Volume 11 • 2024 • Issue 5

2024 • Volume 11 • Issue 5 The Canadian Dental Association Magazine PM40064661 Charting a Course: Strengthening the Oral Health Workforce in Canada Page 24

AboutCDA Founded in 1902, the Canadian Dental Association (CDA) is a federally incorporated not-for-profit organization whose corporate members are Canada’s provincial and territorial dental associations. CDA represents over 21,000 practising dentists nationwide and is a trusted brand and source of information for and about the dental profession on national and international issues. 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 5 Head of Communications Zelda Burt Managing Editor Sean McNamara Writer/Editor Sierra Bellows Gabriel Fulcher Pauline Mérindol Publications & Electronic Media Associate Michelle Bergeron Graphic Designer Carlos Castro Advertising: All matters pertaining to Display or Online advertising should be directed to: Mr. Peter Greenhough c/o Peter Greenhough Media Partners Inc. pgreenhough@pgmpi.ca 647-955-0060, ext. 101 All matters pertaining to Classified advertising should be directed to: Mr. John Reid jreid@pgmpi.ca 647-955-0060, ext. 102 Contact: Michelle Bergeron mbergeron@cda-adc.ca Call CDA for information and assistance toll-free (Canada) at: 1-800-267-6354 or 613-523-1770 CDA Essentials 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, 1815 Alta Vista Drive, Ottawa, ON K1G 3Y6 Postage paid at Ottawa, ON. Notice of change of address should be sent to: reception@cda-adc.ca or publications@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. Joel Antel Dr. Lesli Hapak Ontario Dr. Brian Baker Saskatchewan President-Elect Dr. Bruce Ward Vice-President Dr. Kirk Preston Dr. Jerrold Diamond Alberta Dr. Mélissa Gagnon-Grenier NWT/Nunavut/Yukon Dr. Raymon Grewal British Columbia Dr. Stuart MacDonald Nova Scotia Dr. Marc Mollot Manitoba Dr. Matthew Moore New Brunswick Dr. Jason Noel Newfoundland/Labrador Dr. Janice Stewart Prince Edward Island 3 Issue 5 | 2024 |

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Contents The Canadian Dental Association Magazine 2024 • Volume 11 • Issue 5 13 19 CDA atWork 7 Solutions for a Robust Workforce 9 Forward Focus: CDA’s New Strategic Plan 13 CDA ITRANS Celebrates 20 Years of Claims Service for Canadian Dentists News and Events 16 Dental Digest 19 Canadian Oral Health Summit Issues and People 24 Charting a Course: Strengthening the Oral Health Workforce in Canada 30 Oral HealthWorkforce in Canada: The Data Desert is Shrinking Did You Know? 43 Dentists in Cultural History: The Sweet Version Supporting Your Practice 34 Ensuring Cultural Safety in the Dental Office 38 Dental Management of Patients on Antiresorptive Medications 42 A Guide to Creating Lasting Habits Classifieds 44 Offices and Practices, Positions Available, Miscellaneous, Advertisers’ Index 34 38 Obituaries 46 Dr. Charles Daly 5 Issue 5 | 2024 |

