The Canadian Dental Association (CDA) offers a wide range of metrics to provide an overview of oral health in Canada as the national voice for the dental health sector. CDA declares that Canada is among the world's leaders in terms of its population's general oral health. However, more work must be done to enhance oral health in Canada for specific demographics. The most vulnerable parts of Canada's population (e.g., Indigenous peoples, children, seniors, low-income populations, individuals with special needs, refugees, etc.) encounter difficulty in getting the oral health care they need. Oral health is defined by the World Health Organization (WHO) as the absence of tooth decay, oral and facial pain, oral and throat cancer, oral infection and ulcers, periodontal disease, tooth loss, and other diseases and disorders (Petersen, 2003). Oral health encompasses the ability to confidently talk, smile, taste, smell, touch, chew, swallow, and express a variety of emotions through facial expressions while avoiding pain, discomfort, and craniofacial disease.
Worldwide, the most common oral disease is dental caries (cavities, decay). Social and economic determinants of health have a huge impact on dental caries. The Canadian Public Health Association defines the social determinants of health as the social and economic factors that influence people’s health (Canadian Public Health Association, n.d.). The social determinants of health include income, employment, education, social support, gender, culture, race/racism, historical trauma, and access to health services (Government of Canada, n.d.). Based on these determinants of health, Indigenous people experience various challenges, including lack of access to dental care, with no dental offices within a one-hour driving radius and no means of transportation to get there. Due to a lack of evidence-based oral health information to promote appropriate oral hygiene practices, parents are unable to make the best choices for their children's oral hygiene products and oral health behaviors. Food insecurity and poverty levels lead to poor dietary choices and early childhood caries (Kyoon-Achan et al., 2021).
Most public oral health programs fall under provincial/territorial jurisdiction. These include programs administered at the regional and municipal levels. Dental treatment is generally an uninsured service in Canada. In rare situations dental services may be covered by the government if they are received in a hospital or if the patient is a member of an institutionalized and/or at-risk group. Publicly financed dental care expenditures are primarily directed at one of Canada's most vulnerable groups in terms of oral health, namely the First Nations and Inuit peoples, particularly children. Despite the vast sums of money spent on this group every year, substantial discrepancies still exist. Due to the considerable distances these people must travel to attend dental clinics, as well as a shortage of providers willing to work in these communities, access to care is a problem (Canadian Dental Association, n.d.). Indigenous peoples are divided into three groups: First Nations, Inuit, and Métis, each with their own heritage, languages, cultural traditions, and spiritual beliefs. In the 2008-2009 Inuit Oral Health Survey (IOHS), more Inuit reported poor oral health and a greater incidence of food avoidance and dental pain than non-Indigenous Canadians. Nearly two-thirds went to the dentist, even though very few said cost was a factor in delaying a visit or accepting recommended treatment (Canadian Dental Association, n.d.). Although Canada's oral health care metrics are generally above average when compared to other countries, there are disparities in oral care. Families and individuals with lower incomes and lower socioeconomic positions, those without dental insurance, and Indigenous Canadians have significantly poorer oral health than the general population. Closing the oral health inequalities that exist for First Nations and Metis peoples and communities demands equity-oriented healthcare methods that address the specific concerns and challenges that these populations confront. Use of the social-ecological model (SEM) can be helpful in this regard as it recognizes that individuals are part of a larger system. This includes interactions between "individual, interpersonal, organizational, community, and societal/policy factors" (Early, 2016) Cultural awareness and knowledge of family, community, and structural levels of these communities are essential to design interventions that can improve the oral health of Indigenous people.
References:
Canadian Dental Association. (n.d). The State of Oral Health in Canada.
Canadian Public Health Association. (n.d.). What are the social determinants of health?
Early, J. (2016). Health is more than healthcare: It's time for a social-ecological approach. J Nurse Health Stud.1:1.https://www.imedpub.com/articles/health-is-more-than-healthcare-its-time-for-a-social-ecological-approach.php?aid=17440
Government of Canada. (n.d.). Social determinants of health and health inequities.
Health Canada. (2011). Inuit Oral Health Survey Report 2008–2009.
Kyoon-Achan, G., Schroth, R.J., DeMaré, D. et al. (2021). First Nations and Metis peoples’ access and equity challenges with early childhood oral health: a qualitative study. Int J Equity Health 20, 134 (2021). https://doi.org/10.1186/s12939-021-01476-5
Petersen, P.E. (2003). Continuous improvement of oral health in the 21st century - the approach of the WHO Global Oral Health Programe. The World Oral Health Report 2003. https://www.who.int/oral_health/media/en/orh_report03_en.pdf
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