Your smile starts with * *TM Reg’d Colgate-Palmolive Canada Inc. A Joint Venture supplement with the Canadian Dental Association ORAL HEALTH Dr. Alfred Dean, president of the Canadian Dental Association, looks over x-rays with five-year-old patient Darcy Williams of New Waterford. The CDA is promoting a variety of health intiatives designed to promote good oral health for Canadians throughout their lifetimes. JV1 NATIONAL POST, MONDAY, APRIL 4, 2005
Transcript
Your smile starts with *
*TM Reg’d Colgate-Palmolive Canada Inc.
A Joint Venture supplement with the Canadian Dental Association
ORAL HEALTH
Dr. Alfred Dean, president of the Canadian Dental Association, looks over x-rays with five-year-old patient Darcy Williams of New Waterford. The CDA is promoting a variety of healthintiatives designed to promote good oral health for Canadians throughout their lifetimes.
JV1 N A T I O N A L P O S T , M O N D A Y , A P R I L 4 , 2 0 0 5
J O I N T V E N T U R EJV2 NATIONAL POST, MONDAY, APRIL 4, 2005
Canada faces a challenge of unprece-dented proportions, says Dr. AlfredDean, president of the CanadianDental Association (CDA). Its goalmoving forward into this centurymust be to forge links betweenprivate dental care and public healthcare delivery. Only by working as ateam can dentists, physicians,researchers and, in fact, all healthcare professionals overcome thestaggering array of obstacles thatstand between the average Canadianand ongoing good health.
“There is growing acceptance that oral health is directly linked tooverall body health,” he says. “Yet wepersist in treating each as separateand unrelated entities. If Canada istruly to become among the healthiestnations in the world, we have torecognize that two systems, whichhave so long operated in parallel,must now forge links and addressoverall health care.”
Neither Dr. Dean nor the CDAadvocates a publicly funded dentalcare system for Canada. Instead,they are pressing for a new model,where dental care is given its rightand proper place in overall healthcare policy and programs, wheredental care is assigned a fair shareof research dollars, where Canada’s10 university dental schools areproperly funded and expanded tomeet perceived need, and where allCanadians, regardless of age andeconomic circumstances, haveaccess to both prevention programsand treatment.
“The importance of oral health tooverall health has been overlookedfor decades,” Dr. Dean says. “And yetCanadians have been enormouslywell served by the private dentalcare system. Times, circumstancesand demographics have changed,however.
“While in the 1970s and 1980s weappeared to have almost eradicateddental cavities, they are now makinga comeback. One-third of Canadiansreport bleeding gums when theyfloss, a sign of potential gum disease.Gum disease, in turn, has beenlinked by researchers to cardiovas-cular problems.
“Increasing numbers of childrenare reporting serious dentalproblems, serious enough to requiregeneral anesthesia. Finally, Canadafaces a huge growth in its populationof seniors. They will require care and support we simply are not in aposition to give, currently.”
Yet right across Canada, there
are myriad points of light piercingthese clouds of concern. Projectsand initiatives have been launched,research undertaken and policiesdeveloped that give hope thatCanada’s 18,000 dentists can effectmajor change.
For example, this year, the federalgovernment named Dr. PeterCooney the country’s first chiefdental officer. His appointmentgives dentistry a seat at the policytable and a voice in favour ofincreased research and resourcesdirected toward oral health.
In British Columbia in earlyMarch, the provincial government, atthe urging of the British ColumbiaDental Association, announced aseries of new programs aimed atchildren. They include dentalscreening of all children before theyenter grade one, five new dentists forthe University of British Columbiaresidents program to work in under-serviced areas, a public
awareness program focused on early childhood dental decay and the treatment of genetic diseasesaffecting the mouth.
In 2001, a task force of the B.C.Dental Association produced areport focusing on severe dentaldecay among young children andidentifying a number of recommen-dations to address the problem. “InB.C., over 5,000 children a year aretreated under general anesthesia fordental problems, the majority due toextensive tooth decay; of these, 60%are under the age of four,” says Dr. EdO’Brien, president of the B.C. DentalAssociation.
“If we can reduce the number ofchildren affected through preven-tive measures, the government canrealize up to $10-million in savingsin the health care system, shortenwait lists for pediatric surgery and,best of all, give these kids thechance to be just that — kids, happyand smiling, free of pain.”
In Nova Scotia, researchers atDalhousie University’s dental schoolhave undertaken a range of researchprojects involving access to andaffordability of health care forseniors. The goal is to provideevidence-based analysis that willform the basis of policy and actionprograms, says Dr. DeboraMatthews, head of periodontics atDalhousie.
“We look on the research studiesbeing done here and the work onpediatric dentistry done in B.C. asbright lights,” she says. “They givegreat hope for the future.”
Turning those bright sparks intoblazing light of reform will requireinnovative and imaginativemeasures, says Dr. Susan Sutherland,chief of dentistry at Sunnybrook andWomen’s College Health SciencesCentre in Toronto.
“We have to start looking at anew hybrid model, where theprivately funded dental care
system intersects with publiclyfunded health care,” she says. “Thetwo systems should support eachother and treat all health matters,including oral health, as part of asingle holistic approach.”
That means an acceptance bymedical professionals and policymakers that a healthy mouth isessential to a healthy body. Oncegained, that acceptance will likely lead not only to moreresearch funding but also to abetter allocation of resources such as operating room times,educational funding, preventativecampaigns and outreach programsto deliver oral care where it is mostneeded.
“We have to recognize thatCanada has changed greatly sincethe 1980s, when we had dentalcavities in check. We have to gear upto recreate our success of those yearsunder very different circumstances,”Dr. Dean says.
