Clinical decision-making is a complex process influenced by clinical and non-clinical factors. The aim of this study was to investigate the association between provider, patient, and practice factors with clinical decision-making among dentists in Ontario, Canada's most populated province and its largest dental care market. This was a cross-sectional, selfadministered survey of a random sample of general dentists in Ontario (n = 3,201). The 46item survey collected demographic, professional, and practice information. The outcome (treatment intensity) was measured using a set of clinical scenarios, which categorized dentists as either relatively aggressive or conservative in their treatment decisions. Associations were assessed using bivariate analysis and logistic regressions. One thousand and seventy-five dentists responded (33.6% response rate). Age (p = 0.001), place of initial training (p<0.001), number of dependents (p = 0.001), number of hygienists employed (p = 0.001), and perceptions of practice loans (p = 0.020) were associated with treatment intensity. Dentists who were <40-years old (OR = 2.06, 95% CI:1.39-3.06, p<0.001), American-trained (OR = 2.48, 95% CI:1.51-4.06, p<0.001), and perceived their practice loans as large (OR = 1.57, 95% CI:1.02-2.42, p = 0.039), were relatively more aggressive in their treatment decisions. Various non-clinical factors appear to influence the clinical decision-making of dentists in Ontario.

Objectives This study aims to (a) investigate the relationship between dentists' perceived professional role (PPR), defined as the belief that they are health care professionals versus business people, and treatment intensity, determined by the aggressiveness of clinical approaches, such as in number or scope, and (b) identify the demographic and practice characteristics that have a relationship to PPR. Methods A 46‐item survey with questions on dentists' demographic and professional characteristics was mailed to a random sample of 3,201 general dentists in Ontario, Canada. PPR was measured by visual analog scale and by Likert‐type scale questions, which have been validated in the literature in terms of their ability to measure PPR. Treatment intensity was measured by a set of case scenarios. Univariate, bivariate, and multivariable analyses were performed. Results One‐thousand and seventy‐five dentists returned usable surveys (33.6% response rate). When using the two methods to measure PPR, visual analog scale and Likert‐type scale questions, dentists who identified as business people tended to have a higher treatment intensity compared to those who identified as health care professionals (p < 0.1 and p < 0.05, respectively). In multivariable logistic regression, years of practice, number of technologies used in a practice, and perceiving other dentists as competitors rather than colleagues were significant predictors of identifying as a business person. Conclusions Dentists' PPRs had a significant relationship to the aggressiveness of treatment decisions. Demographic and practice characteristics also had significant relationships to PPR. These findings may have implications for public trust and dentistry's status as a health care profession.

Objectives To investigate the association between dentists' geographic density and perceptions of market competition with clinical decision‐making among a representative sample of dentists in Ontario, Canada's most populated province. Methods Competition was quantified using dentist density, defined as the number of dental clinics lying within a one kilometre radius around the respondents' clinic address and by self‐reported perceived pressure from other dental clinics. The outcome (clinical decision‐making or treatment intensity) was measured using a set of clinical scenarios, which categorized dentists as either relatively aggressive or conservative. Associations were assessed using bivariate analysis and logistic and linear regression. Results Dentists who perceived large competitive pressure from other dentists (OR = 1.63, 95% CI: 1.07‐2.49) were relatively more aggressive in their treatment choices. Interestingly, dentists located in very low dentist density areas (OR = 1.31, 95% CI: 1.03‐1.68) were also relatively more aggressive in their treatment choices. Conclusion This study is the first to explore the impact of competition on the clinical decision‐making of dentists in a Canadian context. It presents a valuable addition to the competition literature and helps to understand current dynamics in the Canadian dental care market.

The Biomedical Engineering Department at Niagara Health has recently launched a 3-dimensional printing program to better support the maintenance and repair of medical devices. Originally, the program was conceived to extend the life of equipment that is no longer supported by the manufacturers. The program is gradually expanding to cover clinical and digital imaging applications mostly geared toward the education of residents and patients. Recently, with impetus from the Information and Communication Department, a partnership has been set up with Brock University, Niagara College, and the Buffalo Niagara Medical Campus. This is gradually evolving to become a regional endeavor.