The Canadian Dental Association Magazine 2025 • Volume 12 • Issue 6 PM40064661 Understanding Chronic Pain Page 22–28 + IN THIS ISSUE Adopting the Montreal-Toulouse Model P. 18 Talking about Obesity P. 14 Remembering Dentistry Leaders Dr. David Sweet, O.C. P. 38
About CDA 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. 2025 • Volume 12 • Issue 6 Head of Governance & 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 Canadian Dental 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 2025 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 or sponsored content 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 solely produced by advertisers. The CDA Essentials editorial department is not involved in its creation. CDA Board of Directors President Dr. Bruce Ward Dr. Raymon Grewal British Columbia Dr. Brian Baker Saskatchewan President-Elect Dr. Kirk Preston Vice-President Dr. Jason Noel Dr. Joy Carmichael New Brunswick Dr. Jerrold Diamond Alberta Dr. Mélissa Gagnon-Grenier NWT/Nunavut/Yukon Dr. Lesli Hapak Ontario Dr. Paul Hurley Newfoundland/Labrador Dr. Stuart MacDonald Nova Scotia Dr. Marc Mollot Manitoba Dr. Janice Stewart Prince Edward Island 3 Issue 6 | 2025 |
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Contents The Canadian Dental Association Magazine 2025 • Volume 12 • Issue 6 9 14 CDA at Work 7 Ethics and Professionalism 9 The Future of Dentistry at the CDA/Dentsply Sirona Student Clinician Research Program News and Events 12 Catching Up with the Oral Health Community in Canada: ACFD 14 Talking about Obesity Issues and People 18 Adopting the Montreal-Toulouse Model 22 Understanding Chronic Pain 26 Oral Health Associated with Chronic Pain Did You Know 34 Viral Online Stories Supporting Your Practice 30 Managing Medical Emergencies in the Dental Office 32 Managing Your Tax Bracket After Retirement: 10 Smart Steps to Follow Classifieds 36 Positions Available, Advertisers’ Index 26 38 Obituaries 38 Dr. David Sweet, O.C. 5 Issue 6 | 2025 |
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Dr. Bruce Ward president@cda-adc.ca Ethics and Professionalism I recall a public opinion survey from several years ago showing that Canadians placed dentists in the same range as car mechanics when it came to public trust. But the survey results were more nuanced; it turned out that most members of the public trusted their own dentist a lot, but less so dentists as a group. That distinction gives me pause. It suggests to me that most dentists are practising with a high standard of ethics and professionalism. But in a world where social media can bring public attention to an ethical misstep, the actions of one dentist can reflect poorly upon the profession as a whole. Ethics and professionalism are closely linked, but they are not the same. Ethics refers to the moral principles that guide our judgment, the internal compass that helps us decide what is right or wrong, fair or unfair. Ethics is why we make certain choices: our commitment to honesty, integrity, and doing what’s in the best interest of our patients. It’s the inner framework that shapes our decisions, even when no one is watching. Ultimately, ethics goes beyond simply following regulations. It’s about upholding the spirit of dentistry that defines us as a health care discipline rather than a commercial enterprise. Professionalism, on the other hand, is about how we put these ethical principles into practise. It’s the outward expression of our values through behaviour, in how we communicate, respect others, maintain competence, and uphold the reputation of dentistry. Professionalism is visible, while ethics is often unseen. One is the moral foundation, the other the lived expression. The CDA Principles of Ethics articulate the core commitments that shape the moral and professional responsibilities of dentists—to patients, society and the profession. These principles provide both a foundation for those entering the field and a compass for those already practising. They affirm that dentistry’s privilege of self-regulation and status as a profession is earned through the conscientious application of knowledge, skill, and integrity. Central to these principles is trust, the cornerstone of the relationship between dentist and patient, grounded in honesty, competence, fairness and accountability. Equally vital is the commitment to health as the primary goal of dental practice, upheld through respect for patient autonomy, a steadfast duty to care for all members of society without prejudice, and a proactive commitment to prevention and health promotion within broader social contexts. One of the clearest signs of professionalism is how we relate to those around us. Patients may not know whether we’ve placed the perfect restoration, but they do know if we treat them with honesty and respect. And our own staff often see more than we think. Dental assistants, dental hygienists, and our front office teams can tell when a practice may be crossing ethical lines. We need to cultivate workplaces where feedback and accountability are welcomed. Even the most experienced clinician benefits from trusted voices who can speak up and say, “This doesn’t feel right.” Our professional culture matters. A strong culture of accountability makes it easier to uphold high ethical standards. We can’t control when one dentist’s bad choice paints us all in a bad light, but we can control how we practise, how we treat our teams and how we represent our profession. We must remember that an ethical profession isn’t something we inherit—it’s a privilege and obligation that we build, choice by choice, patient by patient, day after day. From the President 7 Issue 6 | 2025 | CDA at Work
