Open Dialogue Live event explores issues in access to oral health care
By Niecole Killawee for Dal News
Good oral health is recognized as a basic human right, yet oral disease remains a major public health concern despite many conditions being preventable. That’s because there’s a direct association between oral disease and the social determinants of health, such as income, education, job insecurity, food insecurity, geographic location and more. Disparities in access to oral health care are leaving many Canadians without the care they need to prevent and treat conditions like tooth decay and loss, periodontal disease, infections and more.
On April 21st from 6:30 to 7:30 ADT, Dalhousie’s Faculty of Dentistry is hosting Oral Health is Health, an Open Dialogue Live panel discussion that will address the current oral health care issues facing Canadians across the lifespan, from children under the care of government to aging populations in long-term care facilities.
Dr. Rebecca Affoo and Shauna Hachey, the co-leads of Dalhousie’s Healthy Populations Institute’s flagship project Putting Oral Health is Health Into Action will moderate this session. Panelists include:
- Dr. Tracy Doyle, assistant professor with the Faculty of Dentistry and associate chief of dentistry at the IWK Health Centre
- Dr. Carolyn Mitchell, assistant professor with the School of Nursing and primary health care nurse practitioner with the Nova Scotia Health Authority
- Dr. Mary McNally, professor and associate dean of research, Faculty of Dentistry
- Dr. Brandon Doucet (DDS’19), dentist with Pasadena Dental and founder of Coalition for Dentalcare
- Floyd Prosper, dental therapist, Eskasoni School Dental Therapy Clinic
Increased risk in vulnerable populations
Dr. McNally spent 10 years as a dentist in private practice before embarking on an academic research career. Throughout her practice, she recognized that a decline in oral health was connected to a decrease in someone’s ability to care for themselves as they aged. This observation shaped her research interests.
“The mouth is four cubic inches that is often not considered a part of overall health,” says Dr. McNally. “But I’m interested in how oral health can be the canary in the coal mine that helps us identify other systemic health concerns.”
Even a moderate amount of frailty in an older adult can impact how well they can brush their own teeth. She says patients whose oral health suddenly deteriorates after a lifelong record of good oral health is a red flag for a number of conditions associated with aging, such as frailty or dementia.
People with special needs and intellectual disabilities are another group that can have difficulty practicing their own oral health care. Dr. Doyle is the clinical director of the Special Smiles program with the Special Olympics, where she arranges for on-site dental screening, education, and fluoride applications at the games.
“In that particular population, 1-2 in every 10 athletes have active, visible dental disease,” says Dr. Doyle.
Older adults and those with special needs tend to depend on caregivers to recognize oral health issues, schedule treatment appointments, and arrange transportation to the appointment. This dependency compounds the difficulties in maintaining good oral health.
“I think that people need to recognize that access to dental care differs for many different populations for many different reasons,” says Dr. Doyle.
Children under the care of government also have to rely on appointed guardians to ensure their oral health is getting the attention it requires. Dr. Mitchell, a primary health care nurse practitioner, has experience working with these children and found that most of them needed an urgent referral to a pediatric dentist.
“What I’ve witnessed is a lack of coordination of care between provincial departments,” says Dr. Mitchell. “Departments are working in siloes, and the children are falling between the cracks.”
Bridging the gaps in access to care
All the panelists agree that what’s going on in the mouth is key to overall health and wellbeing. But in Canada, dental care isn’t covered under universal health care. According to Dr. Doucet and the Coalition for Dentalcare, that’s a key barrier to more equitable access to oral health care.
“There’s plenty of evidence to say oral health is related to overall health,” says Dr. Doucet. “So why don’t we treat it like that?”
In addition to advocating for the inclusion of dental insurance in Medicare, The Coalition of Dentalcare also wants to see publicly owned dental clinics, something Dr. Doucet says would help meet the needs of people who currently lack access to care because of financial, geographic or other circumstantial reasons. This vision includes the incorporation of dental clinics within school settings, long-term care facilities, health centres in Indigenous communities, and prisons.
“This is a very effective way to meet the needs of those populations in a more organized manner than the private clinic model can,” says Dr. Doucet.
Panelist Floyd Prosper, a dental therapist in Eskasoni First Nation who runs the Eskasoni School Dental Therapy Clinic, says that as a public servant “you know you have a duty to prevent the preventable diseases like tooth decay,” adding that the duty serves population-wide outcomes, and not just individual patients.
He explains that dental therapy programs in Canada were originally designed to provide rural and remote communities with a qualified oral health workforce in an effort to improve access to care in these communities. Dental therapists can tackle routine dentistry needs within a population and are well-positioned to provide preventive treatment. But with the closure of Canada’s last dental therapy school in 2011, dental therapists will eventually retire with no one to replace them. Prosper is hopeful that dental therapy will see a reboot in Canada given Saskatchewan’s recent efforts to re-establish an accredited dental therapy program.