Read the audio transcript below:
Dr. Luisa Schult (LS): Hi everyone. Welcome to Brush Up, presented by Oral Health Group, the dental podcast where we speak with industry experts to discuss a variety of topics such as technology, finance and practice management. I’m your host, Dr. Luisa Schult, a prosthodontist and periodontist based out of Fonthill, Ontario. Today we’ll be discussing public health with Dr. Sanj Mohanta. Welcome! Sanj is a general dentist who graduated from the University of Toronto in 1999 and practices general dentistry in Brampton, ON. Welcome again, Sanj. It’s so nice to have you here and to be able to talk about a topic that I think is really on everybody’s mind right now. Public health and the new dental care program.
Dr. Sanj Mohanta (SM): Thank you so much, Luisa. I’m pumped to talk about public health. Let’s go.
LS: Why did you get into this topic after being in private practice and having graduated from U of T? What piqued your interest?
SM: Actually, it was my son who was four years old at the time. One day I was going to work and he’s like “Mommy, where are you going?” And I said, “Going to work.” And he said, “Why are you going to work?” And I said, “To make money” and he said, “Is money more important than us?” And I was like, oh, I guess he could tell that I wasn’t happy in private practice. And I shouldn’t be going to work for money. This is a career; this isn’t my part-time high school babysitting job. And I thought if I’m going to leave my kids, where I’m their only mother, I have to leave them for people who need me more than they do. And I remembered in dental school at U of T, my favorite thing was working at the public dental clinics in Toronto because that’s where you could really make a difference. I was their first dentist. They were scared. They often didn’t speak English. And I got them to trust me and I got to teach them how to take care of their teeth. And I got to teach them that they were worth it. And it’s like, that’s what I should do. I should work in public health. So the next day, I looked at a dental journal and there was an ad for one public health position job. And I got it. And I’ve been in public health ever since.
LS: That’s a really amazing story, Sanj. Everybody talks about how much our time is worth, how much the effort we put into our day-to-day is worth. And just having that impact on some patients’ lives is invaluable. That’s amazing. How have you found it different, other, of course, than fees and income. What’s so different about public health and private practice?
SM: I love working in public health because I get to focus on the patient. I get to focus on prevention like in dental school. I just felt a disconnect. I’m like what’s going on here? Why is it that we’re spending so much time taking teeth out and studying that? Shouldn’t we be studying how to keep the teeth in the mouth? Isn’t that the endpoint? And when I was in private practice, it was more focused on profit, more focused on operative dentistry, whereas in public practice, I get to focus on the patient, not just their mouth but their whole being. I get to focus on their social determinants of health, which is their food security, their housing security, their employment status, their citizenship status, how that all affects their oral health. So I get to spend time with the patient getting to know them, spend a lot of time on oral hygiene routines, on diet counseling, and it’s very basic dentistry because of the schedule of services. At my clinic, we see children on Healthy Smiles Ontario and the Ontario Seniors Dental Care Program. So kids and seniors. And we’re not doing ortho and veneers, but basic services doesn’t mean it’s low end services. It’s actually the most important services because we’re getting people out of pain and we’re keeping those teeth in the mouth. My favorite dental procedure is Baby’s First Dental Visit. And people are like, you’re not doing anything. And it’s like, we’re doing everything, because we’re establishing those great health routines for life. So the schedule of services is different. The types of patients we see are different because you’re seeing a very specific group that qualifies for the program reimbursements different. So, I get a salary, pension, benefits, fixed hours. Just I do work one evening a week. I work some Saturdays. It’s a flat hierarchy at work, so we’re all equal and I like that as well because it’s an amazing team. And I just like helping the people who need it the most, the people who can’t get dental care anywhere else.
LS: That’s amazing. I think so many people who enter the area of healthcare enter for the exact reasons you are describing. We go into it wanting to have an impact on people’s lives, help people feel better, be healthier. And then we in private practice are in this duality of trying to balance having a business or supporting a business and trying to do the best by our patients, and that can be really challenging and you’ve eliminated one of those barriers. Truly focusing on patients’ well-being. That’s really sounds very fulfilling for you.
SM: Yeah, I love it.
LS: How do you feel that this new Federal Dental Care Program is going to impact – so, I’m going to go into a little bit of a wider scope – how do you think it’s going to impact patients in general, in Ontario, your own practice, and potentially some of the private practices around you?
SM: First of all, I love the fact that everyone’s talking teeth, that we have this new Canada Dental Care Program. I have to tell you a little back story. I’ve been advocating for improvements in public health programs for years. Jagmeet Singh used to be my MPP and I used to go to his office regularly in Brampton and at Queens Park. And I had petitions to improve the public dental programs and to the point where, I mean, any time you saw me, you’d be like, oh Doc, I know what you’re going to say. You’re going to talk about how we need better dental programs. Let’s just talk about something else. So I thought he didn’t care. But then when he became the national leader of the NDP, he started talking about dental care, and it’s because there are so many people who fall through the gaps. There are public programs, there are private programs, where there’s so many people who don’t qualify for either, so they’re not getting dental care. They’re living with pain. So, the way it’s going to impact Canada is it’s going to make Canadians healthier. The way it’s going to impact our practices is we’re going to see more patients and we’re going to see less oral disease, which is fantastic. We’re going to see that financial barrier eliminated for the majority of people, but, unfortunately, it’s not going to help everyone. So it’s going to be a huge benefit. We need to make sure that the program is sustainable, but it looks like it’s heading that way. So, I’m really looking forward to it.
