Fall 2015 Summary

Canada has a growing need for dental care and dental coverage for people of low socio-economic status. More programs are needed for preventative care. Preventative care is very important and in the long run, will reduce Canada’s spending on emergency dental care. Currently, Ontario offers a few programs that cover children with disabilities, emergency care for children, and all dental for children whose parents are being helped by Ontario Works. Lack of preventative dental care for children can result in adults who never had a chance to have healthy teeth. Growing up with untreated dental diseases can reduce a child’s chance for happiness and success in life. It is a financial and emotional burden.

Canada chose not to have government covered dental insurance in the 1960’s because of factors that are not the same as they are now. In England, no one has to go without dental insurance, because they have a comprehensive dental coverage program. If Canada’s government covered more dental insurance for children who would otherwise not have it, the quality of life of a lot of people would be improved.

-Marie S

Dental services provided in other Countries

We’ve shown to you in the past weeks the importance of dental care for our children, and the lack of funding that is provided here in Canada. I wanted to consider the difference in care between countries, what are they doing and does it work?
Through research I found that the UK has a government funded program set up for not only children but for the general public. On the National Health Services, NHS, website for the UK it is stated that:
 “You do not have to pay for NHS dental treatment if, when your treatment starts, you are:
·         under 18
·         under 19 and in full-time education
·         pregnant or you’ve had a baby within the 12 months before treatment starts
·         staying in an NHS hospital and the hospital dentist carries out your treatment
·         n NHS Hospital Dental Service outpatient (although you may have to pay for your dentures or bridges)”
This is a small portion of qualifications for free care in the UK, but it is clearly stated that children are covered in the Nation Health Services provided by the country.
While looking into the National Health Services of the UK, it’s stated that the program is completely funded by taxation. “When the NHS was launched in 1948, it had a budget of £437 million (roughly £9 billion at today’s value). For 2015/16, it was around £115.4 billion”, this budget does not only include dental care, but other medical needs of the population including eye care.
This program has also provided 1.6 million jobs nationwide that include, “40,236 general practitioners (GPs), 351,446 nurses, 18,576 ambulance staff, and 111,963 hospital and community health service (HCHS) medical and dental staff.” So not only has the Nation Health Services been able to provide adequate services to the population, but has also been proficient in creating more job opportunities for its people.
In 2014 the Commonwealth Fund had found that the Nation Health Care system had out ranked 10 other countries health care systems including, Canada. It stated that, “The NHS was rated as the best system in terms of efficiency, effective care, safe care, co-ordinated care, patient-centred care and cost-related problems. It was also ranked second for equity.”
Clearly this program has been effective for many years in providing efficient and adequate care for the population. If this program can be successful in the UK, why have we not adopted it into our general health care system here in Canada?
Sharon L
Resources:
NHS Choice. (07/01/2015). The NHS in England. About the National Health Services. Retrieved from: http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx
NHS Choice. (07/01/2015). Who is entitled to free NHS dental treatment in England? Retrieved from: http://www.nhs.uk/chq/Pages/1786.aspx?CategoryID=74

Jason’s Story- The Exception

For the beginning of Jason Jones’s story, it can be found in the post titled “Jason’s Story". His story left off where all Jason could afford to do was get all but four of his teeth extracted. Where, at the age of twenty-five, Jason had the smile of an 80 year old man. Jason was unable to get the dental care he needed because he could afford it and could only afford the cost of the aftermath from the untreated problems - dental decay. Jason Jones lives in a country where they are not willing to provide free dental care to those in need. Because of Jason’s situation, it made it harder for him to find a job to pay for his dental needs. This continuous cycle is not an uncommon one to live through and many people have to face it every day. After the Star, one of Canada's largest online news site, published Jason’s Story the public finally responded. A Markham dentist named Dr. Raj Singh, was willing to offer Jason Jones free dentures and dental implants. Jason’s first step in treatment was a full set of dentures and two implants to hold them in place. This procedure would have normally cost about $10,500, but luckily Jason Jones can have this done for free because of Dr. Raj Singh generosity and how the public responded.

Many Canadians across the nation are not as fortunate.  Dental care is not included in Canada's universal health system and many suffer because of it. Especially people from a low-socioeconomic status background.