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Dr. Joel Antel president@cda-adc.ca Solutions for a RobustWorkforce At my own practice, a dental hygienist who I have worked with closely for 35 years retired. Six months later, we are still trying to find someone to fill her position. Other dentists have told me they have also found it challenging to find new staff the past few years. A 2019 CDA survey found that nearly one-third (36%) of dental offices had unfilled dental assisting positions, and, anecdotally, some dentists think the number is higher now. On a personal level, the people that I work with often determine how efficiently and smoothly my workday goes. A good team absolutely makes providing high quality oral health care possible. Thinking holistically about dental offices across Canada, a strong workforce where each member of the oral health team has the work environment, tools and support they need to contribute to the oral health of patients is not just an ideal, it is a necessity. Workforce challenges have real consequences for the health of Canadians. In June, CDA convened a workshop that brought together dental assistants, dental hygienists, denturists and dentists to discuss our respective workforces (p. 24). While there, I learned that denturists share many of the challenges that dentists have running their practices. We talked about education and bringing new people into the oral health care sector. We also talked about the reasons why some careers in oral health care don’t last as long as they should. Since 2020, there is an upward trend in the number of people entering dental assisting and dental hygiene in Canada. Data suggests that rather than exiting their occupations, both dental assistants and dental hygienists are more likely to accept a position at a different dental practice. Survey data shows that almost half of all new dental assisting hires came from another dental office, one-quarter are new graduates, and 12% were returning to the workforce. Coming together to talk about our shared challenges brought us insight and a feeling of camaraderie. But more importantly, we discussed possible solutions. Survey data from both the Canadian Dental Assistants’ Association and Canadian Dental Hygienists Association suggest that an unhealthy work environment is the leading cause of people leaving a position. Learning how to create and nurture a healthy work environment is something that all dental team members can do. Our associations have collaborated on educational tools and resources that can be accessed on Healthy Workplace Matters (see: oasisdiscussions.ca/healthyworkplace-matters). We also discussed longer term goals to improve educational opportunities for the future oral health workforce and create supports for each member of the team so that each of us can make contributions to the oral health of Canadians. In this issue of CDA Essentials, we discuss the data necessary for workforce planning and how we are just beginning to be able to create models for both the supply and demand sides of oral health care in Canada (p. 30). We learn more about how the oral health care workforce is influenced by complex forces from the aging population to government funding to technological change. Building a robust oral health workforce is complicated and will require a concerted effort in many areas. And those efforts will only be successful if we work collaboratively. The team we need to solve workforce challenges is the same one we need in our own dental practices working together toward our shared goal of meeting the oral health needs of our patients. I believe we are taking the first steps of a long journey, but that we are headed in the right direction. From the President 7 Issue 5 | 2024 | CDA atWork

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As the national voice for dentists, we promote oral health, support our members and advance the dental profession. Forward Focus: CDA’s New Strategic Plan CDA has a new official strategic plan called Forward Focus: Strategic Plan 2024–2029, approved by the CDA board of directors in May. The plan was the result of almost two years of work overseen by the CDA Strategic Planning Working Group. “We had an opportunity to refocus our mission because we just completed a governance review, an internal staff realignment and had a new CEO,” says Dr. Bruce Ward, chair of the working group and CDA presidentelect. “It was an excellent moment to set a direction for the association. Dr. Aaron Burry, CDA’s CEO, wanted a roadmap, so to speak, to help move the association forward in a collaborative way where we are all working toward shared goals.” CDA was not mandated to formulate and present a strategic plan. However, a strategic plan is good governance practice; it determines CDA’s mission and vision, activities and priorities. It also allows CDA to effectively operate within a framework that is accountable to the board and to other stakeholders. In addition to Dr. Ward, the working group included CDA board members Drs. Kirk Preston, Stuart MacDonald and Jason Noel. It was facilitated by an external consultant, who conferred with CDA’s stakeholders, including the provincial and territorial dental associations (PTDAs), CDA staff, and board members. “I’m the kind of person who would rather do pretty much anything other than create a strategic plan, but thankfully our facilitator made the task a pleasure,” says Dr. Ward. During the process, CDA engaged with the PTDAs to gather insights and feedback. This collaboration helped to shape the plan and ensured that it aligns with the needs and expectations of Canadian dental associations. “It was interesting to find out how passionate people were about the plan,” says Dr. Ward. “There was a lot of 9 Issue 5 | 2024 |

