tag:theconversation.com,2011:/uk/topics/dental-care-3003/articlesDental care – The Conversation2024-02-26T13:09:10Ztag:theconversation.com,2011:article/2238422024-02-26T13:09:10Z2024-02-26T13:09:10ZNHS dentistry is in crisis – are overseas dentists the answer?<figure><img src="https://images.theconversation.com/files/576767/original/file-20240220-22-2pedi7.jpg?ixlib=rb-1.1.0&rect=0%2C16%2C2703%2C1760&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-yellow-teeth-due-heavy-smoking-448144885">wk1003mike/Shutterstock</a></span></figcaption></figure><p>Images of a long line of desperate people <a href="https://www.youtube.com/watch?v=iIZJ7pshm0U">queuing around the block</a> in the hope of getting on the list at a new dental practice in Bristol paint a bleak picture of the state of NHS dentistry. </p>
<p>The situation got so desperate that police were called to provide crowd control in a scene more typical of a Taylor Swift concert than a dental waiting room. This unprecedented demand is due to a shortage of dentists in the UK, particularly ones who are willing to work for the NHS.</p>
<p>There may be a record number of dentists on the General Dental Council (GDC) register – <a href="https://www.gdc-uk.org/news-blogs/news/detail/2024/01/15/number-uk-dentists-recent-renewal">over 44,000</a> at the start of 2024 – yet a workforce shortage is still considered a major contributing factor in the lack of dental access in the UK. </p>
<p>Registration figures can be misleading. Although the number of dentists in the UK is increasing, there are <a href="https://www.bda.org/news-and-opinion/news/nhs-dentistry-pm-must-drop-the-spin-and-accept-the-facts/">1,100 fewer doing NHS work than before the pandemic</a>, the lowest since 2012. These figures do not take into consideration changing work patterns within the dental profession, which indicate that younger dentists are working <a href="https://bmchealthservres.biomedcentral.com/counter/pdf/10.1186/s12913-020-4980-6.pdf">fewer clinical hours and less time within the NHS</a>. </p>
<p>It is worth noting that the UK has lower numbers of dentists per head of population <a href="https://www.nao.org.uk/wp-content/uploads/2020/03/Dentistry-in-England.pdf">compared with</a> many other European countries. The UK has 5.3 dentists per 10,000 of the population compared with 6.5 in France, 8.3 in Italy and 8.5 in Germany.</p>
<p>The shortage of dentists, and other dental care professionals, has finally been recognised by the government, with a <a href="https://www.england.nhs.uk/long-read/nhs-long-term-workforce-plan-2/">NHS long-term workforce plan</a> setting out clear goals to increase the number of training places for dentists, hygienists and dental therapists. </p>
<p>The government <a href="https://www.gov.uk/government/publications/our-plan-to-recover-and-reform-nhs-dentistry/faster-simpler-and-fairer-our-plan-to-recover-and-reform-nhs-dentistry#supporting-and-developing-the-whole-dental-workforce">aims</a> to increase dental training places in the UK by 40% by 2031-32, with 1,100 UK dentists qualifying each year. </p>
<p>Dentistry is a five-year university programme. Following that, graduates need to work for a minimum of one year as a dental foundation trainee before they are allowed to work independently as a general dental practitioner in the NHS. As a result, any increase in training places will take more than a decade to have a significant effect.</p>
<p>The workforce plan will offer little in the way of solace to the millions of people who currently cannot find a dentist. Urgent action is needed to avoid lengthening queues, and the government appears to have identified overseas graduates as a potential answer to their problems. </p>
<p>Thirty per cent of dentists on the GDC register qualified <a href="https://www.gdc-uk.org/about-us/what-we-do/briefing">outside the UK</a>, and in 2022, 46% of new dentists joining the register were <a href="https://www.gdc-uk.org/news-blogs/news/detail/2023/05/18/general-dental-council-publishes-registration-and-fitness-to-practise-statistical-reports">international dental graduates</a>.</p>
<p>The process of obtaining registration for international dental graduates is difficult, expensive and inefficient. It can take several years to pass the necessary exams and obtain UK registration. During that time applicants are unable to work as a dentist. </p>
<p>The situation is compounded by a limited number of examination places each year and <a href="https://www.gdc-uk.org/news-blogs/news/detail/2023/07/31/the-gdc-announces-more-ore-places-and-boosts-the-size-of-the-international-registration-casework-team">a low pass rate</a> for the practical exam (45%). </p>
<p>The GDC has announced an increase in exam capacity, which will allow more dentists to take the <a href="https://www.gdc-uk.org/news-blogs/news/detail/2023/07/31/the-gdc-announces-more-ore-places-and-boosts-the-size-of-the-international-registration-casework-team">overseas registration exams</a>. This is a practical approach to increase capacity while safeguarding standards.</p>
<h2>No need to pass UK exam</h2>
<p>The government has just announced a further development: the introduction of <a href="https://www.gov.uk/government/consultations/provisional-registration-for-overseas-qualified-dentists/provisional-registration-for-overseas-qualified-dentists">provisional registration</a>, aimed at accelerating the registration process and allowing international dental graduates to work as a dentist without having to pass a UK examination. </p>
<p>This has already caused concern within the dental profession, with some commentators fearful that patient safety will be <a href="https://www.globalplayer.com/videos/2JsSaaVAsHR/">sacrificed</a> in a race to increase dentist numbers and improve NHS access. </p>
<p>This view is clearly not shared by the GDC who have been quick to welcome the introduction of <a href="https://www.gdc-uk.org/news-blogs/news/detail/2024/02/16/we-welcome-the-provisional-registration-changes-and-further-collaboration-with-the-dental-sector-to-create-a-new-system-that-benefits-professionals-and-the-public">provisional registration</a>.</p>
<p>The GDC has a responsibility to ensure that any dental professional joining the dental register has undergone the appropriate training, is capable of providing a high standard of patient care, and is fully aware of their responsibilities as a dental registrant. </p>
<p>The NHS is a complex system, and the current NHS dental contract and regulations are complicated and confusing. UK graduates often struggle to comprehend the nuances of the NHS, and international dental graduates will need support to ensure they are able to integrate into a new system. </p>
<p>Training and mentorship are important considerations. This will be a critical aspect of integrating overseas dentists into the NHS and ensuring the highest standards of care are maintained. This cannot be done without the support of the existing primary care workforce, and consideration must be given to how this is going to be delivered and resourced.</p>
<h2>Patient safety</h2>
<p>International dental graduates are an important part of the solution to the current workforce shortage, and a review of the present registration process was certainly long overdue. There is huge potential to use an overseas workforce more effectively, but we must ensure that patient safety remains paramount.</p>
<p>We must also reflect on the ethical implications of recruiting dentists from another country while considering the fairness and appropriateness of introducing international dental graduates into a widely criticised NHS system. Sustainability and continuity are valuable assets in healthcare, and the creation of a two-tier system delivered by an itinerant workforce must be avoided at all costs.</p>
<p>Simplifying the recruitment of overseas dentists will not save NHS dentistry alone. The problems run much deeper than a simple workforce shortage. There needs to be an honest discussion with the public, the profession and politicians about NHS dentistry. What do we want? What do we need? And what can we afford? There is no merit in recruiting more dentists if there is no commitment to address the reason so many of the workforce are leaving the NHS.</p><img src="https://counter.theconversation.com/content/223842/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Mills is affiliated with:
Member of British Dental Association
Past Dean of the Faculty of General Dental Practice of Royal College of Surgeons of England
Fellow of College of General Dentistry
</span></em></p>New government proposals include scrapping the exam that overseas dentists usually have to take.Ian Mills, Associate Professor in Primary Care Dentistry, University of PlymouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2194782023-12-28T19:36:45Z2023-12-28T19:36:45ZWill the supply-and-confidence deal between the Liberals and NDP survive in 2024?<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/will-the-supply-and-confidence-deal-between-the-liberals-and-ndp-survive-in-2024" width="100%" height="400"></iframe>
<p>Signed in March 2022, <a href="https://www.pm.gc.ca/en/news/news-releases/2022/03/22/delivering-canadians-now">the supply-and-confidence agreement between the governing Liberals and the opposition New Democrats</a> has already led to significant social policy expansion, including the adoption of the <a href="https://www.tvo.org/article/everything-we-know-so-far-about-the-canadian-dental-care-plan">Canadian Dental Care Plan</a>.</p>
<p>The deal eased the uncertainty facing Prime Minister Justin Trudeau’s minority government while allowing the NDP to <a href="https://www.jstor.org/stable/4007281">take credit</a> for some of the government’s social policy announcements.</p>
<p>But the future of the deal <a href="https://www.cbc.ca/player/play/2293259843686">has been called into question</a> in recent months. That’s because of the Trudeau government’s failure in 2023 to deliver on pharmacare, a central aspect of the March 2022 agreement.</p>
<p><a href="https://www.cbc.ca/news/politics/pharmacare-ndp-liberal-1.7059558">With the deadline for a pharmacare bill recently extended until March 1</a>, it’s helpful to look back at the origins of the supply-and-confidence agreement as we examine its fate in the year ahead.</p>
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Read more:
<a href="https://theconversation.com/politicians-come-and-go-but-the-clock-is-now-ticking-on-long-promised-pharmacare-215492">Politicians come and go, but the clock is now ticking on long-promised pharmacare</a>
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<h2>Past agreements</h2>
<p>Inter-party agreements in Canadian Parliament are extremely rare. Apart from the <a href="https://www.tvo.org/article/how-the-ndp-saved-pierre-trudeaus-government">1972 agreement between the Liberals and the New Democrats</a>, there had never been an alliance between federal political parties in Canada before the <a href="https://www.pm.gc.ca/en/news/news-releases/2022/03/22/delivering-canadians-now">2022 agreement between Trudeau and NDP Leader Jagmeet Singh</a>.</p>
<p><a href="https://www.theguardian.com/politics/2017/jun/11/confidence-and-supply-what-does-it-mean-and-how-will-it-work-for-the-new-government">Such supply-and-confidence agreements are common elsewhere in the Commonwealth</a>, but largely unprecedented in Canadian politics. </p>
<p>That’s why understanding the origins and impacts of this agreement — in which the NDP stays in opposition but supports the Liberal government, actively contributing to the implementation of key policy — is important.</p>
<h2>Three factors at play</h2>
<p>Three recent changes in federal politics help explain why both parties entered into the agreement in 2022. </p>
<p>First, since Trudeau became prime minister in late 2015, the Liberals and NDP have moved closer together. The two parties share more policies than in the past, especially in the area of social policy. </p>
<p><a href="https://doi.org/10.1093/polsoc/puac002">The COVID-19 pandemic, in particular, provided an opportunity for greater co-operation in the design and implementation of temporary and expansive emergency measures.</a> In the aftermath of the pandemic, both parties agreed that new permanent federal programs are necessary, which is reflected in the details of the supply-and-confidence deal.</p>
<p>Second, public support over the last four years has left the Liberals and the NDP in a tricky situation. <a href="https://www.mqup.ca/canadian-federal-election-of-2021--the-products-9780228013822.php">Liberal victory margins were small in 2019 and 2021, in both cases leading to a minority government.</a> </p>
<p>Because both the Liberals and the NDP support an expanding social welfare program, the supply-and-confidence agreement provided both parties with a short-term political solution to both implement new key social policies and delay a federal election that could have led to a Conservative victory.</p>
<p>Third, although the Conservative Party consistently won the biggest portion of the popular vote <a href="https://ca.news.yahoo.com/erin-otoole-conservatives-popular-vote-canada-election-054033279.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAFCeLBB_d2APEP9wMlTtDSoV1uKcEbQMD5gEB1inwhzk6OPc_8t9U93WBRGx-rBCYS_VUkh8hD_8N-veDfo0dnlsbUz9Jfli4I9R42CBbKjuGYEY1-AJ4BY6iWu5kZn2fDfZcXbCzgwSqJrPF6f9EyoUldoZQEzr3qD2mW6v_Elx">in both 2019 (34.3 per cent) and 2021 (33.7 per cent)</a> — and are ahead in recent polls — the competition is fierce on the political left. </p>
<p>Together, the more progressive parties — the Liberals, the NDP, the Bloc Québécois and the Green Party — have the support <a href="https://www.theglobeandmail.com/politics/article-majority-of-canadians-comfortable-or-somewhat-comfortable-with-liberal/">of a significant majority of Canadians</a>, so each have to be seen as a credible political option to assert dominance over the others. </p>
<p>To this end, the supply-and-confidence deal has helped both parties develop and take credit for the expansion of social policies across Canada. <a href="https://www.cbc.ca/news/politics/trudeau-cabinet-retreat-inflation-housing-wherry-analysis-1.6940959">It’s allowed the Liberals to maintain their identity as the defender of the middle class while the NDP has continued to oppose the wealthy and support the working class.</a></p>
<h2>Political tensions</h2>
<p>Both parties share a progressive identity that has facilitated their alliance. But currently, <a href="https://nationalpost.com/news/politics/ndp-members-grow-frustrated-over-garbage-deal-with-liberals-seek-harder-line-from-singh">growing tensions between the Liberals and the NDP</a> make the future of the agreement increasingly uncertain.</p>
<p>That’s largely because of the recent sharp decline in public support for the Liberals. The plunge has prompted <a href="https://vancouversun.com/news/politics/jagmeet-singh-bc-ndp-convention">Singh to become harshly critical of Trudeau</a> in an effort to distance the NDP from an increasingly unpopular government and prime minister. </p>
<p>Singh has suggested the Liberals have only agreed to enact progressive policies that truly help Canadians when forced to do so by the NDP. He said in November 2023: “<a href="https://www.ctvnews.ca/politics/jagmeet-singh-blasts-trudeau-poilievre-at-b-c-convention-1.6651723">One of our MPs has described working with the Liberals like wrestling eels that are soaked in oil.”</a> </p>
<p>Singh apparently doesn’t want to be regarded as a mere servant of the Liberals, keeping an unpopular government in power through the supply-and-confidence agreement. </p>
<p>That’s why he regularly reminds Canadians that he could pull the plug on the agreement if the Trudeau government fails to support the measures contained in the deal. Pharmacare is a case in point.</p>
<h2>Death of the deal ahead?</h2>
<p>Will the agreement be dissolved soon? </p>
<p>Terminating the agreement could help the NDP distance itself from the increasingly unpopular Liberals without necessarily triggering a federal election since the party could still support the Trudeau government in confidence votes through one-off deals.</p>
<p>Those types of agreements are much more common in Canada’s minority parliaments than formal legislative coalitions like the existing supply-and-confidence agreement. </p>
<p>The question for the NDP is whether it’s better off electorally with or without the agreement. Because public support for the NDP remains stable (or even slightly higher) while Liberal support has plummeted, that might make the Liberals cling longer to the agreement.</p>
<p>In the next few months, we’ll know whether this unusual agreement survives.</p><img src="https://counter.theconversation.com/content/219478/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel Béland receives funding from the Social Sciences and Humanities Research Council.</span></em></p><p class="fine-print"><em><span>Louis Massé receives funding from Social Sciences and Humanities Research Council. </span></em></p>The supply-and-confidence agreement between the Liberals and NDP has helped both parties develop and take credit for the expansion of social policies across Canada. But is it on life support?Daniel Béland, Professor, Political Science, McGill UniversityLouis Massé, PhD Student, Political Science, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2198782023-12-19T23:42:53Z2023-12-19T23:42:53ZOral health is health: Better access to dental care may have potential benefits beyond Canadians’ mouths<figure><img src="https://images.theconversation.com/files/566686/original/file-20231219-15-3hv10x.jpg?ixlib=rb-1.1.0&rect=688%2C22%2C4303%2C2964&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Because oral health is linked to overall health, dental care needs to be viewed as an integral part of health care. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/oral-health-is-health-better-access-to-dental-care-may-have-potential-benefits-beyond-canadians-mouths" width="100%" height="400"></iframe>
<p>Oral diseases, particularly dental decay and periodontal (gum) diseases, are largely preventable, yet are some of the <a href="https://www.who.int/data/gho/data/themes/oral-health-data-portal">most common non-communicable diseases around the world</a>. Pain due to untreated dental decay impacts eating and sleep quality, among other essential functions. Indeed, the agonizing nature of dental pain earned it the title of “<a href="https://doi.org/10.1038/sj.bdj.4809302">the hell of all diseases</a>” more than 200 years ago.</p>
<p>But pain is only the most obvious of the many ways oral health is linked to overall health.</p>
<h2>Access to dental care</h2>
<p>The federal government recently launched the long-anticipated <a href="https://www.canada.ca/en/services/benefits/dental/dental-care-plan.html">Canada Dental Care Plan</a> (CDCP) to improve access to dental care for the almost <a href="https://www.canada.ca/en/health-canada/news/2023/12/the-canadian-dental-care-plan.html">nine million Canadians</a> who lack dental insurance.</p>
<p>The program comes in light of the increasing barriers to dental care with the most recent data from Statistics Canada showing that <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/231106/dq231106a-eng.htm">one in four Canadians avoid seeing a dental professional due to costs</a>. While this burden affects mostly low-income families, seniors and people living with disabilities, it also places a huge toll on the population as a whole.</p>
<p>On top of the time lost from school or work due to dental problems, many without the means to access dental care end up seeking care in hospital emergency departments, unnecessarily costing the health-care system billions of dollars.</p>
<p>The CDCP is an important milestone that could eventually get many Canadians the dental care they need and deserve. Meanwhile, this investment in oral health is a reminder of the importance of a healthy mouth, what makes it fundamental to overall health, and notably, how the potential impact of improving access to dental care for those who need it most may extend beyond the mouth.</p>
<h2>Oral health is integral for overall health</h2>
<p>The <a href="https://www.who.int/health-topics/oral-health#tab=tab_1">World Health Organization</a> (WHO) defines oral health as “the state of the mouth, teeth and orofacial structures that enables individuals to perform essential functions such as eating, breathing and speaking, and encompassing psychosocial dimensions such as self-confidence, well-being, and the ability to socialize and work without pain, discomfort and embarrassment.”</p>
<p>A healthy, disease-free mouth is key to quality of life and well-being. Being fundamental to various essential functions, the lack of oral health connects it to a number of chronic diseases in several ways.</p>
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Read more:
<a href="https://theconversation.com/filling-the-gaps-why-canada-still-needs-a-public-dental-health-plan-despite-decades-of-medicare-181306">Filling the gaps: Why Canada still needs a public dental health plan despite decades of medicare</a>
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<p>The most <a href="https://iris.who.int/bitstream/handle/10665/373542/9789240070820-eng.pdf?sequence=1">recent WHO report</a> shows that dental decay and gum diseases affect almost 25 per cent of Canadian adults — a higher figure than that observed in the United States. Importantly, both conditions are among the most common causes of tooth loss in adults globally, thereby impacting the ability to eat, the quality of nutrition and, in seniors, <a href="https://doi.org/10.1111/jgs.16377">contributing to frailty</a> and <a href="https://doi.org/10.1111/jgs.13190">declining cognitive health</a>.</p>
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<figcaption><span class="caption">Prime Minister Justin Trudeau making an announcement about applying for the federal dental benefit, at one of Western University’s dental clinics in December 2022.</span></figcaption>
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<p>Severe gum disease in particular is an inflammatory condition that is linked to several other chronic conditions through <a href="https://doi.org/10.1038/s41577-020-00488-6">exacerbating inflammatory reactions</a> in other organs and body systems and that may arguably contribute to some <a href="https://doi.org/10.1016/j.amjcard.2016.05.036">heart</a> and <a href="https://doi.org/10.1111/nep.13225">kidney diseases</a>, among others.</p>
<p>Importantly, there is <a href="https://doi.org/10.1038/sj.bdj.2017.544">a bidirectional relationship between gum diseases and diabetes</a>, where severe inflammation of the gums and supporting bone can aggravate the risk and complications of diabetes, and vice versa.</p>
<p>The consequences of an unhealthy mouth also extend to an individual’s social interactions. For example, those experiencing poor esthetics due to crooked, broken or stained teeth are more likely to be <a href="https://doi.org/10.1016/j.ssmph.2015.11.001">stigmatized and blamed for their dental appearance</a>. In severe cases, they may potentially have <a href="https://www.thestar.com/news/why-is-he-out-of-work/article_711c362f-333c-5580-97ae-7f4646eb092d.html">fewer opportunities for employment</a>.</p>
<p>Observations such as these bring to mind the 19th century’s French naturalist and father of paleontology, Georges Cuvier who famously said, “<a href="https://wellcomecollection.org/articles/W3LpDykAACgAEVFi">Show me your teeth and I will tell you who you are</a>.” </p>
<p>Cuvier’s statement at the time intended to describe how teeth where distinctive of populations according to diets and environmental impacts. Nevertheless, it is not hard to see its relevance to the appearance and health of the mouth and teeth and their impact on how one is perceived in today’s society.</p>
<h2>Children’s health and dental care</h2>