LS: Just before seeing what we were going to be chatting about today, I was looking at some numbers. You know, those coincidences in life. And I was looking at the thousands of patients that go to emergency rooms, looking for pain management and support for infections, that could potentially be completely preventable. And be less of a burden on our healthcare system. And I think the number of patients visiting family physicians was like 200,000 a year searching for relief, because that is covered by our OHIP and dental care is not. And physicians and dentists, we don’t do the same thing. They only have limited options in how they can support patients. These patients need dentists.
SM: Yeah, it cost the healthcare system $500 every single time someone goes to the ER for a dental visit, and no treatments being done. They’re just getting a prescription. So might as well put that money into, you know, the dental care program.
LS: What barriers remain, even with the support that our patients are receiving with the Federal Dental Care Program? What other barriers are there?
SM: Now, the financial barrier is the number one barrier, so that’s good that in most cases, for most people, the Canada Dental Care Program will address that. But the other thing is accessibility. Can people even get to the dental office? Last month I worked in a remote area in Northern Ontario, Sachigo Lake, First Nations community. It’s a fly-in community of 500 people. So, they don’t have a dentist. They fly in a dentist, you know, once every couple of months. So, if someone’s in dental pain, they have to get on a plane to go to a dentist. So, accessibility is huge.
LS: Language as well.
SM: Yes, language. So, you know, acceptability. Can you speak the language? Are you available the times that I need you, can I get to you? How about mobility issues? How about other things I need like maybe I need a lot of other people in the room with me. Do you accept that in your office? If there are a few steps to get to your dental office, can I get up those few steps? Or how about I’m part of a marginalized community? Do I feel comfortable going to your office? Do I feel like it’s an accepting office? So yeah, there’s so many other issues.
LS: And fear, I think, is another barrier, which hopefully seeing babies really early on, we can create a different environment and a different relationship with our patients.
SM: Yes. good point. Yeah. Fear. The dental anxiety is a barrier as well.
LS: What more do you think we can do in Canada to help accessibility and more access to care in addition to what is starting now with this new Federal Dental Care Program? What more should be done?
SM: Yeah, it’d be great if every single person could access a dentist whenever they want and not have to worry about money. I would say, let’s prevent the need to even have dental services. So having more Baby’s First Dental Visits. Baby’s First Dental Visits should be free anywhere so that way we can instill those good oral hygiene habits. Good health, good dietary habits at a young age, establish a dental home, increase the responsibility for oral health community, water fluoridation, sugar tax, so that way people are encouraged to buy healthier foods, and to make healthier foods cheaper. And, of course, there’s a social determinant of health, so it’s not just teeth. You have to think, the better the economy is, the more people feel safe in their community. Food security, housing, security, employment, all those things actually improve oral health.
LS: Well, we can’t forget that our teeth – it’s part of a human being. It’s part of a person that is complex and has many other issues that need to be addressed. I really love how much you’re talking about prevention. It is the number one thing that can help make dental care more sustainable. What options do people who want to do more to serve their community, who want to participate, whether it’s part time or full time in public health, what resources do dentists have?
SM: Yeah, you don’t have to be a public health specialist or work in a public health clinic to do public health. Public health means you’re just thinking about what you can do to improve the population in general, instead of just focusing on an individual. So, whether it’s advocating for community water fluoridation, fluoride varnish programs at the school, having those Baby’s First Dental Visits. So one of the things people can do in their own offices is just to advertise the fact that they do free Baby’s First Dental Visits, and then we also have to help the people who can’t afford dental care. So doing things like accepting public dental programs, participating in the New Canada Dental Care Programs, and signing up for it. Doing free dental days at your offices, providing payment plans or discounts at your offices. And the social determinants of health, supporting those things that help your oral health. You could do food drives at your office to support food security and having a lot of prevention in your offices. So, spending the time doing oral hygiene instruction, dietary counseling. It can be as simple as every single time a patient comes in, ask them, “Hey, did you brush your teeth today? What did you eat for breakfast? Are you flossing? OK, why not? Do you want me to show you again how to floss? Is there another aid do you want me to use?” And harm reduction. If someone’s drinking pop all the time and they can’t stop, say OK, you can’t stop. At least do things that will prevent harm on your teeth, like decreasing the frequency and duration of that pop, things like that. So harm reduction and being very understanding of all the different things that affect oral health, like encouraging someone to finish their high school credits, encouraging someone to eat healthier. All of those things will improve their oral health.