Canadians pay for dental care in four different ways. The first is through third-party insurance, second through private dental insurance, third is by paying directly out-of-pocket; and lastly through government-subsidized programs. The vulnerable group who face the hardest struggle are families from low income. With that said, pediatricians and family doctors play an important role in knowing which child is at an increased risk for dental disease. They also have a role in advocating for more comprehensive and universal dental care for all families but especially those in need.

The Canadian Oral Health Strategy (COHS) was developed by the Federal, Provincial/Territorial Dental Working Group in 2004. It was created to make goals and strategies for oral health promotion, access, and surveillance for oral health. Thanks to the development of COHS, many provinces have made changes in their policies for children from low-socioeconomic backgrounds. However, it’s important to note that programs in each province vary in what they cover. Also important to know is that while COHS is helping, it has still left many vulnerable people without dental coverage.


Hawa

Rowean-Legg, A. (2013, January 11). Oral health care for children-a call for action. doi:18(1):37-43 Retrieved from: http://www.cps.ca/documents/position/or al-health-care-for-children

Welsh, Moira. (2007, June 23). He has a new smile; system still in decay. Toronto Star News. Retrieved from http://www.thestar.com/news/2007/06/23/he_has_a_new_smile_system_still_in_decay.html

How Much Does Canada Spend on Dental Care?

A SMILE IS THE PRETTIEST THING ONE CAN EVER WEAR,THEREFORE IT SHOULD BE TREATED AS THE HEART.

The following statistics display how much Canada spends on its health care system compared to dental care.
The data below shows the difference between what Canada spends on health care and dental care while looking at both public and private sector funding.
According to an article written by Andrea Janusat CTVNews.ca on September 13, 2015, "taxpayers money covers 70 per cent of health care costs to the tune of about $148 billion whiles 6 per cent of dental care costs summing up to $800 million is paid for with public funds".
Even without the graph or any type of display, one can tell the huge gap funding between the health and dental care.
Additionally, a data from the Canadian Institute for Health Information collected in 2011 states the following:
• 59 per cent of private dental care expenditures, about $6.6 billion, were paid for by insurance.
• The remaining 41 per cent some $4.6 billion, was paid by patients out-of-pocket.

The following charts and table gives a visual view of the above statement.
Table is Retrieved from www.ctvnews.ca/.../high-costs-keep-6-million-canadians-from-the-dentist.

Table is Retrieved from www.ctvnews.ca/.../high-costs-keep-6-million-canadians-from-the-dentist.

Table is Retrieved from www.ctvnews.ca/.../high-costs-keep-6-million-canadians-from-the-dentist.

  In  summary, lack or insufficient dental care for people with low-socioeconomic status is  a serious and
growing problem in Canada. That requires a dedicated and effective policy to ensure that primary prevetative measure is   applied  before it spins into a tertiary preventative measure.

Nathalina M.

Andrea Janusat(2015).High cost of 6million Canadians from the dentist each year:Report.Retrieved from http://: www.ctvnews.ca/.../high-costs-keep-6-million-canadians-from-the-dentist.

Jason's Story

Jason Jones. Do you know that name? Are you currently wondering where we are going with this? First, let us tell you a story.

Once upon a time there was a young boy named Jason Jones. He lived in North Bay, a small city in northern Ontario. Jason lived with his mom. She was a nice lady, but had a hard time finding work so she had to rely on social assistance.
One day, Jason started feeling a bit of pain in his mouth. His mom took him to a dentist so he could have a couple of fillings done. The dentist did what he could, but Jason's mom did not have coverage, and social assistance only covered so much. The dentist filled Jason's teeth, and told him that his teeth were crowded, and needed braces to fix this.
Fast forward a few years, and Jason has now worn down the enamel on his teeth because he grinds so much. Jason wore through the mouthguard they gave him for free in a matter of days. Again the dentist tells him he needs braces if he wants his problem to be fixed. The crowding is just going to get worse and its the reason he's grinding his teeth so much. Jason's mom still cannot afford braces, so Jason is forced to continue on in life despite the pain.
By the age of twenty, Jason had ground his teeth to the point of exposing nerves. He was in constant pain, and even struggled to brush his own teeth. At this point, his wife had been working long enough to acquire benefits. Jason went to the dentist, and had some fillings placed, along with a cleaning. However, Jason's teeth were in such poor condition that the fillings fell out and there was nothing they could do as they had used up all of their coverage. Jason went to another dentist to see what he could do, and was told that his teeth were in such poor condition that they needed to be extracted. An oral surgeon at Scarborough Grace Hospital accepted Jason, and extracted all but four teeth.
At the age of twenty-three, Jason has the smile of an 80 year old man. Why? Because he lives in Canada, and Canada is not willing to provide free dental care to those in need.