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<img alt="A boy being examined. by a dental care worker out of shot" src="https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Canadian kindergarteners in need of dental treatment are found to score lower on physical, cognitive, social and emotional development scales than those without dental problems.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Certainly, oral diseases affect all age groups and children are no exception. Recent reports show that almost <a href="https://iris.who.int/bitstream/handle/10665/373542/9789240070820-eng.pdf?sequence=1">39 per cent of Canadian children</a> under nine years old have dental decay. Just like in adults, the impact of dental decay on children extends to poor nutrition, and affects sleep and development.</p>
<p>For example, Canadian kindergarteners in need of dental treatment were found to <a href="https://doi.org/10.1186/s12887-019-1868-x">score lower on physical, cognitive, social and emotional development scales</a> than those without dental problems. On top of this, researchers found the treatment of severely decayed teeth to be by far <a href="https://publications.gc.ca/collections/collection_2014/icis-cihi/H118-94-2013-eng.pdf">the most common reason for children aged one to five years old to receive general anesthesia to undergo surgery</a>.</p>
<h2>Dental care and chronic conditions</h2>
<p>The connection between oral health and overall health is evident in myriad ways, and so is the need to improve oral health and access to dental care in Canada. It also raises the question of whether dental care can help alleviate chronic conditions beyond the mouth. </p>
<p>The <a href="https://doi.org/10.1038/s41467-022-35337-8">scientific evidence on that varies</a>, and largely depends on the chronic condition in question. For example, patients with diabetes are among those who can benefit the most from having better access to dental care. Treating gum diseases can help subside body inflammation and <a href="https://doi.org/10.1002%2F14651858.CD004714.pub4">reduce the risk and complications of diabetes by helping the body regulate blood glucose levels</a>. </p>
<p>Notably, Canada ranks <a href="https://iris.who.int/bitstream/handle/10665/373542/9789240070820-eng.pdf">fourth out of 29 countries</a> in the Region of the Americas in its rate of lip and oral cavity cancer. Many dentists are trained to spot the signs of oral cancer and can help in its early detection, which can be lifesaving.</p>
<p>As we learn more on the impact of dental treatment on chronic disease management, we know that facilitating access to dental care can have promising results on several fronts. In addition to saving costs for individuals and our health-care system, it would enhance the population’s oral health and potentially help in the management of some chronic diseases, such as diabetes. </p>
<p>Importantly, it can reduce the pervasive and inequitable burden of oral diseases. </p>
<p>Indeed, investing in better access to dental care may bring us closer to a healthy smile and beyond, for every Canadian.</p><img src="https://counter.theconversation.com/content/219878/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Noha Aziz-Ezzat Gomaa receives or has received funding from the Canadian Institutes of Health Research, the Schulich School of Medicine & Dentistry at Western University, and the Children's Health Foundation. She is affiliated with various national and provincial dental professional associations.</span></em></p>In addition to saving costs for individuals and our health-care system, facilitating access to dental care would enhance the population’s oral health and potentially help in managing chronic diseases.Noha A. Gomaa, Assistant Professor, Dental Public Health and Oral Medicine, Schulich School of Medicine & Dentistry, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2157862023-12-13T02:00:58Z2023-12-13T02:00:58ZWhat happens to teeth as you age? And how can you extend the life of your smile?<figure><img src="https://images.theconversation.com/files/563479/original/file-20231204-29-83y9fl.jpg?ixlib=rb-1.1.0&rect=159%2C0%2C5447%2C3732&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/elderly-person-toothache-174163370">Shutterstock</a></span></figcaption></figure><p>A healthy smile <a href="https://pubmed.ncbi.nlm.nih.gov/37314011/">helps us</a> live long, well and happy lives. But just <a href="https://pubmed.ncbi.nlm.nih.gov/37436910/">like our bodies</a>, our teeth succumb to age-related changes. </p>
<p>So what happens to teeth as you age? And what can you do to ensure your smile lasts the distance?</p>
<h2>First, what are teeth made of?</h2>
<p>The tooth crown is covered by a hard enamel coat that surrounds softer, brown dentine, which protects a centrally located pulp. </p>
<p>Enamel is a complex weave of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2584618/">brittle</a>, honeycomb-clustered strands that interact with light to make teeth appear opalescent (a pearly, milky iridescence).</p>
<p><a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1601-1546.2012.00269.x">Dentine under enamel</a> forms most of the tooth crown and root, and is made of collagen, mineral, water and proteins. Collagen strands are <a href="https://www.sciencedirect.com/science/article/pii/S0003996922002102?via%3Dihub#bib12">woven</a> to stretch and spring back, to <a href="https://www.sciencedirect.com/science/article/pii/S0003996922002102?via%3Dihub#bib12">prevent teeth</a> from cracking and breaking when we grind and chew.</p>
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<a href="https://theconversation.com/curious-kids-what-is-inside-teeth-187258">Curious Kids: what is inside teeth?</a>
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<p>The pulp has blood vessels and nerves that communicate with the rest of your body. </p>
<p>Enmeshed in the dentine mineral and collagen are small, <a href="https://pubmed.ncbi.nlm.nih.gov/8809302/">interconnected tubules</a> formed by specialised cells called <a href="https://www.sciencedirect.com/science/article/abs/pii/S1047847799940960">odontoblasts</a> that settle around the pulp, once our teeth completely form.</p>
<p>Each tooth contains a <a href="https://pubmed.ncbi.nlm.nih.gov/23803461/">finite number of odontoblasts</a>, unlike the constantly replenished special bone cells that renew. </p>
<h2>How do our teeth change as we age?</h2>
<p>Unable to renew, our teeth <a href="https://www.sciencedirect.com/science/article/pii/S0003996922002102?via%3Dihub#bib19">become brittle</a>, and prone to fracture as dentine loses its spring. </p>
<p>This is <a href="https://www.sciencedirect.com/science/article/pii/S0002817714613532?casa_token=1K9Y6CJXmsAAAAAA:t6y_b_Iy02AWpUGaiz4H8Fk0Kdfx6z1ypHiGOEjFqFNlU1jvSRCVjfYOyysgIErJvgCzh33c2hfX">more common</a> in teeth with existing crack lines, large fillings or root canal treatments. </p>
<p>With time, the outer surface of enamel <a href="https://www.sciencedirect.com/science/article/abs/pii/S0022391305004348?casa_token=xXfdecXrLaoAAAAA:YE_0swAFtT3RyCUeJmPwciixQ0hwL-foLyC2RGtnlyUSJ9O-pPLQz0B8XNd4Gq1AMtCN2BgnCrqo">thins</a> to reveal the relatively opaque dentine that darkens as we age.</p>
<p>The dentine darkens because the collagen weave <a href="https://www.sciencedirect.com/science/article/abs/pii/S1047847722000697">stiffens and shrinks</a>, and the fluid in the tubules <a href="https://www.sciencedirect.com/science/article/pii/S2590152422000010?via%3Dihub">fills with mineral</a>.</p>
<p>The odontoblasts continue to form dentine inside the tooth to reduce the translucent pulp space. The increase in dentine makes our teeth appear <a href="https://www.sciencedirect.com/science/article/abs/pii/S0003996913003294">opaque</a> and insulates from hot and cold sensations. This is why <a href="https://www.sciencedirect.com/science/article/pii/S0300571215000494?casa_token=iiLtoxOZOYQAAAAA:RfaGR7lrq9dgWuO_nh6hLETzVUiIWdu-mB-Ev019vZH5t6meVyAHs3YpZzcu9FNrDBYQL6OExu6j">X-rays</a> are useful to detect cavities we may not feel. </p>
<p>Food and drink particles fill micro-gaps and age-related fine crack lines that run up and down enamel to <a href="https://www.researchgate.net/profile/Yash-Kapadia/publication/322509199_Tooth_staining_A_review_of_etiology_and_treatment_modalities/links/5b4cd922a6fdcc8dae245b7d/Tooth-staining-A-review-of-etiology-and-treatment-modalities.pdf">discolour and stain</a>. These stains are easily managed by <a href="https://www.sciencedirect.com/science/article/pii/S2772559622000207">tooth whitening</a>.</p>
<p>How else can you extend the life of your teeth and brighten your smile? Here are seven tips to avoid dental decline:</p>
<h2>1. Avoid unnecessary forces</h2>
<p>Avoid <a href="https://www.nature.com/articles/sj.bdj.2012.722">using</a> your teeth to hold things such as working tools or to open packaging. </p>
<p>Take measures to avoid forces such as <a href="https://www.sciencedirect.com/science/article/pii/S1882761622000059">grinding or clenching</a> by wearing a night guard. </p>
<p>If you have <a href="https://www.sciencedirect.com/science/article/pii/S0109564122002421">large fillings</a> or <a href="https://www.sciencedirect.com/science/article/pii/S0109564122001579?casa_token=kQPjGNgU2iQAAAAA:ytMnT5MLV8aRehNyyWD7qC7FXSBE5xpPCxnzZ2ryKsuyJePq1jHisue1udtN0Cs6NDYJ37xYHy_5">root canal-treated</a> teeth, speak to your dentist about <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/aej.12002?casa_token=RwMhhwmgjwwAAAAA%3AGCWVA9vjFX68S2DdKbCFl4jwTAjMeqVDoT3GtXTSjA7SMEc3ksktOMCUSz9ArikD4XhBM5v08nGCvmVF0g">specific filling materials or crowns</a> that can protect your teeth from cracking or breaking.</p>
<h2>2. Share the load</h2>
<p>If you are missing molars or premolars, distribute chewing forces evenly to prevent overloading your remaining teeth. </p>
<p>Replace missing teeth with <a href="https://www.sciencedirect.com/science/article/pii/S010956411100858X?casa_token=4vrj3ssj0PEAAAAA:UODaFxNDCKmQ_lQs1faL6lh0xIeIfSFrRQBq-s0KF1ZvUJd6ytbXX37TVaiHLRzJPJaSDF_2aVmL">bridges</a>, <a href="https://aap.onlinelibrary.wiley.com/doi/full/10.1902/jop.2008.080188?casa_token=uA0r7imcRbUAAAAA%3AeXGszI5-Dcu4oKi33FCrRRviiAj0uyoP7V5wApIRQD1-1Zu-rkLAcoLhKMAJYVnC9tEnxj33UdNJIndEBA">implants</a> or well-fitted <a href="https://www.mdpi.com/1660-4601/18/13/6776">dentures</a> to support your bite. Get your dentures <a href="https://www.sciencedirect.com/science/article/pii/S0022391320301554">checked regularly</a> to ensure they fit and support adequately, and replace them at least every ten years. </p>
<h2>3. Preserve your enamel</h2>
<p>Reduce <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jcpe.12330?casa_token=W2Ib34A77-QAAAAA%3AnLZtwwqZuueyHf1CMX0K9MERSW_Pvc3w0KlpArFT1KNusuopjEUcWmGd8pDUA7fQcj6DMkcS-JnXISFV1w">further enamel and dentine loss</a> by selecting soft-bristled <a href="https://www.tandfonline.com/doi/full/10.1080/00016350802195041?casa_token=E-ErdP543QUAAAAA%3A0Wz5AWwQxntBIc3UndFX_5nVbAYoPDx-PX1tg7Umxjr_QepX3CSIFVXYcrrxWV9iTx99Afk8c_zff-o">tooth brushes and non-abrasive toothpastes</a>. </p>
<p>Certain whitening toothpastes can be abrasive, which can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8874033/">roughen and wear</a> the tooth surfaces. If you are unsure, stick with toothpastes that are labelled “sensitive”. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-brush-your-teeth-properly-according-to-a-dentist-177219">How to brush your teeth properly, according to a dentist</a>
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<p>Reduce your exposure to <a href="https://www.nature.com/articles/sj.bdj.2012.722">acid</a> in food (think lemons or apple cider vinegar) or illness (reflux or vomiting) where possible to maintain enamel and prevent erosion. </p>
<h2>4. Enhance your saliva</h2>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jtxs.12356?casa_token=1moXbwnrDQIAAAAA%3AHz3Im9lmR3h75TmG8FSUQH-8_0UGnQ9TNkgaPL79LlrCmwC3kzZZJaAB2mSZHf4X7PX5y3GKaVoY5cm5JA">Saliva</a> protects against acid attacks, flushes our teeth, and has antibacterial properties to reduce erosion and decay (holes forming). </p>
<p>Saliva is also important to help us chew, swallow and speak. </p>
<p>But our saliva quality and quantity reduces because of age-related changes to our salivary glands as well as certain medications prescribed to <a href="https://pubmed.ncbi.nlm.nih.gov/19392837/">manage chronic illnesses</a> such as depression and high blood pressure. </p>
<p>Speak to your doctor about other medication options to improve your saliva or manage reflux disease to prevent erosion. </p>
<figure class="align-center ">
<img alt="Man looks at medicine bottle" src="https://images.theconversation.com/files/563889/original/file-20231206-15-e9rzdk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563889/original/file-20231206-15-e9rzdk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563889/original/file-20231206-15-e9rzdk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563889/original/file-20231206-15-e9rzdk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563889/original/file-20231206-15-e9rzdk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563889/original/file-20231206-15-e9rzdk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563889/original/file-20231206-15-e9rzdk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Some medications can reduce your saliva production.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-worried-senior-man-medicine-pills-2301033245">Shutterstock</a></span>
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<h2>5. Treat gum disease</h2>
<p>Aesthetically, <a href="https://pubmed.ncbi.nlm.nih.gov/37358230/">treating gum disease (periodontitis)</a> reduces gum shrinkage (recession) that typically exposes the relatively darker tooth roots that are more <a href="https://journals.sagepub.com/doi/abs/10.1177/00220345231166294">prone to developing holes</a>.</p>
<h2>6. Manage and prevent senescence</h2>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/36908187/">Cellular senescence</a> is the process that changes DNA in our cells to reduce our ability to withstand physical, chemical or biological damage. </p>
<p>Cellular senescence enhances new cancer formation, the spread of existing cancers and the onset of chronic illnesses such as Alzheimer’s disease, diabetes, osteoporosis and heart disease. </p>
<p>You can prevent cell damage by managing lifestyle factors such as smoking, uncontrolled diabetes and chronic infections such as gum disease. </p>
<h2>7. Adapt and ask for help</h2>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jan.15769?casa_token=SC-LouFQThsAAAAA%3A4jcvLRuJ56dGEm7ttvMad65hvUoZ7V5nvILg5sLFVZo8jxyQGR6YFeTcfM8sByTbdVrCWR1O5ytI3Z_crA">Ageing</a> can affect our cognition, hand dexterity and eyesight to prevent us from cleaning our teeth and gums as effectively as we once could. </p>
<p>If this describes you, talk to your dental care team. They can help clean your teeth, and <a href="https://www.magonlinelibrary.com/doi/full/10.12968/bjon.2020.29.9.520?casa_token=_rol0NXx9c8AAAAA%3Aq8zgxiMSASwF1MRQZnZzfzmttn2x7FfGwsiIv71C_s_PTTmGD9JOIbqqtLNXa0oF9ogOjOCZwwpwB94">recommend products and tools</a> to fit your situation and abilities.</p>
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Read more:
<a href="https://theconversation.com/reform-delay-causes-dental-decay-its-time-for-a-national-deal-to-fund-dental-care-217914">Reform delay causes dental decay. It’s time for a national deal to fund dental care</a>
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<img src="https://counter.theconversation.com/content/215786/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arosha Weerakoon's PhD research was funded by the UQ School of Dentistry Research Fund and Colgate Palmolive Australia. </span></em></p>Just like our bodies, our teeth succumb to age-related changes. Here are seven ways to keep your teeth healthier for longer.Arosha Weerakoon, Senior Lecturer, School of Dentistry, The University of Queensland and General Dentist., The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2179142023-11-30T07:18:00Z2023-11-30T07:18:00ZReform delay causes dental decay. It’s time for a national deal to fund dental care<p>A <a href="https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/RB000078/toc_pdf/AsystemindecayareviewintodentalservicesinAustralia.pdf">Senate committee</a> has investigated why so many Australians are missing out on dental care and made 35 recommendations for reform. </p>
<p>By far the most sweeping is the call for universal coverage for essential dental care. The committee also proposed a suite of measures to get more dental care to groups who are missing out, including those in rural areas. </p>
<p>The government has three months to respond. It should lay out a plan to gradually expand coverage, while putting guardrails in place to make sure care is effective, efficient and equitable. </p>
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Read more:
<a href="https://theconversation.com/expensive-dental-care-worsens-inequality-is-it-time-for-a-medicare-style-denticare-scheme-207910">Expensive dental care worsens inequality. Is it time for a Medicare-style 'Denticare' scheme?</a>
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<h2>If Australians can’t pay, they miss out</h2>
<p>The <a href="https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/RB000078/toc_pdf/AsystemindecayareviewintodentalservicesinAustralia.pdf">Senate committee report</a> follows <a href="https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/RB000080/toc_pdf/Interimreport.pdf">more than a dozen</a> national inquiries and reports into dental care since 1998, many with similar findings.</p>
<p>Dental care was left out of Medicare from the start, due to opposition from dentists and <a href="https://johnmenadue.com/why-dental-care-was-excluded-from-medicare-and-why-it-should-now-be-included-an-edited-repost/">concerns</a> about cost. </p>
<p>Half a century later, Australia still funds oral health very differently to how we fund care for the rest of the body, with patients paying most of the cost themselves. </p>
<p>As a result, many people miss out on care. In <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/latest-release">2022-23</a>, 2.3 million Australians skipped or delayed necessary dental care because of the cost – 17.6% of people, up from 16.4% the year before.</p>
<p>People on lower incomes were much more likely to miss out. People living in the poorest areas are around three times as likely to wait more than two years between visits to the dentist, compared to people in the wealthiest areas. One in four report delaying care. </p>
<p>Even if you can afford to see a dentist, you might not be able to get in. Our analysis of census data shows there is one dentist for every 400 to 500 people in inner-city parts of most capital cities. But in Blacktown North in outer Sydney, there is only one dentist for every 5,100 people. </p>
<p>Regional areas fare even worse. There is only one for every 10,300 people in the northeast of Ballarat in Victoria. In some remote areas, there are no working dentists at all.</p>
<h2>Missing dental care can affect the whole body</h2>
<p>The consequences of missing dental care are serious. Around 80,000 hospital <a href="https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia/contents/hospitalisations">visits</a> a year are for preventable dental conditions. </p>
<p>Oral health problems are also <a href="https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia/contents/introduction">linked</a> to a range of chronic diseases affecting the rest of the body too, and may cause <a href="https://thenewdaily.com.au/life/2023/07/15/gum-disease-shrinks-your-brain/">damage</a> to the brain. </p>
<p>On top of that, there are costs from people not being able to work or study, leading to further economic costs of more than <a href="https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/j.1834-7819.2012.01718.x">half a billion</a> dollars a year. </p>
<p>Those numbers only hint at the individual suffering involved. Dental disease often means pain, embarrassment and stigma. </p>
<p>The Senate inquiry heard from one 30-year-old on a low income who couldn’t afford dental care for years. They skipped meals for months to save up enough money to go to the dentist, and were finally diagnosed with advanced gum disease. They now expect to lose teeth, which will affect them for the rest of their life.</p>
<h2>Dental problems are rising, spending is falling</h2>
<p>Compared to five years ago, more of us have untreated dental decay, are concerned about the appearance of our teeth, avoid food due to dental problems, and have toothaches. </p>
<p>Despite all this, government spending on dental health has been <a href="https://www.aihw.gov.au/getmedia/52d76196-5884-479c-93e5-12a17afbb2bb/aihw_den_231_costs_datatables_oralhealthanddentalcareinaustralia_tranche_6_17032023_1.xlsx.aspx">falling</a>. In the ten years to 2020-21, the federal government’s share of spending on dental services – excluding premium rebates – fell from 12% to 5%, while the states’ share fell from 10% to 9%.</p>
<p>Federal government spending on private health insurance rebates for dental care increased, but that doesn’t close the funding gap, and it doesn’t help the most vulnerable.</p>
<h2>Time for universal dental care</h2>
<p>Most submissions to the Senate inquiry supported major reform to expand coverage for dental care, as previous <a href="https://apo.org.au/sites/default/files/resource-files/2009-07/apo-nid17921.pdf">reviews</a>, <a href="https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1.pdf">Royal Commissions</a> and a 2019 Grattan Institute <a href="https://grattan.edu.au/wp-content/uploads/2019/03/915-Filling-the-gap-A-universal-dental-scheme-for-Australia.pdf">report</a> have recommended. </p>
<p>Getting there will be costly. </p>
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Read more:
<a href="https://theconversation.com/worried-about-your-childs-teeth-focus-on-these-3-things-212870">Worried about your child's teeth? Focus on these 3 things</a>
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<p>The May <a href="https://budget.gov.au/content/bp2/download/bp2_2023-24.pdf">budget</a> kicked the can down the road by extending the current, inadequate funding for public dental services for another year. That funding will now stop in mid-2025, the same time that federal and state governments need to agree on a new National Health Reform Agreement – the biggest financial health deal in Australia.</p>
<p>With national health funding up in the air, there is an opportunity to finally work out a plan to expand dental coverage, starting in less than two years. </p>
<h2>Phasing, fairness and efficiency will be key</h2>
<p>Building a new, universal health care system is something Australia hasn’t done for generations. It will take more than simply expanding funding. Instead, governments should seize an historic opportunity to avoid the <a href="https://grattan.edu.au/wp-content/uploads/2022/12/A-new-Medicare-strengthening-general-practice-Grattan-Report.pdf">problems</a> in other universal coverage schemes. </p>
<p>First, dental coverage should ramp up gradually. The Senate committee <a href="https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/RB000078/toc_pdf/AsystemindecayareviewintodentalservicesinAustralia.pdf">recommended</a> phasing in a universal scheme, and mentioned establishing a Seniors Dental Benefit Scheme, and expanding the Child Dental Benefits Schedule to cover all children over time. </p>
<p>Starting with these steps would allow time for the workforce, providers, and government funding to expand to care for more people, as Australia builds a universal scheme.</p>
<p>Second, policies should ensure care is available where it’s needed most. This means getting more dentists in <a href="https://content.vu.edu.au/sites/default/files/media/is-medicare-fair-cities-and-country-mitchell-institute.pdf">disadvantaged</a> and rural areas.</p>
