The Canadian Dental Association Magazine + IN THIS ISSUE GLP-1 Medications and Oral Health P. 14 Filling in the Cracks: Hospital Clinic P. 18 Supporting Patients Through Chemotherapy P. 22 A New Digital Front Door for CDA Page 8 2026 • Volume 13 • Issue 5 PM40064661
The Bulk Fill Over-Achiever Discover what bioactive can do. pulpdent.com/bulk-fill-overachiever RELEASE & RECHARGE OF FLUORIDE, CALCIUM AND PHOSPHATE IONS DEFENSE AGAINST MICROLEAKAGE1 BIOFILM MODULATION2 1Zmener O, Pameijer CH, Della Porta R. Efficacy of Bioactive Resin Composites in Sealing the Marginal Gap: An Ex Vivo Study. Scientific Archives Of Dental Sciences. 2025;7(9):48-54. 2See: Maher YA, Rajeh MT, Hamooda FA et al. Evaluation of the Clinical Impact and In Vitro Antibacterial Activities of Two Bioactive Restoratives against S. mutans ATCC 25175 in Class II Carious Restorations. Nigerian Journal of Clinical Practice, 2023;26(4):404-411. Mah J, Merritt J, Ferracane J. Adhesion of S. mutans biofilms on potentially antimicrobial dental composites. J Dent Res. 2017;96:2560. | 80 Oakland Street Watertown, MA 02472 USA | (800) 343-4342 | pulpdent.com Before and after treatment with ACTIVA™ BioACTIVE Bulk Flow™. Images courtesy Dr. Les Rykiss. Everything you expect from a bulk fill, plus bioactive performance SCAN TO DEMO
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. 2026 • Volume 13 • Issue 5 Head of Governance & Communications Zelda Burt Managing Editor Sean McNamara Writer/Editor Sierra Bellows Gabriel Fulcher Pauline Mérindol Publications Specialist Michelle Bergeron Graphic Designer Carlos Castro Advertising: For all Display, Online and Classified advertising inquiries, or to request the 2026 CDA Media Kit, contact: Michelle Bergeron, CDA Publications Specialist mbergeron@cda-adc.ca CDA Essentials is available online at cda-adc.ca/essentials. All display and classified advertisements are included in the full PDF version, with direct links to corporate/ product websites. The online CDA Essentials generates >21,000 page views monthly. Contacts: Michelle Bergeron, CDA Publications Specialist mbergeron@cda-adc.ca CDA Essentials email: publications@cda-adc.ca Notice of change of address send to: reception@cda-adc.ca or 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. ISSN 2292-7360 (Print) ISSN 2292-7379 (Online) © Canadian Dental Association 2026 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. Kirk Preston Dr. Todd Graham Saskatchewan Dr. Daron Baxter Manitoba President-Elect Dr. Jason Noel Vice-President Dr. Marc Mollot 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. David Lim British Columbia Dr. Stuart MacDonald Nova Scotia Dr. Janice Stewart Prince Edward Island 3 Issue 5 | 2026 |
Contents The Canadian Dental Association Magazine 2026 • Volume 13 • Issue 5 14 CDA at Work 7 From the President: The Strength of Listening 8 A New Digital Front Door for CDA News and Events 11 Dental Digest 14 GLP-1 Medications and Oral Health Issues and People 18 Filling in the Cracks: Hospital Clinic 22 Supporting Patients Through Chemotherapy: A Practical Guide for General Dentists Classifieds 35 Positions Available, For Sale and Advertisers’ Index Supporting Your Practice 26 Rethinking the Conversation Around Gum Disease 28 Know The Law: Handling Patient Complaints About Staff 30 Managing Emotional Contagion in the Dental Office 32 Protecting Your Practice Without Compromising Trust Obituary 38 Dr. Alastair Nicoll 26 22 38 5 Issue 5 | 2026 |
Dr. Kirk Preston president@cda-adc.ca The Strength of Listening In today’s dental office, technology allows us to see more, diagnose with greater precision and provide treatments that would have been difficult to imagine earlier in my career. Yet one of the most valuable tools available to us remains among the simplest: the ability to listen. Listening helps us become better clinicians. It can lead to more accurate diagnoses by revealing details that may not be immediately apparent through radiographs, scans or clinical observation alone. It helps us understand the circumstances and preferences that shape treatment decisions. Most importantly, it allows us to provide care that is centred on the individual sitting in our chair. I have found that my patients are more likely to accept treatment recommendations when they feel heard and understood. And they are more likely to follow through with preventive advice when they know I’ve considered their perspectives. The pace of modern practice can make listening difficult. Our chairs are full, our schedules are demanding and other tasks are always competing for our attention. Dentistry is a profession of action. We are compensated for what we do, our actions, not for sitting quietly while someone tells us their story. Yet listening should not be considered a pause in the productive aspects of an appointment. It is where care begins. As a prosthodontist, I often see patients whose concerns have not been resolved elsewhere. In some cases, the clinical work is only part of the difficulty. The patient and dentist may have left an earlier conversation with very different understandings of what was wanted, what was recommended and what could reasonably be expected. A patient may arrive with one immediate problem while our examination reveals a much longer list of needs. We have a professional responsibility to explain what we find and to recommend appropriate care. At the same time, the patient may not be ready or able to address everything at once. Listening allows us to establish priorities together. It may reveal an anxiety, a financial concern or a previous experience shaping the patient’s behaviours or decisions. It may require allowing someone to finish speaking, asking more questions, recognizing a moment of hesitation or inviting the patient to describe the proposed plan in their own words. These may seem like small acts, but they can prevent significant misunderstandings, strengthen trust and lead to better care. A qualitative systematic review of 36 studies