Giving dental health its due
Dr. Susan Sutherland, chief of dentistry at Sunnybrook and Womens College Hospital in Toronto, says a new model for oral health care delivery is needed.
J O I N T V E N T U R E JV3NATIONAL POST, MONDAY, APRIL 4, 2005
Many Canadians have a false senseof security about the state of theiroral health, according to a recentsurvey by the Canadian DentalAssociation (CDA).
While 90% of respondentsdescribed their oral health as goodor better, a full 33% said their gumsbleed when they floss — a telltalewarning sign of potential gumdisease. The survey indicates allCanadians should go back to thebasics and adhere to the mainprinciples of oral health: Twice-daily brushing, daily flossing,regular dental checkups and ahealthy, balanced diet.
“Bleeding gums should be takenseriously — it could be a signal thatsomething is beginning to goseriously wrong, not just in themouth but in the rest of the body,”says Dr. Jack Cottrell, president-elect of the Ottawa-based CDA.“Gum disease is a silent threat. Youmight not have any pain. You mightnot even know you have gumdisease. But it is the most commonreason for tooth loss in adults.”
Worse yet, recent research has shown potential links betweengum disease and other serious, life-threatening conditions.
“Gum disease has been connectedto a number of serious healthconcerns, including heart disease,diabetes and pre-term, low-weightbabies,” Dr. Cottrell says.
One theory is that harmful bac-teria can form in the hard-to-reachpockets between teeth and gumtissue. These bacterial colonies candislodge and enter the bloodstream,settling in other parts of the body. Arecent study in Circulation, theAmerican Heart Disease journal,found a direct relationship betweenperiodontal disease and the thicken-ing of the carotid arteries.
“The good news is that almost allgum and tooth disease is pre-ventable,” says Dr. Euan Swan, theCDA’s manager of dental programs.“All that is required is that people goback to the basics and religiouslyfollow a simple program of oralhealth and hygiene.”
That program starts with good
nutrition. Researchers have longknown that a healthy, balanced dietis an effective preventative toolagainst an entire range of lifestyle-related diseases — not just cavitiesand gum disease but also type 2diabetes, heart disease, highcholesterol, circulatory problemsand the rising epidemic of obesityaffecting Canadian adults andchildren alike.
“Prevention all starts with whatgoes in the mouth,” Dr. Swan says.“Start children at an early age andteach them that health is all wrappedup in a diet that is low in sugars andhigh in fruits, vegetables and fibre.
“Avoid between-meal snacks thatare high in sugars and carbo-hydrates. The mouth needs time torecover and clean itself naturallyafter meals. The mouth has anamazing ability to look after itself ifyou follow simple rules.”
The second basic principle is tobrush thoroughly at least twice aday. Three minutes in the morningand before bed will do the trick, Dr.Cottrell says. Use fluoridated
toothpaste and a soft-bristledbrush. The type of toothpaste and the type of brush — manual or electric — is secondary. Theimportant element is just to makesure you brush.
“We suggest people discusspreferences, needs and problemswith their dentist,” he says. “If indoubt, look for the CDA seal ofrecognition on a product. There issuch a wide range of products onthe market that finding one thatbest suits individual needs is not aproblem.”
Step three may be the one that poses the greatest challenge for many people — flossing. Yetflossing is vital not just for theprevention of cavities but to wardoff the danger of gum disease,experts say.
“Flossing deals with areasbetween teeth that brushing can’treach,” Dr. Swan explains. “Thosecrevices and crannies can catch tinybits of food debris, which slowlyharden into plaque and protectharmful bacteria as they eat theirway into healthy teeth and gums.“Floss, and you can remove thatdebris; plaque doesn’t have achance to form.”
While mouthwashes are notessential, they, too, can play a role in
good oral health, Dr. Cottrell adds.Mouthwashes reduce harmfulbacteria and can be especiallyeffective if used after flossing.
The final basic rule for good oralhealth is regular visits to a dentist,starting about six months after thefirst baby tooth appears and contin-uing though a long life.
Granted, third-party dental plansmake an enormous difference inaccess to regular checkups. CDAsurveys show that more than 75% ofthose with dental insurance visit thedentist at least once a year, comparedwith only 45% of those withoutcoverage. On the plus side, surveysalso show that more than 60% ofCanadians have some form of dentalinsurance coverage.
“Regular checkups are crucial to both prevention and earlytreatment,” Dr. Cottrell says. “Thedentist will not only clean teeth andremove tartar but also check forsigns of a wide range of otherproblems, everything from cancersto early stage gum disease.
“The mouth is most often thebellwether for overall health. Our goal as dentists is to makeCanadians not just the healthiestpeople in the world from an oralperspective but the healthiestpeople in the world, period.”
Oral health a daily dutyDr. Jack Cottrell prepares dental floss in his Port Perry, Ont., office. Flossing is one of the key elements in maintaining oral health, along with regular brushing, proper diet and regular checkups.
J O I N T V E N T U R EJV4 NATIONAL POST, MONDAY, APRIL 4, 2005
A bright, healthy smile that lasts alifetime starts even before that firstbaby tooth pops though the gums.The best thing parents can do toensure their children enjoy a life-time of oral health is to teach themthe basics, start early and make itfun, say Canada’s dental experts.
“If you can start children at avery early age on a regular programof oral health, then it becomesingrained. It becomes secondnature,” says Dr. Kelly Wright,president of the Canadian Academyof Pediatric Dentistry. “Make it aspleasant an experience as possibleand make it a regular part of theirroutine.
“The rewards are enormous. It is not just a matter of cavities. The mouth is a vital part of overall health. What happens there affects almost everything in the body.”