discussion about how to make the plan effective, but also accessible. If a plan is too aspirational and can’t be applied to the daily work of the association, then it isn’t useful. It only works if you use it.” Through a variety of consultations, including inperson meetings and surveys, CDA identified critical issues that required collective action and a shared vision for the future of dentistry in Canada. The new strategic plan outlines the areas that CDA should operate within, focusing on systemic issues, advocating for change and fostering a resilient dental community. “In the end, I think we made a plan that everyone can support, which is important because there is a lot of variation in the experiences and needs of dentists across the country,” says Dr. Ward. “But as a profession we are dealing with some very big changes and challenges that we need to come together to address.” Although the strategic plan covers the next five years, it is designed to be flexible and adaptable. It looks ahead to envision the future landscape of dentistry and charts a course to navigate this path successfully. The plan outlines three primary priorities to guide the work of the association, which will be supported by an operational plan and specific program plans. The three primary priorities are: z Trusted Voice: Be the national voice for dentists to the public, federal government, and stakeholder organizations. z Member Support: Contribute to the ongoing success of CDA corporate members (PTDAs) and dentists. z Strong Profession: Advance the dental profession to improve the oral and overall health of all people living in Canada. “One thing that I like about the new strategic plan is that it recognizes the dentists of Canada as stakeholders,” says Dr. Ward. “There were Forward Focus: CDA’s New Strategic Plan many discussions about who CDA serves, and we acknowledged that we serve both the corporate members (PTDAs) and practising dentists. Ultimately, the plan is written to clarify that relationship. We serve the dentists of Canada through the PTDAs.” There will always be challenges in the oral health sector—financial, access to dental care, workforce issues, as well as changes in expectations—but these challenges also present opportunities. Through the plan, CDA will expand its thinking and strengthen its resolve to do things better and differently for the benefit of patients, dentists, the PTDAs, and employees. Forward Focus: Strategic Plan 2024–2029 is not just a formal document; it is a dynamic roadmap designed to guide the association into the coming years. CDA aims to provide exceptional advocacy efforts, support services, and address pan-Canadian issues to help PTDAs and their member dentists thrive. “It’s not just business as usual or doing things one way because they’ve been done that way since CDA was founded in 1902, and I’m excited and hopeful about how we are looking to the future,” says Dr. Ward. “We’re examining how and why we do things and thinking critically about what is most important.” A trusted national leader working to improve the oral health of all people living in Canada. Access the new CDA Strategic Plan at: bit.ly/4er8XMn Through a variety of consultations, including in‑person meetings and surveys, CDA identified critical issues that required collective action and a shared vision for the future of dentistry in Canada. 10 | 2024 | Issue 5

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ITRANS was designed to be simple for software vendors to switch to and to not change the way dental offices operated. We wanted it to be secure, easy-to-use andmost importantly, we wanted to provide it at no additional cost to dentists. CDA ITRANS Celebrates 20 Years of Claims Service for Canadian Dentists CDA introduced CDAnet in 1991, a service which allowed dentists to use telephone modems to transmit claims to dental benefits claims processors. By the early 2000s, most Canadian dental offices had adopted CDAnet, and most claims were transmitted using a dial-up modem that required its own phone line. Dental offices would transmit information from their dial‑up modem to CDAnet’s system, which would then transmit the information to insurance carriers. Some dental offices still sent paper claims through the mail. “By 2001, it was abundantly clear that the internet was not a fad, it was going to stick around,” says Geoff Valentine, head of programs and services at CDA. “E-business had become a trend. Businesses began to get high speed internet and no longer used dial-up modems.” At CDA, both staff and CDA board members were thinking about the future. Dentists needed a secure, fast, easy way to send claims and the internet offered a viable solution. “New computers didn’t have a reliable port for a business-class modem,” says Valentine. “Offices needed the extra phone line for their debit and credit card machines. When we began to think about what the dental office of the future might need, we felt that an internet-based benefit claims service would be very useful.” It was a big, ambitious idea, and CDA wanted to build it. “There was a feeling that we could let the world happen to us, let tech companies determine how dentistry would fit into the claims marketplace,” says Valentine. “Or we could be proactive and determine our own role in the market, make it so dentistry had an influential voice in matters affecting dentistry.” To develop the technology, CDA created a new company called Continovation Services Inc. (CSI). Using leading edge security technology, CSI created ITRANS, a smooth path for dentists to transition their offices to using the internet for claims transactions. “ITRANS was designed to be simple for software vendors to switch to and to not change the way dental offices operated,” says Valentine. “We wanted it to be secure, easy-to-use and most importantly, we wanted to provide it at no additional cost to dentists.” The Start of ITRANS In 2004, ITRANS was officially launched as a free service for CDA members. Transmissions occurred online instead of using phone lines. Together, CDAnet and ITRANS created a national approach for the future of benefits claims transmission in what could otherwise be a fragmented market. “Instead of different claims processors devising their own internet benefit claims transmission, we created a national system, which serves dentists more efficiently,” says Valentine. In the US, 13 Issue 5 | 2024 |