published in the Journal of Dental Research found that patients view respect, empathy, communication and shared decision-making as foundational to quality dental care.1 These qualities shape not only how patients experience their care, but also whether they remain confident and engaged in it. The importance of listening extends well beyond the operatory. Within our practices, we must listen to our teams. Within organized dentistry, we must listen to colleagues whose experiences and perspectives may differ from our own. Listening does not require agreement, nor does it mean setting aside our professional opinions and judgment. It is an expression of respect, and respect is the foundation of meaningful collaboration. The tools, techniques and structures of our profession will continue to evolve. Our values will guide how we respond. Effective leadership is not demonstrated by having a definitive and immediate answer. Sometimes, its greatest strength lies in listening long enough to understand the question that is truly being asked. From the President 1. Tay AHC, Chow DY, Ng E, Chen SMS, Ong YJ, Tay JRH. How patients define quality in dental care: a qualitative systematic review. J Dent Res. 2026 Sep 7:220345261474417 7 Issue 5 | 2026 | CDA at Work
A New Digital Front Door for CDA The Canadian Dental Association has redesigned its website (cda-adc.ca) to bring together a more intuitive user experience, updated bilingual content and modern technology to make trusted information and services easier to access. CDA launched its newly redesigned website in September, marking an important milestone in an overall modernization initiative that began in 2024. “This is much more than a new look for our website,” says Dr. Aaron Burry, CDA CEO. “We wanted to make it easier for people to find the information and services they need, while also building a stronger digital platform that can evolve with us over time.” The project involved extensive planning, content review and development, as well as a significant modernization of the technology behind CDA’s primary public digital platform. The result is a more modern, secure and flexible foundation designed to respond to users’ needs today while giving CDA the ability to continue developing future online services. Making information easier to find One of the main objectives of the website redesign was to make it easier for visitors to find the information they are looking for. The new website features improved navigation and streamlines access to key resources, helping users reach relevant information more quickly. Its clean, responsive design provides a consistent experience whether people are accessing the site from a desktop computer or mobile device. This emphasis on usability was informed by feedback from dentists and the public. The information users find when they navigate the site has also undergone considerable work. Bilingual content was reviewed, updated and reorganized to improve clarity and accessibility and to better align information with the needs of CDA’s different audiences and strategic priorities. “People come to CDA looking for information they can trust, whether they’re dentists, patients or other stakeholders. The new website helps us make that information easier to find and access,” says Dr. Burry. The way people expect to access information and services has changed. This new platform gives us more flexibility to respond to those expectations and continue improving the digital experience we offer. 8 | 2026 | Issue 5
Modernization beyond the surface Some of the most significant changes to the website may not be immediately visible. The redesign includes a new content management system and a modernized technology platform. These changes give CDA greater flexibility to manage and update content efficiently while providing a more sustainable foundation for future enhancements and digital services. Security for online transactions and payments has also been enhanced as part of the website’s modernization. “The way people expect to access information and services has changed. This new platform gives us more flexibility to respond to those expectations and continue improving the digital experience we offer,” says Dr. Burry. One example of this shift is the Dental Aptitude Test (DAT) program. New self-service functionality makes it easier for prospective dentists to manage their accounts and complete transactions online. The DAT program is a prime example of how the redesigned website supports access to information and facilitates direct interaction with CDA’s programs and services. A stronger bilingual digital presence Updating the website also provided an opportunity to take a closer look at CDA’s English and French content. Rather than simply transferring existing web content to a new platform, CDA made content review and development central to the modernization. Content in both official languages was updated and reorganized to improve clarity, accessibility and relevance for key audiences. This work matters because visitors arrive with different objectives. Dentists may need professional resources, members of the public may be seeking oral health information, and DAT program applicants may want to access specific services. The redesigned site makes each of these paths simpler and more direct. Supporting CDA’s Trusted Voice The website modernization is also closely connected to CDA’s broader strategic direction. The new platform supports priorities around member value, engagement and improving the delivery of information and services. It advances the ‘Trusted Voice’ pillar of CDA’s Forward Focus: Strategic Plan 2024-2029 by strengthening CDA’s ability to provide timely, credible and accessible information about oral health, the dental profession and issues that matter to its partners. A website is often one of the first places people encounter an organization. For CDA, its digital presence is central to how it communicates with the dental profession, the public and others seeking reliable information about oral health and dentistry. “The launch is an important milestone, but it’s also a starting point,” says Dr. Burry. “We now have a stronger platform that will allow us to continue improving the website and the digital services we provide in the years ahead.” 9 Issue 5 | 2026 | CDA at Work
