Groups of interested individuals and organizations working in partnership to increase knowledge about oral health and the need to improve access to care VON, Public Health Units, CHC, Long term Care Homes, Community Social Services, the Ontario Association for Public Health Dentistry, Dental professionals, general public including older adults. We cover a number of coalitions and groups from across Ontario
Clearly one’s entire life is affected by their oral health
Our overall vision is a system that allows for equitable dental care for all Ontarians
To advocate for a continuum of oral health for everyone from oral health promotion and disease prevention to timely access to care.
As an alliance (of various coalitions) we have a number of strategic actions which we use. These include: Creating awareness and educating the general public: that there is a problem accessing dental care in our community that this problem matters because poor oral health can have a negative impact on the health and well-being of the population, that the root of this problem is structural and cannot be solved by behavior change approaches alone (we cannot just tell people to brush their teeth more ) but rather our system must build supports that will help facilitate healthy oral health behaviors Some members of the alliance are part of coalitions that work on providing interim access to services: There are some coalitions that have done some very good work on fundraising to help pay for urgent or immediate dental treatment needs (usually very limited “one time only” resources). Although this strategy can help treat some people in need, it is NOT sustainable and is just a band aide solution. Example of how quickly funds are used (i.e. $5000 was used in 48 hours through the Kingston Community Health Centre) It is NOT acceptable to rely on donations and the pro bono work of dental professionals to solve this problem. Finally, we believe that one very important strategy that we could work on as an alliance is advocating to improve access to services by speaking with policy makers and government officials about the problem.
For too long the mouth has been excluded as part of the body. Example: When you walk into an emergency room with an injured arm you would get treatment but if you walked into an emergency room with an broken, infected tooth you would be told to go to your dentist for treatment (and may receive a prescription for a pain killer or antibiotic). (*speaker could insert their own example here*) As illustrated by the April 28 th , 2007 Toronto Star Article “Plunged Into Darkness” that describes the heart breaking story of the Oakville man who went blind because of an untreated infected tooth: infections in the mouth are treated differently (and ignored). As noted by Dr. Hazel Stewart (Toronto Oral Health Coalition), in this article, “People don’t realize that teeth are vital organs. If your finger was rotting away, you wouldn’t just sit there with it.” Unresolved dental issues lead to a host of other problems (This is also clearly illustrated in this article)
(*Each group or speaker may want to think of community stories to illustrate these inequities*) What do we mean by inequities? Our current system leaves many Ontarians without access to dental treatment Dental benefits that are available are not all sufficient (i.e coverage may not be 100% comprehensive) Emergency coverage alone is NOT sufficient Ontario Disability Support Program (ODSP) is centrally administered, while Children In Need Of Treatment (CINOT) and Ontario Works differ in each community (no standardized rules). This makes the system hard to use by people requiring the services and by the representatives from community organizations trying to help those who need services . The rules are complicated….making them difficult for even health professionals to understand The public needs to be made aware of these inequities.
Due to these kinds of inequities….Various barriers exist which prevent people from going to the dentist. Because oral health is so important and the poor oral health can negatively affect people’s overall health and the economy, increasing access to dental care is a priority. We will speak to all these issues in the following slides.
one third of residents of Ontario do not see a dentist on a regular basis There are many reasons that prevent people in our communities from accessing dental care. Some of these reasons include: Fear of going to a dentist, trouble getting to or finding a dentist, shame of seeing a dentist if on social assistance, or perception that going to the dentist is not that important (People relying on a financial assistance program to pay for their dental treatment may be more likely to miss their dental appointments for a number of reasons including transportation problems, not realizing the importance of getting the problem treated or because of the embarrassment of being labeled because of the stigma that is attached to those individuals with lower incomes.) And of course, since dental treatment is not a universal service in Ontario, and dental treatment is very expensive…cost is the most common & serious barrier
Importantly, dentistry is an example of the inverse care law which states that individuals with the greatest need for services will be those with the least ability to pay for services. So only people with dental benefits through their places of employment or those that are able to pay for services out of pocket can access dental services more regularly.
Despite this…. Not all Dental Insurance coverage is equal. If only 60% of Ontarians had OHIP it would not be tolerated Some people have partial dental plans which only cover a percentage of treatment (so some individuals may not be able to afford to pay the uninsured portion of their dental treatment) And some coverage is not comprehensive (i.e. does not cover a broad range of preventive and treatment services) So cost is still a barrier for many individuals who have insurance Plus, as already mentioned there are many barriers that prevent individuals from accessing dental treatment and care.