Why did we tell you about Jason? Because Jason was a young boy, brought into a family of low-socioeconomic status and was not given the care he needed. If Jason had been brought up in a wealthy family, he would have received braces and fillings as he needed them. His parents would have been able to afford a proper nightguard when he started grinding his teeth, and Jason would not have needed to have his teeth extracted at the age of 23.

Jason is not the only Canadian who had to grow up in pain as a result of limited access to dental care. MANY Canadian children live like this, and we need to do something for them. Dr. Stephen Adam's, spokesperson for the Ontario Dental Association says, "The association wants the ministry, along with the ministry of health, to increase funding so dental services can be offered in private clinics, the dental schools at the University of Western Ontario and the University of Toronto, and community health clinics. Prevention of tooth decay is a cornerstone of the ODA's proposal." Evidently, there is a desire for change, and many dental professionals are pushing for this.

Our next post will discuss the individuals involved in making a change to Canada's current oral health system. We will also take a peak into Jason's life and see how his story ends... Stay tuned!!

Bronwen P.

Welsh, Moira. (2007). Why is he out of work?. Toronto Star News. Retrieved from: http://www.thestar.com/news/2007/02/10/why_is_he_out_of_work.html

Importance of Dental Care for Children

Over the past few weeks, we have discussed the lack of access that children from a low-socioeconomic status background have regarding dental care. A question some may think about is why should it matter if a child, from any financial background, has dental care or not? The Canadian Dental Association has recommended that children should start visiting a dental office within 6 months of the first tooth coming in or by a year old. This recommendation was made to ensure that the parents have given adequate hands on teaching for brushing and flossing of their children's teeth. By starting dental care for children as early as 6 months old, the dental team, along with the parents, can be better equipped to begin preventative care against caries and other possible dental diseases. Another reason why dental professionals need to start seeing a child at such a young age is to allow the child to see that going to the dentist helps solve problems not create.

Some parents may feel that if their child has a cavity in his/her mouth there would be no point in filling it since it will fall out. The Canadian Dental Association remarks that when dentists advise for fillings to be done, it would best to do so. This recommendation is not only for the child’s oral health and potential pain but suggested because if the cavity is left untreated it may begin to affect the overall health of the child. The infected tooth may have to be removed because the decay had spread deeper into the tooth. This could result in needing a space maintainer, or other orthodontic appliances to prevent other teeth from shifting into the space required for the permanent tooth. These potential additional treatments could be more expensive to do than if the recommended filling was done.

The amount of times parents take their children to the dentist depends on the status of the child’s oral health. The more severe it is, the more frequent dental exams need to be and vice versa. If the parents’ dental plan only covers so much treatment care for their child, then it would mean parents have to pay any additional treatment needed out of pocket. Things get complicated when parents feel it’s too expensive and don’t have the means to pay. Programs listed in the previous blog entry only cover so much and is based on income of parents not the needs of their children. This gives parents limited options of what they can and can’t do for their child’s oral health.

Hawa S.

Reference
Canadian Dental Association. (2015). Your Child's First Visit. Retrieved October 31, 2015, from http://www.cda-adc.ca/en/oral_health/cfyt/dental_care_children/first_visit.asp

Current Programs in Ontario

Here are the main programs in Ontario that offer free dental care and below in italics, what they cover:

-Healthy Smiles Ontario (HSO)
Healthy Smiles will cover children based on low income and number of children.


-Ontario Works (OW)
Ontario Works will cover children under 18 for basic dental care if the parent(s) are unemployed and actively searching for a job.

-Assistance for Severely Disabled Children (ASDC)
-Ontario Disability Support Programs (ODSP)
ODSP and ASDC only offer dental treatment to families dealing with disabilities.

