There are many aspects of dentistry that continue to change everyday, and have been changing for years. One of the biggest shifts in dentistry has been over the past 50-70 years. For years dentistry had been a reactive approach. If an individual had a dental issue, they got their teeth extracted and dentures made. Today we practice a much more preventative approach. For most Canadians, routine hygiene visits are the 'norm', oral hygiene at home is valued, decayed teeth are treated with restorations, root canals, and crowns with extractions as a last resort. This preventative approach of course results in individuals retaining their own dentition for much longer than in the past, creating more expenses throughout life. While many individuals are retaining healthy teeth much longer than in the past, there are some groups within the population that experience extreme barriers to care. I could discuss extensively areas of dental health that can & need to be improved in the future, however I will just touch on a few points that I believe are going to change for the better in the near future.
Seniors
Many individuals in long term care now retain their own teeth, which has been a shift in the last few decades. This has resulted in many older adults entering long term care homes with a natural dentition. Often residents of long term care cannot complete daily oral care on their own and require assistance. This daily often isn't completed for a variety of reasons. A study completed in 2012 noted that only 5% of residents in LTC who require assistance completing oral care receive that help, and even when care was received it was often inadequate (16.2 seconds brushing compared to the recommended 2 minutes). A significant amount of this lack in care is a results in a lack of education on oral care with nursing staff (Stein et al., 2012). Lack of oral care can also be a result of overworked staff, difficultly performing these tasks on non-compliant individuals, among many other reasons. Access to adequate oral health care in long term care settings is something that hopefully in the next years will change and evolve to better serve this population.
Here in Halifax there has been a shift in education to long term care staff so that they are better equipped, and trained to aid long term care residents in proper oral hygiene. Beginning in 2016 Dalhousie created a program where dental hygiene staff/students collaborate with nursing students to instruct them how to care for seniors teeth, and the importance of doing so. Dalhousie in collaboration with the Atlantic Health Promotion Research Center, and Capital Heath has also developed a guide to aid in creating a daily oral care program in continuing care. This program discusses the importance of good oral health, how the roles/responsibilities can be distributed within continuing care teams, and provides great references on issues a provider may encounter while providing oral care (McNally, 2011).
I believe the future of dentistry within long term care homes will continue to expand to serve more individuals within these settings. I believe programs and education sessions such as those listed above will begin to become 'normal' as more and more seniors are retaining their full or partial dentition. I also believe dentists & dental hygienists will eventually begin to treat patients within long term care facilities (when appropriate) as access to travel outside of facilities may not be an option, or a very difficult one.
Public Funding
Currently within Canada there are very few publicly funded dental programs, and often their coverage is minimal. An average of 5% of dental treatments are funded through the public sector, the rest is funded either through private insurance plans, or out of pocket expenses (Canadian Centre for Policy Alternatives, 2011). The Canadian Association of Public Health Dentistry has created a collection of programs that are publicly funded within each Canadian province.
The NDP government has announced and been encouraging the creation of a publicly funded dental program for all. While I think that a program to cover every Canadian for free may be unattainable there does need to be more programs, coverage, and emphasis placed on providing adequate preventative care for vulnerable groups. I also think programs that place emphasis on prevention and hygiene are key to setting individuals up for life long good oral health. There needs to be more programs throughout Canada to support children's oral health, such as the one we have here in Nova Scotia.
Oral Health link to Systemic health
Over the years we have begin to realize how connected oral health is to the rest of the body. There are many illnesses that have dental manifestations, as well as there are many negative implications that poor oral health and dental diseases can have on other areas of the body. The following conditions have been linked to oral health, but it is not completely clear exactly how they are linked (Mayo Clinic, 2019).
• cardiovascular disease has been linked to inflammation/infections from oral bacteria
• periodontitis has been linked to premature birth/low birth weight
• Those with poor oral hygiene may be more susceptible to pneumonia
Eventually we will know more research about how oral condition/overall health, and exactly how those connections are made. Hopefully this will add an emphasis on oral health within the general healthcare system.
Overall in the coming years I hope (and believe we will) to see dentistry become of an increasing importance for all Canadians and access to care be increased for populations that cannot as easily access care. I believe more preventative programs should and will be created to educate the importance of good oral hygiene, which leads to good overall dental health for life, as well as overall healthy. It is amazing to see how dentistry is changing, and will change throughout my lifetime.
References
Canadian Centre For Policy Alternatives. (2011). Putting Our Money Where Our mouth is: The Future of Dental Care in Canada. https://www.caphd.ca/sites/default/files/Putting%20our%20money%20where%20our%20mouth%20is.pdf
Mayo Clinic. (June 2019). Oral health: A window to your overall health. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20047475
McNally, M., (2011). Brushing Up on Mouth Care: An oral health resource for those who provide care to older adults. https://cdn.dal.ca/content/dam/dalhousie/pdf/dept/ahprc/BrushingUp-OCManual.pdf
Stein, P., Aalboa, J., Skelton, J., Bright, B., Housley, M., (September 2012). Meeting Oral Health Challenges in Long-Term Care Facilities. Annals of Long-Term Care: Clinical Care and Aging. 20(9):30-34. https://www.managedhealthcareconnect.com/articles/meeting-oral-health-challenges-long-term-care-facilities
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