dentists must pay private companies, often a few at the same time, for similar claims transmission services. Dental offices adopted the new service as dialup modems were phased out. In 2014, CSI created a company called instream that has the mission to eliminate the inefficiencies of claims submission and payment systems between Canadian dental offices and insurers. CSI, which is a wholly owned subsidiary of CDA, concentrates its efforts on serving CDA members and providing technical support to dental offices in their use of ITRANS while instream provides the technical skill sets to continue to improve ITRANS. In December 2005, when ITRANS was in its infancy, it transmitted about 75,000 claims a month. In April 2024, ITRANS transmitted about 4,200,000 claims! “ITRANS is a service that dental offices absolutely rely on,” says Valentine. “We’re proud that it is so useful and that we can offer it as a member service. CDA contributes a great deal to the claims market in Canada, and we do it with the ethos of ‘by dentists, for dentists.’” The Evolution of ITRANS CDAnet and ITRANS also provide CDA with anonymized data about claims transmission activities within the Canadian oral health system. “This data helps us monitor how well the claims system is being used and identify opportunities for improvement. We are constantly working with dental software vendors and claims processors ironing out issues and helping them improve their systems,” says Valentine. “As well, it provides us with information about the treatments that dentists are performing across Canada that helps us measure, track and ultimately improve the oral health of Canadians.” When the COVID-19 pandemic interrupted routine dental care in 2020, it was ITRANS data that was able to show how patients were returning to the dental office and what kinds of care they required during those challenging initial stages. Similarly, anonymized, aggregated data was invaluable in informing the federal government about the nature of dentistry as it worked to develop the Canadian Dental Care Plan. ITRANS continues to adapt and evolve as technology, privacy laws and the overall business environment changes. An updated ITRANS 2.0 version was launched in 2017; it boasts enhanced ITRANS services and provides opportunities for the automation of some routine insurance-related tasks. It also has heightened security features and makes the claims process more direct. Learn more about CDA ITRANS at: cda-adc.ca/cdanet CDA contributes a great deal to the claimsmarket in Canada, and we do it with the ethos of “by dentists, for dentists.” 14 | 2024 | Issue 5

The CDAnet and CDA ITRANS claims service is used by Canadian dentists to submit dental benefit claims to insurance claim processors on behalf of their patients, securely and efficiently. The service includes valuable features like simple integration with dental office software, the ability to view the status of transmitted claims in the CDA Practice Support Service (PSS) (services.cda-adc.ca), and full access to a dedicated technical support help desk. “CDAnet includes the codes, the messaging standards that contain the rules of the road, and the agreements that dentists and claims processors sign to be part of the system,” says Geoff Valentine.“ITRANS is a secure technical solution for transmitting claims on the internet as well as some value-added services.” Continovation Services Inc. (CSI), a wholly owned subsidiary of CDA, is the provider of the CDA ITRANS suite of services. CSI provides secure, real-time claim services exclusively to CDA members. instream is a national, privately owned company dedicated to providing specialized online claims, payment and patient communication solutions that create greater efficiencies between dental professionals, insurance carriers and third-party plan administrators. Contact the CDA PSS Help Desk M-F 9:00am–5:00pm at 1-866-788-1212. 15 Issue 5 | 2024 | 0% interest for 36 months lease-to-own T2 Plus CBCT Auto-nerve tracing AI implant placement Simplified AI digital imaging info@hiossen.ca www.hiossenimplantcanada.ca 1.855.912.1112

CDA submitted its recommendations to the House of Commons Standing Committee on Finance for the PreBudget Consultation in advance of the Federal 2025 Budget. Presented in August 2024, the recommendations focused on issues impacting dental health and accessibility for Canadians. CDA’s key recommendations included: • Protecting Employer-Sponsored Dental Coverage: CDA urged the federal government to take measures to prevent Canadians from losing their employer-sponsored dental coverage due to the Canadian Dental Care Plan (CDCP). • Enhancing the Non-Insured Health Benefits (NIHB) Program: CDA advocates for improved accessibility of the NIHB program through enhanced access to surgical suites, a comprehensive review of the program, aligning NIHB coverage for children with Jordan’s Principle, and creating an indigenous oral health investment strategy. • Exempting Small Business Health Care Offices from Capital Gains Tax Changes: Recognizing the unique circumstances of small business health care offices, CDA recommended exempting these entities from the proposed changes to capital gains taxation announced in the 2024 federal budget. This exemption is crucial for maintaining the financial stability of small dental practices across the country. CDA Pre-Budget Submission and Key Recommendations CDA Supports Federal Efforts to Prevent Youth Access to Nicotine Replacement Therapies In August, the federal government introduced measures to reduce the access and use of nicotine replacement therapies (NRTs) for recreational purposes by young people in Canada. The new measures will ban advertising, labelling and packaging that could appeal to youth. “CDA supports the federal government’s efforts to regulate and restrict the sale and advertising of NRTs, such as nicotine pouches, to youth in Canada”, said Dr. Joel Antel, CDA president. “Flavours like citrus, cool mint and cherry can attract youth. Companies must ensure these harmful and addictive products don’t appeal to children. NRTs should not target youth or be used recreationally, especially by those under age 18.” Other measures included requirements that NRTs in new and emerging formats, such as nicotine pouches, be sold only by a pharmacist or an individual working under the supervision of a pharmacist and be kept behind the pharmacy counter. Manufacturers must also submit mock-ups of labels and packages to ensure there is no youth appeal and there needs to be a frontof-package nicotine addiction warning while clearly indicating its intended use as a smoking cessation aid for adults. See: bit.ly/3XJztv0 DENTAL DIGEST • Advancing Canada’s Healthy Eating Strategy: CDA emphasized the importance of prioritizing and advancing Canada’s Healthy Eating Strategy, including fully implementing restrictions on food advertising targeted at children. This measure is essential for fostering healthier dietary habits and reducing dental diseases linked to poor nutrition. These recommendations reflect CDA’s commitment to promoting oral health and ensuring accessible, equitable dental care for all Canadians. 16 | 2024 | Issue 5