That is why the basics begin witha healthy, balanced diet, explainsDr. Rob McGregor of Kentville, N.S.,member of the board of directors ofthe Ottawa-based Canadian DentalAssociation. The other three includea thorough brushing twice a day,flossing daily and regular visits to adentist for checkups.
“Diet is an intrinsic part of dental care, yet it may be the mostoverlooked,” he says. “Sticky, sweetfoods, carbonated beverages andsweetened juices can play havocwith teeth and gums and yet, because children love them, parentstoo often give in.”
Sweetened juices are especially
problematic, adds Dr. Wright, whois in private practice in BrentwoodBay, B.C. “Parents seem to think that juice is better for children than water. It just isn’t so, in mostcases. The sugars in those juices can have a devastating effect onbaby teeth.”
While neither dentist suggestscutting out sugars entirely, theysuggest concentrating sweets atmeal times. “If a child gets sugars allat once, then it allows the mouthtime to recover between meals,” Dr.Wright says.
He also suggests small childreneat six to eight small meals a dayinstead of three large ones, but theynot be permitted to “graze.” Mealsshould have definite time limits andthen periods in between, to allowthe mouth to recover and clear itselfof sugars naturally.
Oral health to last a lifetimebegins with a visit to the dentistabout six months after the first babytooth erupts, or by the age of one.The goal is not treatment butinformational and educational, Dr.McGregor says, to explain to parentswhat can happen and how to avoidit.
Before a baby has teeth, use asoft, moist cloth to clean the gums,Dr. Wright says, and then move tobrushing with a soft brush and atiny smear of toothpaste once thefirst tooth appears. Parents shouldhandle brushing chores until the child has enough dexterity tomanipulate a toothbrush — aboutthe same time they can handlecrayons, Dr. McGregor says.
Even then, parents should do oneof the twice-daily brushings until achild is seven or eight years old, hesays.
The choice of manual or electrictoothbrush — and the preference ofcartoon character on the handle —is up to the individual. Whicheverencourages the child to diligentlybrush for three minutes at a time isthe route to go. Dr. Wright suggestsalternating between manual andelectric, to allow the child to devel-op necessary dexterity and to allowbristles to dry thoroughly.
Nor does choice of toothpastematter, as long as it contains fluorideand it has a taste that encouragesbrushing — just don’t let them getcarried away with big globs of tooth-paste. A pea-sized amount is plenty.Dentists suggest the choice in brush-es and toothpastes be guided by theCanadian Dental Association Seal ofRecognition, awarded to productsthat meet CDA standards.
Admittedly, flossing can pose a challenge, the dentists say.Persistence reaps enormousrewards, however. Inculcating in a
child a regimen of brushing andflossing is the best safeguard againstdental problems down the line.
“There are now flavoured flosses, an electric flossing aidshaped like a slingshot that vibratesand disposable single use floss picks,”Dr. Wright says. “Choose the one thatworks best for the child.”
Molars deserve special attention,because food trapped betweenthem in hard-to-brush spaces is the most common cause of cavitiesin small children, Dr. MacGregorsays. Flossing is the only effective
way to remove those particles.Above all, make dental and oral
health fun and involving, dentistssay. They point to the Nova ScotiaDental Association’s award-winninghealthy teeth site, www.healthy-teeth.org, as a terrific resource forelementary school children. Even thetooth fairy can play a role.
Finding a shiny loonie under thepillow to replace a lost tooth caninvolve a child in oral health.
“It is a great opportunity to talkwith kids about oral health,” saysCDA president Dr. Alfred Dean.
A lifetimeof smiles startswith first tooth
‘IF YOU START CHILDRENAT AN EARLY AGE ON A REGULAR PROGRAM
OF ORAL HEALTH, IT BECOMES INGRAINED’
Children should be taught at an early age the habits that provide a lifetime of healthy teeth, the CDA says.
J O I N T V E N T U R EJV6 NATIONAL POST, MONDAY, APRIL 4, 2005
Canada faces a unique challenge,according to the Canadian DentalAssociation (CDA). With a hugedemographic bulge of BabyBoomers moving toward seniorcitizen status, the problems associated with providing themwith continued dental care arecertain to strain an already tightlystretched medical and dental caredelivery system.
Chief among those challenges are access and ability to pay, says Dr. Wayne Halstrom, CDA vice-president. Access is an issue because,as people age, they begin to losemobility, and a trip to a dental officecan become an almost insurmount-able chore. At the same time, fewnursing and long-term care facilitieshave dental services adequate tomeet the projected need.
Ability to pay is a major factor,because few third-party dentalinsurance plans provide coveragemuch beyond retirement. After a life-time of dental plan coverage, seniorsmay suddenly find themselves forcedto rely on limited retirement incometo pay for dental care.
“So many of these soon-to-be-seniors have had wonderful careover the years,” Dr. Halstrom says. “Iknow that here in British Columbia,where I practise, about two-thirds ofthe population has some form ofcoverage. Early on in life, they havehad restorative work done — rootcanals, crowns and bridges.
“The problem is that restorativework ages just as people age.Seniors will likely face the need toreplace that work as ageing takes its toll. The problem is, how canthey afford it and where can theyget the work done?”
Those most at risk will be the frailelderly 85 years of age and older,says Dr. Mary McNally, assistantprofessor of dentistry at DalhousieUniversity in Halifax.
“They are becoming the fastest-growing segment of the elderlypopulation, and that change iscreating a serious issue for dentalcare,” she says. “Dental care has atremendous impact on overallhealth. If you can’t chew and swallowproperly, you can’t eat. The resultscan be devastating.”
Compounding the problem is the fact that only now is seriousresearch being done into the impacton dental care delivery this bulge ofseniors will have, says Dr. DeboraMatthews, head of periodontics atDalhousie.