With fast wrapped-load cycles, BRAVO G4 keeps instruments ready for the next patient. Keep your patients moving, not waiting. Busy practices are choosing two-unit BRAVO G4 setups to support a smoother sterilization rhythm. While one unit is running, the other can be loaded or unloaded. Keep your wrapped instruments in active rotation and reduce bottlenecks. No stop-and-wait sterilization. Just flow. MORE INSTRUMENTS BRAVO G4 finishes more loads than competitor chamber sterilizers in the same time.* READY FOR MORE BRAVO G4 is faster and excellent at drying wrapped complex instrument loads, compared to other sterilizers. SIZED FOR YOUR PRACTICE Bigger isn’t always better. BRAVO G4 has a 17 L or 22 L chamber to suit the pace of your practice. RECORDS EVERY DETAIL Simplify traceability for your team. Store cycle reports on the unit, email them, or use our free myCOLTENE portal. BRAVO is a trademark of SciCan Ltd. NEVER WAIT WITH BRAVO. *Based on a 42-minute solid wrapped cycle with BRAVO G4 22L / 240 V
Following the suspension of trade negotiations between Canada and the United States, the U.S. implemented 50% tariffs on over $27 billion of Canadian products, effective August 22, 2026. In response, the Government of Canada announced matching tariffs on various American products, effective September 8, 2026. Based on a preliminary review of the new list of U.S. products subject to counter-tariffs, finished dental and medical devices are not explicitly named or targeted. This is consistent with the previous counter-tariffs introduced in early 2025, which affected a limited quantity of dental products. Hand tools, such as vices and clamps, do appear to be included on the list at this time. Dental operatory costs could also increase indirectly as counter-tariffs raise the prices of essential clinic infrastructure and operating inputs. CDA, together with provincial and territorial dental associations (PTDAs) and other partners, will continue to List of U.S. Products Subject to Counter-Tariffs In 2026, CDA launched its first Reverse Days on the Hill initiative, giving Board members an opportunity to meet with MPs in their local ridings. Throughout the summer, CDA Board members participated in over 10 meetings with MPs across the country. During these conversations, Board members highlighted CDA’s federal advocacy priorities, including oral health workforce challenges and practical opportunities to strengthen the Canadian Dental Care Plan (CDCP) for patients and dentists. These meetings allowed Board members to connect national oral health policy issues with the experiences of patients and dental offices in MPs’ communities, providing valuable insights to inform CDA’s federal advocacy efforts. Reverse Days on the Hill helped build and strengthen relationships with MPs across Canada, while increasing Reverse Days on the Hill Brings CDA Advocacy to MP Ridings awareness of oral health issues in their communities and reinforcing CDA’s role as a trusted, nonpartisan partner on oral health policy. DENTAL DIGEST See: lnkd.in/p/gqrRJgCh monitor and analyze developments, provide updates, and advocate on behalf of Canadian dentists. Since the landscape is fluid, grassroots data is critical. CDA encourages PTDAs to report any immediate changes, vendor warnings or unusual freight surcharges dentists encounter. For this reason, if your dental office experiences any immediate changes, vendor warnings or unusual freight surcharges, please contact your PTDA with the details. See: bit.ly/4hyKZTI (L. to r.): Dr. Daron Baxter, CDA Board of Directors; Dan Mazier, Member of Parliament for Riding Mountain, Manitoba. 11 Issue 5 | 2026 |
CDA and the Uniform System of Coding & List of Services (USC&LS) Committee have implemented changes to apexification and apexogenesis services to better reflect their distinct clinical complexity and treatment requirements. Health Canada advised that the Canadian Dental Care Plan (CDCP) and Non-Insured Health Benefits (NIHB) programs are unable to implement these changes until their 2027 fee grids are released. Therefore, when submitting predeterminations or claims for apexification or apexogenesis services to the CDCP or NIHB programs, dentists must use the procedure codes listed in the applicable 2026 CDCP and NIHB fee grids. For all other insurers, use your 2026 provincial or territorial fee guides. The 2026 Environmental Scanning Report from CDA was released earlier in the year. This comprehensive resource examines the political, economic, social, technological, health care, and dental trends reshaping Canada’s oral health landscape. It identifies the key factors expected to influence dentistry over the next five to ten years, including the continued evolution of the Canadian Dental Care Plan (CDCP), workforce challenges, affordability pressures, advances in artificial intelligence, and growing integration between oral health and the broader health care system. Bringing together data, research, analysis, and emerging trends, the report provides valuable insights to support strategic planning and informed decision-making across the profession. The report is also available through your provincial and territorial dental association (PTDA). Apexification and Apexogenesis Procedure Codes CDA Environmental Scanning Report As part of Health Canada’s regular Member Eligibility Review (MER) program, a large-scale mail-out to Canadian Dental Care Plan (CDCP) patients was expected in September 2026. Through this process, Health Canada will review patients’ eligibility to confirm if they continue to be eligible under the plan. This review process may change some individuals’ eligibility status. As the review gets