LS: To me it sounds like just being an active participant in our communities with our patients, with our team members. I know the Ontario Dental Association supports public health with the Oral Health Month which I think is that April of every year? Yeah, there’s lots of opportunities there and I know the different associations are always looking for volunteers, and that might be a short-term commitment, where schools are visited or each district has its own projects. But having an opportunity to work with our local associations and be part of that.
SM: Yeah, I’m part of the Halton Peel Dental Association. So, every year we do Smile Days where we do free dental days at private offices. And we also do presentations to classrooms and seniors’ groups.
LS: Oh, that’s great. The seniors are an often forgotten group on Oral Health Month. Oh, that’s amazing. Here in Niagara, most of the time we do visits to women’s homes, schools.
SM: Oh, that’s great.
LS: Yeah, EarlyON Centres. Teach about brushing, give samples, some kids activities to make the whole concept of just dentistry and teeth more fun. It’s something that they want to be involved with.
SM: Oh, that’s fantastic.
LS: Are there any other bits of tips and tricks or tools you’d like to let us know that are maybe happening in the area of public health?
SM: Yeah. I’d really like to advocate that people use silver diamine fluoride. It’s not just for kids. You can use it on adults as well. It’s used to arrest carries. It also decreases sensitivity. So, you can use it on those early carious lesions or carious lesions that are hard to reach or for young children, where general anesthesia, is maybe something that parents don’t want to do, or it’s takes a long time for them to get an appointment for general anesthesia. Silver diamine fluoride.
LS: You’re mentioning the seniors as well. For some of them it might be a really great, easy as possible option.
SM: Yeah, yeah. If you’re medically compromised, where you can’t do the dental care or, you know, it’s underneath crowns, bridges, root carries, to use silver, diamond fluoride.
LS: It’s a great tool. It also breaks one of those barriers of fear. It’s not as invasive or painful or painstaking time wise, less time in the dental chair. Lots of benefits for our patients.
SM: Yeah, I agree.
LS: And you were mentioning the team you work with at the Public Healthcare Centre you are at. I’m assuming you have a team of multiple hygienists and assistants. What are their participation in these different steps or parts of preventive care?
SM: Yeah. So, we have a denturist as well. So yeah, the great thing with silver diamond fluoride is that dental assistants, hygienists, and dentists can use it.
LS: I assume that your dental hygienist work…you know, you were saying you work as a team alongside you with the education portion and getting those relationships with the patients.
SM: Yeah. So, what we do is we do oral hygiene right in the mouth. So instead of throwing them on a model, do it right in the mouth and then we give them the toothbrush, we give them the floss and say, “Okay, now you show me.” So, if we see that they’re struggling with a manual toothbrush, then we’ll say use a power toothbrush. We see they’re struggling with the floss, it’s like, okay, use the floss stick or use a water flosser. So that way we know that they’re going to be able to do their own oral hygiene at home. And we do a lot of harm reduction. We do a lot of pairing of habits. So, someone says I don’t have time to brush my teeth. It’s like, okay, well, why don’t you stick the toothbrush in the shower and brush in the shower? Or why don’t you just have some floss sticks out by your iPad, and when you’re watching a video, you can floss your teeth as well?
LS: So again, trying to find those barriers that are making it difficult for patients to keep up with things that are going to help them in the long run. You were mentioning how easy it is to sign up for the new Federal Dental Care Program. There’s an e-mail sent out to dentists. Do you know how long it is or how much of a time investment it is to set that up? What advantages or challenges there are for the dentists in getting set up for it?
SM: Yes, so it is voluntary for dentists to take part in the Canada Dental Care program. So, there’s going to be a simple sign up process. It’s going to be administered by Sun Life. And we’ll be able to do electronic claims transmission through CDA. The patients will have a card just like people with private benefits will have a card with all their information, so we know they’re eligible for the program. And it will be a coordination of benefits with any provincial dental public programs that they’re on and people who are on private dental programs won’t be able to qualify. So, the good thing is that they’re designing the program to protect the private dental programs. And it’s going to be in full force in 2025. So, this year all they’re doing is they’re gradually signing up people to be part of the program. And then this summer of 2024, that’s when seniors, youth and people living with disabilities will be able to use the program and then next year it will open up to other adults. So, it’ll be very similar to seeing people who are on private dental programs. They’ll just be a different schedule of services, a different fee schedule. And we’re hoping that dentists get reimbursed at 100%, not only to make sure that dentists sign up for the program, but we want to make sure it’s sustainable. Because dental offices are small businesses and they need to be profitable because if they’re not, they’re not going to be able to provide services to anyone. So, we need these public dental programs to have a much higher reimbursement rate than the current ones.
LS: It sounds like there’s at least an attempt to try to make this streamlined, easy, similar to how we do other things, and, as you mentioned, profitable enough that the services can be provided. Well, thank you so much for your time. It’s been a really great conversation. I’ve learned so much from you and I’m feeling even more motivated to do what we do every day.
SM: Great. Thanks, Luisa. It’s been great chatting with you and thank you to all the listeners.
LS: Thank you so much for listening. Be sure to subscribe on Spotify and follow us on social media to be notified every time we post a new episode. Keep brushing up!