The State of Oral Health in Canada

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The State of Oral Health in Canada

The State of Oral Health in Canada

Contents

Executive Summary..............................................................................................................3 Oral health: A global perspective...........................................................................5 Oral health in Canada compared to the world.....................................................................................................................................7 A snapshot of oral health in Canada ..................................................................10 Dental usage in Canada...................................................................................................12 Dental health services in Canada..........................................................................13 Publicly financed oral health programs in Canada.............................................................................................................16 Provincial public oral health programs.............................................................17 Vulnerable Canadians and the need for targeted oral health programs ...........................................................................................................18 The Canadian Oral Health Roundtable ........................................................21 The CDA: Working to improve access to care...........................................22 Access-to-care initiatives by provincial dental associations.................................................................................................................23 Volunteerism by Canadian dentists.....................................................................26

? March 2017 Canadian Dental Association

Executive Summary

The State of Oral Health in Canada

Good oral health is essential to overall health and quality of life. Good oral health enables us to speak, smile, breathe, drink, and eat. The oral cavity also plays a central role in the intake of basic nutrition and protection against microbial infections.

As the national voice for the dental profession, the Canadian Dental Association (CDA) is pleased to present this overview of oral health in Canada. In the following pages, you will find insights and information on:

the state of oral health around the world;

how Canada compares against other countries;

information on funding models, statistics on dental usage and access to oral care;

key trends;

priority areas for improving oral health;

programs being spearheaded by provincial dental associations and more.

Based on a wide range of metrics, we can state definitively that Canada is among the world leaders when it comes to the overall oral health of its citizens. In addition to ranking favourably in terms of oral health indicators such as decayed, missing and filled teeth (DMFT), severe chronic gum disease and instances of oral and lip cancer, Canadians also enjoy among the best access to oral health care in the world. Three out of every four Canadians visit a dental professional at least once per year, and 84% of Canadians believe they have good or excellent oral health. In Canada, wait times to see a dentist and receive treatment are among the shortest in the world. And for most Canadians, choice and availability of dentists is a non-issue.

However, there is still work that needs to be done in order to improve the state of oral health in Canada for specific groups. Like many other countries around the world, Canada faces challenges providing the most vulnerable segments of its population (e.g. seniors, low-income populations, people with special needs, children, Indigenous peoples, new immigrants with refugee status, etc.) with the oral health services they require. Research indicates that poor oral health is experienced by those Canadians who do not have access to regular dental care. In the following pages, we outline some of these challenges, along with work being done to address them.

Canada is among the world leaders when it comes to the overall oral health of its citizens.

Oral health: A global perspective

Oral health has been recognized as a basic human right.

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Oral health: A global perspective

Oral health: A global perspective

What is oral health?

The World Health Organization (WHO) defines oral health as a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss and other diseases and disorders.1

According to the FDI World Dental Federation, oral health is multi-faceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow and convey a range of emotions through facial expressions with confidence and without pain, discomfort and disease of the craniofacial complex.2

Oral health disease worldwide

Worldwide, the most common oral diseases are dental caries (cavities, decay), periodontal (gum) disease, oral cancer, oral infectious diseases, trauma from injuries and hereditary lesions.3 Around the globe, 60-90% of school-aged children and nearly 100% of adults have tooth decay.1,2,3 In fact, dental caries (which includes all stages of tooth decay) is the most common, yet preventable, chronic disease on the planet and constitutes a major global public health challenge.

In Canada, an estimated 2.26 million schooldays are missed each year due to dentalrelated illness4 and tooth decay accounts for one-third of all day surgeries performed on children between the ages of 1 and 5.5

In the United States, a child is five times more likely to seek emergency room treatment for dental problems than for asthma, often because they are unable to see a dentist, are uninsured or cannot afford routine dental care and half of all children enter kindergarten with tooth decay.6

The accompanying chart (Table 1) shows the worldwide prevalence and ranking of various oral health and other conditions:

Table 1.

Oral health condition

World prevalence

World ranking of disease in prevalence

Untreated decay (caries) of permanent teeth

35% of population

1st

Severe periodontal (gum) disease

11% of population

6th

Severe tooth loss

2% of population

36th

Oral cancer

1 to 10 cases per 100,000 people

-

Other conditions

Tension-type headache

21% of population

2nd

Migraine

15% of population

3rd

Low back pain

9% of population

9th

Diabetes

8% of population

Asthma

5% of population

Source: Global Burden of Disease 20107

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Oral health: A global perspective

The economic impact of oral diseases

Across OECD countries, on average, 5% of total health expenditures originate from treatment of oral diseases.8 Direct treatment costs due to dental diseases worldwide have been estimated at US$298 billion yearly, corresponding to an average of 4.6% of global health expenditure. Indirect costs due to dental diseases worldwide amounted to US$144 billion yearly, corresponding to economic losses within the range of the 10 most frequent global causes of death. The global economic impact of dental diseases amounted to US$442 billion in 2010. Overall improvements in oral health may imply substantial economic benefits, not only in terms of reduced treatment costs, but also because of decreased productivity losses in the labour market.9 Recent findings suggest that oral diseases account for productivity losses of over $1 billion per year in Canada alone.10