<p>Even with more funding and broader coverage, some areas will struggle to attract dentists, particularly where there is a small population, few people who can afford fees and where clinics need to be set up from scratch. </p>
<p>The committee proposed incentives for providers in rural areas, new dental schools in regional universities, expanding rural medical student subsidies to dentistry and oral health, and better pay for clinicians in public dental clinics.</p>
<p>Third, given the <a href="https://www.pbo.gov.au/sites/default/files/2023-11/For%20publication%20PR-2023-367-Various%20policy%20options%20for%20reforming%20Commonwealth%20subsidies%20of%20dental%20services%20-%20PRR_0.pdf">huge costs</a> involved, care must be efficient and effective. The committee outlined some ways to get good value for money. It said the universal scheme should fund essential oral health care, which would exclude cosmetic dentistry, for example. And it wants regulations and funding changed so oral health therapists can do more. </p>
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Read more:
<a href="https://theconversation.com/collaborating-with-communities-delivers-better-oral-health-for-indigenous-kids-in-rural-australia-141038">Collaborating with communities delivers better oral health for Indigenous kids in rural Australia</a>
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<p>Governments and the public should also be able to see where the billions of dollars of new investment are going, and the difference it is making. </p>
<p>Participating public and private clinics should record the treatments they provide, how satisfied their patients are, wait times and their results. And clinics should commit to following evidence-based guidelines and using data to continually improve their care. </p>
<p>Successive governments have skimped on dental care even as demand has risen. But those savings are a false economy that causes unnecessary disease and entrenches inequality. Today’s proposal for an overhaul should be the last – it’s time to fill this gap in the health system.</p><img src="https://counter.theconversation.com/content/217914/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Breadon's employer, Grattan Institute, has been supported in its work by government, corporates, and philanthropic gifts. A full list of supporting organisations is published at <a href="http://www.grattan.edu.au">www.grattan.edu.au</a>.</span></em></p><p class="fine-print"><em><span>Anika Stobart does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Access to dental care in Australia is worse than ever and is simply unaffordable to many.Peter Breadon, Program Director, Health and Aged Care, Grattan InstituteAnika Stobart, Senior Associate, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2119712023-09-20T15:27:43Z2023-09-20T15:27:43ZWhy grinding your teeth might not always be a bad thing<figure><img src="https://images.theconversation.com/files/543775/original/file-20230517-29-2703gn.jpg?ixlib=rb-1.1.0&rect=522%2C126%2C5484%2C3881&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/es/image-photo/mad-crazy-beautiful-caucasian-woman-wearing-2166914531">Jihan Nafiaa Zahri/Shutterstock</a></span></figcaption></figure><p>According to the <a href="https://consejodentistas.es/item/2213-la-pandemia-y-el-estres-que-genero-disparan-los-casos-de-bruxismo-en-espana.html">Council of Dentists of Spain</a>, bruxism is the dental diagnosis that has increased the most since the pandemic, almost quadrupling. In fact, its incidence among the population has gone from 6% to 23%.</p>
<p>Whether we are affected or not, we all know what this behaviour basically entails: clenching or grinding one’s teeth. But, in recent years, the concept has changed and is now classified into two distinct forms: sleep bruxism and awake bruxism. And they can be approached as two separate phenomena – although the two sometimes appear together. </p>
<p>While the first arises involuntarily while we sleep, the second manifests itself when we are awake. In the latter case, the person may be aware of their behaviour and, thus, stop it.</p>
<h2>Two different phenomena</h2>
<p>Currently, sleep bruxism <a href="https://onlinelibrary.wiley.com/doi/10.1111/joor.12663">is defined</a> as “a masticatory muscle activity during sleep that is characterised as rhythmic (phasic) or non-rhythmic (tonic) and is not a movement disorder or a sleep disorder in otherwise healthy individuals.” </p>
<p>Awake bruxism is described as “a masticatory muscle activity during wakefulness that is characterised by repetitive or sustained tooth contact and/or by bracing or thrusting of the mandible and is not a movement disorder in otherwise healthy individuals.” </p>
<p>In other words, what we popularly think of as clenching/grinding our teeth when we sleep (either during the night or during the day) would be called sleep bruxism, while jaw clenching, sustained tooth contact, or thrusting when awake would be awake bruxism.</p>
<p>Although the two definitions seem to refer to very similar behaviours, their origin, the way they work, and how they should be approached are different.</p>
<p>In some clinical settings, both types can be considered a risk factor or sign of underlying disease, such as headaches (both common headaches and migraines) or temporomandibular disorders (which affect the jaw joint and the muscles that control its movement). And there is always the possibility that these two varieties of bruxism will have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9142364/">negative consequences</a>: they <a href="https://europepmc.org/article/med/36964364">can cause</a> tooth wear and fractures, as well as muscle or joint pain.</p>
<h2>But, what if bruxism were beneficial?</h2>
<p>In any case, current research implies another important modification for the conception of bruxism: it is no longer considered a pathology but a mere motor activity. That is to say, it does not have to be harmful in and of itself.</p>
<p>Firstly, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755641/">a 2020 study</a> concluded that waking bruxism could be a stress release mechanism. And secondly, the variety that occurs while we sleep seems to be related to gastric reflux and <a href="https://link.springer.com/article/10.1007/s11325-019-01919-y">obstructive sleep apnoea</a> (pausing in breathing during nightly rest). Some authors hypothesise that it could play a protective role against the effects of both disorders.</p>
<h2>The psychological factor</h2>
<p>As for the origin of this behaviour, it is still not entirely clear, but risk factors such as alcohol, nicotine, recreational drug use, caffeine, some medicines, anxiety, and stress have been identified. Emotional stress seems to play an important role, especially in awake bruxism. In fact, it is considered the main trigger.</p>
<p>Along these lines, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9916215">a recent study</a> carried out by researchers from the Faculty of Dentistry of the Complutense University of Madrid compared samples of participants before, during, and after the COVID-19 pandemic. According to the researchers’ conclusions, sleep and awake bruxism could be influenced by different levels of anxiety: while the former would be related to passive stress (associated with worry or helplessness), awake bruxism seems to be linked with immediate, daily activities to a greater extent.</p>
<p><a href="https://link.springer.com/article/10.1007/s00784-022-04405-0">In a previous study</a>, that same research team found that teeth grinders who watched stressful negative videos with scenes of pain had greater muscle tension than those who do not typically grind their teeth. This relationship supports the notion of a link between more immediate, daily stress and awake bruxism.</p>
<h2>Effective treatments against bruxism</h2>
<p>Therefore, and even though awake bruxism can be a release mechanism for stress, grinding one’s teeth can be prevented by learning to detect the habit (aiming to reduce the bracing of muscles in the first place) and by subsequently reducing stress levels through techniques for relaxation and coping. </p>
<p>With that in mind, perhaps one of the most effective treatments is <a href="https://www.elsevier.es/es-revista-revista-internacional-protesis-estomatologica-315-resumen-biofeedback-electromiografico-una-alternativa-terapeutica-X1139979109539626">biofeedback</a>. This consists of having patients learn to identify and reduce muscle tension by adopting a jaw resting position thanks to the use of an <a href="https://en.wikipedia.org/wiki/Electromyography">electromyograph</a>, a device that measures the electrical activity of the muscles.</p>
<p>Many people are unaware of the fact that for the jaw to be relaxed and at rest, there should be no contact between the teeth, as can be deduced from the definition listed above. The mere fact of being aware of that and trying to correct it reduces the incidence of bruxism.</p>
<p>Recently, mobile applications have been developed to achieve these two objectives. However, these types of applications are usually not sufficiently optimised and end up being a bit tedious for users.</p>
<p>Perhaps the easiest way to detect if we are clenching our teeth is to put Post-it notes in visible places (computer screens, mirrors, etc.) to act as a reminder. And, since stress is chronically present in our lives, we should regularly undertake relaxation techniques and techniques to control the bracing of jaw muscles – techniques that are simple and easy to fit into our daily routine.</p><img src="https://counter.theconversation.com/content/211971/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Las personas firmantes no son asalariadas, ni consultoras, ni poseen acciones, ni reciben financiación de ninguna compañía u organización que pueda obtener beneficio de este artículo, y han declarado carecer de vínculos relevantes más allá del cargo académico citado anteriormente.</span></em></p>Teeth grinding is on the rise. Although it causes problems, research also suggests that bruxism can alleviate stress or protect us from certain pathologies.Laura Jiménez Ortega, Profesora del Departamento de Psicobiología y Metodología en Ciencias del Comportamiento, Universidad Complutense de MadridEva Willaert Jiménez-Pajarero, Profesora asociada de Prótesis y Disfunción Craneomandibular, Universitat de BarcelonaMaría García González, Profesora de Odontología, Universidad EuropeaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2079102023-07-02T20:02:21Z2023-07-02T20:02:21ZExpensive dental care worsens inequality. Is it time for a Medicare-style ‘Denticare’ scheme?<figure><img src="https://images.theconversation.com/files/533361/original/file-20230622-27-i2qy62.jpg?ixlib=rb-1.1.0&rect=0%2C14%2C4920%2C3238&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/pain-armchair-dentist-suffering-52527/">Pixabay</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>There’s <a href="https://grattan.edu.au/wp-content/uploads/2023/06/A-growing-cavity-why-expanding-dental-coverage-is-increasingly-urgent.pdf">growing awareness</a> public dental programs are unable to meet the demand for services. Private dental care is increasingly unaffordable, and millions of Australians go without the treatment they need. </p>
<p>The <a href="https://www.canberratimes.com.au/story/8039058/years-of-pain-wait-times-for-public-dentist-appointments-blow-out/">potentially avoidable costs</a> to the health-care system and to people’s quality of life has led to <a href="https://www.abc.net.au/news/health/2019-03-18/calls-for-medicare-funded-dental-health-scheme-in-australia/10903574">increased pressure</a> for a Medicare-style universal insurance scheme for dental care (Denticare) or the inclusion of dental care into Medicare.</p>
<p>Affordable and available dental care is crucial to addressing inequality in Australia. Teeth and gum problems can affect everything from your life expectancy and general health to your job prospects. The “<a href="https://www.mja.com.au/journal/2014/201/11/closing-dental-divide">dental divide</a>” between rich and poor actually replicates disadvantage in Australian society. </p>
<p>So how did we get here? And what might change look like?</p>
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<strong>
Read more:
<a href="https://theconversation.com/the-greens-want-medicare-to-cover-a-trip-to-the-dentist-its-a-grand-vision-but-short-on-details-181239">The Greens want Medicare to cover a trip to the dentist. It's a grand vision but short on details</a>
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<h2>Why wasn’t dental included in Medicare in the first place?</h2>
<p>The prevailing wisdom is that when the Whitlam Government put Medibank (the precursor to Medicare) forward in 1974, dental care was not included because of <a href="https://johnmenadue.com/why-dental-care-was-excluded-from-medicare-and-why-it-should-now-be-included-an-edited-repost/">cost and politics</a> – the battle with doctors’ groups opposed the new health-care insurance plan was difficult enough without taking on dental groups too.</p>
<p>There is, however, little to no evidence on the extent to which the Whitlam government pushed for dental to be included or how much it was opposed by dentists. It seems it was not on the agenda when Medicare was restored by the Hawke government.</p>
<p>Financial issues aside, there are two likely reasons dental wasn’t included.</p>
<p>Firstly, medicine and dentistry remain <a href="https://www1.racgp.org.au/ajgp/2020/september/medicine-and-dentistry">isolated practices</a> that have never been treated the same way by the health-care system, health insurance funds, policymakers and the public. </p>
<p>Despite all the <a href="https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia/contents/introduction">evidence</a> on the importance of oral health, too often it is seen as merely a “nice-to-have”.</p>
<p>Secondly, the provision of public dental health services – often linked to dental hospitals and dental schools – has long been seen (especially by <a href="https://www.smh.com.au/national/howard-lays-dental-blame-on-states-20061205-gdoz3t.html">Coalition governments</a>) as the responsibility of states and territories. These services have always been directed at children, low-income adults, and defined disadvantaged groups.</p>
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<a href="https://images.theconversation.com/files/533378/original/file-20230622-29-xr1bx2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/533378/original/file-20230622-29-xr1bx2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533378/original/file-20230622-29-xr1bx2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533378/original/file-20230622-29-xr1bx2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533378/original/file-20230622-29-xr1bx2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533378/original/file-20230622-29-xr1bx2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533378/original/file-20230622-29-xr1bx2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533378/original/file-20230622-29-xr1bx2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A dental check-up shouldn’t cost the Earth.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/man-in-gray-shirt-having-dental-check-up-3845807/">Anna Shvets/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>A short history</h2>
<p>Section 51(xxiiiA) of the Australian Constitution, added in 1946, accords dental services the <a href="https://www.aph.gov.au/parliamentary_business/committees/senate/community_affairs/completed_inquiries/1996-99/dental/report/c04">same status as medical services</a>. This section gives the Commonwealth the power to legislate and fund these services but it’s not obligated to do so.</p>
<p>The Whitlam government was the first to provide national funding and direction to these state-based programs through the <a href="https://parlinfo.aph.gov.au/parlInfo/download/library/prspub/75IR6/upload_binary/75ir60.pdf%3BfileType=application/pdf#search=%2522library/prspub/75IR6%2522">Australian School Dental Program</a>. </p>
<p>Under the Keating government, the Commonwealth took a more substantial role in the funding of dental services with the introduction of the <a href="https://parlinfo.aph.gov.au/parlInfo/download/library/prspub/75IR6/upload_binary/75ir60.pdf%3BfileType=application/pdf#search=%2522library/prspub/75IR6%2522">Commonwealth Dental Health Program</a>, directed at financially disadvantaged adults. </p>
<p>This began in January 1994 but was abolished by the Howard government in 1996. </p>
<p>The Gillard government introduced National Partnership Agreements for Public Dental Services for Adults, which currently provide <a href="https://federalfinancialrelations.gov.au/sites/federalfinancialrelations.gov.au/files/2023-03/Public%20Dental%20Services%20for%20Adults%20-%202022-23.pdf">A$107.8 million annually</a> to the states and territories.</p>
<h2>The barriers to universal dental care</h2>
<p>Proposals to expand Medicare to include dental services have been variously estimated to cost between $5.6 billion in additional Commonwealth spending per year (according to the <a href="https://grattan.edu.au/wp-content/uploads/2019/03/915-Filling-the-gap-A-universal-dental-scheme-for-Australia.pdf">Grattan Institute</a>) and $7.5 billion a year (according to <a href="https://www.theguardian.com/australia-news/2022/apr/12/billionaire-tax-to-fund-greens-75bn-plan-for-medicare-to-cover-dental">The Greens’ 2022 election policy</a>).</p>
<p>These figures don’t factor in the savings made to health-care costs due to preventable dental cavities and gum disease (estimated by the Australian Dental Association at <a href="https://www.ada.org.au/ADHP">$818 million per year</a>) and reduced productivity. Nevertheless, this is a huge budget impost. It would require increases in the Medicare levy, and/or increased taxation and/or cuts to the private health insurance rebate.</p>
<p>The other approach is to reduce costs by limiting the number of people covered and/or the number and type of services covered.</p>
<p>Means testing access to Medicare Benefits Schedule items for dental care is risky; it could easily lead to means testing of access to other MBS items. </p>
<p>Limiting the type of services covered is possible but would require a huge amount of work and endless debate on what constitutes basic and necessary services.</p>
<p>The establishment of an entirely separate scheme (the Denticare model) will still require enormous amounts of evidence-based decision-making around who and what is covered, how this is paid for, and what subsequently happens to current federally- and state-funded dental programs.</p>
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<h2>There’s more we can do</h2>
<p>Previous attempts to incorporate dental services into Medicare have arguably failed. Researchers have described the Chronic Dental Disease Scheme (introduced by the Howard government) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494828/">as</a> as “the most expensive and controversial public dental policy in Australian history”. As a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494828/">2012 analysis</a> showed, it blew out its budget and did not result in dental health improvements.</p>
<p>The current Child Dental Benefits Schedule has a <a href="https://www.anao.gov.au/work/performance-audit/administration-child-dental-benefits-schedule">low uptake</a>. Less than <a href="https://www.ada.org.au/News-Media/News-and-Release/Latest-News/Have-your-say-on-the-Child-Dental-Benefits-Schedul">40%</a> of those eligible for the scheme actually use it.</p>
<p>As I <a href="https://theconversation.com/how-to-fill-the-gaps-in-australias-dental-health-system-35371">wrote</a> in 2014, there is plenty Australia could do to better integrate dental and medical care, including focusing on best-value investments such as fluoridation and preventive services. It’s worth noting many of the preventive actions needed to address <a href="https://www.dentalnews.com/2019/07/25/is-there-a-link-between-obesity-and-oral-health/">obesity</a> (for example, encouraging breast feeding and limiting sugary beverages) will also improve dental health.</p>
<p>We could also expand emergency dental services in hospital emergency departments and create a “Dental Health Service Corps” of dentists and other medical professionals to help in rural and remote areas.</p>
<p>Almost a decade later, little as been done. Sadly, in the many years I’ve been writing about the <a href="https://www.mja.com.au/journal/2014/201/11/closing-dental-divide">dental divide</a>, the only movement I’ve seen is in the increasingly bad numbers around waiting lists and costs to patients.</p>
<p>A Senate Select Committee is currently conducting yet another <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Dental_Services_in_Australia/DentalServices">inquiry into dental services</a> in Australia. Its just-released <a href="https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/RB000080/toc_pdf/Interimreport.pdf">interim report</a>, which discussed some of the proposals heard so far by the committee and some possible questions for it to consider, described Australia’s current oral and dental health system as “broken”. Public hearings, which will inform the committee’s final report, will be held later in the year.</p>
<p>Hopefully, this inquiry will (finally) drive politicians to see dental care as essential to health, wellbeing and a fair society – and to act.</p>
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<strong>
Read more:
<a href="https://theconversation.com/how-to-fill-the-gaps-in-australias-dental-health-system-35371">How to fill the gaps in Australia's dental health system</a>
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<img src="https://counter.theconversation.com/content/207910/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lesley Russell worked for the federal Australian Labor Party as a policy advisor from 2001 to 2007.</span></em></p>Affordable and available dental care is crucial to addressing inequality in Australia.Lesley Russell, Adjunct Associate Professor, Menzies Centre for Health Policy, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1711892022-10-03T12:06:13Z2022-10-03T12:06:13ZNo, it’s not just sugary food that’s responsible for poor oral health in America’s children, especially in Appalachia<figure><img src="https://images.theconversation.com/files/453131/original/file-20220319-27-1rh8vob.jpg?ixlib=rb-1.1.0&rect=34%2C25%2C5716%2C3802&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tooth decay can cause pain, embarrassment, missed school and more.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/little-girl-with-a-sad-and-frightened-face-holds-royalty-free-image/1307147643?adppopup=true">Olga Simonova/EyeEm via Getty Images</a></span></figcaption></figure><p>Brushing your teeth is essential for maintaining optimal oral health, but like most aspects of health, the full story is more complicated.</p>
<p>As directors of the <a href="https://www.dental.pitt.edu/research/center-oral-health-research-appalachia">Center for Oral Health Research in Appalachia</a>, <a href="https://www.upmc.com/media/experts/mary-l-marazita">we</a> <a href="https://psychology.wvu.edu/faculty-and-staff/faculty-directory/daniel-mcneil">know</a> firsthand that inequalities exist when it comes to oral health, including in children. Some people or groups have considerably more oral health problems than others because of a combination of factors beyond personal dental hygiene.</p>
<p>For example, Appalachia – which stretches from the northern part of Mississippi, Alabama and Georgia up through the southern part of New York, and includes all of West Virginia – has one of the <a href="https://www.arc.gov/report/an-analysis-of-oral-health-disparities-and-access-to-services-in-the-appalachian-region/">greatest burdens of oral health problems per person</a> in the U.S.</p>