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The Future of Dentistry at the CDA/Dentsply Sirona Student Clinician Research Program Each year, one undergraduate student from each of Canada’s ten dental schools steps into the national research spotlight. The CDA/Dentsply Sirona Student Clinician Research Program celebrates the best in student-driven dental research in Canada. The 2025 edition, held at the National Oral Health Convention in St. John’s, Newfoundland, in August, showcased the next generation of clinician-scientists. At its core, the competition offers an opportunity for students to gain national recognition by presenting their research findings before a panel of expert judges and exchanging ideas with peers and colleagues from across Canada. “For 10 years I have been fortunate to be one of the judges for the program,” says Dr. Mitch Taillon, a CDA past-president who shared the judges chair with Dr. Benoit Soucy, CDA Chief Knowledge Officer, and Dr. Lesli Hapak, CDA Board of Directors. “This year in St. John’s, I was thoroughly impressed at the variety and quality of the student research taking place at the dental schools in Canada,”says Dr. Taillon. For over 50 years, the annual program’s core values—intellectual sharpness and practical clinical skills— have been demonstrated by student clinicians, including this year’s first place winner, Samer Karkout from McGill University, and runner-up, Ahmed Abbas of Western University. 9 Issue 6 | 2025 |
Winner: Samer Karkout Runner-Up: Ahmed Abbas Predicting Oral Cancer Outcomes Samer Karkout of McGill was awarded first prize for his research on predicting survival outcomes of oral cancer patients, a study that compared two comorbidity indices: the Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologists (ASA) classification. “Oral cancer is a global issue, with many thousands being diagnosed all over the world,” Karkout says in an interview on CDA Oasis. “The challenge is that many of these patients do not solely have cancer... it often comes with other medical conditions such as cardiovascular disease, hypertension and diabetes,” says Karkout. These comorbidities impact treatment, recovery and survival. Karkout and his collaborators’ study sought to determine which index (ASA or CCI) was a better predictor of survival outcomes in oral cancer patients. Using data from the Montreal General Hospital, the study looked at 348 oral cancer patient cases, categorizing patients by comorbidity scores after stratifying cases. When comparing outcomes, Karkout’s study found that the CCI consistently outperformed the ASA classification. “The CCI had a wider and earlier separation between the two groups, indicating that it might be a better predictor than ASA for overall survivability,” he explains. The CCI remained effective after major treatments such as radiotherapy and surgery, while the ASA score lost its predictive power. “This indicates for us is that CCI may be a reliable tool that we can use to predict survivability for our patients with oral cancer across different treatment modalities,” he says. For Karkout, these findings could help with better cancer patient outcomes. “We want to refine this tool and see how it could be personalized towards patients,” he says. “How can we make it more specific to oral cancer to individualize treatment therapies to our patients so they benefit the most?” This reflects the rise of precision medicine over universal treatment models, emphasizing the importance of using medical data to enhance overall patient care. Connecting Gums, Aging, and the Body From a different perspective, Ahmed Abbas, a fourth-year dental student from Western University’s Schulich School of Medicine and Dentistry, explored the systemic links between periodontal disease and biological aging. His study, Moderate to Severe Periodontitis Contributes to Accelerated Biological Aging in MiddleAged and Older Canadians with Multimorbidity, examined how gum disease interacts with chronic illnesses to accelerate the aging process. “This project was many years in the making,” Abbas explains. “Our research group has been looking at epigenetics and aging and the relationship between periodontitis and overall health,” he says. “I would also like to acknowledge my mentor, Dr. Noha Gomaa, whose steadfast mentorship, support, and guidance throughout my four years of dental school were indispensable to this research and beyond,” says Abbas. With individual diseases such as cardiovascular, Alzheimer’s, and Parkinson’s, it was crucial to understand periodontitis’ impact in the context of multimorbidities. “We wanted to see how periodontitis associates with a combination of chronic conditions, because we know that periodontitis has an underlying mechanism of inflammation which can spread all over the body,” says Abbas. That inflammation can become a self-perpetuating cycle: “The inflammatory mechanism can accelerate how people age, and faster aging can lead to even further inflammation,” says Abbas. “As dentists, we need to understand more about how periodontitis relates to other chronic conditions to help us manage our patients and deal with general inflammation of the body.” Using data from the 2007-09 Canadian Health Measures Survey, his team analyzed over 1,000 participants over age 45. “When we combine multimorbidity and periodontitis,” Abbas explains, “those patients who had showed both had about a 20 to 40% increased prevalence of having accelerated aging.” The findings highlight the importance of dental care as part of holistic health management, particularly for aging populations. “This helps dentistry because as providers, we can know our population better,” Abbas says. “Our research gives us a better picture of how periodontitis, multimorbidity, and aging interact and this can guide further research.” Hear more from the two winners on CDA Oasis at: bit.ly/4oSR1ju 10 | 2025 | Issue 6