underway, dental offices should be aware that some patients’ eligibility or coverage may change. CDA continues to recommend that dental offices verify a patient’s CDCP eligibility and coverage at each visit, even if the patient has previously received care under the plan. Should a patient undergo treatment without CDCP eligibility on that day, any associated claims will be denied. Under the MER process, CDCP members receive a letter requesting additional documentation to confirm their eligibility. Individuals have 45 days to submit the required information. Members who do not respond within this period will have their CDCP coverage terminated on day 46. CDCP Member Eligibility Review Underway Regularly checking patient eligibility helps dental offices ensure they have the most up-to-date eligibility and coverage information and identify and discuss any potential changes with CDCP patients before treatment. Dental offices should continue to use established CDCP processes to confirm patient eligibility and coverage. See: bit.ly/3UP1pyJ To learn more about what codes to use for CDCP or NIHB, see: bit.ly/4cViqNH See: tinyurl.com/4te76vjm 12 | 2026 | Issue 5
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GLP-1 Medications and Oral Health As GLP-1 medications become increasingly common, their effects are showing up more in the dental chair. Learn how to recognize the oral health risks and what dentists can do to help patients manage them. Dr. Aviv Ouanounou, BSc, MSc, DDS, is an associate professor in the Faculty of Dentistry at the University of Toronto. He recently published the article, “Oral Health Considerations and Dental Management Guidelines for Semaglutide Medications,” in the Canadian Journal of Diabetes. A patient mentions that their mouth has felt unusually dry. Another has developed new tooth sensitivity. A third reports persistent bad breath or frequent reflux. At first, these concerns may seem unrelated. But they may share a common factor: the patient has recently started taking a GLP-1 medication. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), including semaglutide, are now widely prescribed for type 2 diabetes and weight management. As their use grows, dentists are more likely to encounter patients taking these medications and to see some of their side effects in the dental chair. Semaglutide works by increasing insulin secretion, reducing glucagon release, slowing gastric emptying and helping patients feel full. These effects can provide significant metabolic benefits, but they may also contribute to dry mouth, nausea, vomiting, gastroesophageal reflux and changes in appetite. Each of these can have consequences for oral health. The reassuring news is that current evidence does not suggest that semaglutide directly damages enamel, dentin, the dental pulp or the periodontal ligament. Rather, oral complications tend to develop indirectly, through changes in salivary flow, digestion, diet and exposure to gastric acid. Knowing what to look for allows dentists to identify problems early and offer practical preventive care to patients. Start by Asking About Dry Mouth Xerostomia and reduced salivary flow are commonly reported by patients taking semaglutide. This is more than just a matter of comfort. Saliva lubricates and cleanses 14 | 2026 | Issue 5
the mouth, helps control microorganisms, neutralizes acids and supports enamel remineralization. Patients may report persistent thirst, a dry or sticky feeling in the mouth, or burning of the tongue or oral mucosa. Some may find it harder to chew or swallow, while denture wearers may experience increased irritation or difficulty keeping their dentures comfortable. Clinically, saliva may appear thick, ropey or frothy. Reduced salivary flow can increase the risk of caries, particularly root caries in older adults. It may also contribute to gingivitis, oral candidiasis and mucosal discomfort. Management should focus on hydration and salivary stimulation. Encourage patients to drink water regularly and consider xylitol-containing sugar-free gum or pastilles. Oral moisturizers may also provide relief. Fluoride is especially important for patients with xerostomia. Those with significantly reduced salivary flow and a high risk of caries may benefit from a more intensive preventive regimen, including professional topical fluoride and shorter recall intervals, such as every three to four months. Frequent or persistent reflux and vomiting should also prompt communication with the patient’s physician. These symptoms may indicate that the medication or treatment plan needs to be reassessed. Look Beyond “Ozempic Breath” Some patients taking semaglutide report pronounced halitosis, sometimes referred to informally as “Ozempic breath” or “Ozempic burp.” There is rarely a single cause. Reduced salivary flow limits the mouth’s natural cleansing, while delayed gastric emptying, reflux and belching may add an extraoral component. It is important not to assume that the medication explains everything. A complete assessment should still include plaque and calculus levels, periodontal health, tongue coating and the patient’s oral hygiene routine. Management may be relatively straightforward: more thorough brushing, daily interdental cleaning, tongue hygiene and adequate hydration. Addressing xerostomia may also help. Changes in taste are another possible concern. Some patients describe a persistent metallic or bitter taste, known as dysgeusia. Others experience enough appetite suppression that they begin skipping meals or following a highly restrictive diet. Asking about changes in eating habits can reveal concerns that might otherwise go unnoticed. When dietary intake appears inadequate or unbalanced, a nutritional assessment may be appropriate. Take Extra Care with Sedation and General Anesthesia GLP-1 medications deserve particular attention when dental treatment involves deep sedation or general anesthesia. Because these drugs delay gastric emptying, food may remain in the