“For years, the private dental caredelivery system has run parallel tothe public health care deliverysystem,” she says. “While medicalresearch received public funding,dental research did not. As a result,we have no hard evidence on whichto base policies and practises to dealwith the growing problem of dentalcare for the elderly.
“We have a wealth of anecdotal
evidence that inextricably linksproblems with the mouth withproblems in the rest of the body, but [we] are only now beginning to do the research necessary. Ourmain goal now is to find a way toconnect those two parallel healthcare delivery systems.”
The bright light on the horizon isthat a variety of public and privateinstitutions have begun that neces-
sary research. In Nova Scotia, forexample, the Nova Scotia HealthResearch Foundation, the provincialministry of health and Dalhousiehave funded a pilot project calledthe Seniors’ Oral Health AssessmentProject.
The project is examiningtreatment options available withinthe community, in nursing homesand in assisted-living facilities.
Dr. Matthews also points out thatDalhousie research is working tocreate a coding system for dentaltreatments, which might becomepart of the proposed nationalelectronic health records system.
“If dental treatment becomespart of that national database, it will provide much-needed raw data, which can be used forresearch,” Dr. Matthews says.
Dr. McNally points to the NovaScotia Oral Health of Seniors Pro-ject, a study recently completedafter two years. The study examinedcontinuity of care for seniors, andpolicies in place to deal with theissue. That study found, amongother things, that oral health amongseniors is certain to grow in impor-tance as a public policy issue. It alsofound there was no infrastructurein place to ensure continuity of care,that any successful approach willlikely require collaboration amongall health care professionals, andthat those solutions will demand innovative and imaginative newapproaches.
Dr. Halstrom draws comfort fromvarious studies being undertaken by private insurers. Some, he says,are looking at the feasibility ofcreating group plans designedspecifically for those over the age of65. Others are studying personalwellness investment plans, whichwould operate much like registeredretirement and registered educationplans.
“People could start puttingmoney into the plans when they areyoung and thereby have enough toensure affordability of dental careafter work-related benefits run out,”he says.
Access, however, may be themore serious issue, Dr. McNallysays.
“The ability to pay does not ensure care,” she says. “Aspeople age, they lose mobility. Theycan’t come to a dental office; theymay be living in a nursing home orassisted-care facility. We need toaddress a whole new approach todelivery of dental care.”
At the same time, Canada’s 10 dental schools must find the funding and continuing support for education in geriatricdental care.
“We simply don’t have a systemyet to train specialists in geriatriccare, and the problems of the elderlyare quite different from those of theyoung,” Dr. Halstrom says.
New challenge: senior care
Dr. Wayne Halstrom says the growing seniors population poses new challenges to the delivery of oral health care.
Ask Dr. Aaron Burry what he does,and he explains that he oversees asafety net. As dental officer of healthfor the City of Ottawa, his job is totry to prevent its residents fromslipping though the cracks when itcomes to dental care.
It is a large net, indeed, and onethat may have some holes in it. Forthe overall public, he oversees thewater fluoridation system, addingthat amazing tooth decay prevent-ative to the city’s drinking water. To catch oral health problems early on, he runs screeningprograms for children in theelementary school system. Forthose on public assistance, hemanages basic care and treatment.
Equally important, he is an evan-gelist for oral health, creating andmanaging education programs.
Like municipal dental healthofficers in those regions across thecountry fortunate enough to havethem, Dr. Burry is an integral part ofCanada’s public health team. He seesfirst-hand that oral health is directlyrelated to overall health.
Expanding the reach of Canada’s
public health system has become atop priority for the Canadian DentalAssociation, says Andrew Jones,CDA director of corporate andgovernment relations.
“There is a straight-line connec-tion between oral health and publichealth in general,” he says. “Effective-ly preventing or treating oral prob-lems in their early stages can savemillions of dollars — the health caremoney that must be spent on resolv-ing more serious problems later on.”
The public health system, in fact,includes five main functions: Healthpromotion, disease prevention,protection of the public, surveillanceagainst disease and assessment ofoverall and specific health.
Fulfilling all those obligations
may prove to be a challenge goingforward in this new century, Dr.Burry says.
The CDA has taken positive stepstoward creating a bridge betweenprivate dental care and publichealth care, Mr. Jones says. Canadanow has a chief dental officer and,through him, a voice at the tablewhen it comes to creating healthpolicies.
The CDA joined the 37-memberCanadian Coalition for Public Healthin the 21st Century last year. Thatgroup includes virtually all of Cana-da’s major non-governmental healthcare organizations. The goal of thegroup is to make Canadians thehealthiest people in the world.
The coalition has called for $1-billion to be spent annually onpublic health, with a portion of that spending directed toward oralcare. The federal government hascommitted $665-million over threeyears, plus the $400-million initiallygranted the new Public HealthAgency of Canada, created after theSARS outbreak.
One of the coalition’s earlysuccesses was lobbying for theappointment of a Minister of Statefor Public Health, a cabinet post heldby Dr. Carolyn Bennett.
“Our goals are to refocus attentionon the need for prevention, toencourage expansion of the educa-tion system for dentists and to raiseawareness of the need for oral healthresearch,” Mr. Jones explains.
“To date, our public healthsystem has proven [to be] anenormous asset in many areas. Lookat the impact water fluoridation hashad,” he says. “The challenge wenow face is to find innovative waysto continue and expand thosepublic health programs.”
Part of the problem is a simplechange in demographics, Mr. Jonessays. In the past 20 years, Canadahas seen an enormous influx of newimmigrants, many of whom starttheir new life here in low-payingjobs. They have neither the moneynor the cultural understanding ofthe Canadian dental care system toreadily access dental care.
The public health system shouldfind ways to identify their problemsand then deliver basic care to thosesegments of that population most inneed — the young and the elderly.
