduate program in psychology, which offered a full scholarship. But after a summer doing psychology research on a NSERC grant, she decided to go to dental school at Dalhousie that fall. “I like working with people and I wanted to be in a caring profession where I helped others, but I wasn’t interested in medicine,” she says. “And the idea of being my own boss was attractive.” The first year of dental school was challenging and academically focused. “In second year, we started learning in the clinic, learning by doing, which I just loved because it was working with people,” Dr. Carr says. As a dental student, Dr. Carr edited the Dalhousie Dentistry Journal and became president of the student society. She also had a study group who would meet regularly in the library. Dr. Bernadette McCarthy was a member of this group, “Heather has always been brilliant, and she had an excellent instinct about what was most important and what we should focus on,” she says. Dr. McCarthy says her friend’s work ethic was inspiring, and the study group had a supportive atmosphere rather than a competitive one. “Which was good because Heather was the top of our class, but she helped other students a lot and was also invested in our success,” she says. After dental school, the two dentists remained friends. “It has been a real gift to be able to call her up to talk about our work and our families, to commiserate about the struggles and joys of our lives as women and as a dentists,” Dr. McCarthy says. When Dr. Carr graduated from dental school in 1988, she earned another University Medal and the Golden D from Dalhousie Dentistry. A Carr family photo from the 1980s. Graduation day from King’s College with parents, Sandra and Bill. Women graduates of the Dalhousie Dentistry Class of 1988. CDA President 2023–24 14 | 2023 | Issue 3
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Work Life “After I graduated, I was planning to buy a practice, but at the last minute it didn’t work out,” says Dr. Carr. Instead, a Halifax practice hired her as an associate and, over time, she became a partner. Dr. Carr has been at the Atlantic Dental Centre ever since. “I’ve been working with my partners at the practice for more than 30 years now,” she says. “I guess when I like something, I stick with it.” Dr. Carr says that if she ever moved, she’d miss her connection with her patients. “I’ve known some of them since they were children,” she says. “There are a few that I treated as a student and I’m still seeing them and now their grandchildren. We’ve grown together and many ask about my family during appointments.” For six years, Dr. Carr was a clinic instructor and lecturer in removable prosthodontics at Dalhousie. Dr. McCarthy says that whenever her patients moved to Halifax, she’d refer them to Dr. Carr, especially if they had complicated dental needs. “Clinically, Heather is excellent and she’s great at developing a rapport with people,” she says. Dr. Carr enjoys working with patients with special health care needs and has volunteered at events including the Special Olympics Special Smiles. Before she leaves her office, Dr. Carr makes sure to thank each of the staff members she worked with that day. “I really appreciate Atlantic Dental Centre team efforts in caring for our patients and learned the importance of acknowledging the contributions of others from my dad,” she says. Family Life In the time between her undergraduate and dentistry degrees, Dr. Carr married and went on to have two children, Chelsea and Evan. Early in her career, her marriage ended, and Dr. Carr embraced the role of a single mother. “I’ve been raising my children pretty much on my own since they were about age 2 and 4,” she says. “So, it’s been just the three of us for quite a long time. In their younger years, I adjusted my schedule so I could be with them as much as possible. I wanted to create a stable foundation for them.” Dr. Chelsea Carr Kinnear, now a chiropractor in Fall River, says that her mother would work longer shifts so that the next day she could volunteer to accompany a class trip. “She made us a priority and we felt it,” she says. Dr. Carr was a Spark leader, volunteered with organizations her children were involved in and went cycling across P.E.I. with her son’s Scout troop. Heather with her daughter, Chelsea. Dr. Carr volunteering for the Special Smiles program at the Special Olympics. CDA President 2023–24 17 Issue 3 | 2023 |
CONTINUEDP.21 Dr. Evan Carr Kinnear says that it wasn’t until he became a dentist himself that he truly appreciated how hard his mother worked to excel as both a dental professional and single parent. “I get tired after a long day chairside, but my mom basically worked all the time, with her patients at the practice and then she’d come home and take care of us,” he says. “And you never would’ve known because she was so energetic and emotionally present, both at home and the office. She never complained.” Steve Jennex, executive director of the Nova Scotia Dental Association (NSDA), met Dr. Carr when Chelsea and Evan were small. “We were holding an event where dentists volunteered their time to provide free dental care on a weekend, and Heather arrived wearing scrubs with her kids in a double stroller, ready to volunteer,” he says. “She’s always been a giver. She thinks of other people