Thank you very much.
My name is Paul Allison. I'm a professor at the Faculty of Dental Medicine and Oral Health Sciences at McGill University. Thank you very much for the invitation to present to this committee and to respond to your questions on the important topic of oral health and the introduction of the Canadian dental care plan.
Why is this issue so important? Dental decay is the most common non-communicable disease in the world. It is caused by sugar, and it's completely preventable. It results in pain, infection and thousands of people visiting hospital emergency rooms every year and taking time off work and time off school. It is the most common reason that young children in Canada need to have general anaesthetic.
As with many diseases, the poorest and most marginalized Canadians have much more dental decay than wealthier Canadians. At the same time, the poorest and most marginalized Canadians often have no dental insurance and cannot afford dental care.
This is why the CDCP is so important. There are many Canadians with oral diseases who cannot afford oral health care even when they are in pain. My example was dental decay, but gum disease is also very common. Many Canadians have missing teeth, affecting their ability to eat, to smile, to socialize and to work. On top of this, many seniors in long-term care centres who are unable to clean their mouths are at risk of catching pneumonia and dying because of accumulated dirt in their mouths. Also, rates of cancer of the mouth and throat are increasing in Canada.
Oral health is health. Oral health care is health care. It is very important that we put the mouth back in the body and reverse this historical anachronism. The CDCP is an excellent first step in this direction.
Among OECD countries, Canada has nearly the lowest level of publicly funded dental care, even lower than our neighbours to the south. The WHO recently published its global oral health action plan, stating, among other things, that countries should “integrate oral health care” in universal health care. Canada is now moving in that direction.
How can the CDCP help Canadians? It means that the poorest and most marginalized Canadians can obtain a good range of oral health care. It means that young kids can obtain timely care to prevent dental decay and not be subject to general anaesthetic. It means that seniors living in long-term care centres can be more easily visited by an oral health professional to have their mouths cleaned. It means that people at risk of mouth and throat cancer can be seen more regularly by health professionals who are experts in caring for the mouth so they can be diagnosed and treated earlier.
However, there are limits to the CDCP. While cost is the largest barrier to dental care, it is not the only one. The CDCP is an excellent first step in addressing cost, but it does not deal with other barriers. For instance, many seniors living in long-term care centres have limited mobility, and providing dental clinics and/or mobile dental care in those centres is important.
People with a broad range of disabilities have difficulty accessing dental care services that can accommodate their wheelchair, their hearing problem, their communication problem or their multiple other health issues, making their dental care complex. Also, many people live in rural and remote areas with no dental services and need both mobile dental care and teledentistry services, and care integrated with the other health services they receive.
Oral diseases have the same causes and occur in the same people who have a range of other chronic diseases, such as diabetes, heart disease, asthma, arthritis, cancer and dementia. These people often access community health centres for a range of health and social services. Dental care needs to be integrated in these community centres on a large scale.
An unfortunate unintended consequence of the CDCP has to do with university and college clinics, where dentists, dental hygienists and denturists are trained. They used to be primary sites for dental care for people who had problems accessing dental care, but the CDCP will mean that many of them will be able to access that care more quickly in private offices. The CDCP is inadvertently depriving future oral health care professionals of essential training opportunities. This issue needs to be urgently addressed.
What needs to be done to address the non-cost barriers?
We need to better integrate dental care with health care in community health centres, long-term care settings and hospitals. We need to better train oral professionals to care for people with more complex oral health care needs and to provide a broader range of services using modern technology in a broader range of settings.
We need to recognize that caring for a person with, for instance, Alzheimer's disease is more complicated and takes more time than does caring for a healthy adult. Alternative, additional compensation models for the professionals providing those services need to be developed.
We need to use the data that Statistics Canada is collecting to evaluate the new CDCP services so we can adjust them as needed. We also need to better integrate the university and college dental training programs into CDCP-related activities so they can train personnel appropriately in a range of settings and develop tests and evaluate programs to address the non-financial barriers to dental care that I have outlined.
Thank you very much.