-Ontario Health Insurance Plan (OHIP)
-Children in need of treatment (CINOT)
OHIP and CINOT only offer emergency dental treatment for children.

We feel that Ontario needs a more comprehensive program so that no child is neglected.
It is important to have programs for emergency care and special needs; however, routine dental care is important to keep children healthy and reduce the financial burden of emergency dental care for families and society. All children should receive routine dental care. If the family can’t afford dental insurance, the province should have a program to help them, even if the parents are already employed and slightly over the bracket for Healthy Smiles. A comprehensive dental program in Ontario is desperately needed. There are too many children who suffer from oral disease and will be affected for the rest of their lives.

Marie S.


References:

Healthy Communities: Dental Health (CINOT). (2011). Retrieved October 23, 2015, from
http://www.mhp.gov.on.ca/en/healthy-communities/dental/

No-cost or Low-cost Programs. (2013, February 12). Retrieved October 23, 2015, from
https://www.healthunit.com/no-low-cost-programs

Ontario Works: Who can receive Ontario Works. (2012). Retrieved October 23, 2015, from
http://www.mcss.gov.on.ca/en/mcss/programs/social/ow/eligibility.aspx

Quiñonez, C., Locker, D., & Sherret, L. (2005). An environmental scan of public dental
programs in Canada. Retrieved October 23, 2015, from http://www.caphd.ca/sites/default/files/pdf/ON.pdf

Health Coverage, No Dental Coverage!

Health coverage, no dental coverage!
In Canada, incidence of dental or poor oral health related issues among people from low-income families keeps increasing each day. What are the causes of these incidences? It either due to lack of money, little or no coverage for dental procedure for people in low-income brackets. For instance about 6% of Canadians have dental coverage through government dental programs out of 35.16 millions Canadians (CAPHD, n.d). This leaves the remaining 94% to either seek their oral health care coverage through work|private insurance, direct payment and community|NGOs organizations. In particular with community and NGO’s that offer dental coverage for people in low-income families, there are some restrictions as to how much coverage one can receive. For example, a child from a low-income family needs to be a certain age range. With his or her parents making a certain amount annually, depth of the child’s case and sometimes location of parents. Despite the hassle of going through all these processes, there might still be some restriction as to what treatment they might offer.
According to the latest oral health component of the Canadian Health Measures Survey (CHMS):
• 62% of Canadians have private dental insurance
• 78% of respondents from the higher income bracket have private insurance coverage
• 53% of adults between 60 and 79 of age do not have any dental insurance.
50% of respondents from the lower income bracket do not have any dental insurance (CAPHD, n.d).
Hence my question is, if majority of the health care coverage in Canada covers almost everything. Why can’t the government include dental care into that coverage without any restrictions?
Currently, dental coverage in Canada, Ontario to be precise, is limited to people that fall under the low-income bracket.
For example, this is a dental coverage a family can receiver from Healthy Smile Ontario. (NOTE: IT’S BASED ON INCOME LEVELS AND NOT ON NEEDS).
Income level at which a family would qualify for the Healthy Smiles Ontario program
Number of dependent children in household Adjusted family net income
1 child $22,070 or lower
2 children $23,740 or lower
3 children $25,410 or lower
4 children $27,080 or lower
5 children $28,750 or lower
6 children $30,420 or lower
7 children $32,090 or lower
8 children $33,760 or lower
What the program covers
The program covers a full range of preventive and early treatment, including:
• Check-ups
• Cleaning
• Fillings
• X-rays
• Scaling. Table retrieved from http:\\: www.ontario.ca/page/get-dental-care. Under healthy smile.


To find out more about the dental coverage offered through government programs in Ontario and other provinces in Canada .One can visit the site below for further information.

http:\\:www.caphd.ca/programs-and-resources/government-dental-programs.

In summary, I ask the following questions:
1 Why do we as a country, have to put a limitation to an aspect of health coverage?
2 Why is oral health is not classified as important as the other coverage’s under the Ontario health insurance plan (OHIP)?

Nathalina M.
REFERENCE
Canadian Association of Public Health Dentistry(n.d).Government Dental Programs.Retrieved from http:\\www.caphd.ca/programs-and-resources/government-dental-programs.