In the areas serviced by the HKPR District Health Unit (*different depending on health unit area…this information can be adjusted based on area or used as example of what is covered for a health unit close by*): Currently, children with urgent treatment needs up to their 13 th birthday (grade eight), are eligible for assistance through the Children In Need Of Treatment (CINOT) program administered through all health units in Ontario. *The government recently announced that the CINOT program will be extended in 2009 to include all children up to their 18 th birthday. Kids are eligible for CINOT if their families do not have any dental insurance , are not on social assistance and are unable to pay for dental treatment themselves The health unit also offers preventive dental services to children whose families do not have insurance and are unable to pay for it themselves And Children who are dependants of Ontario Works or Ontario Disability Support Program recipients are eligible for dental services included in the fee guide Even though it may seem like most children with urgent dental treatment needs have access to dental services there are a great deal of kids with cavities that do not have access to dental treatment… (*Insert your communities example here*) For example, in 2005/2006, 8.1% of children in the communities serviced by the HKPR District Health Unit were assessed as having cavities that weren’t serious enough to meet the criteria for CINOT. There are times that health unit staff must actually say “come back next year when the cavity is bigger” And some dentists put limits on the number of children they accept on CINOT or OW The main reason for this is that the reimbursement for dentists for treating OW, CINOT and ODSP patients is 57% of the current fee guide set by the ODA.…this is the lowest reimbursement of any province in Canada And…This percentage keeps decreasing, which will only limit access to care for more children.
There is no government program available for the general public! As for adults in the areas serviced by the HKPR District Health Unit (*each coalition can plug in their communities info here*) Young parents (aged 16 and over) and adults who are recipients of Ontario Works are each eligible for up to $500 in a calendar year for basic exams, extractions, and fillings that are required to “alleviate pain” or required to assist in their participation of the program ( for instance a client in need of dental work to assist in their ability to gain employment may receive coverage through social assistance) And … pregnant women who are recipients of social assistance are eligible for 100% coverage for cleanings and regular checkups up until a few months after giving birth Once again, the dental coverage that social assistant recipients are eligible for differs throughout Ontario
But unfortunately there is NO financial assistance program to pay for dental services for the Adults, older adults and families with lower incomes (including individuals and families with children that have partial insurance) As mentioned in an earlier slide, children whose parents are not on social assistance but have partial insurance coverage are not eligible for CINOT. And so a child may have a serious cavity that their parents cannot afford to pay for because they cannot afford to pay the uninsured portion of the dental treatment bill And many older adults have no coverage and cannot afford to pay for expensive dental treatment. There is no (formal) program to take care of this group.
(*each coalition can plug in any specific examples here*) PHYSICAL: Oral cancer is the eighth most common form of cancer and mainly affects men over the age of 40. And current studies have shown an association between the health of one’s gums and diabetes (stronger linkages) and have suggested links between gum disease and cardiovascular disease, respiratory disease and pre-term and low birth weight births. (HKPR website, CDA Position). PSYCHOLOGICAL and SOCIAL: The pain associated with dental problems can have a negative impact on one’s ability to eat, speak, sleep, and confidently fulfill everyday activities. The most common pain affecting daily life was toothache (associated with missed work) ( Matear D, Locker D. 2000) Economic- The pain associated with dental problems can lead to missed time at work, resulting in employers paying more in sick leave benefits. Poor oral health can make it difficult to gain employment (which would ultimately provide more opportunity for one to get insurance coverage that would pay for dental services)
This problem impacts people of all ages!
Early childhood tooth decay- A rapid type of dental decay, which affects preschool aged children and often impacts negatively on the quality of their lives. ECTD can lead to pain, along with troubled sleeping and eating habits. This in turn can play a causative role in ‘failure to thrive’, in which children demonstrate lower than average weight and height for their age. Although preventable, dental decay is one of the most prevalent chronic disorders to affect children (Matear D, Locker D. 2000). (*Insert local example here*) For example - according to the 2005-2006 statistics gathered by the dental staff from the HKPR District Health Unit during school screening, an average of 13% of junior and senior kindergarten students have experienced ECTD (over half of these had untreated ECTD).