before she thinks of herself.” Dr. Carr says she might have been a bit firm with her kids. “But I wanted them to get good grades so they would have more choices and opportunities.” Chelsea says she felt supported and inspired by her mother. “She had high expectations for us, but she had even higher expectations for herself,” she says. “She wanted us to do the best we could and she showed us what that looked like, in every part of her own life.” A mother who was high-achieving in dentistry helped encourage Chelsea’s own ambitions. “Having my mom as a role model of a woman who has achieved so much and become a leader in her profession has made me realize what is possible for me,” she says. Of parenthood, Dr. Carr says that is what changed her. “Growing up, I was always strong-willed and hardworking, but my children taught me what selflessness is,” she says. Organized Dentistry Dr. Carr was inspired by her mother to volunteer and become deeply involved with her community. “My mother was recently awarded the Queen’s Platinum Jubilee medal for being a community leader,” she says. “My sisters and I learned early on that we had a duty and responsibility to contribute.” Dr. Carr began her involvement in organized dentistry as a student and then a few years into her professional life, she got involved with the NSDA, first joining committees, then chairing them, and eventually serving as president in 2012–13. She was the third female president of NSDA and became the first female Nova Scotia representative on the CDA Board of Directors in 2015. “People talk about how it takes time when you’re already so busy, but personally I have received so much back from being in organized dentistry,” Dr. Carr says. “I’ve met amazing people and built relationships with dentists all around the world.” Jennex says that Dr. Carr was a “go-to person” for themost challenging committee work and for tasks that required someone who was outgoing and up-for-anything. Dr. Carr appeared on the CBC television show “Street Cents” when Dr. Evan Carr Kinnear and Dr. Chelsea Carr Kinnear. At Dr. Carr’s International College of Dentists Fellowship ceremony in St. John’s, Newfoundland, withDr. IanDoyle (l.) andDr. EricHatfield. CDA President 2023–24 18 | 2023 | Issue 3 C M Y CM MY CY CMY K
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the producers wanted a Nova Scotia dentist to demonstrate tooth whitening on camera. Another time, Dr. Carr and Jennex brought a wheelbarrow carrying 88-pounds of sugar onto the set of “Breakfast Television” to demonstrate how much sugar the average Canadian consumed in a year. “She did everything asked of her at NSDA basically, served in every conceivable role,” Jennex says. “No one works harder than Heather.” Dr. Stuart MacDonald, who now represents Nova Scotia on the CDA Board of Directors, worked with Dr. Carr often when she was president of the NSDA and he was vicepresident. “Heather is a direct and action-oriented leader, but she is also a good listener and thoughtfully considers the perspectives and opinions of others,” says MacDonald. “I really enjoy organized dentistry,” says Dr. Carr. “I’m a true extravert. I thrive when I’m busy and surrounded by people.” Outside of Dentistry For several years, Dr. Carr participated in multi-day bicycle rides to raise money for a Multiple Sclerosis charity. In her mid-30s, Dr. Carr took up kayaking as a Cheema Master. “Competitions took me right across Canada, toWashington, D.C. and eventually the Worlds Master Games in Torino, Italy,” she says. In her 40s, she decided to learn how to ski with Chelsea and Evan. “I found that I enjoyed skiing so now I have a place in Wentworth where I love to spend time in the winter with friends and family,” she says. She’s currently learning to golf and is a member at Oakfield Golf Club. Dr. Carr and her partner John Ormsby, a retired Canadian Air Force service member, enjoy traveling together. “Our first trip together was to NewYork and our return flights got completely mixed up and we ended up being in transit for over 30 hours. We could’ve driven home in less time,” she says. “John said, ‘If we can survive that together, we can survive anything.’ And now when we travel, we know that unexpected challenges can be met because we’re facing them together.” The couple often attends dental events around the world together. “For the last twelve years, his love and support has made it possible for me to do the work that I do for my patients and the profession,” she says. Dr. Carr’s house is situated next to Lake Fletcher outside of Halifax and she likes to spend time on her dock, usually with friends and family. Her children threw her a 60th birthday party on a beautiful day in her backyard. Dr. Carr said it was heartwarming to see people from the various parts of her life together in one place. “My dentist friends, my childhood friends, my dental school friends, my ski friends, my kayaking friends,” she said. “And my family, of course.” Dr. Carr’s sisters are all very accomplished in their respective fields and, after living and working in other provinces and countries, have returned to Nova Scotia. “My mom lives nearby, and both my adult kids are building their careers here,” she says. “I feel very lucky.” With her partner John Ormsby at the FDI World Dental Congress in Argentina. Leading