The federal government continues to promote its Canadian Dental Care Plan (CDCP), calling it “one of the country’s largest social programs.” To help track the program’s reach in Canada, the government launched a website in the summer featuring CDCP statistics on the total number of eligible applicants, total number of eligible applicants who received care, and total number of oral health providers participating in the CDCP. This latter category includes dentists and dental specialists, denturists and independent dental hygienists. The statistics, available with a complete provincial and territorial breakdown, will be updated on a monthly basis. The stats are available at: bit.ly/3MPQHAE The government also created multilingual factsheets to help explain the CDCP to patients. Available in 13 languages, the factsheets can be downloaded and printed at: bit.ly/4d8Z4C2 Canadian Dental Care Plan Updates CDA, in collaboration with the national associations representing pharmacists, optometrists and chiropractors, submitted a joint response to the federal consultation on capital gains in September. A joint letter was also sent to Health Minister Mark Holland. The letter expressed concerns about the proposed changes to capital gains taxation announced in the 2024 federal budget, specifically regarding the implications for health care professionals who rely on their businesses as a significant component of their retirement planning. “Many of our members plan their retirement based on the equity built in their businesses, and the new tax regime could significantly diminish the value they expect to derive from years of service…(w)e strongly urge your office to consider the unique circumstances of the health care professionals we represent, who may not have the same financial backing or pension safety nets as other professionals and rely on capital gains for their retirement planning.” CDA is monitoring capital gains tax updates with MNP, who provided insights on the draft legislation along with cohosting a webinar with CDSPI on the capital gains changes and what they mean for dentists. Capital Gains Tax Advocacy 17 Issue 5 | 2024 | Patient centric. Provider efficient . Everybody wins. Secondary Caries Defense* · Bulk Fill Moisture-tolerant · Dual Cure Fluoride, Calcium, and Phosphate Release & Recharge Scan the QR Code to Discover a Higher Standard of Care *ACTIVA™ BioACTIVE physically seals the margin of the material-tooth interface through mineral apatite formation, thereby protecting against microleakage, the leading cause of secondary caries and recurrent decay.

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CanadianOral Health Summit The inaugural Canadian Oral Health Summit (COHS) brought together a wide audience across oral health care and research to advance oral health in Canada and internationally. Over three days in June 2024, academic leaders, professors, students, oral health professionals, researchers, representatives from organized dentistry, health policy experts, and patients gathered at Dalhousie University’s faculty of dentistry in Halifax, Nova Scotia, to attend symposia, presentations and workshops. “The idea for the summit arose from how much important work and dynamic change is happening in dentistry in Canada and around the world,” says Dr. Paul Allison, chair of the COHS organizing committee. “The Association of Canadian Faculties of Dentistry (ACFD) normally holds an in-person biennial meeting, historically a small event primarily involving academic and other dental leaders.” In 2022, the ACFD reached out to other oral health research organizations to gauge their interest in collaborating. “They all immediately jumped on-board,” says Dr. Allison. At the same time, the Institute of Musculoskeletal Health and Arthritis (IMHA) at the Canadian Institutes of Health Research (CIHR) initiated a project to create Canada’s first ever National Oral Health Research Strategy (NOHRS). “We quickly decided that the summit would be the ideal event to formally announce the new strategy,” says Dr. Allison. The Canadian Dental Care Plan (CDCP) was rolling out and the COHS organizing committee wanted to invite the federal Minister of Health, the Honourable Mark Holland, and representatives from Health Canada to discuss the program with the research community. “And of course, the World Health Organization (WHO) published its Global Strategy and Action Plan on Oral Heath in May 2024, which has objectives directly related to activities in Canada,” says Dr. Allison. Minister Holland attended the summit in Halifax and officially announced the NOHRS. With its presentation at the summit, Canada became the second WHO member The Canadian Dental Care Plan was rolling out and the COHS organizing committee wanted to invite the federal Minister of Health and representatives from Health Canada to discuss the programwith the research community. 19 Issue 5 | 2024 |