stomach longer than expected. This can increase the risk of regurgitation and pulmonary aspiration, even when the patient has followed standard fasting instructions. Perioperative recommendations for GLP-1 medications have changed over time, and universally stopping the medication before a procedure is not currently recommended. The safest approach depends on several factors, including the specific drug, how long the patient has been taking it, whether gastrointestinal symptoms are present, the patient’s glycemic control, the type of procedure and the planned depth of sedation. Dentists providing or arranging deep sedation or general anesthesia should consult current perioperative guidance and coordinate with the patient’s physician and anesthesia provider. Patients should not be advised to stop taking a GLP‑1 medication without appropriate medical consultation. Reduced salivary flow can increase the risk of caries, particularly root caries in older adults. It may also contribute to gingivitis, oral candidiasis and mucosal discomfort. Watch for the Effects of Reflux and Vomiting Because GLP-1 medications slow gastric emptying, some patients experience nausea, gastroesophageal reflux or vomiting. Repeated exposure to gastric acid can gradually dissolve tooth structure and cause permanent enamel erosion. Early erosive lesions often appear smooth, shallow and cupped. They are frequently found on the palatal or lingual surfaces of the teeth, where they can be easily missed. Once erosion reaches the dentin, patients may begin to experience sensitivity to cold, heat or sweet foods. What patients do immediately after vomiting can make a difference. They should be advised not to brush right away, because gastric acid temporarily softens the enamel surface and makes it more vulnerable to wear. Instead, patients should rinse with water or a mild sodium bicarbonate solution to help neutralize the acid. After waiting 30 to 60 minutes, they can brush gently with a soft-bristled toothbrush and fluoride toothpaste. 15 Issue 5 | 2026 | News and Events
Make GLP-1 Therapy Part of the Dental Conversation For most patients taking a GLP-1 medication, routine dental care does not need to change dramatically. The priority is to ask the right questions, recognize individual risks and intervene early. During the medical history review, determine which GLP-1 medication the patient is taking, why it was prescribed and how long they have been using it. Ask directly about dry mouth, nausea, reflux, vomiting, bad breath, changes in taste and changes in appetite or diet. Patients may not realize that these symptoms are relevant to their dental care unless the dentist makes the connection for them. The clinical examination should include an assessment of salivary flow, new or progressing caries, gingival inflammation, candidiasis and signs of dental erosion. Preventive advice should emphasize careful oral hygiene, twice-daily brushing with fluoride toothpaste, regular hydration and salivary stimulation. Professional topical fluoride and more frequent recall appointments may be appropriate for patients at increased risk. The Bottom Line For dentists, the key is not to treat every patient taking a GLP-1 medication as medically or dentally complex. A few well-chosen questions, a careful examination and timely preventive care can help patients protect their oral health while continuing to benefit from these medications. Reference Kofman K, Ouanounou A. Oral health considerations and dental management guidelines for semaglutide medications. Can J Diabetes 2026 Apr 10:S1499-2671(26)00066-3. Watch Dr. Ouanounou discuss GLP-1 medications and oral health on CDA Oasis at: tinyurl.com/9nrxd235 GLP-1 Medications & Oral Health (Chairside Quick-Reference for General Dentists) Clinical Finding / Risk Likely Mechanism Key Screening Questions Chairside Management Xerostomia / Dry Mouth Reduced salivary flow associated with systemic medication effects and reduced fluid intake. • Do you experience a dry or sticky mouth or persistent thirst? • Do you have difficulty swallowing or wearing dentures? Saliva support: Encourage regular hydration, xylitol-containing gum/ pastilles, and oral moisturizers. Caries prevention: Reinforce topical fluoride and consider 3–4-month recalls for patients at increased caries risk. Dental Erosion & Sensitivity Delayed gastric emptying may contribute to reflux, nausea, and vomiting, increasing oral acid exposure. • Have you experienced reflux, heartburn, nausea, or vomiting? • Have your teeth become more sensitive to hot, cold, or sweets? After vomiting/reflux: Avoid immediate brushing. Rinse with water or sodium bicarbonate solution and wait 30–60 minutes before brushing. Medical liaison: Persistent or significant reflux should be discussed with the patient’s physician. Halitosis (“Ozempic Breath”) Likely multifactorial: xerostomia, reduced salivary cleansing, dietary changes, and reflux/belching. • Have you or others noticed a recent or unusual change in your breath? Evaluate first: Do not automatically attribute halitosis to the medication. Assess plaque, calculus, periodontal disease, tongue coating, and other causes. Management: Encourage interdental cleaning, tongue cleaning, and adequate hydration. Dysgeusia & Nutritional Changes Medication-related taste alteration combined with appetite suppression and substantial changes in food intake. • Have you noticed a bitter, metallic, or altered taste? • Have you significantly changed your diet or begun skipping meals? Dietary screening: Ask about major caloric restriction, meal skipping, or restrictive eating patterns. Referral: Consider medical or nutritional assessment when significant dietary or nutritional concerns are identified. Sedation & Aspiration Risk Delayed gastric emptying may result in retained gastric contents and potentially increase aspiration risk during deep sedation or general anesthesia. • Are you taking a GLP‑1 medication? • Have you had nausea, vomiting, bloating, or other GI symptoms? Preoperative assessment: Do not rely solely on routine fasting history. Coordination: Follow current perioperative guidance and communicate with the anesthesia provider/physician when deep sedation or general anesthesia is planned. 16 | 2026 | Issue 5 News and Events
