There are many reasons why some Canadians choose not to go to the dentist, but a new report released recently from the Canadian Academy of Health Sciences (CAHS) found that cost is a major factor -- and that Canada's most vulnerable populations have the highest rates of dental decay, pain and disease, but the worst access to this much needed healthcare service.
The price tag for hospital care and most physician services is covered through our publicly funded healthcare system, but dental care is largely paid for privately in Canada. The CAHS report reveals that a whopping 95% of dental care is paid out-of-pocket or through private dental insurance and is delivered in private dental offices. The remaining 5% is covered through a hodgepodge of public health programs offered federally and provincially, targeting the needs of specific populations, with many falling through the cracks.
So what happens when you don't have dental insurance?
The report found that almost half of all Canadians without dental insurance -- commonly, new Canadians, the elderly, people working in insecure jobs and for low wages, and their children - avoid visiting a dentist due to costs. In fact, those in the poorest income group were almost four times more likely to avoid the dentist due to costs than the richest group of Canadians.
Vulnerable Canadians with difficulty accessing dental care are also those with the most dental pain, the greatest difficulty eating a healthy diet and the ones with the highest levels of gum disease, which in turn can increase their risk for general health problems, such as diabetes and cardiovascular disease.
In other words, those who need dental care the most are the least likely to be able to get it, and the ones who suffer the most because of it. It may also be costing all of us through increased visits to already crowded emergency rooms and physician offices, and valuable time lost from work, school and other activities.
There are other reasons that people skip seeing their dentist, such as lack of transportation, fear of dental treatment and the dental office, and misunderstandings between dental professionals and certain groups in the population. These complex issues have complex solutions.
But they cannot be addressed without first addressing equity in access to dental care. The CAHS report finds that inequalities in oral disease and access to dental care in Canada are greater than inequalities in general health problems and medical care.
What might surprise many is that Canada actually provides less publicly funded dental care than the United States -- and internationally, Canada is among the lowest funders of dental healthcare programs.
Inequality in access to dental care is but one manifestation of the increasing inequalities in Canadian society and it needs to be addressed. With societal changes such as the increasing proportion of the population who are elderly and the decreasing proportion of the population with dental insurance, difficulty accessing dental care is only going to increase unless we start acting now.
All people living in Canada should have reasonable access to dental care. We need to bring dentistry into the general healthcare system by having some dental clinics in hospitals and community health centres. We need to explore the use of a variety of dental and other health professionals delivering care in a variety of settings. And we need to explore the financing of dental care for vulnerable groups -- including anomalies in tax legislation that help those with dental insurance but not those without.
We need concerted professional, government and community action now to begin to address these issues so that many Canadians will get the dental health care they so desperately need.
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While dried fruits may be a definite step up from processed fruit snacks, they are still sticky and high in sugar. That means they not only adhere to teeth easily, but the sugar feeds the bacteria in the mouth, which can promote dental erosion, notes Joy Dubost, Ph.D., R.D., a spokesperson for the American Academy of Nutrition and Dietetics. "I'm not saying don't eat them, but just brush your teeth afterward," Dubost says. Messina adds that regular fresh fruits don't typically have this problem because -- even though they still have sugar -- chewing them up promotes saliva and they don't stick to the teeth. "Fruits are generally pretty safe because they're good for overall health and they're chewy, so your average fruit has some substance to it and we chew through it, causing us to salivate more," Messina says. "Saliva is a good thing because it has washing action and it's a nautral buffer [to] acid."
Sugary drinks, such as sodas and sports drinks, are especially bad for teeth when sipping for long periods of time. "If I have a soft drink or sports drink and I'm sipping it every 20 minutes, my teeth are getting bathed with a constant layer of acid," Messina says. "So sitting down and drinking it all at once, or with a meal, is better than snacking or sipping throughout a meal." For this reason, Dubost recommends that parents don't fill their kids' sippy cups with sugary drinks, since kids, whose teeth are still developing, tend to sip at those drinks over long periods of time.
For the same reason sipping on sodas all day is bad for teeth, hard candies aren't ideal for oral health, Dubost notes. These sweets pack a double whammy in that they not only stick to the teeth, but they also linger in the mouth for a long time as you wait for them to dissolve.
You may not realize it, but alcohol can be bad for the teeth, as it causes natural saliva production to decrease, according to the Yale Medical Group. And again, saliva helps to wash away food particles and provides a buffer against acid. People who are alcoholics may experience dental and gum disease since "alcohol irritates all the soft tissue in the mouth and it decreases the amount of natural saliva," Dr. Parimal Nagjee, a dentist in Beverly Hills, told The Fix. "In terms of the tissue, the skin of the mouth is very delicate and the alcohol is corrosive to the gums, cheeks and skin. It can affect the way the tissue cells divide, which is why people who drink heavily have a greater chance of getting mouth or throat cancer.”
Foods high in acid, such as citrus or tomatoes, can promote tooth decay, especially when eaten alone, Dubost notes. But these foods are fine to eat so long as you flush your mouth with water after consuming them in order to buffer the acid. Citrus not only has acid, but also sugar -- and people who have a habit of sucking on lemons or limes are actually harmfully bathing their teeth in acid, Messina says. "If you look in their mouths, their teeth have a shiny, glossy surface -- that's from constant bathing with the acids," he says. "They will have almost a peculiar look in that you'll see it on the front surfaces of their teeth, but not the back sides of the lower front teeth because those are under the tongue -- and the tongue protects the surface of teeth."
Starchy foods, such as potato chips and white bread, easily get trapped in teeth, which can then feed the bacteria that make up plaque, according to the Yale Medical Group.
Not only do drinks like coffee and tea stain the teeth, they also make the teeth stickier -- meaning more food particles can latch on, Messina says.
Dr. Gore recalls the food and beverages with the most harmful effects on your teeth.