The judges of this year’s program (L. to r.): Dr. Benoit Soucy, CDA Chief Knowledge Officer; Dr. Lesli Hapak, CDA Board of Directors; Dr. Mitch Taillon, CDA past-president. Dr. Heather Carr, PFA Canadian Trustee, talking to student participants at the PFA Luncheon. The Broader Significance A key highlight of the student clinician events in Newfoundland is the Pierre Fauchard Academy (PFA) Luncheon, in recognition of all participants’ accomplishments. The PFA is an international honour society comprised of dentists who are acknowledged for their professionalism and contributions to the dental profession. Pierre Fauchard Academy Each student clinician is awarded a $1,000 scholarship from PFA, recognizing their dedication, innovation, and contributions to advancing dental research. Through the support of the PFA Oral Health Foundation, the Canadian chapter of PFA continues to demonstrate its commitment to nurturing the next generation of dental professionals. Its ongoing support of student research and excellence remains a cornerstone of the CDA/Dentsply Sirona event. Dr. Lisa Bentley (shown in photo above, PFA Canadian Trustee at the time of the event) and Dr. Heather Carr (recently elected PFA Canadian Trustee) were pleased to present the scholarships.“These student clinicians are the leaders of tomorrow and most deserving of this recognition of their efforts,” says Dr. Carr.“It was a pleasure to meet them and watch their excellent presentations. It is my hope that more of the profession will attend the talks as they are informative and present unique perspectives on current research and issues in our profession,” she says. PFA Canada plans to host a gala luncheon on April 17, 2026, at the CDA/Manitoba Dental Association Prairie Lights Dental Convention.“The event will honour both the student clinicians and deserving Canadian PFA members,” says Dr. Carr.“We hope to see our PFA members and guests at that event celebrating excellence in our profession.” For the student participants, the experience in St. John’s was memorable. “This event will help guide further research to paint a better picture of how oral and systemic health interact,” says Abbas. And for Karkout, the competition provided both validation and motivation: “We want to refine this tool for the purpose of treatment individualization,” he said. “So that patients with oral cancer can benefit the most. I would also like to express my gratitude to Drs. Amal Idrissi and Nicholas Makhoul for their invaluable support, guidance, and encouragement throughout this project. Their mentorship and dedication have profoundly shaped this work and made this achievement possible.” Both student research projects embody the spirit of the program: interdisciplinary, patient-centered, and deeply relevant to the future of health care. “I have no doubt these student clinicians will be our future leaders of the Canadian dental profession,” concludes Dr. Taillon. 11 Issue 6 | 2025 |
Catching Up with the Oral Health Community in Canada: The Association of Canadian Faculties of Dentistry (ACFD) We checked in with ACFD president Dr. Ben Davis to learn more about the work the association does. Dr. Ben Davis is a dentist and oral-maxillofacial surgeon who serves as dean of the Faculty of Dentistry at Dalhousie University and president of the Association of Canadian Faculties of Dentistry. What does ACFD do, in a nutshell? The Association of Canadian Faculties of Dentistry (ACFD) is the national voice and resource for academic dentistry in Canada. It represents faculty members, both full- and part-time, from the country’s ten dental schools, a community of well over one thousand educators, researchers, and clinicians. ACFD’s role is to advance teaching, research, and service within dental education. The organization advocates on behalf of dental faculties at the national level, particularly with Health Canada, and also supports individual faculties in their conversations with provincial governments about funding and policy. Within ACFD, several standing committees, representing areas such as academic affairs, clinical affairs, research, and the deans of the faculties, create structured opportunities for collaboration. These committees meet regularly to share challenges, exchange ideas, and develop solutions to common issues in areas ranging from curriculum design to clinical operations and research initiatives. A recent example of ACFD’s collaborative approach comes from the University of Manitoba, which received funding through Health Canada’s Oral Health Access Fund to develop shared curriculum modules for all ten Canadian dental faculties. These modules cover essential topics such as ethics and professionalism, geriatric care, and emergency medicine—areas that every dental program must teach, but can be costly and time-consuming for each school to create independently. By developing these resources centrally and distributing them across the country, ACFD and its member schools are ensuring consistency in education, reducing duplication of effort, and making the most of limited budgets. It’s a model that illustrates the strength of a unified academic community working together toward common educational