At the same time, the Baby Boom
bulge is beginning to press intosenior citizen status. The fastest-growing segment of the elderly is the85-plus age group. These often-frailelderly simply lack the mobility toregularly visit a dentist. Nor are there safety nets in place within thecommunity, assisted living facilitiesor nursing homes to meet their oralhealth needs.
“We do not have in place thetraining in geriatric dentistry,
the research necessary to identifyissues and develop responses or the delivery systems to ensurecontinuing dental care for seniors,”Dr. Burry says.
The solution will likely be found in a revamping of both the privatedental and public health caresystems, he suggests. While thosetwo systems operated on parallelcourses over the past half-century,there has been no direct linkage.
Today’s understanding — that oralhealth is intrinsic to overall health —demands the two find ways ofworking together, he says.
“Research is key,” Dr. Burry says. “If we are to successfullytackle the challenges we canalready identify anecdotally, thenwe simply must devote time andmoney to quantifying the problemand finding effective ways to dealwith it.”
J O I N T V E N T U R E JV7NATIONAL POST, MONDAY, APRIL 4, 2005
Protectors ofpublic health
Fluoridation of municipal water systems is one of the public health initiatives to promote oral health.
‘THERE IS ACONNECTION BETWEEN
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J O I N T V E N T U R EJV10 NATIONAL POST, MONDAY, APRIL 4, 2005
From correcting nature’s minorfailings to entirely rebuilding afterthe traumatic results of illness orinjury, modern dentistry is up to thetask. An entire new range of tech-niques and technology has equippedCanadian dentists with the ability toprovide almost any patient a bright,even, white smile and a set of teethup to any chewing task.
“Restorative and cosmetic workhave become everyday parts of ourpractice,” says Dr. Jack Cottrell,president-elect of the CanadianDental Association. “The past decadehas seen advances in dental care thatcan literally work miracles.”
Today’s dentist can work withsurgeons to rebuild and reshapejaws, to permanently implantreplacements for missing teeth, andto straighten, whiten and even outsmiles. Severely damaged or missingteeth can be replaced with porcelaincrowns or plastic and metalpermanent or removable bridges.Cavities from small to large can befilled almost invisibly with new poly-mers. Spaces can be filled with bond-ing materials and veneers can be ap-plied to less-than-perfect teeth.
Above all, dentistry is now almostentirely pain-free. The focus today ison saving teeth, not pulling them, asin the past. In fact, dentists willmake almost heroic efforts to retainunaffected pieces of teeth or evenroots and incorporate what isnatural into artificial replacements.
“There has been a dramaticchange in the approach to dentistryduring the past two decades,” Dr.Cottrell says. “Today’s dentist will goto imaginative lengths and takeinnovative measures to preserveteeth, even to the extent of preser-ving parts of teeth to be used in therestorative process.
“It reflects a dedication to theprinciple that our job is to preserveand prevent. No matter howadvanced our skills and materialsbecome, nothing matches the teethnature endowed us with.”
This is not to say that nature doesnot sometimes play cruel tricks.
“All of us would like perfect teethand the perfect body; few of us geteither,” says Dr. Amanda Maplethorp,president of the Canadian Assoc-iation of Orthodontists. “It is all amatter of heredity. With a good manypeople, the size of the teeth is not agood match for the size of the jaw.”
The same applies to toothcolour, the spacing of teeth and the angles they come in at. Some
people are even more susceptibleto cavities, thanks to a fluke ofnature.
“That is where dentists come in,” Dr. Maplethorp says. “Our roleis to correct nature’s mistakes, toovercome the effects of unhealthydiet or lifestyle [and] to offset the impact of disease or accident.In short, to provide patients withthe teeth they want or need, orboth.”
The restorative process most oftenstarts with straightening of teeth.That is where Dr. Maplethorp andCanada’s more than 600 certifiedorthodontists come in. They arespecialists in moving teeth. Using a variety of braces, retainers andappliances, orthodontists cantransform a snaggle-toothed grimaceinto a snow white smile. The bracesexert steady pressure on individualteeth, usually over a two-year period.As the tooth shifts, new bone formsin the space in the jaw left behind.The result can have dramatic effects.
“North Americans prize a white,straight and even-toothed smile,”she says. “I have had patients asyoung as six and as old as 76 cometo have teeth straightened. Whilemost are in their late childhood orearly teens, an increasing number ofadults are now taking advantage of
the wonders we can perform andare opting for braces.
“Straightening is usually the firststep in cosmetic work.”
The next can be restorative, Dr. Cottrell says. Here, teeth can be physically reshaped withabrasives or through bonding newmaterial on to the surface. Gaps
can be filled and veneers applied.“We can use titanium implants
to anchor porcelain crowns to thejaw. We can create permanent orremovable bridges. We can buildporcelain crowns,” Dr. Cottrell says.“In fact, in almost all instances, adentist can suggest a range of
options to suit individual needsand pocketbooks.”
In addition, there are many moreoptions available in filling materialsthan there were a few decades ago —some are tooth-coloured and hardenin seconds when exposed to bluelight. The result is a filling thatmatches natural tooth shadings
and is almost undetectable at normal distances.
New ultra-high-speed drills andalmost instantly effective freezingadministered by whisper-thinsyringe tips ensure near pain-freework.
After restorative work or simplyto correct the ravages of time andlifestyle, dentists are now able tosafely and speedily whiten teeth,restoring them to the natural,pristine beauty.
“The past five years have seen a terrific upsurge in whiteningproducts,” Dr. Cottrell says. “There are over-the-counterproducts and treatments that can be administered in a dentist’soffice. When done by a profess-ional, the process is both simpleand safe.