state to release a national strategy. A symposium about the strategy was hosted by NOHRS co-chairs Dr. Leigha Rock and Dr. Allison, among others. “This strategy is a first of its kind and will inform governments and decision makers, funding agencies, researchers and their organizations, health care practitioners, the public, and others to focus both on emerging, priority issues for Canadian society and on innovative methodological and technological approaches to address these issues,” says Dr. Rock. “We have seen this incredible momentum in recent years from the Canadian oral health research community, oral health care professionals, and patient and public partners,” says Dr. Hetty Mulhall, associate scientific director at CIHRIMHA. “Canada is one of the first countries in the world to create a strategy like this. It is a ‘map’ that aims to advance the health of people living in Canada through research. The summit was a timely opportunity for people to come together and amplify learnings from these initiatives, find solutions to shared challenges, and encourage everyone to take ownership of the next steps.” A symposium about federal initiatives to support oral health in Canada provided a detailed overview of the CDCP. It included a presentation by Dr. James Taylor, Chief Dental Officer of Canada, which provided the context, rationale and overall goals of the CDCP. A Health Canada representative spoke about expected outcomes of the CDCP, Over 350 people attended the inaugural CanadianOral Health Summit, held at Dalhousie University. and how they will be measured, while a representative of Statistics Canada discussed the upcoming collection of oral health data through the Oral Health Statistics Program. This was followed by a facilitated discussion of these issues with the audience. Further symposia topics included cultivating equity, diversity, and inclusivity in dental education, harnessing complex and multimodal data to advance Canadian population oral health research, and exploring the relationship between oral health and frailty, among others. A day-long workshop on Canadian Health Measures Survey (CHMS) data use, with a spotlight on oral health, was led by Dr. Aimee Dawson and representatives from Statistics Canada. The workshop showed users where to find and how to navigate sources of information about the CHMS and help end users understand what, why and how various aspects of the survey design need to be We have seen this incredible momentum in recent years from the Canadian oral health research community, oral health care professionals, and patient and public partners. 20 | 2024 | Issue 5 News and Events

The Canadian Oral Health Summit was organized by: z The Association of Canadian Faculties of Dentistry (ACFD) z The Canadian Association for Dental Research (CADR) z The Network for Canadian Oral Health Research (NCOHR) z The Institute of Musculoskeletal Health and Arthritis (CIHR-IMHA) The federal Minister of HealthMarkHolland (l.) attended the event, officially announcing the launch of the Canadian National Oral Health Research Strategy. considered and incorporated when analyzing the data. The workshop also provided users with best practices when analyzing the data and provided an overview of the oral health component, past and present, including hands-on examples of analyzing oral health data. Further workshops topics included a vision for sustainable virtual oral health care, patient and public engagement in research, and how to get published, among others. “The symposia and workshops that I attended were excellent and extremely relevant to both researchers and anyone who cares about oral health in Canada,” says Dr. Astha Shah, health policy advisor and scientific editor at CDA. “As well, there were meetings for smaller groups with specific shared interests. On behalf of the Journal of Canadian Dental Association (JCDA), I attended a meeting of editors from different scientific journals to discuss our work and policies. Dr. Nicholas Jakubovics, editor-in-chief of the Journal of Dental Research, answered questions from fellow editors, and as a group, we had a productive discussion on many topics, including one on policies surrounding the use of AI in research.” “I came away from the sessions that I attended with some overarching themes that pertain to this moment in oral health research,” says Dr. Diego Proaño, a PhD candidate in dental public health who works on special projects for CDA. “One is that with oral health data, we need to be very aware of what we have and what is 21 Issue 5 | 2024 | News and Events