This is an additional example of what can happen as a result of not being able to pay for dental treatment. http://www.washingtonpost.com/wp-dyn/content/article/2007/02/27/AR2007022702116_pf.html
An ideal example to point to when talking about adult’s who lack access to dental care is the story of Jason Jones, featured in the Toronto Star “War on Poverty” series article entitled: “Why is He Out Of Work?” Jason Jones Story (February 10 2007): After years of pain due to having a mouthful of decayed teeth 25 year old Jason Jones paid $600 to have some of his teeth extracted, but was left with 2 bottom teeth, both decayed and is still in pain. He is forced to eat soft food and due to his appearance he struggles to find employment. Jones, an Ontario resident, lost his teeth due to not being able to afford the cost of dental care and treatment and not having access to dental insurance. Another story to tell: “ Plunged into Darkness” Moses Han Story (April 28, 2007) Moses Han lost his eye sight as a result of an infected tooth that was left untreated due to not being able to pay for it. Now Moses and his wife, both Ontario residents, have lost their convenience store and are out of work. How will Moses support his family?
Example of an older adult’s story: Maureen is a 69 year old widow living in Ontario on a fixed income She did not grow up in a generation that valued preventive treatment and since her late husband did not have dental coverage she rarely visited the dentist She always did her best to take care of her teeth but without regular dental visits she now has periodontitis, an infection of the gums. She is socializing less (due to embarrassment of the condition her teeth are in and bad breath). And even though the Canada’s Food Guide recommends 5-12 servings of fruits and vegetables, Maureen has trouble biting into carrot sticks and apples as a result of the state of her teeth. Overall, because Maureen has an oral infection not only is her quality of life compromised but so is her overall health.
An example of gum disease in an older adult’s mouth (local Northumberland County resident)
Clearly something has to be done. As stated by Ontario Community and Social Services Minister Madeleine Meilleur ‘ it’s expensive. But it’s expensive not to do it”, referring to the need to establish a national dental care program for people on low incomes (Toronto Star, Feb 11, 2007).
Dr. Peter Cooney, the first ever Chief Dental Officer for Canada within Health Canada was appointed in Oct 2004. In addition to raising the profile of oral health, increasing the oral health of Canadians and preventing of oral diseases he is in charge of the oral health component of the Canadian Health Measures Survey, which will determine oral health of Canadians including inequalities in access to health care. The interest to advocate for increasing access to oral care is growing . (Here each coalition could list letters of support from specific communities) Volunteers exist throughout the province (for example dental clinics in Toronto like the SHOUT clinic are run by volunteer dental professional, Student clinics at Durham College or U of T offer lower cost dental treatment). Volunteer dental professionals are appreciated, however not universal or sustainable, just a band-aide solution.
In addition to the article ‘Why is he out of work’ referred to earlier, the Toronto Star’s War on Poverty series has featured numerous articles about the problem of access to dental care in Ontario.
A Toronto based task force called: Modernizing Income Security for Working-Age Adults- endorse the idea of expanding Community Health Centers to include dental care. ODA president – Dr. Don Russell endorses proposals to expand dental care in existing community health centers Ontario NDP:if elected plan to launch a $100 million public dental care plan for children and needy Ontarians, a program called “Ontario Smiles” a 4 year plan to create “community dental health teams” to deliver the service as a public health program in community health centres where available or other settings like schools, mobile clinics or long term care facilities. Ontario Liberals: will look at increasing funding to provide more subsidized dental care for children and low-income residents
In March 2008 the government of Ontario announced that it will work with professionals and community partners to deliver prevention and treatment services for low income Ontarians, especially children. The government has announced that in January 2009 the Children In Need Of Treatment (CINOT) program will be expanded to include children in low income families until their 18 th birthday. In addition, the government will work with public health units, community health centres and dental hygienists to deliver prevention and treatment services for low income Ontarians (ON Budget 2008: Chapter 1, Section C)
Our vision is an Ontario with equitable access to oral care for all.
While we know that $135 million dollars for three years will not be sufficient to reach this ultimate goal we are are encouraged to see that the current Ontario government has recognized the importance of oral health by taking the critical steps forward to begin to improve access to dental care for low income individuals
OOHA has established a model of recommendations that outlines how they think the money invested by the Ontario government should be spent.
OOHA has established a model of recommendations that outlines how they think the money invested by the Ontario government should be spent.
Community Health Centres (CHCs) are non-profit, community-governed organizations that provide primary health care, health promotion and community services, using multi-disciplinary teams of health care providers, social workers and form time to time volunteers in the delivery of services. These teams are paid by salary rather than through a fee for service arrangement. Offering basic dental treatment and preventive dental care within a CHC setting would provide low income families with a comfortable, non threatening place to obtain access to dental care. This would also help lessen the transportation burden faced by many families, as they can visit their local CHC once to get all their health needs met.