“When it comes to dentalmakeovers, there is now little we can’t do to effectively correctnature’s mistakes or the ravages oftime, accident and disease.”
Returning the smile to a face
Dr. Amanda Maplethorp of Maple Ridge, B.C., says dental medicine is now so sophisticated it can return a smile to almost any face.
‘THERE IS NOW LITTLE WE CAN’T DOTO EFFECTIVELY CORRECT NATURE’S MISTAKES’
J O I N T V E N T U R E JV11NATIONAL POST, MONDAY, APRIL 4, 2005
Canadian dentists are taking a front-line stance in the battle to convince anation to stop smoking. Earlier thismonth, l’Ordre des Dentistes duQuébec joined Ontario, BritishColumbia and Alberta dentists increating a campaign to help theirpatients butt out.
“It is our responsibility as healthcare professionals; it is part of ourmandate. The damage done bysmoking is enormous,” says Dr.Robert Salois, president of the ODQ.“The number of smokers in Quebecis significantly higher than the rest ofCanada, and anything we can do tostem the tide, to persuade people toquit smoking, we must do.”
Many people are unaware of thehealth effects on the mouth ofsmoking, says Dr. Ian McConnachie,vice-president of the Ontario DentalAssociation. Since 2000, the ODA,working collaboratively with theOntario Medical Association and theOntario Pharmacists Association,has had a Clinical Tobacco Inter-vention (CTI) program in place
to train dentists, physicians andpharmacists to help their patientsquit tobacco use.
“All patients usually see are thecosmetic changes, the staining ofteeth. In reality, smoking presents avery grave health care risk to themouth, lips and throat.”
Last year, for example, 3,100 newcases of oral cancer were reported bythe National Cancer Institute ofCanada; they accounted for 2.1% ofall new cancer cases. The death ratefor oral cancers is one in three,significantly higher than the one infour for breast cancer and one in fivefor prostate cancer.
“If diagnosed early, thosemortality rates drop significantly,”Dr. McConnachie says. “If, however, we can advise and assistour patients to quit tobacco use, the threat virtually disappears.”
Of special concern is smokingamong teens, says Dr. BurtonConrod, Canadian Dental Asso-ciation past-president and a pastmember of the Minister’s Advisory
Council on Tobacco to former healthminister Allan Rock. The averageteen smoker starts at age 12, he says.
“About 20% of teens who startsmoking at that age will die in their40s or 50s,” he says. ‘We feel thatdentists are one of the most effec-tive resources in the fight againstsmoking. The nature of our relation-ship with patients is a definite plus.”
While provincial anti-smokingcampaigns include radio, television,print and billboard advertising plusmedia conferences, the heart oforganized dentistry’s fight againsttobacco use is in dental officesthemselves.
The advantage dentists have isthat they can show the direct effectsof smoking on the mouth and teeth,Dr. Conrod says. “A physician cantalk about lung disease and cancers,but we can show them in their ownmouths exactly what is happening.”
This is a big part of CDA’s contri-bution to the national campaign forwarning labels on cigarette pack-aging. As a member of the CanadianCoalition for Action on Tobacco, CDAadvocated warnings to show theeffects of smoking on oral health.That can include the appearance ofrough white patches called leuko-plakia on the mouth and tongue,which are a form of pre-malignantlesions; between 4% and 5% willbecome full-blown cancers. Smokingalso promotes gum disease and helpsdestroy the tissue anchoring teeth.
“If we can help patients quit, wecan very quickly show them thedifference it makes to oral health,” hesays. “Six months later, on their nextcheckup, they can usually see adramatic difference in their teeth and mouth. It is positivereinforcement.”
With teens, the major thrust ofthe campaign is on the cosmeticand social effects of smoking, Dr.McConnachie says. Dentists canshow first-hand the effects on thesmile of a healthy mouth.
CTI, the five-year-old Ontarioprogram, starts with trainingphysicians, dentists and pharma-cists through a series of evidence-based seminars held throughout the province. In addition, the ODAhas a two-year-old, award-winningcommunications campaign toincrease public awareness or oralcancer.
In Quebec, the media campaign
goes hand in hand with a concertedeffort by individual dentists tocounsel and coach patients in anti-smoking techniques.
“Quebec has the highest propor-tion of smokers in Canada; 25% ofthe population smokes as opposedto 21% as a national average,” Dr.Salois says. “The situation amongteens is especially worrisome: 26.2% of girls and 20.1% of boyswere regular smokers in 2002.
“Of equal concern is the ignor-ance of many smokers. Only 50.5%of smokers thought oral health wasimportant, [compared with] 72.9%of non-smokers.”
According to Dr. Conrod, thebattle against smoking is a fightdentists can not afford to lose.
“Dentistry is all about preven-tion,” he says. “And preventingpeople from smoking is absolutelynecessary to oral and overallhealth.”
Dentists promotebutt-out policies
Canada’s dentists are trying to convince smokers to quit, warning the habit means more than stained teeth — in the mouth, it contributes to health concerns ranging from tooth loss to cancer.
A patient is examined for signs of oral cancer.
Gum disease. Root cavities and infections. Oral cancer. Most people never see them coming.But these hidden threats to your oral health can lead to severe pain, loss of teeth, and serioushealth implications. Only your dentist has the training, skill, and expertise to spot and treat thesedangers before it’s too late. So see your dentist. Because what you can’t see can hurt you.
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J O I N T V E N T U R EJV14 NATIONAL POST, MONDAY, APRIL 4, 2005
The 10 universities across Canadathat educate and train dentists arein a quandary.
While the current number of newgraduates — between 400 and 450 ayear — is enough to meet demand,even the most rudimentary projec-tions suggest the country will face ashortage of dental professionalswithin the next two decades.