<p>October is <a href="https://www.adha.org/national-dental-hygiene-month">National Dental Hygiene Month</a>, which provides an opportunity to draw more attention to this chronic but often preventable problem.</p>
<h2>Oral health defined</h2>
<p>While the terms dental hygiene and dental health are largely focused on the teeth and gums, <a href="https://doi.org/10.1038/sj.bdj.2016.953">oral health</a> is more comprehensive. According to the <a href="https://doi.org/10.1038/sj.bdj.2016.953">FDI World Dental Federation</a>, oral health encompasses the <a href="https://www.cdc.gov/oralhealth/conditions/index.html">proper functioning of the mouth</a>, including one’s “ability to speak, smile, smell, taste, touch, chew, swallow and convey a range of emotions through facial expressions” without pain or discomfort. Oral health affects not only a person’s teeth but <a href="https://doi.org/10.1016/j.adaj.2016.10.001">also overall well-being and quality of life</a>.</p>
<p><a href="https://www.nidcr.nih.gov/research/oralhealthinamerica">Tooth decay</a> affects children all across the U.S., but far too little attention is paid to how preventable and treatable it is. Cavities, or caries, are the most common <a href="https://doi.org/10.1016/j.yapd.2007.03.012">chronic disease in kids</a> – five times <a href="https://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/study.cgi?study_id=phs000095.v4.p2">more common than asthma and seven times more common</a> than environmental allergies, despite being preventable. More than <a href="https://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/study.cgi?study_id=phs000095.v4.p2">40% of children have tooth decay</a> when they start kindergarten.</p>
<p>However, people who have less formal education or lower incomes, <a href="https://doi.org/10.1542/peds.2021-051481">marginalized ethnic and racial groups</a> and those living in more rural areas, such as Appalachia, tend to have <a href="https://doi.org/10.1111/j.1600-0528.2012.00716.x">more oral health problems than others</a>, and <a href="https://doi.org/10.1542/peds.2021-051481">at younger ages</a>. The <a href="https://doi.org/10.1177/00220345211068033">greater prevalence of childhood tooth decay</a> in specific populations is not only an inequity but also a serious public health problem. Oral health problems early in life extend into adulthood and can be lifelong.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/483778/original/file-20220909-7447-temt35.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A map of Appalachian states indicating economic status of all counties." src="https://images.theconversation.com/files/483778/original/file-20220909-7447-temt35.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483778/original/file-20220909-7447-temt35.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=657&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483778/original/file-20220909-7447-temt35.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=657&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483778/original/file-20220909-7447-temt35.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=657&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483778/original/file-20220909-7447-temt35.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=826&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483778/original/file-20220909-7447-temt35.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=826&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483778/original/file-20220909-7447-temt35.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=826&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">County economic status in Appalachia, fiscal 2023.</span>
<span class="attribution"><a class="source" href="https://www.arc.gov/wp-content/uploads/2022/06/County-Economic-Status_FY2023_Map.png">Appalachian Regional Commission</a></span>
</figcaption>
</figure>
<h2>Beyond personal dental hygiene</h2>
<p>It’s a common misconception that consuming sugary foods and beverages is the only cause of tooth decay. While that is undoubtedly a problem, there’s much more to good oral health. It includes <a href="https://doi.org/10.1177/00220345211068033">consistent brushing and flossing</a>; eating healthy foods, like fresh fruits and vegetables; avoiding tobacco products; and wearing mouth guards while playing certain sports. <a href="https://doi.org/10.1177/0022034509356779">Regular visits for dental care</a> are also critical, as they provide an opportunity for cleanings and preventive care.</p>
<p>Oral health in kids is a <a href="https://www.kentuckypress.com/9780813135861/appalachian-health-and-well-being/">reflection of their overall health</a> and that of their families; however, in addition to behavioral and social influences, genetic and other biological factors are also at play. For example, <a href="https://doi.org/10.1177/0022034510381502">genes influencing taste preferences</a> – such as those for sweet foods – are associated with cavities on certain teeth and surfaces of teeth. It’s possible that our taste genes predispose some of us to prefer consuming sweet foods and drinks, which is a risk factor for developing cavities. </p>
<p><a href="https://dx.doi.org/10.1038%2Fs41598-020-71495-9">Bacteria and other microorganisms in the mouth</a>, known as the oral microbiome, also play a role. Some parts of the <a href="https://doi.org/10.3920/BM2011.0002">oral microbiome are beneficial</a> and even required for good oral health. Other <a href="https://doi.org/10.1111/odi.12509">bacteria</a> are invaders that can lead to oral diseases.</p>
<p>Just as important are <a href="https://doi.org/10.17796/1053-4628-40.2.152">environmental factors</a>, including air quality, access to healthy foods, the cost of dental care, access to transportation to and from the dentist, and school-based programs that encourage good oral hygiene among children. Whether one lives in a community with fluoridated water or otherwise has access to fluoride treatments is also important, as <a href="https://doi.org/10.1542/peds.2014-1699">fluoride helps to prevent tooth decay</a>. <a href="https://www.degruyter.com/document/doi/10.1515/reveh-2017-0012/html?lang=en">Water quality</a> in communities is another factor. If the only available water is toxic or unappealing, people may turn to soda and other sugar-sweetened beverages.</p>
<p>Additionally, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6624082/">mothers’ perceived social support</a> and <a href="https://doi.org/10.1001/jamanetworkopen.2022.6414">parents’ social networks</a> can influence their children’s oral health too. Among mothers with a high number of cavities, the availability of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6624082/">someone to talk to about problems</a> has been shown to be associated with fewer cavities in their children. </p>
<figure class="align-center ">
<img alt="Little girl and dad brushing their teeth together." src="https://images.theconversation.com/files/453132/original/file-20220319-10592-qsrcfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453132/original/file-20220319-10592-qsrcfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453132/original/file-20220319-10592-qsrcfz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453132/original/file-20220319-10592-qsrcfz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453132/original/file-20220319-10592-qsrcfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453132/original/file-20220319-10592-qsrcfz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453132/original/file-20220319-10592-qsrcfz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Parents can help improve their kids’ oral health by modeling good oral hygiene themselves.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/african-adorable-kindergarten-age-girls-and-father-royalty-free-image/1263412992?adppopup=true">Nitat Termmee/Moment via Getty Images</a></span>
</figcaption>
</figure>
<h2>Role modeling good oral health</h2>
<p><a href="https://doi.org/10.1177/2380084417698103">Parents’ and caregivers’ own oral health</a> greatly influences that of their children. Kids and their parents typically drink the same water and many of the same beverages and eat a lot of the same foods. Children often follow the dental hygiene habits of their parents as well. Children typically take on their parents’ and caregivers’ <a href="https://doi.org/10.1111/ipd.12564">feelings about dental visits</a> too – whether it’s comfort, stress, anxiety or fear. </p>
<p>Parents’ thoughts about dental care influence their decisions about preventive care. Dental fear and anxiety can lead to delay or avoidance of dental appointments for themselves and their children. “<a href="https://doi.org/10.1111/cdoe.12621">Oral health values</a>” – the importance one places on maintaining natural and good-looking teeth – affect decision-making about dental hygiene and professional dental care. <a href="https://doi.org/10.1177/0145445515615353">Depression in parents</a> can even influence their own dental hygiene and oral health and that of their children.</p>
<p>Dental problems in kids <a href="http://dx.doi.org/10.15585/mmwr.mm6541e1">can lead to missed school</a>, pain and embarrassment about visible decay, and missing or crooked teeth. Teeth and gums are critical for speaking, eating, development and appearance. They affect social functioning and one’s enjoyment of food. Kids’ dental problems affect their parents, too, as they can result in parents’ unexpectedly missing work to bring their child to the dentist.</p>
<h2>What can be done to improve oral health?</h2>
<p>To a great extent, <a href="https://doi.org/10.1177/0022034514547273">dental problems in kids can be prevented</a>. Some preventive steps are affected by <a href="https://www.nidcr.nih.gov/research/oralhealthinamerica">economic, educational and health care factors</a>. One of the best things parents or caregivers can do is to establish a relationship for their child with a dental practitioner, practice, office or clinic to promote prevention but also to provide emergency care if needed. Within the oral health world, this relationship is called a “<a href="https://digitaleditions.walsworth.com/publication/?i=728372&article_id=4156968&view=articleBrowser&ver=html5">dental home</a>.” The <a href="https://www.mychildrensteeth.org/globalassets/media/policy-center/year1visit.pdf">American Academy of Pediatric Dentistry</a> and other professional health organizations recommend that children see an oral health care provider before age 1 or at the emergence of the first tooth. Access to dental treatment, especially preventive care, has been shown to <a href="https://pubmed.ncbi.nlm.nih.gov/29085793/">improve oral health in families</a> and their communities. </p>
<p><a href="https://media.news.health.ufl.edu/misc/cod-oralhealth/docs/posts_frontpage/SocialInequalities.pdf">System-level changes</a> are surely needed too. Since cost affects whether parents can provide their children with routine dental care, greater access to dental insurance is an important step to ensuring equal access and reducing oral health inequities. Integrating oral health practices into <a href="https://www.cdc.gov/healthyschools/npao/oralhealth.htm">schools and educational programs</a> is another system-level change that would benefit all children regardless of their family’s socioeconomic status. </p>
<p>Oral health is a critical factor in a person’s overall health. Teaching kids this early can help them develop a healthy smile and care for their pearly whites throughout their lives.</p><img src="https://counter.theconversation.com/content/171189/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel W. McNeil receives funding from the National Institutes of Health, including the National Institute of Dental and Craniofacial Research.</span></em></p><p class="fine-print"><em><span>Mary L. Marazita receives funding from the National Institutions of Health, specifically the National Institute of Dental and Craniofacial Research (NIDCR).</span></em></p>Appalachia has one of the highest rates of oral health problems per person in the US.Daniel W. McNeil, Eberly Distiniguished Professor Emeritus, Clinical Professor Emeritus of Dental Public Health & Professional Practice, West Virginia UniversityMary L. Marazita, Director, Center for Craniofacial and Dental Genetics; Professor of Oral Biology and of Human Genetics, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1886732022-08-19T14:49:07Z2022-08-19T14:49:07ZNHS dentistry is at breaking point – only radical action may be enough to fix it<figure><img src="https://images.theconversation.com/files/480053/original/file-20220819-21-s8s0s6.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5607%2C3724&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Those lucky enough to get an appointment often have to wait months for their care.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-dentistiry-clinic-asking-information-fill-1960682797">DC Studio/ Shutterstock</a></span></figcaption></figure><p>Almost 90% of NHS dental practices in the UK are no longer accepting new adult patients, according to a <a href="https://www.bbc.co.uk/news/health-62253893">report by the BBC</a>. Only one in five practices are willing to accept children as new patients. </p>
<p>Reports also show that between 2019 and 2021, only <a href="https://digital.nhs.uk/data-and-information/publications/statistical/nhs-dental-statistics/2021-22-biannual-report">around 36% of UK adults</a> were able to get an appointment with an NHS dentist. Those fortunate enough to get an appointment often have to <a href="https://bda.org/news-centre/blog/Pages/NHS-dentistry-have-we-reached-the-point-of-no-return.aspx">wait months for routine dental care</a>. The lack of access to emergency care is even worse, with many patients taking matters into their own hands and <a href="https://www.theguardian.com/commentisfree/2022/may/30/superglue-self-extraction-diy-dentistry-britain-nhs-dental-treatment">resorting to DIY dentistry</a>.</p>
<p>While these figures are shocking, they come as no surprise to many within the profession. For years, the British Dental Association has warned the government that NHS dentistry was <a href="https://bda.org/news-centre/blog/Pages/NHS-dentistry-have-we-reached-the-point-of-no-return.aspx">hanging by a thread</a>. And without urgent action, the situation will only continue to deteriorate. </p>
<h2>NHS funding</h2>
<p>Dentistry has always been on the fringes of the NHS. Part of this is because dental services are commissioned and delivered differently compared to other parts of the NHS. Approximately 90% of UK dentistry is provided by high street dental practices which are independently owned and are simply contracted to <a href="https://en.wikipedia.org/wiki/NHS_dentistry#:%7E:text=Dentists%20are%20private%20contractors%20to,provide%20an%20NHS%20dental%20service.">deliver NHS services</a>. Staff are not part of the NHS and practices operate as small businesses. For many, dental care is not free at the point of delivery, and since 1951, patients have had to <a href="https://bda.org/museum/exhibitions-and-events/nhs70-celebrating-70-years-of-nhs-dentistry">pay towards the cost</a> of their treatment. </p>
<p>Since 2006, funding for NHS dental services has been restricted – with the current level only sufficient to provide care for <a href="https://www.nao.org.uk/wp-content/uploads/2020/03/Dentistry-in-England.pdf">50% of the population</a>. Reports have also shown that between 2014 and 2019, NHS dentistry actually saw a <a href="https://www.nao.org.uk/wp-content/uploads/2020/03/Dentistry-in-England.pdf">4% reduction in funding</a> while overall NHS funding during the same period <a href="https://nhsfunding.info/nhs-crisis-making/">increased by an average of 1.4% per year</a>. During the same period, patient dental charges increased by 9% in real terms, which equated to a 17% increase in patient contributions. In a nutshell, government funding for NHS dentistry has decreased while patients are being asked to pay more to prop up an ailing service. </p>
<p>At the same time, the costs of delivering dentistry are rapidly rising, making it increasingly difficult for <a href="https://bda.org/news-centre/blog/Documents/DDRB-evidence-2022-23-British-Dental-Association-25Jan22.pdf">NHS practices to survive</a>. Delivering high quality healthcare in a safe environment provided by highly skilled professionals is expensive, and costs continue to spiral. </p>
<p><a href="https://bda.org/news-centre/latest-news-articles/Pages/NHS-Dentists-demand-lifeline-as-dental-inflation-soars.aspx">Analysis by the British Dental Association</a> indicates that dental inflation is running at over 11% with the cost of wages, materials, consumables, laboratory items and utility bills all rising dramatically. With NHS funding being reduced in real terms, dental practices are being forced to look to the private sector to maintain financial viability. This has been a longstanding issue for NHS practices, but has become more acute as a consequence of <a href="https://bda.org/advice/Coronavirus/Documents/Investigation-into-the-resilience-of-mixed-dental-practices-following-the-first-wave-of-the-COVID-19-pandemic.pdf">COVID</a>, <a href="https://www.gdpuk.com/news/latest-news/4111-is-brexit-beginning-to-bite-uk-dentistry">Brexit</a> and <a href="https://bda.org/news-centre/latest-news-articles/Pages/NHS-Dentists-demand-lifeline-as-dental-inflation-soars.aspx">UK inflation</a>. </p>
<h2>Contracts and recruitment</h2>
<p>But funding is only one part of the problem. </p>
<p>In 2006, a radical new dental contract was introduced with ambitious plans to modernise dentistry in England and Wales for the benefit of patients and the dental profession. It has been viewed as an <a href="https://bda.org/news-centre/press-releases/Pages/Unfit-for-purpose-Health-Committee-slams-contract-fuelling-crisis-in-NHS-dentistry.aspx">abject failure by many</a>, although it has enabled the Treasury to cap dental funding and <a href="https://www.nature.com/articles/sj.bdj.2016.214">control NHS spending</a> on dentistry.</p>
<figure class="align-center ">
<img alt="A male dentist performs a dental procedure on an older woman." src="https://images.theconversation.com/files/480054/original/file-20220819-26-e0nlgt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/480054/original/file-20220819-26-e0nlgt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/480054/original/file-20220819-26-e0nlgt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/480054/original/file-20220819-26-e0nlgt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/480054/original/file-20220819-26-e0nlgt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/480054/original/file-20220819-26-e0nlgt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/480054/original/file-20220819-26-e0nlgt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The dental contract rewards quantity over quality of treatment.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/dental-practitioner-moving-drill-close-pensioner-1936340263">Svitlana Hulko/ Shutterstock</a></span>
</figcaption>
</figure>
<p>This 2006 contract also saw the introduction of a novel method of measuring performance based on a crude points system (known as <a href="https://www.nature.com/articles/vital1131">Units of Dental Activity</a> or UDAs) which has proved highly unpopular. In short, dentists are given a certain number of points for performing different procedures (such as a filling) on a patient. Practices have an annual target of UDAs to achieve, which need to be delivered in order to retain their NHS funding. However, UDAs often don’t add up – with dentists being given the same number of UDAs for performing a small filling as they would if they did multiple fillings, root canals and gum treatment on the same patient.</p>
<p>This target-based system rewards quantity of UDAs over quality of treatment, fails to promote preventative dentistry and impedes access for new patients. As a consequence, the contract does little to promote improvements in oral health and actively disincentivises the treatment of patients with the greatest needs. </p>
<p>Despite <a href="https://publications.parliament.uk/pa/cm200708/cmselect/cmhealth/289/28902.htm">widespread</a> <a href="https://bda.org/news-centre/latest-news-articles/Pages/england-marginal-changes-under-scrutiny.aspx">criticism</a>, the contract is still in place 16 years later – and patients continue to suffer as a consequence. Recent <a href="https://www.england.nhs.uk/2022/07/better-access-to-nhs-dental-services-under-new-reforms/">proposals from NHS England</a>, aimed at addressing some of the failings, are seen as <a href="https://dentistry.co.uk/2022/07/25/nhs-staffing-crisis-a-serious-risk-to-safety-of-patients-report-finds/">too little too late</a>. Dentists want to care for their patients, rather than chase UDA targets in a desperate bid to retain their NHS funding. <a href="https://bda.org/news-centre/blog/Pages/NHS-dentistry-I-don%E2%80%99t-want-to-leave-but-I-feel-there-is-no-choice.aspx">This is a key driver in many leaving the NHS</a>. </p>
<p>The government’s failure to invest in NHS dentistry has also undermined the profession’s confidence, with many seeing <a href="https://dentistry.co.uk/wp-content/uploads/2022/05/ADG-Report_The-urgent-need-to-level-up-access_April-2022_V3.pdf">little future in the NHS</a>. There have been too many false promises and dentists are increasingly <a href="https://dentistry.co.uk/2018/02/22/seventy-per-cent-dentists-plan-leave-nhs-within-five-years/">looking to the private sector</a> in order to protect their patients, their staff and their businesses. </p>
<p>Unfortunately, many young graduates see no future in the NHS and aim to work in the private sector from an <a href="https://www.nature.com/articles/sj.bdj.2018.359">early stage of their career</a>. The <a href="https://dentistry.co.uk/wp-content/uploads/2022/05/ADG-Report_The-urgent-need-to-level-up-access_April-2022_V3.pdf">situation has been compounded</a> by Brexit, COVID-19, reduced numbers of UK graduates and increased part-time working. </p>
<p>NHS dentistry does not and cannot deliver a “<a href="https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england#:%7E:text=The%20NHS%20provides%20a%20comprehensive,marital%20or%20civil%20partnership%20status.">a comprehensive service, available to all</a>” under the present funding. There is unlikely to be any additional investment in NHS dentistry now as we head into a recession, especially since dentistry is considered low priority.</p>
<p>With current services at breaking point, we need urgent, decisive and radical action to safeguard the future oral health of the Nation. Investment needs to focus on prevention and provision of emergency care. The limited NHS dental resources need to be targeted responsibly at the most vulnerable in society. Prioritisation must be given to those with the greatest need, which will place a greater onus on those who can afford to pay. </p>
<p>Tough decisions need to be made, which will not be universally popular. But without it, the current crisis will only deepen and those with the greatest need will inevitably suffer the most.</p><img src="https://counter.theconversation.com/content/188673/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Mills does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Reports have shown 90% of NHS practices are not currently accepting new dental patients.Ian Mills, Associate Professor in Primary Care Dentistry, University of PlymouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1822672022-05-02T16:38:45Z2022-05-02T16:38:45Z7 principles to guide a national dental care program in Canada<figure><img src="https://images.theconversation.com/files/460635/original/file-20220501-24-htxo8o.jpg?ixlib=rb-1.1.0&rect=216%2C0%2C4220%2C2643&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A national dental care program for low-income Canadians plans to launch coverage for children under age 12 in 2022.