The Whole Tooth & Nothing But The Truth Presented to you by: The Ontario Oral Health Alliance
The Whole Truth Presented to you _________________ Insert your coalition here
Ontario Oral Health Alliance <ul><li>Geographic groups </li></ul><ul><li>Hastings </li></ul><ul><li>Prince Edward </li></ul><ul><li>Kingston </li></ul><ul><li>Northumberland </li></ul><ul><li>Ottawa </li></ul><ul><li>Peterborough </li></ul><ul><li>Toronto </li></ul><ul><li>Haliburton </li></ul><ul><li>Lennox & Addington </li></ul><ul><li>Halton </li></ul><ul><li>Organizations </li></ul><ul><li>VON </li></ul><ul><li>Public Health Units </li></ul><ul><li>Community Health Centers </li></ul><ul><li>Long Term Care Homes </li></ul><ul><li>Social Services </li></ul><ul><li>Ontario Association for Public Health Dentistry </li></ul><ul><li>Dental Professionals </li></ul><ul><li>General Public </li></ul>
Oral Health Defined <ul><li>“ A state of the oral and related tissues and structures that contributes positively to physical , mental and social well-being and the enjoyment of life’s possibilities , by allowing the individual to speak , eat and socialize unhindered by pain, discomfort or embarrassment”. </li></ul><ul><li>Canadian Dental Association – http:www.cda-adc.ca </li></ul>
Our Vision <ul><li>A system that allows for equitable </li></ul><ul><li>dental care for all Ontarians </li></ul>
Our Collective Mission <ul><li>To advocate for a continuum </li></ul><ul><li>of oral health for everyone </li></ul><ul><li>Oral Health Promotion & </li></ul><ul><li>Disease Prevention </li></ul><ul><li>Timely Access to Care </li></ul>
Strategic Actions <ul><li>Creating awareness </li></ul><ul><li>Educating general public </li></ul><ul><li>Providing limited interim access to services (band-aid solution) </li></ul><ul><li>Influencing government policy to improve access to services </li></ul>
Background Information <ul><li>One third of residents of Ontario DO NOT see a dentist on a regular basis ( Matear D, Locker D. Oral disorders, systemic health, well-being and the quality of life. Community Dental Health Services Research Unit. Faculty of Dentistry, University of Toronto; 2000) </li></ul><ul><li>Barriers exist that prevent many people in our communities from accessing dental care </li></ul><ul><li>Cost is the most common & serious barrier </li></ul>
Inverse Care Law <ul><li>Individuals with the greatest need for </li></ul><ul><li>services will be those with the least </li></ul><ul><li>ability to pay for services. </li></ul><ul><ul><li>Webb E. Children and the inverse care law. BMJ 1998; 316:1588-1591. </li></ul></ul>
Inequalities in Oral Care <ul><li>52% of Canadians and 60% of Ontarians have </li></ul><ul><li>some form of dental insurance </li></ul><ul><li>BUT… </li></ul><ul><li>Not all insurance plans are created equal </li></ul><ul><li> Matear D, Locker D. 2000 </li></ul>
Dental Care for Children <ul><li>Children (up to age 13*) from low-income families: </li></ul><ul><li>Urgent dental treatment (Health Unit) </li></ul><ul><li>Children (up to age 18) who are dependents of Ontario Works or Ontario Disability Support Program recipients: </li></ul><ul><li>Basic dental treatment </li></ul>
Dental Services for Adults <ul><li>General Public </li></ul><ul><li>No government program is available </li></ul><ul><li>Ontario Disability Support Program recipients </li></ul><ul><li>Basic care </li></ul><ul><li>Ontario Works recipients </li></ul><ul><li>Discretionary coverage only that may include: </li></ul><ul><ul><ul><li>Emergency care </li></ul></ul></ul><ul><ul><ul><li>Preventive care (expectant mothers) </li></ul></ul></ul>
A Serious Gap Exists for… <ul><li>Adults & Families earning minimum wage (including those with partial insurance) </li></ul><ul><li>Older Adults </li></ul>
The problem <ul><li>Unresolved dental issues lead to a host of problems: </li></ul><ul><ul><ul><li>Physical </li></ul></ul></ul><ul><ul><ul><li>Psychological </li></ul></ul></ul><ul><ul><ul><li>Social </li></ul></ul></ul><ul><ul><ul><li>Economic </li></ul></ul></ul>