History of Dental Care in Canada

If you knew that dental care was originally supposed to be part of the plan for free health care, how would that make you feel? In addition to this knowledge, what if I told you that we are currently running on a system that was developed by Medicare in the early 1960's, meaning all of its evidence to not include dental care is over 50 years old? Like you, these questions leave me slightly confused, and startled to be honest.

So why are we bringing history into this current issue of limited access to dental care for low-socioeconomic children? The answer is simple: History matters. If we look at the historical reasons for excluding dental care as part of the free health care plan for Canada, we can hopefully see why these reasons have ultimately had a negative impact on the health of Canadians, as opposed to a positive one.

According to Carlos Quiñonez, author of, 'Why was dental care excluded from Canadian Medicare?' there are five primary reasons for the exclusion of dental care: legislative, professional, socio-cultural, economic, and epidemiological reasons. Without going into too much detail, each area had specific reasons for not including dental care as part of Canadian Medicare (the plan for free health care). Legislatively, they decided that at the time, they needed to focus on the need for medical doctors and access to care. They certainly recognized the importance of dental care, but they felt that this need could be addressed at a later date. Dental professionals interfered with the addition of dental care as they believed that addressing dental issues at a young age would prevent the need for adults to need free dental care. In the 1950's, Dentists pushed for fluoridation in water not only as a preventive measure for dental disease, but to prove that dental disease could be controlled without the need of free care. However, it is important to note that dentists also pushed for this so they themselves could have control over their profession as opposed to the government. In addition to these reasons, the importance of oral health was already determined on a social level, and based on evidence from the United Kingdom, only 16% of the population took advantage of free dental care when it was implemented in the 1940s. Finally, it was determined that there was no epidemiological need for free dental care at the time as only 13% of children had untreated dental caries, and the need for dental care in the future was disregarded.
Despite the reasons for the exclusion of dental care from the Canada Health Act developed from Medicare, I think it is fair for all Canadians to question why we are still implementing a Health Care plan developed fifty years ago. Of course we all enjoy the advantages of having free health care, but even the general population is aware of the growing rates of dental disease in both adults, and children.

If we know that oral health is a component of overall health, then we need to push for free dental care. Insurance coverages and provincial programs are not enough. There are still Canadians suffering from the effects of dental disease, and it is absolutely essential that we do something about this not only for today, but for our future.

Bronwen P.

References:

Quinonez, Carlos. (2013). Why was dental care excluded from Canadian Medicare? Network for Canadian Oral Health Research. Retrieved from:http://ncohr-rcrsb.ca/knowledge-sharing/working-paper-series/content/quinonez.pdf

Oral Health in Children

BLOG 1
We are the Pearls of Wisdom, a 5 person group of student Dental Hygienists. Collectively, we have decided to share our voices and research on advocating for children in regards to Oral Care. Over the course of 10 weeks, this blog will be updated once a week with key research revolving around the need, both positive and negative, for access to dental care for those under the age of 18.
There have been many research studies conducted over the years showing a high rate of dental caries, cavities, in children from low socio-economic status. Anne Rowean-Legg from the Canadian Pediatric Society, stated that “Canadian children continue to have a high rate of dental disease, and this burden of illness is disproportionately represented by children of lower socioeconomic status, those in Aboriginal communities and new immigrants.” It has been reported that 57% of children from Canada have been affected by dental disease, averaging 2.5 teeth affected between the ages of 6 to 11 (Rowean-Legg, 2013). Despite this increase of dental disease in Canadian children, families of low socio-economic status have the lowest access to funding as dental care itself has limited funding.
The rate of dental disease in children here in Canada has risen drastically, yet is the lowest funded health care provided. The dental diseases are affecting more than their primary teeth, but can have a major effect on their permanent dentition. The research has proven the need for more access to dental care, for children 0-18 years of age, so why hasn’t the province, or country provided that care to our children? If we are able to recognize this need, how can the government continue to justify low funding? (Rowean-Legg, 2013).


References
Rowean-Legg, A. (2013, January 11). Oral health care for children-a call for action. doi:18(1):37-43 Retrieved from: http://www.cps.ca/documents/position/oral-health-care-for-children

Sharon L