</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Prime Minister Justin Trudeau recently announced plans to establish a <a href="https://pm.gc.ca/en/news/news-releases/2022/03/22/delivering-canadians-now">national dental care program</a> for low-income Canadians. The program arguably represents one of the most significant health-care initiatives since Canadian Medicare and flows from the Liberal–NDP “<a href="https://pm.gc.ca/en/news/news-releases/2022/03/22/delivering-canadians-now">supply and confidence</a>” agreement.</p>
<p>The program will cover an estimated <a href="https://www.cbc.ca/news/politics/liberal-ndp-dental-plan-1.6393981">6.5 million</a> Canadians, paying dental care fees for families making less than $90,000 annually, with no co-pays for those under $70,000. Coverage will start with children under age 12 in 2022, then expand to those under age 18, seniors and people living with disabilities in 2023, with full implementation by 2025.</p>
<h2>Billion-dollar questions</h2>
<p>The federal budget committed <a href="https://budget.gc.ca/2022/home-accueil-en.html">$5.3 billion</a> for the new program, resulting in several “billion-dollar” questions, including: </p>
<ul>
<li><p>How will the money flow? Will this be a direct federal program administered by a public agency <a href="https://www.thestar.com/politics/2022/03/24/jagmeet-singh-expects-federal-dental-plan-to-remain-faithful-to-ndp-campaign-promise.html">as promoted by the NDP</a>? Or will the money flow through <a href="https://doi.org/10.1503/cmaj.200143">traditional federal/provincial/territorial</a> (FPT) arrangements for health care? </p></li>
<li><p>How will the national program align with other existing programs at the FPT level, let alone employer and individually sponsored dental benefit plans? </p></li>
<li><p>How will the services be delivered? In public clinics, including community health centres and hospitals, and/or through private clinics where most dental care is provided today? And what services will be covered?</p></li>
</ul>
<p>There are myriad details here, but at minimum, there appears to be increasing policy, public and political consensus that access to dental care should be made consistent, reliable and equitable for all Canadians across all jurisdictions. As a result, like it is for health care, federal policy leadership is key.</p>
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Read more:
<a href="https://theconversation.com/filling-the-gaps-why-canada-still-needs-a-public-dental-health-plan-despite-decades-of-medicare-181306">Filling the gaps: Why Canada still needs a public dental health plan despite decades of medicare</a>
</strong>
</em>
</p>
<hr>
<p>This means the federal government could establish a set of principles to guide either its own direct program or the provinces and territories in qualifying for funding.</p>
<h2>Principles and possibilities</h2>
<figure class="align-center ">
<img alt="A woman in a blue suit stands at a lectern with people seated behind her" src="https://images.theconversation.com/files/460636/original/file-20220501-26-qn2ibi.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/460636/original/file-20220501-26-qn2ibi.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/460636/original/file-20220501-26-qn2ibi.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/460636/original/file-20220501-26-qn2ibi.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/460636/original/file-20220501-26-qn2ibi.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/460636/original/file-20220501-26-qn2ibi.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/460636/original/file-20220501-26-qn2ibi.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Finance Minister Chrystia Freeland tables the federal budget in the House of Commons on April 7, 2022. The budget committed $5.3 billion over five years to a national dental care plan.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Adrian Wyld</span></span>
</figcaption>
</figure>
<p>As dental public health specialists, we propose a set of principles that we hope FPT governments, the oral health-care professions, patient advocates and the public can rally around. The principles apply to both a direct program and/or traditional FPT arrangements. In any case, these are early days, but the timeline is tight, so we believe these principles can be used to facilitate efficient policy and program development.</p>
<p>Most importantly, we offer these principles to move forward in a healthy way: in the service of Canadians who, for far too long, have been unable to meet their oral health-care needs because of a <a href="https://www.cbc.ca/news/canada/toronto/getting-dental-care-a-major-problem-for-a-third-of-torontonians-report-says-1.6345318">lack of access to care</a>.</p>
<p>The principles are:</p>
<ol>
<li><p><strong>Core basket of services.</strong> The federal government can establish a dental services schedule that is scientifically and ethically defensible. Defining this basket can help solve a pressing question in Canadian health-care policy: What is <a href="https://doi.org/10.1177/2380084420941777">medically necessary</a> or essential dental care? There should be a core service basket that all Canadians should have access to. <a href="https://hdl.handle.net/1807/35647">Such a basket</a> would arguably relieve pain and infection (for example, extractions), prevent disease (for example, topical fluorides), and restore physical and social function (for example, dentures). In the context of current FPT health-care arrangements, provincial and territorial programs would need to deliver this defined basket to qualify for funding.</p></li>
<li><p><strong>Fair remuneration.</strong> Public dental programs across FPT jurisdictions can vary substantially in <a href="https://www.caphd.ca/sites/default/files/FINAL%2520-%25202015%2520Environmental%2520Scan%2520-%2520ENGLISH%2520-%252016%2520Feb%252016.pdf">their remuneration rates</a> for services delivered in the private sector. In some jurisdictions, <a href="https://www.canadianscholars.ca/books/the-politics-of-dental-care-in-canada">reimbursement rates</a> are so low that it discourages practitioners from providing the care, limiting access for those that need it most. A negotiated fee schedule should recognize this fact, as well as understand the changing realities imposed by <a href="https://jcda.ca/l5">COVID-19</a>, which have made delivering dental care that much more expensive.</p></li>
<li><p><strong>Public and private administration.</strong> The new program can be publicly and privately administered. Governments need not be in the business of claims-processing. Many FPT dental care programs already take advantage of the efficiencies of <a href="https://www.canadianscholars.ca/books/the-politics-of-dental-care-in-canada">non-profit and for-profit claims-processors</a> specialized in paying dental bills. Yet, to maintain accountability, public oversight of appropriate spending is important to make best use of scarce public resources.</p></li>
<li><p><strong>Public and private delivery.</strong> Across FPT jurisdictions, <a href="https://www.caphd.ca/sites/default/files/FINAL%20-%202015%20Environmental%20Scan%20-%20ENGLISH%20-%2016%20Feb%2016.pdf">publicly funded programs</a> are delivered in private, public or combined settings. Private sector delivery currently dwarfs public sector delivery, yet both sectors are important. Leveraging the strength of both could help fill specific pockets of need, especially in a program that aims to target the unique and complex needs of medically compromised seniors and those living with disabilities.</p></li>
<li><p><strong>Portability.</strong> One of the strengths of our Medicare system is that no one falls through the cracks when moving from one province or territory to another. The home jurisdiction <a href="https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act-frequently-asked-questions.html#a7">maintains coverage</a> until coverage from the incoming jurisdiction begins. This approach should apply to the new program.</p></li>
<li><p><strong>Accessibility.</strong> Another positive aspect of Medicare is that it facilitates accessibility by not asking for any up-front costs from the patient. The new program would leverage the same principle for those whose income falls below $70,000. For those who make between $70,000 and $90,000, co-payments will apply, but they should be proportional to income. There could also be a subset of services (those deemed most important) whose costs would be completely captured by government, and then another set of services where co-pays would apply, again proportional to income.</p></li>
<li><p><strong>Data, evaluation, and reporting.</strong> Canada does not have a well developed <a href="https://www.canadianscholars.ca/books/the-politics-of-dental-care-in-canada">data infrastructure</a> to collect, share and analyze information on oral health. As a result, public investments for dental care in Canada have gone without appropriate evaluation. This will be key for the new program given its importance, and thus investments in surveillance and/or population health assessment are required. Evaluation and, more importantly, reporting of evaluation findings should be part of accountability measures.</p></li>
</ol>
<p>Funds are on the table, and we are still in the early days of resolving what is referred to as a “<a href="https://www.carequest.org/resource-library/wicked-problem-oral-health-care-system">wicked problem</a>.” In other words, dental care is arguably one of the most challenging, complex and underappreciated issues in health care. It is welcome news that there is now a real chance to clarify and act on this important part of Canada’s health-care system.</p><img src="https://counter.theconversation.com/content/182267/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sonica Singhal consults or has consulted to federal, territorial, and municipal governments, and dental regulatory authorities. She receives or has received funding from these organizations. She is affiliated with various national and provincial dental professional associations.</span></em></p><p class="fine-print"><em><span>Carlos Quiñonez consults or has consulted to federal, provincial, territorial, and municipal governments, dental and dental hygiene regulatory authorities, dental professional associations, third-party benefits carriers, and not-for-profit agencies. He receives or has received funding from these organizations. He is affiliated with various national and provincial dental professional associations.</span></em></p>A national dental care program is welcome news, but raises several ‘billion-dollar’ questions about how the program will work and what will be covered. Here are seven principles to guide decisions.Sonica Singhal, Assistant Professor, Faculty of Dentistry, University of TorontoCarlos Quiñonez, Vice Dean and Director of Dentistry, Schulich School of Medicine & Dentistry, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1813062022-04-25T17:13:39Z2022-04-25T17:13:39ZFilling the gaps: Why Canada still needs a public dental health plan despite decades of medicare<figure><img src="https://images.theconversation.com/files/458978/original/file-20220420-24684-mk2q31.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C4827%2C3437&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A public dental care plan would give many Canadians reason to smile.</span> <span class="attribution"><span class="source">(Unsplash)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/filling-the-gaps--why-canada-still-needs-a-public-dental-health-plan-despite-decades-of-medicare" width="100%" height="400"></iframe>
<p>Canadians pride ourselves on our health-care system, especially in comparison with our neighbours to the south. But there are significant gaps in coverage. <a href="https://www.cda-adc.ca/stateoforalhealth/snap/">Nearly one-third of Canadians do not have dental insurance, and that number climbs to 50 per cent for lower-income Canadians</a>. Without dental care, minor issues like cavities can result in serious infections. </p>
<p><a href="https://publications.gc.ca/collections/collection_2010/sc-hc/H34-221-2010-eng.pdf">Over 10 per cent of Canadians live with pain in their mouth</a>. People <a href="https://www.tvo.org/article/these-ontario-experts-are-calling-for-universal-dental-care">visit emergency rooms</a> for care that could be better delivered in a dental office. Canadians lose teeth that could have been saved, which makes it hard to eat nutritiously and can make it <a href="https://www.dentistrytoday.com/missing-teeth-damage-job-prospects/">more difficult to find work</a>. </p>
<p>Poor oral health can also <a href="https://www.dentalhygienecanada.ca/pdfs/Profession/Resources/Disease_Link_Article.pdf">complicate or contribute to diabetes, heart disease and other chronic diseases</a>. </p>
<h2>Why was dental care not included in medicare?</h2>
<p>My forthcoming book, <a href="https://www.mqup.ca/smile-gap--the-products-9780228010623.php"><em>The Smile Gap: The History of Oral Health and Social Inequality</em></a>, explores why dental care was left out of medicare. <a href="https://www.canada.ca/en/health-canada/services/health-care-system/commissions-inquiries/federal-commissions-health-care/royal-commission-health-services.html">The 1964 Royal Commission on Health Services</a>, which set the stage for medicare, recommended the establishment of a dental care program for children, using dentists and dental professionals with less training called dental auxiliaries. </p>
<p>The idea was to start with younger children and then expand eligibility to older children. Eventually, adults might be included. </p>
<figure class="align-right ">
<img alt="Book cover will an illustration of two smiling children" src="https://images.theconversation.com/files/458022/original/file-20220413-20-estivy.jpg?ixlib=rb-1.1.0&rect=6%2C95%2C239%2C359&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/458022/original/file-20220413-20-estivy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458022/original/file-20220413-20-estivy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458022/original/file-20220413-20-estivy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458022/original/file-20220413-20-estivy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458022/original/file-20220413-20-estivy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458022/original/file-20220413-20-estivy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">‘The Smile Gap: The History of Oral Health and Social Inequality’ explores why dental care was left out of medicare.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>At the time, there was a significant shortage of dentists in Canada and a universal program was not practical. Dentists opposed the idea of publicly funded denticare, especially the use of auxiliaries to treat children. </p>
<p>The idea of using auxiliaries came from New Zealand, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2554050/">where specially trained dental nurses provided treatment in schools</a>. Despite the success of the New Zealand program, dentists did not believe that dental auxiliaries had sufficient training to work without a dentist’s direct supervision. </p>
<p>Dentists thought that more emphasis should be placed on prevention, especially education and water fluoridation. <a href="https://doi.org/10.3138/chr.89.3.345">Many had been fighting for water fluoridation in their communities for over a decade</a>. Water fluoridation had been shown to significantly reduce cavities and yet Canadians repeatedly <a href="https://doi.org/10.3138/jcs.44.2.146">rejected water fluoridation in municipal referendums</a>, leading dentists to conclude that Canadians did not value their oral health. </p>
<p>When the <a href="https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/health-care-system/canada.html">Medical Care Act of 1966</a> passed, dental care was not included. For the most part, dentists were delighted that they could continue their practices without state interference.</p>
<h2>The provinces step in</h2>
<p>My book covers the history of dental programs in Canada. Even before medicare, quite a few provinces provided public dental insurance for people on social assistance. </p>
<p>The Ontario dental insurance program, for example, was established in 1958 to provide care for children whose mothers received state support. In 1965, all parents who received family benefits became eligible. Unfortunately, many people who lived in regions without a dentist were unable to access the program. </p>
<p>According to a study by dental public health researcher <a href="https://www.dentistry.utoronto.ca/news/award-distinction-2018">James Leake</a>, dentists also had problems with the program. They disliked it because it only included basic services and they found it professionally challenging to not provide the best possible service. Dentists also complained that people on social assistance were much more likely to miss appointments than other patients. </p>
<figure class="align-center ">
<img alt="A child in a dentist's chair, obscured by the dentist's shoulder and hands." src="https://images.theconversation.com/files/458981/original/file-20220420-15105-4d4vjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/458981/original/file-20220420-15105-4d4vjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458981/original/file-20220420-15105-4d4vjg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458981/original/file-20220420-15105-4d4vjg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458981/original/file-20220420-15105-4d4vjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458981/original/file-20220420-15105-4d4vjg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458981/original/file-20220420-15105-4d4vjg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In the years after the Second World War, some provinces began providing dental care to all children.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>Access to care continues to be a problem today. While <a href="https://www.caphd.ca/sites/default/files/FINAL%20-%202015%20Environmental%20Scan%20-%20ENGLISH%20-%2016%20Feb%2016.pdf">all provinces provide some dental services to people on social assistance</a>, dentists are often reimbursed at less than their usual fees, making them reluctant to serve these patients. </p>
<h2>Dental care for children</h2>
<p>In the years after the Second World War, some provinces began providing dental care to all children. <a href="https://policyalternatives.ca/newsroom/updates/putting-our-money-where-our-mouth">The most innovative program was in Saskatchewan</a>, where dental nurses — later called dental therapists — provided care in schools beginning in the mid-1970s. The College of Dental Surgeons opposed the program and it was cancelled in 1987. </p>
<p>In other provinces, children received state-funded care in private dental offices. Although there were significant cutbacks to children’s programs in the late 20th century, Québec, Newfoundland and Labrador, Prince Edward Island and Nova Scotia still have universal dental care programs for children. <a href="https://www.caphd.ca/sites/default/files/FINAL%20-%202015%20Environmental%20Scan%20-%20ENGLISH%20-%2016%20Feb%2016.pdf">In the past 15 years</a>, there has been an expansion of targeted programs aimed at low-income children, such as <a href="https://www.health.gov.on.ca/en/pro/programs/dental/">Ontario’s Healthy Smiles</a> </p>
<h2>Rise of private dental insurance</h2>
<figure class="align-center ">
<img alt="A man holding a compress to his jaw and wincing" src="https://images.theconversation.com/files/458983/original/file-20220420-20-himkco.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/458983/original/file-20220420-20-himkco.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458983/original/file-20220420-20-himkco.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458983/original/file-20220420-20-himkco.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458983/original/file-20220420-20-himkco.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458983/original/file-20220420-20-himkco.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458983/original/file-20220420-20-himkco.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One in 10 Canadians live with mouth pain.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>In the 1970s, unions began demanding dental insurance. Companies that no longer needed to provide medical benefits to their employees began to offer dental insurance. <a href="https://books.google.ca/books/about/Dental_Care_Programs_in_Canada.html?id=rvp93b4XSvMC&redir_esc=y">By 1982, approximately two-thirds of collective agreements included dental benefits and just over one-third of Canadians had private dental insurance</a>. <a href="https://publications.gc.ca/collections/collection_2010/sc-hc/H34-221-2010-eng.pdf">By the mid-90s, over half of all Canadians had private dental insurance</a>. </p>
<p>Even though dental insurance did not cover all services, access to insurance diminished the demand for universal dental insurance.</p>
<h2>Gaps in care</h2>
<p>This has left some Canadians without dental care. In 2007, journalist Moira Welsh wrote about <a href="https://www.thestar.com/news/2007/02/10/why_is_he_out_of_work.html">Jason Jones for the <em>Toronto Star</em></a>. Jones was a young man, but his teeth had rotted away. In severe pain, he spent his wife’s life savings to remove them. </p>
<p>At the time the article was published, Jones had just two teeth, which the dentists had left in as anchors for dentures. He could only eat soft foods, his appearance was adversely affected and he couldn’t find a job. </p>
<p>Jones’ story had a happy ending. <a href="https://policyalternatives.ca/sites/default/files/uploads/publications/National%20Office/2011/04/Putting%20our%20money%20where%20our%20mouth%20is.pdf">In response to the front-page story</a>, numerous dentists and denturists reached out and dentist Raj Singh provided him with a new smile. Unfortunately, many other Canadians are not so lucky.</p>
<h2>The future of denticare</h2>