standards and improved oral health care outcomes. How does ACFD contribute to the dental profession and oral health in Canada? At its core, ACFD’s mission is to educate the next generation of oral health professionals. Most of the dentists practising in Canada today have graduated from Canadian dental schools, making ACFD’s member institutions the foundation of the nation’s dental workforce. As educators, our primary responsibility is to ensure that students graduate ready to serve the oral health needs of Canadians. Beyond education, the faculties are also home to the country’s highest concentration of dental expertise. Governments, dental associations and other organizations frequently turn to academic experts for evidence-based input on issues such as community water fluoridation, oral cancer, or access to care. In this way, the faculties—and by extension, ACFD— serve as a national resource for the profession and for policymakers. 12 | 2025 | Issue 6
Research is another pillar of ACFD’s contribution. Canadian dental schools conduct a wide range of research, from traditional biomaterials science (like ceramics and adhesives) to interdisciplinary studies that cross into medicine and engineering. Some dental researchers are developing drug delivery systems for cancer treatment or studying the biological mechanisms behind oral and systemic diseases. Others work in dental public health, epidemiology, and health economics, fields that help shape how oral health care is delivered and understood in Canada. managing the unintended impacts of the Canada Dental Care Plan (CDCP), which has increased administrative workloads in dental schools and affected both student clinical experience and clinic revenues. ACFD is actively working with Health Canada to find long-term solutions that allow faculties to focus on teaching and patient care while adapting to the evolving policy landscape. Behind the scenes, the Canadian Dental Association (CDA) has been working closely with the ACFD to address the impacts of the CDCP on dental schools. These efforts from the CDA board and president reflect the quiet, but essential, collaboration that often goes unseen. It’s a reminder that Canada’s oral health community is at its strongest when we work together. The ACFD is a section at CDA’s Annual General Meeting, representing the academic community. Another pressing issue is the erosion of provincial funding for dental faculties. Rising costs for equipment and supplies, coupled with static or shrinking government support, are placing significant strain on programs that are already among the most expensive in the university system. ACFD is advocating for renewed provincial investment to sustain the quality of dental education without unduly burdening students, who already graduate with substantial debt. Curriculum renewal is also on the horizon. Faculties are reassessing what should be taught and how, incorporating emerging areas such as geriatric dentistry, special needs care, Indigenous and racialized health and digital dentistry. The goal is to modernize programs while ensuring graduates remain competent in traditional areas of practice. Finally, ACFD is overseeing the Bridge Training to Dental Practice in Canada Program, a pilot initiative that creates a new pathway for internationally trained dentists from non-accredited programs who are permanent residents in Canada. This program, currently being piloted at several universities, aims to provide a third-pathway to practising in Canada while maintaining rigorous standards of competency. Learn more about the ACFD at: acfd.ca How does your work touch the lives of dentists across Canada? ACFD’s influence extends beyond dental school walls through continuing education (CE), policy development, and leadership training. Many of the CE opportunities available to practising dentists are delivered by faculty members who belong to ACFD. The organization also nurtures the next generation of educators, ensuring that new faculty are skilled, effective teachers who can sustain the quality of dental education in Canada. ACFD and its members also play a key role in shaping policies and guidelines that affect dental practice. Faculty experts often collaborate with dental associations and government agencies to craft position statements, contribute to public health policy, and advance best practices in oral health care. One major initiative that connects academia with the wider profession is the Canadian Oral Health Summit, a national conference held every two years. In 2024, the summit was held in Halifax, Nova Scotia, and, in 2026, it will take place in Saskatoon, Saskatchewan. This event brings together people from across the oral health care community to discuss research, policy, and public health. It’s a forum that fosters collaboration and helps align the academic and clinical branches of the profession toward common goals. What’s coming up for ACFD in the future? Looking ahead, ACFD is focused on addressing several key challenges and opportunities. One major priority is ACFD is actively working with Health Canada to find long-term solutions that allow faculties to focus on teaching and patient care while adapting to the evolving policy landscape. 13 Issue 6 | 2025 | News and Events
© World Obesity Talking about Obesity New research shows strong public support for addressing obesity in dental settings, and experts argue that because caries and obesity share some common risk factors—and oral health is so closely linked to overall health—dentists have a vital role to play. 14 | 2025 | Issue 6