CDA “I’m excited and honoured to serve my profession during this historic time in Canadian dentistry,” says Dr. Carr. After several challenging years of living through the pandemic, she feels that now is the time for dental communities across the nation to come together. “Each province and territory is unique and the dentists in each area have their own needs, but I truly believe that we’re stronger as a profession together. And I love bringing people together.” The profession is diverse, and Dr. Carr believes such diversity is a real strength. “Having people with different ideas working towards a common goal will provide dentistry with the best possible solutions. Diverse ideas and opinions are how innovation happens,” she says. Training for Masters at Melbourne Beach, Florida. CDA President 2023–24 21 Issue 3 | 2023 |
The Carr family at the CDA President’s Installation, held in Winnipeg in April 2023. Dr. Carr believes that there is much to be done to further strengthen the profession and ensure that the new federal funding for dental care meets the needs of those who need it most. “I’m already rolling up my sleeves and getting to work on these big tasks including critical dental office staff shortages,” she says. “I want to continue the excellent work that Dr. Lynn Tomkins has done as president and all that CDA has achieved in the past few years.” There’s a story that Chelsea and Evan share about their mother that exemplifies her true nature. The year before Chelsea graduated from high school, Dr. Carr brought the family on surprise trip to London, England, to celebrate the New Year. The trip went well until New Year’s Eve, when the streets became crowded and rowdy. “We got stuck on a very crowded Tube train, and Chelsea almost fainted,” said Evan. “Then we got out, people were throwing bottles and fights were breaking out. It felt dangerous.” “But mom just took each of us by the arm,” says Chelsea. “And she stands tall and leads us through the disturbance, calmly but with authority. She convinced a police officer to let us through a barricade near rioting Trafalgar Square and got us safely back to our hotel, literally holding me up because I was woozy.” “She had our backs when a situation got tough,” says Evan. And the thing about our mom is she would do that for anyone, because that’s the kind of person she is.” Professional Memberships and Awards z Fellow of the International College of Dentists z Fellow of the Pierre Fauchard Academy z Fellow of the American College of Dentists z Member of the East Coast Endodontic Study Club z Member of the Canadian Academy of Restorative and Prosthodontic Dentistry z Member of the Halifax County Dental Society, NSDA and CDA z 2021 Winner of the NSDA Dr. P.S Christie Award for Distinguished Service z 2015 Winner of the NSDA Award of Excellence z 2005 Winner of the NSDA Volunteer of the Year z 1988 Winner of University Medal, Dalhousie Dentistry z 1988 Winner of the Golden D, Dalhousie Dentistry z 1988 Winner of the Dr. Frank Woodbury Memorial Prize for Highest Average 4th Year z 1988 Winner of the Dr. John Dobson Memorial Prize for greatest Proficiency in Periodontics 22 | 2023 | Issue 3
CDA President 2023–24 Mentors and Colleagues Since she began dental school, Dr. Carr says she’s been fortunate to have people who supported and positively influenced her career. At Dalhousie, Drs. Doug Chaytor, Wayne Maillet and Richard Price were some faculty members important to her educational experience. “They influenced how I learned,” she says. Dr. Chaytor was the head of the Dalhousie Dental Journal, which she edited. “Ever since, whenever something good happens, he sends me a congratulatory note or card. He’s been one of my biggest supporters since dental school.” “Dr. Eric Hatfield was a mentor to many of us and, sadly, he passed away suddenly in 2020,” says Dr. Carr. “The CDA recently honoured Dr. Hatfield posthumously with its inaugural Mentorship Advancement Award recognizing all that he did for the dental community in Nova Scotia. Dr. Hatfield and Dr. Aaron Burry, CDA’s CEO, graduated two years ahead of me at Dalhousie and have volunteered in the profession since we were students.” Steve Jennex, executive director of the NSDA, and his predecessor Don Pamenter were both significant to Dr. Carr’s involvement in organized dentistry. Other CDA past-presidents from Nova Scotia—Drs. Robert MacGregor, Alfred Dean, and Burton Conrod—were also inspiring because they showed what was possible in organized dentistry. “When Iwasofficially installedasCDApresident, Dr. DeanandDr.MacGregor were in attendance. And my ‘wingman’ from my term as NSDA president Dr. Stuart MacDonald, current Nova Scotia rep on the CDA Board, has always supported my efforts. It was great that they could all be there in Winnipeg at the installation.” Dr. Carr has treasured colleagues and friends among her Dalhousie classmates, and among the dentists practising in Nova Scotia. “I’m blessed to have a dental community filled with individuals I respect and admire. Especially during the pandemic, these relationships really sustained me,” she says. “Drs. Bernadette McCarthy, Cheryl Wenn, Jo-Anne Matheson, Jane Porter, Karen Furlong and myself stayed in touch during the pandemic though Zoom calls and a messenger group called Classy Girls from 1988. We have a 35th class reunion this summer in P.E.I. which will give our graduating class another chance to reconnect.” And of course, Dr. Carr’s family have always inspired and supported her. “Among my family, there’s a belief that we each must define success for ourselves. For me, they have always been a huge part of it.” 23 Issue 3 | 2023 |