<p>In 2011, the Canadian Centre for Policy Alternatives published the report <a href="https://policyalternatives.ca/publications/reports/putting-our-money-where-our-mouth">Putting Our Money Where Our Mouth Is</a>, drawing attention to the need for better dental care. In 2019, the NDP included denticare in its <a href="https://www.cbc.ca/news/politics/ndp-singh-health-policy-federal-election-1.5175899">federal election platform</a>. The Liberal government promised to explore universal dental care in its <a href="https://www.canada.ca/content/dam/pco-bcp/documents/pm/Speech-from-the-Throne_2019.pdf">throne speech of December 2019</a>, and in October 2020, the <a href="https://www.pbo-dpb.gc.ca/web/default/files/Documents/Reports/RP-2021-028-M/RP-2021-028-M_en.pdf">Parliamentary Budget Office costed a program</a> to provide dental care to all Canadians with a household income of under $90,000, similar to what the <a href="https://www.sac-isc.gc.ca/eng/1576790320164/1576790364553">Non-Insured Health Benefits</a> program provides for Indigenous people. </p>
<p><a href="https://www.ndp.ca/news/ndp-will-help-more-canadians-get-dental-care-they-need">The NDP made denticare a key demand</a> in its 2021 electoral platform. Most recently, the <a href="https://www.cbc.ca/news/politics/trudeu-jagmeet-singh-deal-government-1.6393021">Liberal government agreed to provide a denticare program</a>, starting with children under 12 and expanding it until everyone with a household income of under $90,000 is covered, with no co-payments for people with a family income of under $70,000. </p>
<p>If the Liberals follow through on their promise, this will reduce the gaps in care and relieve the suffering of many Canadians.</p><img src="https://counter.theconversation.com/content/181306/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Carstairs received funding from SSHRC and AMS Health Services for this research.</span></em></p>Canada’s health system does not include dental coverage, leaving a large gap in care that’s existed since its beginning. It’s time to ensure access to oral care.Catherine Carstairs, Professor, Department of History, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1772192022-02-25T02:16:57Z2022-02-25T02:16:57ZHow to brush your teeth properly, according to a dentist<figure><img src="https://images.theconversation.com/files/447715/original/file-20220222-26-ghb9dy.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5599%2C4073&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Most of us brush our teeth on autopilot. So let’s stop and ask: are you doing it properly? For a full two minutes? Do you use the correct type of brush and toothpaste? </p>
<p>Did you know you’re supposed to spit, not rinse after brushing?</p>
<p>And brushing soon after eating acidic foods, like citrus, can damage your teeth? </p>
<p>Here, I answer five questions commonly asked at the dentist.</p>
<h2>1. Am I brushing correctly?</h2>
<p>For starters, make sure you’re brushing both teeth and gums at least twice a day.</p>
<p>Brushing removes dental plaque, the grey-white bacterial mass that sticks to the tooth and gum surface.</p>
<p>If left undisturbed for at least a day, plaque bacteria <a href="https://journals.asm.org/doi/10.1128/mSystems.00360-19">multiply and begin to mature</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/447984/original/file-20220223-27-1vxn8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/447984/original/file-20220223-27-1vxn8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/447984/original/file-20220223-27-1vxn8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447984/original/file-20220223-27-1vxn8z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447984/original/file-20220223-27-1vxn8z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447984/original/file-20220223-27-1vxn8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447984/original/file-20220223-27-1vxn8z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447984/original/file-20220223-27-1vxn8z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Plaque can cause damage to the tooth enamel and the dentine underneath.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Mature plaque forms an architecturally complex mass with its own sewerage system. </p>
<p>Plaque feeds on the food we eat, particularly carbohydrates (sweet and savoury) to <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/prd.12361">reinforce and build</a> a complex structure that releases <a href="https://link.springer.com/chapter/10.1007/978-3-030-31772-0_3#citeas">acids</a> and gassy, smelly by-products (plaque sewage). </p>
<p>Mature plaque on your teeth and gum surfaces can lead to cavities (holes in our teeth) and gum disease.</p>
<p>Cavities form in our teeth when the mineral in our enamel and eventually, dentine, <a href="https://link.springer.com/chapter/10.1007/978-3-030-31772-0_3#citeas">dissolves to neutralise plaque acids</a>. Over time, the tooth softens and caves in. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/n_A-o-rXMqg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
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<p>Every time you brush, you stop plaque bacteria from feeding on your food, multiplying and maturing. Mature plaque mixed with mineral in your saliva forms <a href="https://journals.sagepub.com/doi/full/10.1177/154411130201300506">calculus or tartar</a>.</p>
<p>Calculus can only be removed completely by a dentist or hygienist using special tools.</p>
<p>Not brushing before bed is <a href="https://link.springer.com/article/10.1007/s40368-019-00463-3">especially risky</a>; saliva flow reduces and food stuck between your teeth ferments, creating a perfect petri dish for plaque growth. This is where flossing or using tapered <a href="https://www.ada.org.au/Dental-Health-Week-2017/Oral-Health-for-Busy-Lives/Flossing">interdental cleaners</a> can help. </p>
<p>Make sure you clean the teeth at the back of your mouth, and don’t rush. The Australian Dental Association recommends brushing for <a href="https://www.teeth.org.au/brushing-teeth">two minutes</a> morning and night.
Watch this video for some handy tips on how to brush your teeth.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/_w3JUUBExoQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<h2>2. How do I look after my gums and prevent bad breath?</h2>
<p>Bad breath can be caused by <a href="https://pubmed.ncbi.nlm.nih.gov/31610030/">gum disease</a>.</p>
<p>After <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/prd.12296">two to three weeks of poor brushing</a>, the mature plaque causes the gums to swell, redden and bleed easily. </p>
<p>This is because the gum’s blood vessels leak <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/prd.12296">immune fighting cells to try and destroy the plaque</a>. </p>
<p>But the plaque’s defence system repels the attack. Everything your body throws at it bounces off and starts to break down the bone that holds your teeth in your head. </p>
<p>This process is known as advanced gum disease or periodontal disease. It happens slowly and painlessly. As the gums recede, teeth appear elongated.</p>
<p>Untreated, your teeth may become painful, loosen and even fall out.</p>
<p>This is why it’s important to have a regular dental check-up and to brush and floss frequently. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/QC11_oLJVrE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<h2>3. What kind of toothbrush should I use?</h2>
<p>The Australian Dental Association <a href="https://www.ada.org.au/Dental-Health-Week/Oral-Health-for-Busy-Lives/Brushing-and-flossing">recommends</a> using a toothbrush with a small head and soft bristles.</p>
<p>Some of us are magnificent manual tooth brushers, but many would <a href="https://www.cochrane.org/CD002281/ORAL_poweredelectric-toothbrushes-compared-to-manual-toothbrushes-for-maintaining-oral-health">benefit by using an electric toothbrush</a>. </p>
<p>Why? The same reason we ditched the broom for a vacuum cleaner. </p>
<p>It’s faster, efficient and does a better job – as long as you hover over the surfaces you need to clean. Aim for teeth as well as gums. </p>
<p>Electric toothbrushes come with <a href="https://www.choice.com.au/health-and-body/dentists-and-dental-care/dental-products/review-and-compare/electric-toothbrushes">various features</a> to suit different budgets and needs. </p>
<p>For instance, some have an in-built warning signal to prevent you from brushing so hard you abrade (wear away) your teeth and gums. </p>
<h2>4. When should I delay brushing?</h2>
<p>Generally, wait at least 30 minutes after vomiting or consuming <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jerd.12706">acidic foods and beverages</a>.</p>
<p>If in doubt, check the food label as there are many <a href="https://adavb.org/publicassets/3a66cf22-4d5b-e911-a2b6-ff21181505bd/Fact-Sheet_Oral-Health_Dental-Erosion.pdf">different acids in our diet</a>.</p>
<p>Acids soften the enamel and dentine like soaking dirty saucepans in the sink. </p>
<p>And if we don’t give our saliva enough time to mop up the acids, the softened tooth surface scratches away when we brush. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/447998/original/file-20220223-13-ileiaz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/447998/original/file-20220223-13-ileiaz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447998/original/file-20220223-13-ileiaz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447998/original/file-20220223-13-ileiaz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447998/original/file-20220223-13-ileiaz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447998/original/file-20220223-13-ileiaz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447998/original/file-20220223-13-ileiaz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447998/original/file-20220223-13-ileiaz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If we don’t give our saliva enough time to mop up the acids before brushing, the acids soften the tooth surface.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>5. What kind of toothpaste should I use?</h2>
<p>Keep it simple. Select a toothpaste that contains <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007868.pub3/full">fluoride</a>. </p>
<p><a href="https://www.teeth.org.au/dental-fluoride">Fluoride</a> fills and reinforces the microscopic gaps in our teeth to create an acid-resistant barrier.</p>
<p>It also forms a non-stick surface to <a href="https://link.springer.com/chapter/10.1007/978-3-030-31772-0_3#citeas">prevent plaque from attaching and maturing</a>. </p>
<p>Do spit and not rinse at the end; avoiding rinsing means you get a fluoride treatment each time you brush. </p>
<p>What about whitening toothpastes? Whitening toothpastes can have strong abrasives that wear the tooth surface to cause sensitivity. </p>
<p>Most stain particles in our natural teeth hide in microscopic gaps in enamel. </p>
<p>The most efficient and least destructive way of removing these stains is by <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jerd.12519">using peroxide-based</a> whitening products.</p>
<p>Talk to your dentist about <a href="https://www.ada.org.au/getattachment/Your-Dental-Health/Resources-for-Professionals/Resources-for-Adults-31-64/Teeth-whitening-the-best-result-for-your-smile/Teeth-whitening,-getting-the-best-result-for-your-smile.pdf.aspx">options</a> and be wary of home remedies or gimmicks. And remember, whitening will not change the colour of dentures, crowns, veneers or fillings.</p><img src="https://counter.theconversation.com/content/177219/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arosha Weerakoon is a self-employed dentist in private practice. She has received funding from Colgate to conduct research on how collagen and mineral characteristics in teeth change as we age. She is a member of the Australian Dental Association and a Fellow of the Royal Australasian College of Dental Surgeons.</span></em></p>Do you brush for two minutes, with the correct type of brush and toothpaste? Did you know you’re supposed to spit, not rinse after brushing? And that brushing at the wrong time can cause damage?Arosha Weerakoon, Lecturer, General Dentist & PhD Candidate, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1722982021-12-03T00:34:31Z2021-12-03T00:34:31ZWhy do I grind my teeth and clench my jaw? And what can I do about it?<figure><img src="https://images.theconversation.com/files/433393/original/file-20211123-23-1mbut6y.jpg?ixlib=rb-1.1.0&rect=9%2C48%2C6480%2C4281&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Dentists have <a href="https://www.abc.net.au/news/2021-11-22/dentists-report-teeth-grinding-increase-during-pandemic/100638656?utm_medium=social&utm_content=sf251412392&utm_campaign=fb_abc_news&utm_source=m.facebook.com&sf251412392=1&fbclid=IwAR2HwkgKaiVbSk4nYXEfWk9GFOrXFEi-SjXU-sR8uHbcL-hnsmX2nnUkXbI">reported</a> a rise in teeth clenching and grinding since the pandemic began. </p>
<p>The symptoms of teeth clenching and/or grinding (also known as bruxing or parafunction) can include pain in teeth and gums, as well as jaw joints and muscles.</p>
<p>The pain it causes can be debilitating and significantly affect your daily life.</p>
<p>We’re specialist dentists who teach, research and practise in the areas of prosthodontics (Dale Howes) and community dentistry (Alexander Holden). Here’s what you need to know about clenching and grinding your teeth.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/433392/original/file-20211123-15-zorbxl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman clasps her jaw." src="https://images.theconversation.com/files/433392/original/file-20211123-15-zorbxl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/433392/original/file-20211123-15-zorbxl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=421&fit=crop&dpr=1 600w, https://images.theconversation.com/files/433392/original/file-20211123-15-zorbxl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=421&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/433392/original/file-20211123-15-zorbxl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=421&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/433392/original/file-20211123-15-zorbxl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=530&fit=crop&dpr=1 754w, https://images.theconversation.com/files/433392/original/file-20211123-15-zorbxl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=530&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/433392/original/file-20211123-15-zorbxl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=530&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Jaw pain is a common symptom.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-i-really-need-this-crown-dentists-admit-feeling-pressured-to-offer-unnecessary-treatments-148638">Do I really need this crown? Dentists admit feeling pressured to offer unnecessary treatments</a>
</strong>
</em>
</p>
<hr>
<h2>Are you clenching your jaw right now?</h2>
<p>Our top and bottom teeth are only designed to meet when we need them to; for biting and chewing food. </p>
<p>We naturally spend only a small portion of the day chewing, with our top and bottom teeth making contact with each other.</p>
<p>As you read this article, think about how, subconsciously, you have positioned your teeth and jaws. Assuming you are not eating or chewing while reading, your teeth should be apart when you’re relaxed, whether or not your lips and mouth are shut.</p>
<p>If we grind or clench more than nature intended, the teeth can become worn over time, while the jaw muscles can become fatigued and tight.</p>
<p>The jaw joints (known as the temporomandibular joints) attaching the lower jaw to the skull contain a disc, which helps control the way the jaw joints move. </p>
<p>This disc can become distorted or dislocated, which can lead to clicking, reduce function and cause pain.</p>
<h2>So why do we grind our teeth?</h2>
<p>Stress is one of the main contributing factors. </p>
<p>When I (Alexander Holden) see patients who complain of soreness in their jaw joints and surrounding muscles, or who have obvious signs of grinding or wear on their teeth, I’ll ask about stress. </p>
<p>“No, I’m not stressed at all!” is often the answer, but then when we sit and talk about what’s really going in their life, the sources of stress quickly become apparent. </p>
<p>Starting a new job, challenges at home or with family, or coping with a life change are all common experiences that stress us more than we realise. It’s not always easy to identify when we’re experiencing tough times.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/433397/original/file-20211123-27-r4ujax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man looks tired and stressed." src="https://images.theconversation.com/files/433397/original/file-20211123-27-r4ujax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/433397/original/file-20211123-27-r4ujax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=418&fit=crop&dpr=1 600w, https://images.theconversation.com/files/433397/original/file-20211123-27-r4ujax.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=418&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/433397/original/file-20211123-27-r4ujax.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=418&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/433397/original/file-20211123-27-r4ujax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=525&fit=crop&dpr=1 754w, https://images.theconversation.com/files/433397/original/file-20211123-27-r4ujax.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=525&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/433397/original/file-20211123-27-r4ujax.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=525&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Stress can contribute to a habit of jaw clenching or teeth grinding.</span>
<span class="attribution"><span class="source">Shutterstock.</span></span>
</figcaption>
</figure>
<h2>What can we do about it?</h2>
<p>The first step is becoming aware you’re grinding and clenching, and making an often subconscious behaviour into one that we can control and stop. </p>
<p>Dental practitioners are trained to check the health and status of the jaw joints and the muscles that help you to chew.</p>
<p>A dental check-up can help reveal the signs of teeth grinding and jaw clenching, which can include cracked teeth and fillings, worn crowns or cusps (which is what the elevated edge of a tooth is called) and tender jaw muscles. Tender muscles around sides of the head and neck are also common.</p>
<p>Stress management and physiotherapy may be important components of a <a href="https://www1.racgp.org.au/ajgp/2018/april/temporomandibular-dysfunction">multi-disciplinary approach to care</a>. </p>
<p>If you grind at night (ask your partner), you might wake with sore teeth, jaw joints or head and neck muscles. Chat with your dentist about whether a bite guard (also known as a bite raising appliance or “splint”) might be right for you. These protect your teeth and jaws while you sleep.</p>
<p>For those who have issues with a sore jaw from clenching and grinding, avoid chewing gum for extended periods of time. Chewing sugar-free gum has been linked to <a href="https://www.nature.com/articles/s41432-020-0110-x">reducing risk of tooth decay</a> but for grinders, it can contribute to jaw pain.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/50-shades-whiter-what-you-should-know-about-teeth-whitening-102474">50 shades whiter: what you should know about teeth whitening</a>
</strong>
</em>
</p>
<hr>
<h2>Addressing the cause, managing the symptoms</h2>
<p>At the end of the day, patients need to also address the stressors which may be the underlying cause. </p>
<p>For many people, teeth grinding is cyclical and periodically disappears after the source of their stress is managed or subsides.</p>
<p>For others, it might not be so straightforward. </p>
<p>That’s where the advice and care of a dentist can help get you the care you require.</p><img src="https://counter.theconversation.com/content/172298/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Alexander Holden is engaged in funded research/evaluation activities for NSW Health and has received research funding from the Australian Skeptics Inc. and the Dental Council of NSW in the recent past. Alexander is also holds Director roles with the Australian Dental Association NSW Branch, Filling the Gap (a charity dedicated to providing care to undeserved community groups) and the Australasian College of Legal Medicine. He holds affiliate appointments as a Clinical Associate Professor with the University of Sydney and as Associate Professor (Status Only) with The University of Toronto Faculty of Dentistry. </span></em></p><p class="fine-print"><em><span>Dale Howes does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Stress is one of the main contributing factors.Alexander Holden, Clinical Associate Professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1670882021-09-09T20:09:43Z2021-09-09T20:09:43ZWhy dental care needs to be part of health care — and on the federal election agenda<figure><img src="https://images.theconversation.com/files/420111/original/file-20210908-27-1holpoy.jpg?ixlib=rb-1.1.0&rect=1201%2C49%2C6953%2C5395&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dental decay is the most common non-communicable disease globally, but treating it is not part of our public health-care system.</span> <span class="attribution"><span class="source">(Pexels/Cedric Fauntleroy)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/why-dental-care-needs-to-be-part-of-health-care---and-on-the-federal-election-agenda" width="100%" height="400"></iframe>
<p>In Canada, dental care is not part of medical care. <a href="https://www.cda-adc.ca/stateoforalhealth/">Approximately six per cent of dental care is paid for by public funds, with the rest being paid through private insurance (56 per cent) or out-of-pocket (38 per cent)</a>. </p>
<p>This contributes to significant inequalities in oral health and dental care, with <a href="https://cahs-acss.ca/improving-access-to-oral-health-care-for-vulnerable-people-living-in-canada/">the poorest Canadians having both the greatest burden of oral disease and the most difficulty accessing dental care</a>. </p>
<p>While Canada’s medical care system has its problems, the fact that it is free at the point of service substantially helps all Canadians access it. The teeth and mouth are part of the body, and this false segregation of care systems costs individual Canadians and the country as a whole money we can ill afford. Writing as a researcher in the field of dental public health, it is my opinion that dental care should be part of medical care. </p>
