While important in the past, access to oral health care is now considered a critical issue with increased evidence that oral and general health are linked. These links include a correlation between periodontal disease and low birth-weight babies as well as a relationship between periodontal disease and cardiovascular disease, respiratory disease and even diabetes.
Although statistics on the oral health of Canadians are limited compared with information available in the United States, a number of studies indicate that oral health access issues need to be addressed. Surveys indicate a lack of accessibility for sizeable groups within the population at large.
Those with higher oral disease rates include individuals with low ‘socio-economic’ status; seniors, immigrants, people with disabilities and Aboriginal peoples.
A number of factors limit access to care: affordability; restrictive dental hygiene legislation; and a lack of coverage by private and public dental care plans. A 2003 position paper from the Canadian Dental Hygienists Association (CDHA) discussed access to oral health services and raised important points. While affordability is an important factor, one study done on a universal, publicly financed dental care program in Nova Scotia challenged this premise. Researchers pointed out that access alone does not eliminate dental caries. The CDHA recommends that provincial governments provide basic oral health programs for low-income Canadians.
On the subject of seniors, in spite of the fact that they have some of the highest rates of oral disease, they continue to be the lowest users of oral health care. According to the CDHA’s position paper, a staggering 75 percent of senior men and 83 percent of senior women do not have dental insurance.
This lack of coverage for women, who account for up to 75 percent of the institutionalized elderly, shows that the provision of oral health services, particularly in long-term care facilities (LTCF), is a serious women’s issue.
“Caregivers in LTCFs providing daily oral hygiene report that it is accorded a low priority for a number of reasons. Caregivers see oral care as invading an individual’s privacy; they view oral care as the most undesirable task over changing diapers, feeding and hair washing…”
Among its recommendations, the CDHA wants provincial governments to revise legislation to allow dental hygienists to provide hygiene services in LTCFs.
The CDHA position paper also revealed some startling, disturbing facts concerning rural, northern and Aboriginal communities.
“Canada, unfortunately, has long struggled with the challenge of providing access to health services, including oral health services, in its vast, sparsely populated areas and its report card in this area has very low marks.” One recent (year 2000) statistic shows the dental decay rates for First Nations and Inuit people in all age brackets range from three to five times higher than the non-Aboriginal population.
“Oral health is an important part of overall health and it is therefore critical that all Canadians have adequate access to oral health services. Dental hygienists… have a vital role to play in spearheading initiatives that will create a comprehensive system that resolves national oral health access issues,” says the CDHA document.