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Filling in the Cracks: Hospital Clinic For patients with special health care needs or other constraints, dental care can be challenging. In a recurring series of articles, we’ll explore three clinic programs across Canada that are helping to change that reality. The first features a hospital clinic in Winnipeg, Manitoba. Across Canada, there are programs—often but not always embedded in hospitals, dental schools or public health settings—that specialize in providing care for people whose health or socioeconomic circumstances make dental care difficult. They include adults with complex medical needs, children with significant behavioural or sensory challenges, newcomers and unhoused people with no paperwork and families facing costs they simply cannot absorb. While their approaches vary, these clinics have a shared purpose: to ensure that oral health care remains accessible, appropriate and responsive to Canadians’ diverse and growing needs. The clinics profiled here represent only a small sample of programs across the country, but together, they point to a larger effort led by dentists, educators, dental students and community partners who are addressing gaps in access and adapting to a changing population. As more Canadians live longer and manage increasingly complex health conditions, the work of these clinics is not only important in many people’s lives, but increasingly indispensable. Dr. Chris Cottick in his happy place in his office at C-3. 18 | 2026 | Issue 5
The three stories in this article series offer a glimpse into this landscape: a hospital-based clinic in Winnipeg that serves medically vulnerable adults; a non-profit pediatric clinic in Quebec delivering specialized care to children; and a dental school navigating policy shifts while preparing future dentists to meet evolving patient needs. Collectively, they illustrate how dentistry, when integrated across settings, helps strengthen Canada’s oral health system and extend care to those who need it most. Inside a Hospital Dental Clinic For two decades, Dr. Christopher Cottick ran the threechair adult dental clinic inside Winnipeg’s Health Sciences Centre. The clinic is understated—half a week of operating time, shared space with oral and maxillofacial surgery and a staff of dental residents—but its impact is enormous. As Dr. Cottick puts it plainly, “We’re really the last place for these patients in Manitoba.” “Alas, poor Yorick.” OMFS residents and dental interns remember their Shakespeare while immersed in learning at the C-3 clinic. The clinic exists for adults who simply don’t thrive in a regular dental office, sometimes because of medical complexity, other times because of physical or cognitive disabilities, or because of profound anxiety or behavioural challenges. “We see hospital patients, medically compromised patients and a lot of patients with special health care needs,” Dr. Cottick says. That includes adults with autism or Down syndrome, cancer care patients, bonemarrow transplant patients, people requiring pre-cardiac evaluations, individuals recovering from traumatic injury and long-term psychiatric inpatients. Some patients need treatment under general anesthesia, others require sedation, many need a team of several staff just to be safely positioned and stabilized. “There are some patients that are very difficult to treat in private practice,” Dr. Cottick says. Because the clinic is the only one of its kind in Manitoba, and also serves Nunavut and northwestern Ontario, patients routinely travel six to eight hours for care. Training That Shapes a Career Dr. Cottick trained in Winnipeg’s Health Sciences Centre dental clinic in 1990–91, an experience he calls transformative. “It made me what I am today,” he says. “The patients I saw, the training in oral surgery, using all modes of sedation, none of that leaves you. I’m a totally different dentist because of it.” The clinic exists for adults who simply don’t thrive in a regular dental office, sometimes because of medical complexity, other times because of physical or cognitive disabilities, or because of profound anxiety or behavioural challenges. 19 Issue 5 | 2026 | Issues and People
Although he had once expected to join his older brother in private practice, his hospital training pulled him in a new direction. He spent 20 years building the residency program, recruiting young dentists who were eager to develop hospital and special-care skills. The rollout of the Canadian Dental Care Plan (CDCP) has added administrative complexity to a clinic already juggling high needs and limited capacity. Most patients are covered through provincial social services or disability programs. Because the CDCP is structured to operate as the first payer, the long-established sequencing and administrative logic built into provincial dental care programs have been destabilized, leaving the usual way of doing things in a state of flux. That tug-of-war leaves vulnerable adults, many living in group homes with high staff turnover, caught in the middle. “You have to reapply every year,” says Dr. Cottick. “Some patients don’t have family involved. Staff might change. Suddenly a patient we’ve been seeing regularly shows up with no coverage.” Every fourth-year dental student completes a oneweek hospital rotation, spending time with oral surgeons and observing special-needs care. Patient education by the OMFS Team in Op 1. C-3 Dentistry and OMFS team members at the clinic. 20 | 2026 | Issue 5 Issues and People
