By Dr. J.M. Symington, BDS, MSc, PhD, FDSRCS and Mr. O.R. Perry, MSc
Over the next 20 years, Canada’s population will age profoundly according to Statistics Canada. In turn, this change will bring about significantly new clinical needs of Canadian dental patients and adjustments to the type and level of services provided by Canadian dental offices. This series of articles provide an overview of these changes.
Canada’s mid-term population prospects
Statistics Canada’s current mid-range forecast reports that Canada’s total population will grow from about 31 million in 2001 to 35.4 million in 2021.1 The population’s age groups will change fundamentally over this period. By 2021, there will be eight percent fewer children and students (up to and including age 24) than in 2001, 33 percent more “older workers” (those between age 45 and 64), 81 percent more retirees, and 56 percent more Canadians age 75 and over. The number of young workers between age 25 and 44, will stay the same over the forecast period. Figure 1 illustrates the growth and decline of certain dental groups from 2001 to 2021.
By 2021, 39 percent of the Canadian population will be between 45 and 75 years, compared to 31 percent today. The numbers of senior citizens will grow from 3.9 million in 2001 to 6.8 million in 2021.
Implications for Canadian dental care
Older dental patients need and purchase dental services differently from younger dental patients. In the past, the frequency of visits to the dentist peaks at mid-life, and spending on dental care peaks between 55 and 65 years.
The mix of dental services required also changes with advancing age. Among older Canadians, the number and value of restorative treatments will rise. These are primarily the long-term consequences of caries and associated co-morbidities such as hypertension, depression and arthritis.
The need for associated prosthodontics and periodontal treatment will also increase. This is reflected in Fig. 3, which shows how dental claims in large Ontario group dental plans were distributed by age and dental service in the early 1990s–the last data available.
Total spending on dental care among insured Ontario residents declined noticeably after age 55–primarily because coverage also declines at this age. Spending on diagnostic and preventive services actually declined with age, and restorative services were the major activities when dental spending peaked between ages 40 and 54.
From a clinical perspective, one of the most important outcomes of the aging population will be the increase in both the prevalence and incidence of root caries. Data from the U.S. indicate that the chances of a patient experiencing root caries can be calculated using this simple formula: the person’s age less 20 percent. In this regard, the first wave of the baby boom generation in Canada now has a 40 percent chance of caries at the root surfaces.
The influence of Canadian dental insurance in an aging population
Dental insurance, normally obtained from the employer, has become a major factor influencing Canadian dental visits. About 75 percent of Canadians with dental insurance report visiting a dentist regularly, compared with 45 percent of the non-insured.
In the late 1990s, participation in dental insurance plans declined from 64 percent for those between 35 to 44 years of age, to 21 percent for senior citizens. If these ratios of age enrolment in dental insurance continue to apply, in 2021 there will be 8 million Canadians age 55+ without dental insurance. Over the next few years, the uninsured retired Canadian could represent almost one out of four Canadians and also be the fastest growing part of the population.
In this context, it is important to the future of reimbursement for dental care in Canada to observe which and to what degree Canadian employers are currently providing dental insurance benefits to their retirees. The most recent data from the Toronto area presented in Table 1 indicate that much of the public sector (governments, teachers, utilities) extends dental insurance to its retired workers, while the private sector rarely does. As of 2003, of 100 Toronto employers, only 17 provide dental benefits to their retired workers.
CONCLUSIONS
While the Canadian population is projected to grow by 14.1 percent between 2001 and 2021, the number of dental visits in Canada can be expected to grow by only 9.8 percent, given a continuation of trends in dental participation observed in the 1990s. Canadian dental visits are likely not to keep pace with the growth of population primarily because older people use less dental service.
A bigger influence on the Canadian dental profession, however, could be the change in the range and type of dental services imparted by an aging Canada. In particular, caries, historically a focus of the profession in younger Canadian age groups, will become far more common on the root surfaces of older adults.
The number of Canadians with root caries is expected to grow by 50 percent from 2001 to 2021 and the majority of those affected by this chronic disease can be expected to have no dental insurance. In this scenario, by 2021, there will be more Canadians experiencing caries at the root surface, than there are children in Canada today.
Dr. J.M. Symington, BDS, MSc, PhD FDSRCS (England).
Mr. O.R. Perry, MSc.
REFERENCES
1.Sources used in this overview are cited in the Figures and Tables.
2.J. Leake, “Clinical decision-making for caries management in root caries”, in N.I.H. Consensus Development Conference, Diagnosis and Management of Dental Caries throughout Life, 2001, pp. 179 – 183.