<p>When health care is discussed as an issue in the federal election, dental care should be part of the discussion.</p>
<h2>Irony and inequality</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/420121/original/file-20210908-19-5wzdxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Gloved hands holding an iPad showing a dental X-ray" src="https://images.theconversation.com/files/420121/original/file-20210908-19-5wzdxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/420121/original/file-20210908-19-5wzdxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420121/original/file-20210908-19-5wzdxu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420121/original/file-20210908-19-5wzdxu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420121/original/file-20210908-19-5wzdxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420121/original/file-20210908-19-5wzdxu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420121/original/file-20210908-19-5wzdxu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Twenty-two per cent of Canadians — about eight million people — avoid going to the dentist due to cost.</span>
<span class="attribution"><span class="source">(Pexels/Tima Miroshnichenko)</span></span>
</figcaption>
</figure>
<p>There is an awful irony that <a href="https://doi.org/10.1016/S0140-6736(19)31146-8">dental decay is among the most common non-communicable diseases globally</a>, but treating it is not part of our public health-care system. The burden of oral disease for those individuals suffering the pain, difficulty eating, embarrassment smiling or talking and time off work or school is enormous. </p>
<p>Furthermore, <a href="https://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00010-eng.htm">22 per cent of the population</a> (approximately eight million people) reports avoiding the dentist due to cost. As a result, the public medical system ends up treating oral disease but often in inefficient and inappropriate ways. </p>
<p>For example, from 2010 to 2012, treatment of dental decay was by far the most common reason for one- to five-year-old children receiving general anesthesia, <a href="https://publications.gc.ca/collections/collection_2014/icis-cihi/H118-94-2013-eng.pdf">accounting for 31 per cent of all general anesthesia care in that age group</a>. In addition, this procedure was much more common among Indigenous children, the poorest families and those living in rural areas. These children often have several severely decayed teeth because their parents are unable to afford dental care. </p>
<p>On top of this, increasing numbers of <a href="https://files.ontario.ca/books/mol_changing_workplace_report_eng_2_0.pdf">Canadians have precarious jobs with lower wages and fewer workplace benefits</a> so have to pay for dental care out of pocket. This results in <a href="https://doi.org/10.17269/CJPH.108.5950">more people consulting physicians and/or emergency departments for dental problems</a>, but often receiving sub-optimal care as those facilities are not equipped to provide the necessary treatment. </p>
<h2>Oral care is health care</h2>
<p>To add to these issues directly related to oral disease and dental care, we also know that the body’s systems do not segregate the mouth from the rest of the body. There are important examples of direct links between oral health and general health. </p>
<p>For example, <a href="https://doi.org/10.1111/idj.12360">worsening gum disease can result in deterioration in diabetes, and vice versa</a>. And this burden of disease and difficulties accessing dental care is experienced very unequally among Canadians. The poorest groups, Indigenous people, recent immigrants, those with disabilities and those living in rural and remote Canada having significantly more problems. <a href="https://cahs-acss.ca/improving-access-to-oral-health-care-for-vulnerable-people-living-in-canada/">These inequalities are also greater among women than men in Canada</a>.</p>
<p>However, there is something that can be done to improve this situation. This has been recognized by the World Health Organization, and is increasingly recognized in Canada. This year, <a href="https://www.who.int/news/item/27-05-2021-world-health-assembly-resolution-paves-the-way-for-better-oral-health-care">the WHO passed a resolution</a> paving the way for improved oral health care globally with the observation that: </p>
<blockquote>
<p>“… oral health should be firmly embedded within the noncommunicable disease agenda and that oral health-care interventions should be included in universal health coverage programmes.” </p>
</blockquote>
<p>The current federal election provides the opportunity to bring this issue to the forefront of the discussion on health care in Canada. In December 2019, the <a href="https://pm.gc.ca/en/mandate-letters/2019/12/13/minister-health-mandate-letter">prime minister’s mandate letter for the Minister of Health</a> requested her to “work with Parliament to study and analyze the possibility of national dental care.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/420120/original/file-20210908-23-17jz93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman dentist and a child patient" src="https://images.theconversation.com/files/420120/original/file-20210908-23-17jz93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420120/original/file-20210908-23-17jz93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420120/original/file-20210908-23-17jz93.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420120/original/file-20210908-23-17jz93.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420120/original/file-20210908-23-17jz93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420120/original/file-20210908-23-17jz93.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420120/original/file-20210908-23-17jz93.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Treatment of dental decay is a common reason for one- to five-year-old children receiving general anesthesia. Most of these cases could have been prevented.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>In October 2020, the federal <a href="https://www.pbo-dpb.gc.ca/en/blog/news/RP-2021-028-M--cost-estimate-federal-dental-care-program-uninsured-canadians--estimation-couts-lies-un-regime-soins-dentaires-federal-destines-tous-canadiens-non-assures">Parliamentary Budget Office</a> published a cost estimate for a federal dental care program for uninsured Canadians. This was based on the NDP proposal for Canadians earning less than $90,000 annually receiving care. The total cost was estimated to be $1.5 billion per year to cover care for approximately 6.5 million Canadians. </p>
<p>However, another <a href="https://doi.org/10.11575/sppp.v13i0.69676">recent report</a> compared the costs of a “Denticaid” system providing public insurance to all children under 12 and others without private insurance, versus a “Denticare” system in which dental care is covered for all, just as with the medicare system. The report concluded that the net costs of the “Denticare” system were less, so Canada should adopt this approach.</p>
<p>Dental care should be moved into the medicare system. On top of the cost savings to individuals and the population as a whole, it would help reduce the substantial inequalities in oral disease and access to care, as well as promote the integration of medical and dental care so as to help people with gum disease and diabetes, the screening of young kids for dental decay and countless other situations in which our mouth is an integral part of our body.</p><img src="https://counter.theconversation.com/content/167088/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Allison receives funding from CIHR, PHAC, the COVID-19 Immunity Task Force and other public research funding agencies. He is affiliated with the Association of Canadian Faculties of Dentistry and the Canadian Academy of Health Sciences. </span></em></p>Canada’s largely private dental care system exacerbates inequalities and is a barrier to integrating oral health with general health.Paul Allison, Professor of Dental Public Health, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1568232021-04-07T20:29:36Z2021-04-07T20:29:36ZCanadians should be able to access dental care with a health card instead of a credit card<figure><img src="https://images.theconversation.com/files/393203/original/file-20210401-23-1an8cgw.jpg?ixlib=rb-1.1.0&rect=14%2C0%2C4977%2C3428&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A woman walks past a photograph of a smiling woman outside a dental office, in Vancouver, B.C., Aug. 3, 2020. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span></figcaption></figure><p>The COVID-19 pandemic has <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/200527/dq200527b-eng.htm">raised Canadians’ anxiety levels</a>: anxiety about contracting the virus, financial hardship and isolation. But one thing Canadians don’t have to worry about is how they’ll pay for essential health care if they need it. For that, at least, all we need is our health card. </p>
<p>Actually, that last part is only partially true. Vital areas of health care were excluded from medicare, our <a href="https://www.canada.ca/en/health-canada/services/canada-health-care-system.html">universal health-care system</a>. And for many Canadians, access to these health services has worsened since the start of the pandemic. Many have lost their jobs, and with that, <a href="https://policyoptions.irpp.org/magazines/october-2020/a-drug-dental-and-mental-health-plan-for-uninsured-canadians/">essential health benefits</a> like dental care. </p>
<p>The COVID-19 pandemic has reinforced just how foundational medicare is. As we recover from the effects of the pandemic, we must strengthen that foundation. It’s time for Canadians to start using their health card, not their credit card, to access dental care.</p>
<h2>Health and oral health</h2>
<p>Dental care is not luxury. Oral health is a critical part of overall health. Dentists and emergency physicians see the consequences of poor oral health on a daily basis. </p>
<p>Poor oral health can <a href="https://doi.org/10.1017/cem.2019.437">cause or worsen other medical conditions due to chronic inflammation</a>. Providing dental care improves diabetic control, reduces the risk of aspiration pneumonia in long-term care homes, improves completion of treatment for substance use disorder and increases drug abstinence.</p>
<p>It has even been shown to increase employability. It’s hard to confidently interview for a job if you’re afraid to smile. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/393355/original/file-20210405-21-1jwyp8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A dentist wearing PPE: gown, mask, face shield and gloves." src="https://images.theconversation.com/files/393355/original/file-20210405-21-1jwyp8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393355/original/file-20210405-21-1jwyp8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=444&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393355/original/file-20210405-21-1jwyp8u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=444&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393355/original/file-20210405-21-1jwyp8u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=444&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393355/original/file-20210405-21-1jwyp8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=558&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393355/original/file-20210405-21-1jwyp8u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=558&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393355/original/file-20210405-21-1jwyp8u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=558&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Dr. Serge Elbaz demonstrates enhanced protective equipment as dentists in Québec re-open amid the COVID-19 pandemic on June 1, 2020, in Laval, Que.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span>
</figcaption>
</figure>
<p><a href="https://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00010-eng.htm">One in three Canadians lack dental insurance and one in five avoid seeing a dentist each year due to cost</a>. In terms of dental care, our “universal” health-care system is anything but. Of all dental care spending, only five per cent is public. <a href="http://ncohr-rcrsb.ca/knowledge-sharing/working-paper-series/content/garbinneumann.pdf">That’s less than the United States, where 10 per cent of dental care spending is public, and not even close to the United Kingdom, where it is 46 per cent</a>.</p>
<p>This already dire situation was worsening before the pandemic, <a href="https://www.cdhowe.org/sites/default/files/attachments/research_papers/mixed/Final%20April%2026%20Commentary%20510.pdf">with more seniors retiring and losing their work-related benefits and more people working in the precarious gig economy</a>. COVID-19 has only exacerbated this. </p>
<p>If Canada’s health-care system were a mouth, it would be too embarrassed to smile for fear of showing the large gap that is our missing dental care system. </p>
<h2>The cost of forgoing dental care</h2>
<p>Many Canadians forgo routine care because they can’t afford it, leaving small problems to fester and grow. Our current system not only stresses our individual wallets, it also puts additional strain on our health-care system. </p>
<p>With <a href="https://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00010-eng.htm">four in 10 low-income Canadians avoiding seeing a dentist</a> due to cost, many end up relying on our emergency departments. <a href="https://www.allianceon.org/sites/default/files/documents/Information-ER-DR-visits-dental-problems_Jan-2017.pdf">Every nine minutes in Ontario, someone visits an emergency department for dental pain</a>, when they really need to see a dental professional. <a href="https://www.dentistrytoday.com/news/industrynews/item/2443-barriers-to-dental-care-send-thousands-to-emergency-rooms-for-treatment">The cost of these visits across the country is estimated to be more than $150 million a year</a>. </p>
<p>The <a href="https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act.html">Canada Health Act</a> makes the objective of Canadian health-care policy very clear: </p>
<blockquote>
<p>“to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.” </p>
</blockquote>
<p>Given this, we must guarantee access to essential dental care for every Canadian. </p>
<p>Expanding public spending to guarantee dental insurance for all would help Canadians access routine care, reducing the need for more costly and complex procedures later. This would benefit individuals, reduce costs for employers and give businesses a competitive advantage similar to the way medicare does now. </p>
<h2>Challenges beyond public financing</h2>
<p>While public financing is important, it doesn’t guarantee access to a provider. The private delivery model has left many <a href="https://jcda.ca/article/f23">poor and rural communities significantly under-resourced</a>. Public delivery of some dental care can ensure that people actually have a provider near their community.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/393356/original/file-20210405-21-to12gq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman in scrubs and a surgical mask positions a light over a person in a dentist's chair" src="https://images.theconversation.com/files/393356/original/file-20210405-21-to12gq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393356/original/file-20210405-21-to12gq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393356/original/file-20210405-21-to12gq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393356/original/file-20210405-21-to12gq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393356/original/file-20210405-21-to12gq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393356/original/file-20210405-21-to12gq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393356/original/file-20210405-21-to12gq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many Canadians forgo routine dental care because they can’t afford it, leaving small problems to fester and grow.</span>
<span class="attribution"><span class="source">(Pexels/Cedric Fauntleroy)</span></span>
</figcaption>
</figure>
<p>Many dentists in private practice <a href="https://doi.org/10.1186/s12939-017-0631-x">have historically been hostile to universal dental care and public delivery</a>. That’s no surprise because it cuts into their monopoly on care. </p>
<p>Doctors were once the same too. <a href="https://canadiandimension.com/articles/view/the-birth-of-medicare">Doctors were the biggest opponents of medicare when it was first introduced</a> in Saskatchewan. On July 1, 1962, the day medicare was born, most of the province’s doctors went on strike. But now, very few would want an American-style health-care system like we currently have for dental care — especially during the pandemic.</p>
<p>The COVID-19 pandemic hasn’t given Canadians many reasons to smile. Investing in a universal, publicly-funded dental care system would ensure that a healthy, pain-free smile is in sight for every Canadian. </p>
<p><em>This article was co-authored by Brandon Doucet, a dentist practising in Newfoundland with interests in surgery and public health and the founder of Coalition for Dentalcare.</em></p><img src="https://counter.theconversation.com/content/156823/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hasan Sheikh does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Oral health is a key part of overall health, but many Canadians skip dental care due to the cost, resulting in emergency room visits and health issues. It’s time for a dental care plan for all Canadians.Hasan Sheikh, Lecturer, Department of Family and Community Medicine, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1527422021-01-19T13:10:31Z2021-01-19T13:10:31ZTooth or consequences: Even during a pandemic, avoiding the dentist can be bad for your oral health<figure><img src="https://images.theconversation.com/files/377476/original/file-20210107-24-ll42iu.jpg?ixlib=rb-1.1.0&rect=8%2C24%2C5455%2C3612&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Your dentist should wear appropriate personal protective equipment.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/little-more-and-the-agony-ends-royalty-free-image/1262270436?adppopup=true"> LukaTDB via Getty Images</a></span></figcaption></figure><p>Dental care remains critical for tens of millions of Americans, even during the pandemic. More than one-quarter of U.S. adults live with <a href="https://www.cdc.gov/oralhealth/publications/OHSR-2019-index.html">untreated tooth decay</a>, with nearly half of adults over 30 showing signs <a href="https://doi.org/10.1016/j.adaj.2018.04.023">of gum disease</a>. And nearly 1 in 4 adults report having felt pain in or around their mouth <a href="https://www.nidcr.nih.gov/news-events/2020-surgeon-generals-report-oral-health">in the past year</a>. </p>
<p>Poor oral health is associated with <a href="https://www.cdc.gov/pcd/issues/2011/may/10_0087.htm">numerous chronic diseases</a>, including heart disease and diabetes. These problems pose an immediate health risk and require urgent care. Yet, less urgent dental conditions can have long-term negative effects as well. </p>
<p>But how can you visit your dentist during a pandemic? <a href="https://ufhealth.org/andrew-j-corsaro">As a professor</a>, I can tell you that dentists have made many changes to the way your care is provided to improve safety. You should still go, but if you are <a href="https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html">high risk</a>, you should discuss with your dentist first. Here are some things you need to know – and do – before visiting. </p>
<h2>Home care: More critical than ever</h2>
<p>With dentists worldwide <a href="https://www.who.int/publications/i/item/who-2019-nCoV-oral-health-2020.1">postponing non-urgent dental treatment</a>, your home care is your first line of defense. Consuming carbohydrates and the subsequent secretion of acid by oral bacteria is what causes tooth decay. Chronic inflammation of the tissues supporting your teeth is called gum, or periodontal, disease. Both conditions are exacerbated by poor diet, tobacco use, a weakened immune system and poor oral hygiene. </p>
<p>You can battle all of these things by controlling dental plaque - the soft, sticky material on teeth and gums consisting of saliva, food debris and bacteria. Plaque that remains on teeth for a period of time will form tartar (dental calculus), further promoting bacterial biofilms, ecosystems of bacteria that cause dental problems. </p>
<figure class="align-center ">
<img alt="A man suffering from a severe toothache." src="https://images.theconversation.com/files/377479/original/file-20210107-15-2elp7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/377479/original/file-20210107-15-2elp7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/377479/original/file-20210107-15-2elp7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/377479/original/file-20210107-15-2elp7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/377479/original/file-20210107-15-2elp7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/377479/original/file-20210107-15-2elp7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/377479/original/file-20210107-15-2elp7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A severe toothache qualifies as a dental emergency.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-man-in-a-medical-protective-mask-on-her-face-royalty-free-image/1257746889?adppopup=true">reklamlar via Getty Images</a></span>
</figcaption>
</figure>
<p>To remove biofilms and plaque, and prevent tartar formation, you must clean all surfaces of the teeth and gums. That means brushing teeth for two minutes, twice a day, using a soft-bristled toothbrush with a fluoride-containing toothpaste. You must also clean the spaces in-between teeth once a day, typically with dental floss. </p>
<p><a href="https://doi.org/10.1111/jcpe.13126">Studies show</a> an electric toothbrush is more effective at cleaning teeth and gums than a manual one. An alcohol-free mouth rinse helps too, but is not a substitute for brushing or flossing. Over-the-counter mouth rinses with fluoride are available for those at higher risk for tooth decay. </p>