The team continues treating these patients to ensure continuity of care, but the system is straining. “If you talk to our billing manager, she’d be pulling her hair out,” Dr. Cottick says. “She does an amazing job of pulling together resources so our patients can get the care they need.” Where Education Meets Reality One of the hardest parts of Dr. Cottick’s former role was triage. With only part-time use of the three-chair clinic, he personally reviewed every referral. “Our superlative longtime support staff screen them first and then I would make a final decision,” he says. The waitlist for a consult is long. Deciding which patients must be seen at the hospital, and which could be managed in private practice, was critical. “A lot of our patients just need more care, maybe some sedation,” he says. “We guide patients to the right level of care, ensuring those who need hospital treatment get it quickly without overwhelming the system.” The clinic also serves as a teaching site for the University of Manitoba’s dental and dental hygiene programs. Every fourth-year dental student completes a one-week hospital rotation, spending time with oral surgeons and observing special-needs care. Hygiene students rotate through as well. “One week is not enough to make them comfortable,” Dr. Cottick says. Still, the exposure is important, especially as the school reviews its curriculum to better integrate care for people with special health care needs. Residents gain deep experience managing complex behaviour, sedation and hospital-based dentistry. Why He Keeps Showing Up Dr. Cottick never planned to be so embedded in academic and hospital dentistry, but it runs in the family. His father taught for decades. His brother taught, too. And unlike some who leave dental school vowing never to return, he had a positive experience. “It is a family atmosphere,” he says. “I like being around students. I get a charge out of helping them with something that’s easy for me now, showing them how to make it easier. The days I go to the dental school, I’m excited.” Dr. Cottick says that leadership of the clinic and residency program is in excellent hands with Dr. Julie Pfeffer and Dr. Darryll Iwaszkiw. They speak about Dr. Cottick with deep respect and warmth. “Through 20 years of blood, sweat and tears, Chris has made this clinic an amazing place for our patients, our resident learners and for everyone on the C-3 Team. It’s an honour and a privilege to have been ‘raised up’ by Dr. Elgazzar working with dental interns in the C-3 control room during a busy OMFS clinic. him over the years to take the reins, which is fitting as he taught us everything we know; we owe our careers to him,” says Dr. Pfeffer. “There are countless dentists and oral surgeons practising across the country who would no doubt say the same. C-3 would not be what it is today without him, and we are eternally grateful for his service,” says Dr. Iwaszkiw. “Personally, we feel that he set the standard for excellence without sacrificing a sense of joy and humour along the way.” Without this clinic, thousands of adults in Manitoba would have nowhere to go. “There are patients who need us,” Dr. Cottick says. That reality continues to motivate both the dentists and residents who work chairside at three dental chairs wedged inside a massive hospital. 21 Issue 5 | 2026 | Issues and People
Supporting Patients Through Chemotherapy: A Practical Guide for General Dentists When a patient mentions a recent cancer diagnosis, many dentists start to think about the oral health complications that may accompany treatment. Yet according to Dr. Jessica Metcalfe, former staff dentist and education director at The Princess Margaret Cancer Centre, the dentist’s role extends far beyond managing any oral side effects. For general practitioners, supporting patients through chemotherapy requires a thoughtful approach that spans the entire course of treatment, from diagnosis and preparation to active treatment and long-term survivorship. Dr. Jessica Metcalfe is a general dentist and former education director at The Princess Margaret Cancer Centre in Toronto. Getting Patients Ready for Chemotherapy Ideally, patients should receive a comprehensive dental assessment before chemotherapy begins. However, in reality many patients don’t think of dentistry as part of their overall cancer care. “They might’ve seen that their dental hygiene visit is on their schedule, and then when we do a medical history update, they may say, ‘Oh, by the way, I’ve had a breast cancer diagnosis and I’m in my second week of treatment,’” says Dr. Metcalfe. 22 | 2026 | Issue 5
When a patient receives a cancer diagnosis and is preparing to begin chemotherapy, the dentist’s primary goal is to identify and address any existing oral diseases that could potentially be problematic during treatment. For established patients, this means reviewing radiographs, previous examinations, and any unresolved dental conditions. Particular attention should be paid to any acute or chronic infections or carious lesions that could cause complications during cancer treatment. The type of chemotherapy a patient is embarking upon is also an important consideration. “If the chemotherapy is an immunosuppressant, you need to consider if a chronic abscess is potentially going to flare up while they’re undergoing chemotherapy,” says Dr. Metcalfe. “It could potentially delay or postpone their treatment.” In such cases, treatment planning may include endodontic therapy, extractions or other interventions even before chemotherapy begins. For new patients, a complete oral examination establishes a baseline and identifies any oral health concerns requiring immediate attention before treatment starts. Helping Your Patients Cope During Chemotherapy Once chemotherapy is underway, the dentist’s role often shifts from active intervention to supportive care. For patients receiving highdose chemotherapy or immunosuppressive medications, the immune system may be significantly compromised. Routine invasive procedures are generally avoided unless absolutely necessary. Patients may present with oral complications such as mucositis, taste alterations, oral sensitivity or