Dentists already coach families on sugar intake, healthy snacks, and routines that protect teeth. Those same behaviours—what we drink, how often we graze and how we structure mealtimes—also influence body weight and overall health. So why not make a broader connection? “That regularity of contact is powerful,” says Dr. Sarah Hampl, a professor of pediatrics at University of MissouriKansas City School of Medicine and leader in childhood obesity care. “School-age kids might see a pediatrician once a year, but if they’re following recommendations, they’ll see their dental team twice a year. That’s two more structured opportunities to talk about sugary drinks, frequent snacking and family routines.” Testing Attitudes First, Dr. Large examined current practice in the UK and beyond, as well as public and professional attitudes. Public support stood out: 83% welcomed weight screening in dental settings, and 85% supported conversations about weight and health.2 Most dental teams do not currently talk about weight and health with patients, but research suggests the majority of dental students and professionals believed dentistry has a role to play. The lesson, she says, was clear: “If it’s done sensitively, consistently, and with training, people feel okay about it.” Next, she focused directly on the public. In a UK survey of more than 3,500 adults, 60% were theoretically comfortable having their height and weight recorded at the dentist, with another 10% saying “maybe.”3 Over half (57%) said that it would be acceptable for their dental team to offer support to help with weight management, with another 15% answering “maybe” when asked if was acceptable. The preferred supports were straightforward: information about local weightmanagement services (84%), referral to a GP (81%), or referral to a local weight management service (78%). What people least preferred was a separate appointment; they preferred action during their dental visit. Interestingly, men were more likely to accept screening and support than women—counter to broader trends in health care engagement. For Dr. Jessica Large, a consultant in pediatric dentistry in Sheffield and doctoral researcher at Loughborough University in England, a research journey that linked dentistry and healthy weight began in 2018, during her pediatric dentistry training in Edinburgh. When a local healthy lifestyle service visited her clinic, she wondered why dentistry and community health programs weren’t more connected. “If these services exist, and we know dental caries and obesity are linked, why don’t we change our pathways?” she says. Her team redesigned new-patient appointments: every child or young person had their height and weight measured if they were happy to do so, BMI was calculated, and families were offered free referrals to the lifestyle service. The evaluation showed that staff and families responded very positively.1 That pilot sparked Dr. Large’s doctoral project. “Obesity and the interplay between oral health and the rest of the body became my research interest,” she says. Her PhD explores specifically how dental teams might contribute to supporting the public with weight management. School-age kids might see a pediatrician once a year, but if they’re following recommendations, they’ll see their dental team twice a year. That’s two more structured opportunities to talk about sugary drinks, frequent snacking and family routines. 15 Issue 6 | 2025 | News and Events
© World Obesity Dr. Large is currently testing the model in real-world dental practices. She will join dental teams in England, measuring patients’ height and weight, with consent, at routine dental appointments. Those living with obesity will be invited into a brief intervention with their dental team: a conversation, resources and referral options. A comparison group receives only the conversation and information. By following patients and dental teams alike, she aims to see whether this approach is both acceptable and feasible in everyday dental practise. “This study is putting it all together—screening, discussion, and referral as part of routine dental care,” she explains. Across her review and surveys, Dr. Large repeatedly heard about a fear of upsetting patients, weight stigma, lack of training and guidance, time pressures and the absence of remuneration. “Dental teams are busy, and some forms of oral preventative care aren’t renumerated,” she notes. “If we want dental teams to take on holistic prevention, they need training, clear pathways, indemnity and regulatory support, recognition and pay.” Stigma, in particular, is a common theme throughout. “There is weight stigma in health care,” Dr. Large says. “Training on weight stigma must be part of any curriculum, alongside how to ask permission and have the discussion sensitively. National guidance in the UK is starting to weave this in, but it isn’t dental-specific yet.” Effective Conversations Dr. Hampl’s clinical advice dovetails with that emphasis on sensitivity. The entry point, she says, is already familiar to dentistry: sugary drinks, ultra-processed snacks, and frequent grazing, behaviours that drive both caries and obesity. “Sometimes framing it as caries prevention is the most acceptable way in,” she says. She encourages asking permission to talk about sugary drinks and snacks and then using motivational interviewing techniques to explore a family’s priorities and constraints. Rather than prescribing a prohibition, she prefers a “replace, don’t remove” approach: swap three daily sodas for a flavoured water or a fruit-infused option that still feels enjoyable. Start small, pick one or two