“There is no way to tell theperceived need,” says Dr. Johann De Vries, dean of the Faculty ofDentistry at the University of Manitoba in Winnipeg. “Very littleresearch has been done, and currentmodels contain too many variables.”
The problems associated withthis projection are manifold. Thatlack of research means the profes-sion cannot project the size of thatshortfall or indicate which commu-nities or dental specialties will be
hardest hit. Nor is there fundingavailable to increase the intake ofdental undergraduates and trainthem through the four-year courseleading to a Doctor of DentalSurgery (DDS) or Doctor of DentalMedicine (DMD) degree.
Rising tuition costs plus the costof associated equipment mean newgraduates may be facing studentloans in the hundreds of thousandsof dollars. Debt of that size meansnew graduates look toward urbanpractices rather than lower-revenuerural ones.
At the same time, applicants todental schools have increased almostgeometrically. The University ofManitoba now gets 10 applicants forevery first-year opening, Dr. De Vriessays.
“Last year, we saw a 23% increasein applicants. Over the past fiveyears, the increase has been close to50%,” he says.
In Canada’s fastest growingprovince, Alberta, the province’ssole dental school graduates only60% of the number of dentists it didin 1980. Other schools across Cana-da have also reduced class size overthis period, says Dr. Darryl Smith, amember of CDA’s board of directors.
“Universities have cut back onfunding to dental schools becausedentistry is probably the mostexpensive course to finance,” he says.“Medical and nursing schools do notprovide clinical training, this is donein hospitals outside the universityand paid for as part of the healthbudget. This is not the case for dentalschools, which must maintain theirown clinics, paid for with educationdollars, to give students vital hands-on experience and prepare them tobe practice-ready.”
The total cost of education for acareer as a dentist ranges from$70,000 to $95,000 a year, Dr. De Vries says, and tuition may only cover 20% of that cost. At the University of Manitoba, forexample, tuition is $13,700 a year.On top of that, however, studentsmust pay a total of about $25,000for necessary equipment and othercosts spread over the four-yearprogram.
The result can be a student loandebt bigger than many homemortgages.
“One young woman I knowrecently graduated from DalhousieUniversity carrying a student loanof $200,000,” says Dr. Alfred Dean,CDA president and a private practi-tioner in New Waterford, N.S. “Withdebt like that, it is hard to attractnew graduates to small towns andrural settings. They feel they musthead to cities and earn as muchmoney as possible to reduce thatburden.”
The result has been a disparity indental care across Canada, Dr.Smith says. While larger towns andcities have more than enoughdentists to meet the demand,
smaller centres and rural areas facea continuing shortage.
The University of Manitobadental school is trying to redressthis disparity by exposing studentsto rural and small-city settings aspart of their hands-on practicaltraining, Dr. De Vries says.
“I am pleased to say that anumber of students have found thatthey very much enjoyed small-townand rural practices,” he says.
Lack of funding for dental schoolsextends beyond training of dentists.Research dollars are also hard tocome by, Dr. Smith says. He notesthat oral health accounts for 7% of all
health care spending in Canada, yetresearch in the field amounts to only1% of total spending.
“Increasing research funding isvital,” Dr. De Vries says. “You can’tcreate effective health care policieswithout it. We need to know what ishappening, and where the need is.We also need laboratory-basedresearch into new treatments andnew preventative care techniques.
“The links between oral healthand low-birth-weight babies,diabetes and cardiovasculardisease are now recognized. Wevery much need the funding toproduce hard evidence on which
preventative and correctivemeasures can be taken.”
Dr. De Vries and Dr. Smith alsocall for more research into the careand treatment of oral health in Cana-da’s fast-growing seniors population.
To date, only Laval University has a program in geriatric dentistry,Dr. De Vries says, and yet care forseniors will pose one of thecountry’s greatest challenges with 15 to 20 years.
“These are all problems thatwon’t disappear,” he says. “If wedon’t begin to address them now,they will just worsen with time.”
Dental schoolsneed injectionof new funds
Dr. Johann De Vries says projections show Canada could be facing a shortage of dentists in the next two decades.
‘WE NEED TO KNOWWHAT IS HAPPENING,
AND WHERE THE NEED IS’
J O I N T V E N T U R E JV15NATIONAL POST, MONDAY, APRIL 4, 2005
Third-party dental plans are a verypopular and well-used benefit,according to the Canadian DentalAssociation (CDA). That verypopularity, though, has lead to some challenges that employers willneed to take into consideration tocontinue to grow the value of dentalplans to their employees.
The upside is that utilizationrates have increased dramaticallysince the plans were introduced 30years ago. As a result, the majorityof Canadians enjoy excellent oralhealth.
Unfortunately, rising utilizationhas meant increased premiums,limits on use or even cutbacks inbenefits.
“The good news is increasedutilization; the bad news is thatwith increased use comes increasedexpense,” says Dr. Michael Connolly,a member of the CDA’s board ofdirectors, with a private practice inCharlottetown, P.E.I. “Usage hasgrown exponentially.”
Dr. Connolly points out that, inthe early 1970s, use of dental plansamounted to just $1-million. Lastyear, it hit $3.6-billion.
According to recent statistics,about 60% of Canadians have someform of third-party dental cover-age, says Dr. Benoit Soucy, directorof membership and professionalservices at the CDA in Ottawa. Inaddition, each province has its own publicly funded dental careprogram, although who is coveredvaries greatly from province toprovince.
“In Quebec, it is those on publicassistance and children under 10; in Ontario, it is those on publicassistance. Each province has itsown approach,” Dr. Soucy says.
The enormous demand has beendriven by an increasingly sophisti-cated public that has ready access toaffordable treatment, Dr. Connollysays.