missing. When it comes to access to care, we are often talking about populations that have data gaps. Populations that are excluded from surveys. We need to know what we don’t know. Also, how do we make sure that we’re asking the right questions? We want our questions to guide our research, not the available data.” “The inaugural summit was a landmark event for oral health in Canada,” says Dr. Ben Davis, dean of the Faculty of Dentistry at Dalhousie University. “We were proud that the federal Minister of Health was there to deliver the keynote address, and that representatives from the WHO, The Lancet, ADEA, and over 350 academics, researchers, and students were in attendance.” He says that the event was a resounding success and there is great commitment and momentum for future summits. “The summit was action-packed, with Minister Holland presenting the CDCP, Health Canada running symposia on it, the formal launch of the NOHRS, a representative from the WHO presenting their action plan and its implications for Canada. There were also many students presenting their applied research and public health dentists and academics sharing their ideas,” says Dr. Allison. He says that from the perspective of the organizing committee, the inaugural summit was a great success and a post-summit survey demonstrated great enthusiasm for it among attendees. The committee is already planning the next summit, likely for June 2026. Dr. Benoit Soucy (l.), CDA’s chief knowledge officer, presented at a symposium about navigating the future of the oral health workforce. The Canadian National Oral Health Research Strategy (NOHRS) The strategy was created by and for people with an interest in oral health care and research. By 2025, it will have been broadly disseminated and the group working on it will have engaged the research, health care and other communities, and formed NOHRS implementation working groups to achieve the milestones in the report. NOHRS is a collaboration between the Canadian Institutes of Health Research’s Institute of Musculoskeletal Health and Arthritis, Canadian Association for Dental Research, Association of Canadian Faculties of Dentistry, Network for Canadian Oral Health Research, Canadian Dental Association, Denturist Association of Canada, Canadian Dental Therapists Association, and Canadian Dental Hygienists Association. Access the full document at: cihr-irsc.gc.ca/e/52773.html 22 | 2024 | Issue 5 News and Events

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Charting a Course: Strengthening the Oral Health Workforce in Canada In June, CDA and the Canadian Dental Hygienists Association (CDHA) co-hosted a meeting in Halifax that included the national Canadian oral health care associations and experts in health care workforce analysis, modeling, planning and economics. The event, Charting a Course: Strengthening the Oral Health Workforce in Canada, included presentations from association representatives and academic experts, along with cross-disciplinary discussions about how to promote a robust oral health care workforce that can effectively serve the Canadian population. “We recognize the immediate need for a strategy to address the current oral health human resource issues across the country,” said Dr. Joel Antel, CDA president, in his opening remarks. “A solution will not be found unilaterally. This gathering is a crucial opportunity for dentists, dental hygienists, dental assistants, denturists, and oral health professionals to come together and collaborate, as we do within the dental office.” 24 | 2024 | Issue 5