realistic goals, and make changes family-wide so children aren’t singled out. “I’ve never met a parent who doesn’t want the best health for their child,” Dr. Hampl says, adding that role-modelling matters. If a parent keeps sugary drinks in the house, it’s unreasonable to expect a child not to want them. Equity and access also demand attention. Dr. Hampl points out that children in underresourced communities face higher risks for both caries and obesity, and that advice must align with what families can actually obtain—whether that’s safe drinking water or affordable fresh food. A brief, respectful question about access, paired with a short list of local resources, can help translate a good plan into a realistic one. “Great advice isn’t helpful if families can’t act on it,” she says. Motivational interviewing, says Dr. Hampl, is less about telling families what to do and more about guiding them to identify their own priorities and feasible next steps. She describes it as an open-ended, counseling-style conversation that puts parents in the driver’s seat of any change. Rather than demanding that a child stop drinking soda altogether, for instance, the dentist might ask permission to talk about drinks, explore whether sugary beverages are a concern, and then help the family choose a realistic alternative they can transition to. The goal is not wholesale dietary reform overnight, but one or two small, family-wide shifts that build confidence and momentum. Training on weight stigma must be part of any curriculum, alongside how to ask permission and have the discussion sensitively. 16 | 2025 | Issue 6 News and Events
Obesity in Canada Over the past half-century, obesity has gone from a marginal public health concern in Canada to a pervasive challenge across age groups. In 1979, 23% of children age 2–17 were overweight or obese, and, by 2017, 30% of children age 5–17 were overweight or obese. In a national survey in 2021, 29.5% of Canadian adults had a BMI (adjusted self-reported) in the obesity range, and an additional 35.5% were overweight, meaning about 65% of adults fall in the combined category of overweight and obese. The costs mirror the scale of the problem. In 2010, obesity and related illnesses were estimated to cost Canada up to $7.1 billion in direct and indirect costs, including hospital care, physician services and lost productivity. As obesity advances, so do associated risks— type 2 diabetes, cardiovascular disease, musculoskeletal issues and increased mortality. Childhood obesity not only raises early life health burdens but also tends to continue into adulthood, perpetuating lifelong risk. Statistics are from the Public Health Agency of Canada. References 1. Large JF, O’Keefe E, Valentine C, Roebuck EM. Weight screening in paediatric dentistry: What do families and staff think? Int J Paediatr Dent. 2022 Sep;32 Suppl 1:64-66. 2. Large JF, Madigan C, Graham H, Biddle GJH, Sanders J, Daley AJ. Public and dental teams’ views about weight management interventions in dental health settings: Systematic review and meta-analysis. Obes Rev. 2024 Jun;25(6):e13726. 3. Large JF, Roalfe A, Madigan C, Daley AJ. Acceptance among the public of weight screening and interventions delivered by dental professionals: observational study. Obesity. 2024 Dec;32(12):2364-75. Adding Dentistry’s Voice Why dentistry? Dr. Large offers two answers: access and science. Family dental practices see millions of children and adults, often more regularly than family physicians. This access provides an opportunity to help improve oral and overall health and wellbeing. And the links between oral and systemic health are well established, especially periodontal disease and conditions such as diabetes and cardiovascular disease of which obesity is a risk factor. Dentistry’s prevention mindset is already in place; aligning it with holistic health is a logical next step. Dr. Hampl adds that consistent messages across settings—dental, medical, school and community—can counter the fragmentation families sometimes experience in health care. With sensitive conversations and supportive systems, dental teams can help families navigate one of the defining health challenges of our time. “As dentists, we’re uniquely placed,” Dr. Large says. “With training and guidance, we can make this routine, compassionate, and effective.” Dr. Hampl puts it plainly: If dentistry adds its voice, she says, “kids will hear the messages about being healthy more often, and that matters.” Dentistry’s prevention mindset is already in place; aligning it with holistic health is a logical next step. Consistent messages across settings—dental, medical, school and community—can counter the fragmentation families sometimes experience in health care. Dr. Jessica Large Dr. Sarah Hampl 17 Issue 6 | 2025 | News and Events
Adopting the Montreal-Toulouse Model In the face of growing challenges—access to care, social inequalities, professional isolation, economic pressures—a fundamental question arises for the dental profession: how can we practise without abandoning clinical and technical excellence, while giving meaning to our work? This question is the focus of the Montreal-Toulouse model, developed by Dr. Christophe Bedos and his team at McGill University and University of Toulouse in France (above, circle). Proposing the adoption of a biopsychosocial approach to care, this model encourages people to rethink the role of the dentist, not only as a clinician, but also as a public health advocate, community partner and socially engaged professional. A Profession Shaped by the Biomedical Model Among the health professions, dentistry maintains a strong identity focused on precision, technique and restoration. This anchoring in the biomedical model has forged generations of skilled and expert dental professionals but has, at times, distanced them from the social and human realms of their patients. According to Dr. Bedos, professor at McGill University and co-director of the Quebec Network for Sustainable Oral and Bone Health Intersectoral Research (Réseau Québécois de recherche intersectorielle en santé buccodentaire et osseuse durable (RiSBOd), this reliance on technical skill is structurally based. “Dentistry has a strong biomedical culture because it is probably one of the final health care professions to 18 | 2025 | Issue 6
