The politics of oral health in British Columbia

1. Waiting for Pain The politics of oral health in British Columbia

2. What is Oral Health? The Canadian Dental Association defines oral health as “a state of the oral and related tissues and structures that contribute positively to physical, mental and social well-being and to the enjoyment of life's possibilities, by allowing the individual to speak, eat and socialize unhindered by pain, discomfort or embarrassment.”

3. What are the most common oral diseases? Dental caries, also known as tooth decay or cavity • A disease where bacterial by-products damage hard tooth structures, causing holes in the teeth. • Untreated, caries lead to pain, tooth loss, infection, and, in severe cases, death. • Caries are one of the most common diseases in the world.

4. What are the most common oral diseases? • Gingivitis: irritation of the gums caused by bacterial plaque between gums and the teeth, and calculus (tartar) on the teeth. • Irritation & inflammation causes deep pockets between the teeth and gums and loss of bone around teeth, known as periodontitis. • The loss of bone from periodontitis can cause teeth to become loose and fall out or need to be extracted because of acute infection. • Proper maintenance above and below the gum line to remove plaque and tartar helps remove the cause of inflammation and helps prevent infection & tooth loss.

5. Ten oral health problems your dentist can see that you can't: • Deterioration in fillings, crowns and other restorations. • Root cavities — decay on roots of teeth exposed by receding gums. • Periodontal pockets caused by gum disease. • New decay under the gum line. • Cavities under existing fillings. • Hairline tooth fractures. • Impacted wisdom teeth. • Early signs of gum disease. • Early signs of oral cancer. • Signs of other problems that could affect your general health

6. The Mouth is a Window... • Average number of filled or decayed teeth per adult = 15.8 (out of 28-32 teeth) • Untreated tooth decay averages 20% across class (concentrated in working class) • 20 % young adults would benefit from orthodontic treatments • 98% of the middle and upper classes have their natural teeth while 25% of those with low income are edentate (have no teeth)

7. The Mouth is a Window to Class Many Barriers Exist to Accessing Dental Care: • 63% of Canadians have some private dental coverage • The poor are concentrated in the 37 % that lack insurance – only 1 in 4 has any insurance versus 3 in 4 in higher income earning brackets • Those without insurance lack funds for dental care • Many workers are unable to take time • Majority of services are in English w/o translation • Many dental clinics are inaccessible to the disabled • Lack of transportation and childcare Maintaining good oral health isn’t a choice – it is a luxury!

8. The Mouth is a Window to Class • In 2005 63.7% of Canadians consulted a dentist: • 12 – 19 years = 78.6% • 75 years + = 40.8% • Total dental expenditures in 2006 were almost 10 B with only 5% as public expenditures – the Federal and Provincial programs are completely inadequate or non-existent

9. The Poor are “Waiting for Pain” • Working class people wait until there is trouble to access dental care, with the result that we’re more likely to suffer: • Loss of teeth • Chronic infections • Chronic pain and all it’s many complications • Heart disease • Diabetes • Stroke • Preterm and low birth-weight babies

10. We Should ALL Smile with Dignity! Poor oral and dental health impacts our: • Self-esteem and sense of self-worth • Employment • Access to education • Nutrition and the pleasure of eating • Emotional expression • Communication and relationships • Participation in community activities • Quality of life • Human dignity

11. Oral Health is a Human Right! “Just as we cannot separate the jaw from the body, we cannot separate oral health care from health care. And yet, throughout the year, citizens, policy makers, and governments engage in critical debates about universal health care in Canada, and absolutely ignore oral health.” Bruce Wallace, VIPIRG Research Coordinator

12. Dental Access Funds • Dental access funds are one way communities addressed access • Administered by a Health Unit, Community Health Clinic, or charitable organization • Has increased access in some communities, and has encouraged some dentists to offer reduced rates or some pro bono work… however: • Disempowering as charitable, patients must have a referral and / or be means tested to receive funds • Funds available are very small – inadequate to cover all needed treatment • Very few are able to be served this way – long wait lists

13. Volunteer Charitable Clinics • “Mandated to relieve pain with a focus on extractions” • A few clinics offer limited cleanings or restorative work • Majority clinics target the homeless, those struggling with addictions, and those with mental health issues • Volunteer dental staff – inconsistent care results • Charity model which can be very disempowering for people • Hours very limited – patients turned away every day • Oral health MUST INCLUDE PREVENTATIVE SERVICES! • Extractions can negatively impact ability to chew as well as having cosmetic implications • Substandard services for the poor is fundamentally unjust

14. Social Enterprise & Subsidized Clinics • Offer lower cost dental, 10 – 100% below standard fee guide • Those with insurance fund those who don’t have insurance • Clinics still rely on fee for service from patients • Full services available, not just extractions • Very limited capacity to meet the need for low cost dentistry • 10-30% reduction of fees is not nearly enough to make preventative and restorative work affordable for many low income people • Sometimes recommended treatment plans are not ideal b/c dentist knows patient is low income • Very long wait lists to get an appointment unless very urgent

15. Teaching Clinics • Resembles social enterprise clinic – reduced fees 60% BCDA guide fees • Offer orthodontics to children assessed to be in need but still this work is >$1000 (60% reduction from private fees) • Not easy to access as on campus (at UBC) • Long wait times at the clinics • Students doing the work • Some dental hygienist programs offer discounted cleanings • Many of the same disadvantages of the subsidized clinics, and more… • Not anywhere near adequate to meet the needs in BC!

16. Universal Dental Care for All! • Access to dental care determined by ability to pay not by need • We are one of few industrialized nations without an oral health strategy • Oral health is completely excluded from our human right to universal health care • We should not accept stop-gap measures! • Structural issues undermining equality in oral health must be addressed! • Include basic dental care services in our BC Medical Services Plan!

17. We’re tired of Waiting in Pain! After more than two years of reaching out in the Mount Pleasant community, and many years of doing popular education and participatory action in East Van, the APH is ready to launch a campaign for universal dental care… • What demands do we want to make to the Ministry of Health? • What slogans and catch phrases can we brainstorm to represent those demands?