(L. to r.) Dr. Aaron Burry, CDA CEO; Dr. Lynn Tomkins, CDA immediate past-president; Prime Minister Justin Trudeau; Dr. Heather Carr, CDA president; and Dr. Joel Antel, CDA president-elect. Photo: Adam Scotti, Office of the Prime Minister DENTAL DIGEST In April, representatives of CDA went to Parliament Hill to meet with members of all political parties for discussions on a range of oral health issues, including the Canadian Dental Care Plan (CDCP). The highlights included a meeting with Prime Minister Justin Trudeau to celebrate the historic funding for dental care in Canada and to discuss a viable path forward to improve the oral health of Canadians. As the federal government considers implementation of the CDCP, it is important that they continue to consult and collaborate with Canada’s dentists and other stakeholders on the design of a long-term program that will provide highquality care to those who need it most. As such, CDA has created a policy roadmap with recommendations to deliver a program that is sustainable, effective, and accessible to all Canadians, while minimizing disruptions for those that already have dental coverage. CDA on Parliament Hill for Discussions on Federal Dental Care Alliance for a Cavity Free Future Policy Lab In 2022, CDA was invited to attend a policy lab, organized by the Alliance for a Cavity Free Future (ACFF) and the Oral Health Policy Lab Network (OHPLN), focused on trying to answer the following question: Given recent developments in oral health care policy and practice in Canada and internationally, what else is needed in terms of investments or other conditions to maximize caries prevention and care amongst infants and children? This policy lab brought together professionals from diverse fields including dentists, dental hygienists, dental assistants, physicians, nurses, pharmacists, academics, as well as government and health services representatives, economists and others to discuss and create a range of policy recommendations for the proposed question. The resulting “menu” of policy options from the lab can then be adapted for use by governments, international bodies and health organizations, as needed. These events encourage rapid and creative interprofessional thinking to develop novel responses that are practical and grounded in the existing evidence base. The results of the November 2022 policy lab are now available as a full report, executive summary and infographics. See: acffglobal.org/projects/policy-network 24 | 2023 | Issue 3
The Alberta provincial government amended its Health ProfessionsAct in2020, requiring all regulatoryhealthcolleges to no longer provide association functions and activities by April 2023. As a result, the previous Alberta Dental Association and College has changed its name to the College of Dental Surgeons of Alberta and will continue to serve as the regulatory body in the province. The legislation also led to the creation of an independent Alberta Dental Association (ADA). The newly formed ADA will serve as the official Corporate Member of CDA going forward. Sandi Kossey is the inaugural CEO of the ADA. Kossey brings over 20 years of health leadership and governance experience at the provincial, national and international levels. Throughout her career, Kossey has developed an acumen for health and social care systems, health policy and health care improvement, and not-for-profit and social enterprise governance, strategy, and operations. Sandi Kossey is CEO of the NewAlberta Dental Association As a Certified Health Executive, she has also established a strong network of relationships built upon mutual respect and collaboration. A lifelong Albertan, Kossey is proud to serve the ADA and the dental profession of Alberta. See: albertadentalassociation.ca More control. More confidence. It all starts here. Performance. Productivity. Profitability. What could you gain by fine-tuning and streamlining your procedure? 3M Direct Restorative Solutions are designed to help navigate your way to restorative success by giving you more control at every step. 3M Direct Restorative Solutions Shade Selection Technique Selection Adhesive Application Composite Placement Light Curing Finishing and Polishing Protection Get started at 3M.ca/DirectSolutions 3M and 3M Science. Applied to Life. are trademarks of 3M. Used under license in Canada. © 2023, 3M. All rights reserved. 2105-20535 E