Affect On A Child <ul><li>Pain & infection </li></ul><ul><li>A ‘failure to thrive’ ( Matear D, Locker D. 2000) </li></ul><ul><li>Negative impact on healthy development & readiness to learn </li></ul><ul><li>Long term impact on school success & success in life! </li></ul>
Early Childhood Tooth Decay Graphic used with permission from the Halton Region Health Unit
“For Want of a Dentist…” <ul><li>“ Twelve-year-old Deamonte Driver died of a toothache ... </li></ul><ul><li>a routine, $80 tooth extraction might have saved him” Washington Post, Wed Feb 28, 2007 </li></ul>
An Adult’s Story <ul><li>Jason Jones: </li></ul><ul><li>A mouthful of decayed teeth </li></ul><ul><li>Unable to eat solid foods and </li></ul><ul><li>Unable to find employment </li></ul>
Case Study Of An Older Adult <ul><li>Maureen’s story: </li></ul><ul><li>Fixed income </li></ul><ul><li>Problems chewing (eating properly) and socializing </li></ul><ul><li>General health compromised </li></ul>
The Lack of Access to Oral Treatment & Care = An Economic Burden on Ontario’s Society
A clear Need For Action… <ul><li>“ It’s expensive. </li></ul><ul><li>But it’s expensive not to do it” </li></ul><ul><li>As stated by Minister Meilleur, Ontario Minister of Community and Social Services (February 11, 2007, Toronto Star) </li></ul>
Some Examples <ul><li>Chief Dental Officer of Health (i.e. National Survey) </li></ul><ul><li>Coalitions & partnerships </li></ul><ul><li>Pro–bono work (cannot rely on volunteers to fix the problem) </li></ul>
The Toronto Star “War on Poverty” Series (2007) <ul><li>“ Why is he out of work” Feb 10 </li></ul><ul><li>“ Reader’s respond to a man’s plight” Feb 11 </li></ul><ul><li>“ Man ‘amazed’ by dental care offers” Feb 13 </li></ul><ul><li>“ Price tag to fix smiles: $2M” Feb 22 </li></ul><ul><li>“ Health minister silent on dental care” Feb 23 </li></ul><ul><li>“ Plunged into darkness” April 28 </li></ul><ul><li>“ He has a new smile; system still in decay” </li></ul><ul><li>June 23 </li></ul>
Toronto Star Headlines continued… <ul><li>“ Dental care should be an election issue, says coalition” July 3 </li></ul><ul><li>“ NDP set to unveil $100M dental program” July 10 </li></ul><ul><li>“ Dental care turns into a hot vote issue” July 11 </li></ul><ul><li>“ Liberals trump NDP dental announcement” July 10 </li></ul><ul><li>“ Liberals vow $45M for low-income dental plan” </li></ul><ul><li>Sept 5 </li></ul><ul><li>“ Poor to get dental plan” Nov 27 </li></ul>
Ontario Government Investment <ul><li>Investment of $135 million </li></ul><ul><li>over three years for a </li></ul><ul><li>Dental Program for </li></ul><ul><li>low-income persons </li></ul>
Ultimate Goal <ul><li>Equitable access to oral care </li></ul><ul><li>for all Ontarians </li></ul>
Small Steps Forward <ul><li>Ontario Government funding </li></ul><ul><li>is a critical first step forward </li></ul>
Equitable Dental Care for All <ul><li>All Ontarians should have FAIR & EQUITABLE access to PREVENTIVE DENTAL CARE & BASIC DENTAL TREATMENT </li></ul>
Equitable Compensation <ul><li>FAIR & EQUITABLE compensation for dentists must be addressed to facilitate FAIR & EQUITABLE access to services </li></ul>
OOHAs recommendations <ul><li>Ensure ALL children have access to a basic dental program </li></ul><ul><li>Offer basic dental services to priority groups one at a time: </li></ul><ul><ul><li>Pregnant women </li></ul></ul><ul><ul><li>Low income individuals, seniors and families </li></ul></ul><ul><ul><li>Include coverage for children whose families have partial </li></ul></ul><ul><ul><li>insurance but are unable to pay the uninsured portion </li></ul></ul>
Alternate Models of Service Delivery <ul><li>Include primary oral health care services within Ontario </li></ul><ul><li>Community Health Centres </li></ul><ul><li>(existing and soon to be established) </li></ul>
Continued action from all levels of government is NECESSARY to guarantee a BASIC level of oral health for ALL Ontarians.
The Ontario Oral Health Alliance Partners Shaping the Smiles of Ontario ~Everyone Has The Right To A Healthy Smile ~