Cross-Disciplinary Discussions During the workshop, attendees were divided into groups to discuss workforce challenges and propose actionable strategies to solve them. “Having representatives from the oral health professions come together to discuss these complex and challenging issues in an inclusive manner was very helpful,” says Dr. Astha Shah, health policy advisor and CDA scientific editor. “Our discussions were fruitful, and further enriched through hearing about the first-hand experiences of the dental professionals at the table. In my group, we talked about creating models based on needs for assessing workforce capacity issues. We also discussed the importance of collaboration among dental professionals, as well as working in tandem with experts in workforce planning to address these issues.” “It was interesting to learn more about what information we have, but also what we are missing when it comes to the oral health workforce in Canada,” says Dr. Diego Proaño, a PhD candidate in dental public health who works on special projects for CDA. “One of the takeaway messages is that we need good data so that we can plan for the future. These challenges aren’t new, and they can’t be fixed instantly, but gathering together and sharing the necessary data is an important first step.” According to internal surveys since 2019, about one-third of dental offices have unfilled dental assisting positions. On top of the most commonly cited issue of dental office work environments, dental assistants sometimes leave a practice for personal or family reasons or they are recruited by other dental practices. In 2023, one in 10 Canadians reported having a dental appointment canceled by the dental office over a 2-month period, which is indicative of the current dental staffing challenges. The demand for an increased oral health workforce seems to be more challenging in the Atlantic provinces. In particular, New Brunswick will face major challenges in the coming years with an increasing number of seniors retiring in that province. Dentists CDA’s presentations at the event explored the current oral health workforce data in Canada. Costa Papadopoulos, CDA’s principal health policy advisor, indicated that CDA represents about 21,000 practising dentists among the approximately 27,000 total dentists in Canada. For the 13,600 dental offices across the country, approximately one-third (37%) of offices have 1-2 employees. About 10% of dentists describe their type of practice as “corporate dentistry,” while others described their practices as a “partnership” or “solo-owned” entity. The gender distribution of dentists in Canada is changing, and the number of female dentists is increasing significantly, now approaching a 50-50 split. The number of new dentists increased until 2020, but has since experienced a decline, partly due to the pandemic. Dental Hygienists Ondina Love, executive director of CDHA, reported that they represent almost 23,000 members among the more than 31,000 total dental hygienists in Canada. The dental hygienist workforce is 97% female and, as a group, is aging slightly year over year. More than half (60%) of dental hygienists work full-time (defined as working more than 30 hrs/week), with a slight increase since 2015. Six percent of dental hygienists are business owners with the highest number of independent dental hygienists in Ontario, Alberta, British Columbia and Quebec. Close to 1 in 4 dental hygienists plan to leave the profession within the next five years. About 20% of dental hygienists leave the profession because they feel that they are not respected or valued. Data from a recent CDHA survey suggest that six in 10 dental hygienists have experienced or witnessed mistreatment. CDHA highlighted the impact of harassment, bullying, or abuse, in the oral health workplace. CDHA also mentioned how the ergonomic set-up in the workplace can have a negative impact on the number of work hours and can push some dental hygienists to consider quitting. Around 1,600 dental hygienists become registered yearly in Canada, according to CDHA data. We need good data so that we can plan for the future. These challenges aren’t new, and they can’t be fixed instantly, but gathering together and sharing the necessary data is an important first step. About one-third of dental offices have unfilled dental assisting positions. On top of the most commonly cited issue, dental assistants leave a practice for personal or family reasons or they are recruited by other dental practices. 25 Issue 5 | 2024 |

Charting a Course: Strengthening the Oral Health Workforce in Canada Dental Assistants The Canadian Dental Assistants’ Association (CDAA) described their own transformation as an organization. Leslie Ann Wirth, executive director of CDAA, mentioned that two years ago, the association’s membership was low with fewer than 5,000 members, which made it difficult for the association to pursue its mission. In the past 18 months, efforts have been made to reinvigorate the CDAA, to increase its effectiveness and attract more members. Wirth underscored the lack of a national database of basic information on dental assistants in Canada. In some parts of Canada, the dental assistant profession is unregulated. Further, she explained that although there is a perceived shortage of dental assistants, there isn’t enough evidence to understand its full magnitude or geographic distribution. The CDAA believes that focusing on the retention of dental assistants in the workforce should take precedence over creating more spaces for training new dental assistants. CDAA surveys have shown that some dental assistants feel undervalued, overworked, underpaid, and have no upward career mobility. CDAA has commissioned three workplace surveys and a literature review to better understandingworkplace-related issues for dental assistants. The CDAA remains committed to further exploring workplace issues and may repeat these efforts with a goal to create a strong baseline of information for comparison over time. CDAA is also rebuilding and creating a strategy map for the future. The association is committed to creating a national database for its membership, strategic direction for standardization in the next five years, and actively focusing on research and education. Denturists Mallory Potter, executive director of the Denturist Association of Canada (DAC), presented an outlook for denturism in Canada that emphasized current strengths and opportunities for growth. Representing approximately 2,400 denturists nationwide, the DAC is focused on navigating the evolving landscape of oral health care and is optimistic about the future of the profession. There is a rising demand for denturist services due to Canada’s aging population and increasing awareness about the importance of oral health. Survey data shows that 62% of denturists reported increased demand over the past five years, largely driven by demographic changes and greater public awareness. This trend positions denturism favourably, offering a promising future for those entering the field. However, to fully capitalize on these opportunities, the DAC recognizes the importance of addressing workforce challenges. Denturism is currently experiencing a period of transition, with one-third of denturists planning to retire within the next 5 years. This presents an opportunity for new professionals to step in and fill these roles, ensuring continuity of care and service to communities across the country. The DAC is proactive in its approach to building a robust workforce pipeline. It is advocating for more educational programs and greater government support to expand training opportunities for denturists. Currently, there are five educational programs in Canada, and the DAC sees potential for growth in this area. Many denturists believe there should be more hands-on training and a curriculum that reflects the latest trends in digital denturism, which is a significant area of growth for the profession. 26 | 2024 | Issue 5

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