Should Parents be in the Operatory? Dr. SanjuktaMohanta is a general dentist in Brampton, Ontario. When Dr. Sanjukta Mohanta was a child, she recalls that it was uncommon for parents to accompany their children into the dental operatory. “Kids were independent and there was a belief that parents’ anxiety could be relayed to their children.” Some dentists feel that having parents in the operatory can interfere with treatment by causing distraction or confusion over who should give instructions to young patients in the chair. “Parents intervening can sometimes make dental treatment go worse,” says Dr. Mohanta. “I’ve seen parents yell, scold or threaten their children when they were acting inappropriately in the dental operatory, which heightens stress for everyone.” When Dr. Mohanta became a dentist, she would politely ask parents to leave the operatory during treatment. “But I noticed reluctance from some parents and occasionally children would get upset and ask for their parent to return.” She asked a colleague who was studying pediatric dentistry if she had any resources or best practices that she could share. “I was surprised to learn that having parents present doesn’t seem to make a difference in children’s behaviour,” Dr. Mohanta says. “So then I thought, if it doesn’t make a difference, I’ll just ask my patients what they would prefer.” Now, Dr. Mohanta finds that having a parent in the operatory makes her time with pediatric patients more successful. “A parent can help soothe a child and their presence contributes to a sense of trust and safety,” she says. She explains that there are a number of benefits to having parents in the operatory; they can provide encouragement and positive reinforcement to young patients. “I think children also have a sense that A parent can help soothe a child and their presence contributes to a sense of trust and safety. 26 | 2023 | Issue 3
nothing bad will happen to them if mom or dad is there,” Dr. Mohanta says. “And the parents can see what is happening instead of sitting in the waiting room feeling worried and maybe hearing sounds that suggest that their child is in distress. There is a sense of trust for both parent and child when they can be in the operatory together.” Dr. Mohanta says that if a treatment isn’t successful and a young patient needs a referral, a parent who was in the operatory will know why and won’t blame the treating dentist. In some smaller dental operatories, there is not a lot of physical space for parents to be present. But having a parent in the operatory is not an infection prevention and control concern at this point in time, according to Dr. Mohanta. “There is no longer a restriction on having chaperones in the operatory or in waiting rooms,” she says. To make the presence of a parent in the operatory a success, Dr. Mohanta suggests having written guidelines for parents to read beforehand. “This sets clear expectations for the parents so they know how to be most helpful to their child and to the dental team,” she says. “I also encourage dentists to be confident because then parents will more naturally take a supportive role instead of trying to give directions to their child.” Dr. Olga Rodrigues, a dentist in Goderich, Ontario, says that she prefers not to have parents in the operatory when treating older children. “I like to focus my attention on the child, instead of trying to have a three-way conversation,” she says. “But after hearing Dr. Mohanta’s advice, I drew up some guidelines for parents. It’s helpful for the parents, for me and the whole dental team to have a shared expectation of how a dental visit should proceed.” She says that, at times, older children are more forthcoming with her about their oral health issues when parents are not also in the room. “My main goal is to successfully provide the care my patient needs,” says Dr. Rodrigues. “In some situations, that means having parents in the operatory while, in others, it means asking them politely to stay in the waiting room.” Dr. Mohanta feels that parenting styles have changed since she was a child. In general, parents are more involved and less trusting of others with their children. “Also, as we practice patient-centered care, which works toward the best experience of dental care possible, children usually want their parents with them,” she says. “Allowing parents in the operatory aligns with the patient-centered values of giving patients choice and control over their own experience.” Please sit in the chair provided. “I actually want them sitting down instead of standing,” says Dr. Mohanta. “People are more relaxed when they sit and they are less likely to get in our way. In our operatory, if they want to sit beside the child, they must sit on the left side.” Please only use positive and appropriate language. “I don’t want the parent to say triggering words like needle, shot or hurt,”says Dr.Mohanta.“I also don’t want the parent to start sharing their own previous dental experiences in front of a child.” Please be calm and relaxed. “Don’t get angry with the child, of course,” says Dr. Mohanta. “We don’t want a child to be more stressed because their parent is anxious, angry or upset. The dentist will be more stressed, too!” Please let it be the dentist who gives directions. “Sometimes I ask parents to be silent observers,” Dr. Mohanta says. “Or I explain that their role is to be supportive and soothing while I give the directions.” Please don’t be offended if you’re asked to leave. “It’s up to the dentist to determine who can be in the operatory and we might think it’s best for your child to complete treatment alone,” says Dr. Mohanta.“Parents can decide that they don’t want their child to be treated,which is their right.” Guidelines for Parents in the Operatory Watch Dr. Mohanta’s full conversation on CDA Oasis: bit.ly/3LVZlxK 27 Issue 3 | 2023 | Issues and People
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