Priority areas for improving oral health

While oral health has been recognized as a basic human right by numerous dental and public health organizations internationally, more than 70% of the world's population (mostly in low- and middle-income countries) are in need of appropriate and affordable oral health care.11 Poor oral health results from a number of factors, including a lack of resources, oral hygiene habits, oral health education and accessible oral health care.12

The WHO has identified priority areas for countries to consider when initiating or strengthening oral health programs.13 These include:

Effective use of fluorides for the prevention of dental caries, Oral health and prevention of oral disease through a healthy diet, Control of tobacco-related oral disease by involving oral health professionals in

tobacco cessation, Oral health promotion in schools, Oral health improvement in the elderly through health promotion and older

adult-friendly primary health care, Integration of oral health into national and community health programs, Development of oral health systems and orientation of services towards prevention

and health promotion.

A recent study found that oral health is a major public health problem in Europe and that oral diseases have considerable negative impacts on the quality of life of populations.14 The study indicated that, `vulnerable and lowincome groups as a whole receive oral health care services less frequently than the general population and more so for emergency situations when in pain, rather than for preventive care'.

The conclusion of the review of dozens of public health programs across European countries was that in the case of oral health, investment in simple preventive programs is cost-effective and that 'solving the problem of poor oral health in Europe does not require an entirely new policy in every case or a reinvention of the wheel'. 14

There are many programs in place to address the oral health inequalities for vulnerable groups, with new models and approaches to care being introduced and explored on an ongoing basis.

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Oral health in Canada compared to the world

Oral health in Canada compared to the world

When considering access to oral health care for entire populations, statistics show that Canada has among the best access to oral health care in the world (Table 2). These figures also reveal that all countries face similar challenges with regard to access to oral health for the poorest segments of society, regardless of whether oral health care is publicly or privately delivered.

Table 2: Percentage of population visiting dentist in past year

Poorest

Average

France ?

63.9

74.9

Czech Republic

50.3

71.0

United Kingdom

58.1

68.8

Slovak Republic

47.6

68.8

Canada

46.5

64.6

Austria

51.6

61.0

Finland

51.3

58.6

Belgium

39.8

58.1

Slovenia

42.6

56.1

New Zealand

43.8

51.2

Estonia

31.0

48.0

Spain

34.5

44.9

United States

26.2

42.4

Poland

26.8

42.3

Hungary

28.1

37.5

Denmark ?

28.1

35.3

Richest 82.3 77.8 74.5 76.3 78.5 70.2 68.5 69.5 64.4 59.8 55.8 57.8 56.9 54.6 50.5 40.0

1. Visits in past 2 years. 2. Visits in past 3 months. Source: Health at a Glance 2011, OECD Indicators, 2011.15

One key oral health measure for comparative purposes is the decayed, missing and filled teeth (DMFT) index measure. This represents the number of decayed (D), missing due to caries (M) and filled (F) teeth (T). There are no other well-established and universally accepted measures of oral health.16 The DMFT is usually measured in 12-year-olds and compared internationally. Recent DMFT data from Canada indicate that 38.7% of 12-year-olds had one or more permanent teeth affected by caries and the mean DMFT was 1.02.17 This measure is better than the OECD average, which was 1.6 in 2006. It also compares favourably with other DMFT scores for 12-year-olds from most OECD countries (Table 3).18

The FDI World Dental Federation has developed a comprehensive world health atlas, comparing select oral health indicators. Canada ranks favourably in terms of low DMFT scores (0.0-1.1 DMFT range), low prevalence of severe chronic periodontitis (less than 10% of the population aged 15 and over), moderate incidence of oral and lip cancer (2.5-4.9 per 100,000 people).19

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Oral health in Canada compared to the world

Canada also ranks on the low end of the scale in terms of the proportion of the population and of seniors who have no natural teeth, a condition known as edentulism.20,21,22 This is an important measure, since the loss of all natural teeth

Table 3: 12-year-old DMFT Comparison of OECD countries

Country

DMFT 12-year-olds

Germany

0.7

can lead to changes in eating patterns,

United Kingdom

0.7

nutrient deficiency and involuntary weight

loss, as well as speech difficulty (if left

Sweden

1.0

uncorrected). In 2010, approximately 6% of

Canada

1.0

the Canadian population aged 20-79 had

Australia

1.1

no teeth and 22% of the population aged

Finland

1.2

60-79 had no natural teeth.17

France

1.2

These findings demonstrate that Canada compares favourably to other similar industrialized OECD countries in terms of

United States

1.3

OECD Average

1.6

New Zealand

1.6

the overall oral health of its population.

Norway

1.6

What Canada has in common with every

Japan

1.7

other industrialized country, however, are

Source: OECD Health at a Glance

the challenges faced by the more vulnerable

segments of society who, face difficulty

accessing appropriate and timely oral health services.4,5,17,23-35

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