xerostomia. These symptoms can have a significant impact on nutrition, comfort and quality of life. One common complaint is oral burning associated with oral hygiene products. Dr. Metcalfe recommends reviewing a patient’s choice of toothpaste and considering alternatives, if needed. “If they’re using a specific toothpaste that has sodium lauryl sulfate (SLS), sometimes the frothing agent can cause a stinging and burning sensation inside the mouth,” she says. “Consider switching them to something that’s more kid-friendly or that doesn’t include SLS.” Similarly, fruit-flavoured or bubblegumflavoured products may help ease any discomfort. Managing Dental Emergencies During Treatment Although most dental treatments can be deferred during active chemotherapy, acute infections can still occur. When this happens, communication with the oncology team becomes essential. “You, along with the oncologist, should work together to help support the patient,” Dr. Metcalfe says. The dentist should assess the patient’s current blood counts, treatment schedule, and overall medical status before proceeding with care. In some cases, the oncology team may temporarily delay chemotherapy to allow management of a significant dental infection. Although these situations are relatively uncommon in general practice, Dr. Metcalfe emphasizes the importance of being prepared. For patients experiencing oral ulceration, symptom management becomes a priority. Dr. Metcalfe notes that topical anesthetics such as viscous lidocaine can improve comfort and help patients maintain adequate nutrition. “Making them feel comfortable so they’re able to ingest food and still increase or maintain their caloric intake is an important treatment goal,” she says. Long-Term Care After Chemotherapy For many dentists, treating patients with a history of cancer can feel intimidating. Dr. Metcalfe believes this apprehension is often unnecessary. Patients who completed chemotherapy years earlier and have returned to good health generally require routine dental care similar to other patients. The dentist should assess the patient’s current blood counts, treatment schedule, and overall medical status before proceeding with care. 23 Issue 5 | 2026 | Issues and People
“If someone has a dry mouth for an extended duration, then you’re likely starting to notice small caries lesions pop up. You might want to review their fluoride use,” says Dr. Metcalfe. Hear more from Dr. Metcalfe on managing patients undergoing chemotherapy on CDA Oasis at: tinyurl.com/yc2nvrvf “You shouldn’t feel scared for them to have the regular hygiene visits or routine dental treatment,” she says. “They are part of your patient base but just with a history of cancer.” One important exception involves patients who may have received bisphosphonate therapy following cancer treatment. Dr. Metcalfe advises asking patients with a history of cancer, particularly breast cancer, lung cancer or leukemia, whether they have started such bisphosphonate therapy. Before performing extractions or other invasive procedures, dentists should ask whether the patient has ever taken bone-strengthening medications and assess the associated risk of medication-related osteonecrosis of the jaw. For patients who have only recently completed chemotherapy, timing remains important. If blood counts are still suppressed or the patient appears medically fragile, it may be prudent to delay elective care. When contacting oncologists, dentists should provide a clear diagnosis, proposed treatment plan and specific questions. Oncologists will lean on dentists for our expertise because we’re experts in the mouth. Understanding Common Oral Side Effects Among the oral complications associated with chemotherapy, xerostomia remains one of the most common. While salivary function often recovers after treatment, some patients experience prolonged or permanent changes in salivary flow. Products such as saliva substitutes, moisturizing agents, and xylitol-containing therapies may be required. However, Dr. Metcalfe cautions against overwhelming patients with too many recommendations at once. “Don’t throw the entire dry mouth box at the patient,” she says. “They’re bound to feel overwhelmed.” Taste changes are another frequent concern. Some patients report that water tastes metallic, making hydration difficult. In these situations, practical coping strategies can be suggested while monitoring overall oral health. Long-term xerostomia may also increase caries risk. When recurrent lesions begin appearing, fluoride-based preventive measures may become necessary. The Human Side of Care Ultimately, the most important intervention may not be clinical at all. Patients undergoing chemotherapy are often overwhelmed, frightened and exhausted. “Take a moment in your busy day and try to slow things down when they’re at your practice,” says Dr. Metcalfe. “This way you can sit and truly be present with that patient.” By combining clinical vigilance with empathy, communication and interprofessional collaboration, dentists can play a meaningful role in helping patients navigate one of the most challenging periods of their lives. “Patients want to feel heard and they will appreciate the fact that dentists are there to offer support,” she says. Building Strong Relationships With Oncology Teams Successful management of patients undergoing chemotherapy often depends on effective interprofessional communication. In such cases, obtaining details about the patient’s complete treatment regimen is crucial. Understanding whether a medication is immunosuppressive, hormonal or another type of cancer therapy can significantly influence any treatment plans for their oral health. When contacting oncologists, dentists should provide a clear diagnosis, proposed treatment plan, and specific questions. “Oncologists will lean on dentists for our expertise because we’re experts in the mouth,” Dr. Metcalfe says. 24 | 2026 | Issue 5 Issues and People
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