implement person-centered care,” he explains. “The surgical nature of dental practice creates a high dependency on technology, and dentists have turned this technicality into an ideology of sorts—a dental art form, the pursuit of perfection.” Although this approach values efficiency, it risks overshadowing the patient’s everyday experiences. The dominant model often pushes for reasoning in terms of optimal treatment, sometimes forgetting that the care objective should come from the patient’s perspective. Dr. Bedos hopes to see a shift away from this top-down logic. This broader perspective allows us to approach oral health as a complex phenomenon, influenced by factors such as diet, housing, education, isolation, poverty and discrimination. The Montreal-Toulouse Model: A Biopsychosocial Vision The Montreal-Toulouse model encourages moving beyond the traditional caregiver-patient dichotomy to adopt a more systemic view. It operates on three levels: • Individual: Understanding the patient’s expectations, resources and personal obstacles, shared decisionmaking and intervention. • Community: Integrating the patient’s immediate environment, available services and support networks. • Societal: Considering public policies, social determinants and structural inequalities. “Dental professionals should be active participants and leaders in their communities, building relationships with other medical and social service providers so that they become part of a team,” says Dr. Bedos. “In this way, we can become part of a local, intersectoral network that supports the well-being of our community members. This broader perspective allows us to approach oral health as a complex phenomenon, influenced by factors such as diet, housing, education, isolation, poverty, and discrimination.” One innovation from this model is social prescribing— guiding patients toward local, non-medical resources that support their well-being such as transportation, food assistance, psychological support and social activities. This community-based network transforms the dental clinic into an active player within the community. And it doesn’t take “Many students tell me, ‘This patient needs this or that.’ I ask them, ‘Do you know this because they told you or because you think so?’” he says. “What’s good for the tooth isn’t necessarily good for the person who has the tooth.” When that mismatch occurs, it can create distance, misunderstanding, or even rejection of the treatment plan. 19 Issue 6 | 2025 | Issues and People
The Montreal-Toulouse model invites practitioners to rethink the role of the dentist within broader society. “We know that there’s a social contract between health professionals and society. Each professional has a duty to act for the wider collective health.” as much time as one might think, explains Dr. Bedos. “What I propose may take an additional three minutes. What sometimes holds people back is the fear of the unknown,” he says. To support this approach, the model comes with a list of questions. Not a checklist per se, but a reflective tool to restructure thinking and practice. These questions can help dentists explore the patient’s context, their own positioning and any potential biases or assumptions. Toward a Connected, Sustainable and Human Dentistry The Montreal-Toulouse model invites practitioners to rethink the role of the dentist within broader society. Beyond the clinic, Dr. Bedos proposes taking a civic-minded posture. “We know that there’s a social contract between health professionals and society. Each professional has a duty to act for the wider collective health,” he says. to practising professionals and aims to bridge the gap between technical expertise and social engagement. “We’re trying to build something on a small-scale initially, but with a potentially much larger effect,” says Dr. Bedos. “What we’re doing now in education is just the first step, but for some students, it will plant a seed.” He also encourages expanding interprofessional collaborations with social sciences, occupational therapy, public health, and ecology. Care Differently for Better Care Shifting towards more of a biopsychosocial model may seem unrealistic and utopian, but Dr. Bedos believes that it’s attainable. “It’s an invitation to reorient dental practice more towards human relationships. It doesn’t have to deny the biomedical foundations of our profession, but expanding our scope can remind our colleagues that behind every tooth is a person, and behind every person, a story,” he says. According to Dr. Bedos, in a health care system undergoing profound change—with the implementation of the Canadian Dental Care Plan, increasing concerns about access and equity, and the climate and ecological changes—dentists have a central, strategic role to play. “People often tell me, they don’t have time for these sorts of things. But the quality of the