“What I have found is thatpeople’s dental IQ has increased,” hesays. “They are increasingly awareof the vital importance of oralhealth and of the benefits preven-tion brings. Changes in technologyhave also made a visit to the dentista pleasure rather than a painfulexperience.
“If people have a plan, they willcertainly use it.”
That use has a direct side effect,however. As use grows, so do thecosts to the third-party insurers. Tomaintain profitability they haveboth raised premiums and, in manycases, frozen or reduced coverage.Their actions have a near-daisychain effect.
Faced with rising premiums,employers who sponsor programslook for ways to contain costs. Therisk is that employees, also facingincreased premiums, may decide toreduce coverage rather than accepthigher paycheque deductions.
This could result in a flip of thepopular adage, or “short-term gainfor long-term pain.”
Dr. Connolly points out thatmany plans have not raised yearlymaximums for benefits during thepast 20 to 25 years. Insurers are alsochanging the frequency of regulardental checkups to nine months or ayear, from every six months.
“With a six-month frequency forrecall visits, dentists can catch prob-lems in the bud,” Dr. Soucy says. “Ifthe visits are annually, then the prob-lems will have become much worse.The cost of restorative work will begreater than any savings [produced]through reducing recall visitfrequency.”
The CDA is addressing the matterby helping insurers save coststhrough increased efficiencies, Dr.Soucy says.
“If we can reduce administrativecosts for insurers, then that leavesmore money in the plan to pay fordental care,” he explains.
In 1992, the CDA introducedCDAnet, a system for the electronictransmission of dental claims fromthe dental office to the benefitadministrator. To make that systemwork CDA provides such featuresas a registry of subscribingdentists, the treatment codes thatthe carriers use in their adjudi-cation and a help line forparticipating dentists.
The association is now working on converting that system to theInternet, to provide access to highercommunication speed at a lower cost.
“What we are focusing on issimplifying the process andreducing any chance of error,” Dr. Soucy says. “Once you becomeused to doing things electronically,you want more and more function-ality with fewer errors.
“Increasing efficiency andreducing overhead costs is a verypositive way to ensure continuingaffordable coverage.”
Dental plans boost oral healthFor four days in late August, thedental world’s attention will befocused on Montreal. An estimated20,000 dentists from countriesaround the globe will gather for theannual meeting of the FédérationDentaire Internationale.
The event, which runs Aug. 24 toAug. 27 at the Palais de Congress, isthe ultimate must-attend conferenceand trade show for the dental profes-sion. There, the gathered dentistswill see such revolutionary advancesas the use of genetic engineering togrow new replacement teeth and theuse of lasers, abrasion and evenozone to remove or reverse decay.
They will stroll the 150,000 squarefeet of exhibition space, be presentedwith cutting-edge research and evenhave an opportunity to make theirown presentations. For Canada, theevent is a feather in the cap of organ-ized dentistry and an unequalledopportunity to focus attention on theprogress dentists have made and thechallenges they face, says Dr. BurtonConrod, past-president of theCanadian Dental Association.
“This is a tremendous opportunityfor Canada. The FDI convention is a global event, and we are host. It is a wonderful opportunity forCanadian dentists, researchers andmanufacturers to show what theyhave accomplished,” he says.
This is only the third time Canadahas played host to the FDI since itsfounding in 1900. Previous venueswere Toronto in the 1970s andVancouver in 1994. Last year’s eventwas in New Delhi and next year,Shenzhen, China, is host city.
“This is an historic event forCanada,” says Dr. Denis Forest, exec-utive director of Journées DentaireInternational de Québec and chairof the Canadian organizing commit-tee. The event is sponsored by theJournées, the CDA, and the FDI. “Itis also a rare opportunity to focus
not just Canadian but internationalpublic attention on dentistry.”
The FDI, based in France, repres-ents 150 dental associations in 130countries. Its goal is to promote oralhealth, facilitate the exchange ofscientific information and pool theresources of developed nations tohelp developing countries createtheir own policies and programs.
As a result, sessions at the annualconference cover an enormouslybroad range, Dr. Forest says.
“For developed countries, theshow will offer an exchange ofleading-edge techniques and tech-nology. Laser drills and geneticengineering are examples. Fordeveloping nations, their greatestneed may be help and support inestablishing basic preventive care.The event offers all of those.”
The FDI is offering dentists theopportunity to make presentationson interesting or leading-edge workthey are doing. Dentists can registerto make 10-minute oral presenta-tions or to submit a poster detailingtheir accomplishments. To date, with the show still four months away, more than 200 dentists haveregistered to submit posters, Dr. Forest says.
The CDA has long played a majorrole in the FDI, Dr. Conrod says.Both staff and elected membersoccupy key positions on variouscommittees. Dr. Conrod himself hasbeen one of the 15 FDI councilmembers for the past five years.
“Canada’s success in preventingand treating cavities and other oralhealth issues has made it a majorplayer in the FDI,” he says. “Whatwe hope to do with the Montrealevent is to refocus both public andgovernment attention on what wehave accomplished, and what wemust now do to face the challengesthis century presents.”
The CDA’s support of FDI extendswell beyond Canadian borders,however. The annual meeting canoften act as a spark leading to actionin developing countries. Last year,for example, the FDI staged aconference on oral health in Nairobi.
“Before that event, oral health wasnot on the agenda of many Africanhealth ministries,” he says. “Sincethat oral health planning conference,organized by the FDI and co-spon-sored by the World Health Organ-ization, several countries havedeveloped and funded their firstpolicies and programs for promotionor oral health. It is gratifying forCanadian dentists to be a part of thesuccess of FDI.”
CONFERENCE SERVES ASCATALYST FOR CHANGE
Dental plans have helped Canadians for more than 30 years.