relationship, the trust, the patient loyalty you gain far outweighs the time invested,” he says. This model can also bring renewed energy to a profession sometimes plagued by isolation, fatigue, and economic pressures. “Dentistry is a difficult profession, but the biopsychosocial model is a way to care for yourself by caring for others,” says Dr. Bedos. Dr. Christophe Bedos (PhD in Public Health) is a professor with the faculty of dental medicine and oral health sciences of McGill University and adjunct professor with the school of public health of Université de Montréal. In a small community this role is obvious—everyone knows the mayor, the local school principal or the pharmacist. But in larger urban settings, these connections must be built by joining networks and getting more involved locally. “This civic-minded approach also benefits the dental professional. It’s uplifting to know that your community sees you and respects you for your engagement,” says Dr. Bedos. Incorporating such changes also requires a shift in training at the university level and more advocacy for curriculum reform. “The majority of university professors are clinicians rooted in the biomedical model. But students who are sensitive to these questions are emerging, and some pilot programs are being developed to meet this need,” says Dr. Bedos. He is working on establishing a 12- to 15-credit microprogram at McGill, in partnership with the University of Toulouse. This program would be available 20 | 2025 | Issue 6 Issues and People
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Understanding Chronic Pain New research from McGill University reveals that pain is shaped as much by our emotions, stress and social circumstances as by our biology. “Chronic pain is a deeply personal experience that is difficult to measure, because it’s based on selfreports,” says Dr. Étienne Vachon-Presseau, a pain researcher at McGill University. He explains that chronic pain, which affects 1 in 5 adults in Canada at some point in their lives, is not merely a symptom of injury or disease—it’s an intricate interplay of biology, psychology and social context. Dr. Étienne Vachon‑Presseau is an associate professor in the Faculties of Dental Medicine and Oral Health Sciences and Anesthesiology at McGill University, where he directs a lab affiliated with the Alan Edwards Centre for Research on Pain. 22 | 2025 | Issue 6
A Cascade of Consequences Pain doesn’t just exist in isolation—it shapes nearly every aspect of a person’s daily life. Dr. VachonPresseau explains that the relationship between pain and mental or physical health is circular and self-reinforcing. “Of course, if you remove pain from these individuals, naturally their mood and other aspects will improve,” he says. “So the pain can, on some level, cause these risk factors, but they are also present before the pain arrives. It’s all embedded.” Dr. Vachon-Presseau’s recent work draws from one of the world’s largest biomedical databases, the UK Biobank, which includes data from a half-million participants. With access to this vast resource, he and his colleagues trained predictive models of machine learning to understand how different factors (biological, psychological and social) predict chronic pain. “When we only use biological measurements, such as blood tests, where you have inflammatory markers, or brain networks seen via scans, we can make some predictions about specific conditions, for instance, who will likely develop arthritis,” he explains. But when it came to predicting the experience of pain, the self-reported intensity and distribution of discomfort, the biological data fell short. “When we only looked at biological data, we failed to predict who would experience chronic pain,” Dr. Vachon-Presseau says. “We couldn’t find biological measurements that could accurately predict the intensity of pain that a person experiences.” Instead, it was psychosocial information, including sleep quality, stress levels, mood, financial strain, and lifestyle habits, that proved the most powerful predictors. “We could predict, using about one hundred different social and psychological features describing the individual, how they will report their pain,” he says. In other words, chronic pain can trigger a cascade of consequences: poor sleep, increased stress, depression and reduced activity. “If you look across different diseases—multiple sclerosis, nerve damage, fibromyalgia—these psychosocial features are good predictors of how the participant will report their pain,” he notes. When pain makes sleep difficult or dampens mood, those same factors, in turn, intensify the perception of pain. This creates a cycle that’s hard to break, one in which biology, psychology, and behaviour constantly influence each other. Dr. Vachon-Presseau’s research also suggests a hopeful idea that interventions aimed at improving sleep, reducing stress, and supporting mental health can make a real difference. Therapies like cognitive behavioural therapy, mindfulness, and pain education programs all target the psychological side of suffering. “Pain management is not just a single approach,” he says. “It’s a multidisciplinary approach that includes psychologists, physical activity, education, sometimes medication. These are all tools to help people live better with chronic pain.” Pain doesn’t just exist in isolation—it shapes nearly every aspect of a person’s daily life. The relationship between pain and mental or physical health is circular and self-reinforcing. 23 Issue 6 | 2025 | Issues and People
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