<p>You can also improve oral health with your diet. Limit sugar intake, along with other carbohydrate-containing foods and drinks, such as sodas, fruit juices, sweetened coffee and tea, and candy. You don’t have to completely avoid their consumption, of course, but cutting back on both can be extremely beneficial. Avoid hard and sticky foods that can break teeth and dental work.</p>
<p>COVID-19’s psychological impact has had <a href="https://doi.org/10.1016/j.janxdis.2020.102268">many indirect effects</a> on oral health. Medications prescribed for depression and anxiety are known to cause dry mouth, which <a href="https://www.ada.org/en/member-center/oral-health-topics/xerostomia">harms oral health</a>. Increased anxiety is linked to bruxism, the clenching or grinding of teeth. More tobacco and alcohol use are not good for your teeth. Poorer diet can lead to many health problems such as gastroesophageal reflux disease (GERD), which can damage teeth.</p>
<h2>When to see your dentist</h2>
<p>Oral pain may indicate an infection; take it seriously. Broken teeth and dental work are other examples of dental emergencies. In the early weeks of the pandemic, many states mandated the restriction of all non-emergency dental procedures. In response, the <a href="https://dental.ufl.edu/">University of Florida College of Dentistry</a>, along with many other care providers, instituted teledentistry services. This remote, virtual consultation with a dental professional is one way to help you decide whether to delay care or to visit a dentist.</p>
<p>If you have a loose or failing dental work, try to keep the area clean without further dislodging it. Usually it’s helpful to insert floss around a loose restoration, then gently pull the floss through to the side, to avoid lifting broken dental work out of place. A completely debonded crown can sometimes be temporarily recemented with over-the-counter dental cements or even toothpaste. A teledentistry consultation can help determine if this is appropriate. </p>
<p>A few rare oral problems can constitute life-threatening emergencies. If you have difficulty breathing or swallowing, or uncontrolled bleeding in or around the mouth, seek immediate emergency care. Extreme pain or a high fever associated with dental problems also requires immediate attention. </p>
<figure class="align-center ">
<img alt="A woman on a teledentistry consult." src="https://images.theconversation.com/files/377482/original/file-20210107-15-mhyp9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/377482/original/file-20210107-15-mhyp9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/377482/original/file-20210107-15-mhyp9r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/377482/original/file-20210107-15-mhyp9r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/377482/original/file-20210107-15-mhyp9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/377482/original/file-20210107-15-mhyp9r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/377482/original/file-20210107-15-mhyp9r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many dental offices now offer teledentistry consults before an in-person visit.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mature-woman-consulting-with-her-doctor-online-royalty-free-image/1282155372?adppopup=true">Marko Geber via Getty Images</a></span>
</figcaption>
</figure>
<h2>Changes at the dentist’s office</h2>
<p>For decades dental professionals have been sterilizing instruments and disinfecting surfaces. <a href="https://www.ada.org/%7E/media/ADA/Publications/ADA%20News/Files/ADAJ_1930.pdf?la=en">Early reports</a> show a lower COVID-19 prevalence among U.S. dentists than in the general public. With COVID-19, additional precautions are needed. Patients should ask their dentists if they are taking these precautions. </p>
<p>Here’s a brief checklist: First, your dentist’s office should screen you and other patients for COVID-19 symptoms. The office may call you in the days leading up to your appointment to make sure you don’t have symptoms. You may be asked to come to your appointment alone, wear a mask, and wash your hands while at the office.</p>
<p>When you arrive, you may be asked to wait outside or in your car until your appointment time. Waiting areas should have fewer chairs, all properly spaced. All magazines and toys should be removed. </p>
<p>Dental staff should wear appropriate personal protective equipment (PPE), including an N95 mask, along with protective gowns, head coverings, gloves, and face shields. Disposable barriers should cover commonly touched surfaces. Air quality controls, such as HEPA filters, single-pass air circulation, and negative pressure should be in use; they help to contain any aerosols generated during dental procedures. </p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>You may be asked to rinse your mouth with a solution containing diluted hydrogen peroxide. This will decrease the viral load prior to your dental procedure. High-volume evacuation, more commonly known as dental suction, should be used for all procedures that may generate aerosols. </p>
<p>The good news is this: the new safety measures now in place <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7560385/">may be sufficient</a> to prevent infection in dental settings. Still, you must consult with a dental professional to help determine the need for treatment. As the COVID-19 pandemic evolves, and new research becomes available, expect more changes at your dentist’s office.</p><img src="https://counter.theconversation.com/content/152742/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew J. Corsaro does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even during COVID-19, there are ways to keep your teeth healthy.Andrew J. Corsaro, Clinical Assistant Professor, College of Dentistry, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1366702020-05-07T12:24:03Z2020-05-07T12:24:03ZIs seltzer water healthy?<figure><img src="https://images.theconversation.com/files/332423/original/file-20200504-83769-lexbjj.jpg?ixlib=rb-1.1.0&rect=564%2C6%2C3710%2C2689&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Carbonation and flavors are all that go into most seltzers.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/glass-of-sparkling-water-on-table-royalty-free-image/157377709?adppopup=true">stockcam/E+ via Getty Images</a></span></figcaption></figure><p>My health conscious friends and colleagues tell me that they need an alternative to soda but plain water is too boring. They, like many people, are turning to sparkling water and flavored seltzer water.</p>
<p>Carbonated waters are being promoted as the low-calorie or <a href="https://healthyeating.sfgate.com/flavored-sparkling-water-calories-11000.html">zero-calorie alternative</a> to soda. In a 12-month period from August 2018 to August 2019, sales of sparkling water <a href="https://www.bevindustry.com/articles/92452-bottled-water-bubbles-over-with-growth">increased by 13%</a> compared to the previous year.</p>
<p>But is it really a healthy alternative? </p>
<p>As a <a href="https://www.fsnhp.msstate.edu/associate.php?id=193">registered dietitian nutritionist</a>, I get this question all the time. As with much of nutrition, the answer is not a clear yes or no. Researchers have studied sparkling water, though not extensively, for its effects on teeth, bones and digestion. Is it bad for you? Probably not. Is it good for you? Maybe. Is it better than soda? Definitely. </p>
<h2>Seltzer vs. soda</h2>
<p>Seltzer water is simply water infused with pressurized carbon dioxide. Carbon dioxide creates the bubbles in fizzy water but also <a href="https://www.theatlantic.com/health/archive/2016/02/the-sad-truth-about-seltzer/433947/">adds acidity to the beverages</a>. Manufacturers also infuse many of these seltzers with the ever mysterious “natural flavors.” These are usually just chemicals <a href="https://www.washingtonpost.com/lifestyle/wellness/what-does-natural-flavors-really-mean/2017/07/24/eccdc47e-67f7-11e7-a1d7-9a32c91c6f40_story.html">extracted from plants or animals</a> that add flavor without using sugar or adding many calories. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/332059/original/file-20200501-42962-1qq9yhl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/332059/original/file-20200501-42962-1qq9yhl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/332059/original/file-20200501-42962-1qq9yhl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=738&fit=crop&dpr=1 600w, https://images.theconversation.com/files/332059/original/file-20200501-42962-1qq9yhl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=738&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/332059/original/file-20200501-42962-1qq9yhl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=738&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/332059/original/file-20200501-42962-1qq9yhl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=927&fit=crop&dpr=1 754w, https://images.theconversation.com/files/332059/original/file-20200501-42962-1qq9yhl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=927&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/332059/original/file-20200501-42962-1qq9yhl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=927&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Soda, specifically cola with its caffeine and phosphoric acid, eats away at teeth and bone.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/fizzy-glass-of-cola-royalty-free-image/87984627?adppopup=true">Jack Andersen/Stone via Getty Images</a></span>
</figcaption>
</figure>
<p>Soda, on the other hand, is carbonated water plus a sweetener such as cane sugar or high fructose corn syrup. Some sodas, in particular colas, also add phosphoric acid or citric acid for flavor and to act as a preservative as well as caffeine.</p>
<p>The most well-studied risk posed by seltzer and soda are their potential effect on teeth and bones. </p>
<p>In 2007, researchers soaked teeth in seltzer water for 30 minutes and found that the seltzer did start to <a href="https://doi.org/10.1111/j.1365-263X.2006.00784.x">erode the enamel</a>. This isn’t great if you plan on soaking your teeth in seltzer or drink it all day. But researchers compared the erosive effects of seltzer to soda, coffee, energy drinks and diet cola and found seltzer to be the <a href="https://doi.org/10.1016/j.adaj.2015.10.019">least harmful to teeth</a>. </p>
<p>While plain seltzer is better than more acidic sodas and coffee, in 2018, researchers looked at the potential risks of added artificial flavors in bottled water. They found that different additives produced varying levels of acidity, and like past studies, that acidity did cause <a href="https://pubmed.ncbi.nlm.nih.gov/18050578/">some enamel erosion</a>.</p>
<p>The bottom line is that both plain and flavored sparkling water could have effects on your teeth after long exposures. The farther you go from plain water – whether that is with carbonation or flavoring – the worse for your teeth. Experts recommend that you drink bubbly water while eating food and avoid swishing it around your mouth to avoid the effects of acidity on your teeth. </p>
<p>Another general concern people have about seltzer is that it <a href="https://www.health.harvard.edu/staying-healthy/does-carbonated-water-harm-bones">might cause osteoporosis</a> – a condition where bones get less dense and become fragile. </p>
<p>In 2006, a team of researchers investigated this idea in a study that looked at 2,500 people and compared cola drinkers to people who drink other carbonated drinks without caffeine or phosphoric acid. They found that people who regularly drank colas were <a href="https://doi.org/10.1093/ajcn/84.4.936">more likely to have some bone loss</a> compared to those who did not. The scientists thought that the people consuming colas were also less likely to consume foods and drinks which helped build bone. People who drank seltzer or other carbonated beverages aside from cola didn’t have any of the bone density loss.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/332063/original/file-20200501-42913-710mv5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/332063/original/file-20200501-42913-710mv5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/332063/original/file-20200501-42913-710mv5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/332063/original/file-20200501-42913-710mv5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/332063/original/file-20200501-42913-710mv5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/332063/original/file-20200501-42913-710mv5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/332063/original/file-20200501-42913-710mv5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/332063/original/file-20200501-42913-710mv5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many people make carbonated water at home and add their own flavors.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/line-of-antique-pouring-bottles-royalty-free-image/80114841?adppopup=true">LOOK Photography/UpperCut Images Getty Images Plus via Getty Images</a></span>
</figcaption>
</figure>
<h2>Unexpected benefits</h2>
<p>More recently, researchers have begun to investigate whether there are any potential health benefits of carbonated water, and there is some early but encouraging evidence. </p>
<p>Two small randomized controlled studies with elderly patients showed that drinking seltzer water <a href="https://doi.org/10.4040/jkan.2011.41.2.269">relieves constipation</a> and <a href="https://doi.org/10.1097/00042737-200209000-00010">stomach pain</a> better than tap water. </p>
<p>So is fizzy water healthy? </p>
<p>Well, there isn’t much evidence that sparkling water is bad for you. If you are more likely to drink water when it is carbonated, there is not enough evidence to give it up. The acidity might harm your teeth if you drink a lot of it, but if the choice is between sugary, acidic soda and seltzer, choose the seltzer. </p>
<p>[<em>Insight, in your inbox each day.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=insight">You can get it with The Conversation’s email newsletter</a>.]</p><img src="https://counter.theconversation.com/content/136670/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rahel Mathews does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Bubbly waters are becoming increasingly popular. While these carbonated, sometimes flavored beverages might cause slight harm to teeth, they are far better than soda. They might even be good for you.Rahel Mathews, Assistant Professor, Nutrition, Mississippi State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1242762019-12-31T13:27:23Z2019-12-31T13:27:23ZHow to avoid the dentist this holiday (and what to do if you need one in an emergency)<figure><img src="https://images.theconversation.com/files/306219/original/file-20191210-95153-19ejhvb.jpg?ixlib=rb-1.1.0&rect=2%2C2%2C995%2C610&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No-one wants to spoil their holiday with a trip to the dentist.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-trunks-toothache-beach-1410768896?src=fc4a2e52-d367-4f6f-9102-053ab85afb6c-1-13&studio=1">from www.shutterstock.com</a></span></figcaption></figure><p>Hooray it’s the holidays! Time to organise the pet sitter, mail and dentist. Wait, what? It might be worth squeezing a trip to the dentist before you go.</p>
<p>One in 12 <a href="https://www.ncbi.nlm.nih.gov/pubmed/11570540">travel insurance</a> claims are for dental emergencies. And of those emergencies, three out of four treatments could be prevented by making a timely dentist visit. </p>
<p>Here’s how to avoid an emergency dentist visit while on holiday. But life happens, and there are ways to help yourself if you get into trouble. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/prepare-for-a-healthy-holiday-with-this-a-to-e-guide-69552">Prepare for a healthy holiday with this A-to-E guide</a>
</strong>
</em>
</p>
<hr>
<h2>Book that check-up before check-in</h2>
<p>The <a href="https://www.ada.org.au/Dental-Professionals/Policies/National-Oral-Health/2-2-7-Emergency-Overseas-Dental-Treatment/ADAPolicies_2-2-7_EmergencyOverseasDentalTreatment.aspx">Australian Dental Association</a> recommends a check-up at least three months before you travel. If it’s too late for this break, you might want to add a dental visit to your “must do” list before your next trip.</p>
<p>At best, an early check-up will include only a scale and clean. However, if you need major work, such as dental implants and wisdom teeth removed, you will have ample time to complete treatment before you go away. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-often-should-i-get-my-teeth-cleaned-121310">How often should I get my teeth cleaned?</a>
</strong>
</em>
</p>
<hr>
<p>If you have dentures, allow enough time with a dentist or dental prosthetist to organise spare plate(s) in case you lose or break your regular ones while you’re away.</p>
<h2>Avoid surgery just before flying</h2>
<p>A planned dental visit before flying can help avoid complications, particularly related to surgical procedures, such as <a href="https://www.healthdirect.gov.au/surgery/removing-wisdom-teeth">removing your wisdom teeth</a>.</p>
<p>It’s generally wise to have your wisdom teeth removed well ahead of travel as you might need a hospital stay. It can also take at least two days for the extraction site to heal well enough to fly. That’s because the dry air and pressure can disturb the blood clot that forms where you’ve had your teeth removed. </p>
<p>Molar teeth (including some wisdom teeth) removed from your top jaw can cause other complications when you fly. If you fly too soon after surgery, changes in air pressure could lead to <a href="http://diposit.ub.edu/dspace/handle/2445/117330">complications related to your sinuses</a> that could see you dribbling your food and drink out of your nose. Not only is this annoying and embarrassing, it can be quite painful. You may also need further surgery to fix this. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/306221/original/file-20191210-95130-b5lvt2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/306221/original/file-20191210-95130-b5lvt2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/306221/original/file-20191210-95130-b5lvt2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/306221/original/file-20191210-95130-b5lvt2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/306221/original/file-20191210-95130-b5lvt2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/306221/original/file-20191210-95130-b5lvt2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/306221/original/file-20191210-95130-b5lvt2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/306221/original/file-20191210-95130-b5lvt2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">It can take at least two days after having your wisdom teeth removed for you to be well enough to fly.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-backpacker-woman-toothache-on-isolated-1378816430">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>People can also experience toothache when flying, or even diving. That’s because of a condition called <a href="https://www.sciencedirect.com/science/article/pii/S1079210409009159">barodontalgia</a> that’s triggered by changes in air pressure, such as when a plane takes off or lands. Often, this pain is a symptom of a loose or leaking filling, a deep cavity close to the nerve inside the tooth, recent dental treatment or sinusitis. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-are-wisdom-teeth-and-should-i-get-mine-out-100019">Explainer: what are wisdom teeth and should I get mine out?</a>
</strong>
</em>
</p>
<hr>
<h2>If going overseas, have your travel insurance in order</h2>
<p>If you’re going overseas, before leaving the country, <a href="https://www.moneysmart.gov.au/insurance/travel-insurance">make sure</a>:</p>
<ul>
<li><p>you have finished any outstanding dental work, as some travel insurers don’t cover pre-existing conditions</p></li>
<li><p>your travel insurance covers emergency dental care </p></li>
<li><p>you keep your travel insurer’s contact numbers handy (local and international numbers)</p></li>
<li><p>you nominate a friend or family member to contact your insurer on your behalf (just in case you are unable to do so yourself).</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/going-travelling-dont-forget-insurance-and-to-read-the-fine-print-107961">Going travelling? Don't forget insurance (and to read the fine print)</a>
</strong>
</em>
</p>
<hr>
<h2>Other tips to avoid an emergency dental visit</h2>
<p>Here are some practical tips to avoid harming your teeth, braces and crowns over summer:</p>
<ul>
<li><p>use scissors, not your teeth, to open packaging</p></li>
<li><p>avoid chewing very hard foods such as ice, popcorn kernels, pork crackling, and crunchy candies. This is particularly important if you have braces, or large fillings or crowns as they can easily come unstuck or fracture </p></li>
<li><p>if you play contact sport, protect your teeth by wearing a custom fitted mouth guard.</p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/306744/original/file-20191213-85367-rogaii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/306744/original/file-20191213-85367-rogaii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/306744/original/file-20191213-85367-rogaii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/306744/original/file-20191213-85367-rogaii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/306744/original/file-20191213-85367-rogaii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/306744/original/file-20191213-85367-rogaii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/306744/original/file-20191213-85367-rogaii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/306744/original/file-20191213-85367-rogaii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Watch how you chew your pork crackling over the holidays if you want to avoid the dentist.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/b0xman/5446437974/in/photolist-9ihqg1-8Zfu4a-e1qquH-bry8JT-66L5HV-8L6Q85-6GDdA-8L3Lat-8L3Lz8-athJYW-8L3Lpz-8L3LgP-8L3LEK-53MqYu-an6nFY-2tmm1t-7vWmwa-6jcFKt-7Up8qd-3beGNZ-SYAnyw-2tqHc1-8mG7g4-7KmBSi-zHJrfW-6hZcxW-2e4NCVj-9PRY6z-Tn5VUK-NpZST-BtSnLo-NpZSH-NaUWve-NpZSz-ssBVfe-8ADkcE-iosrfz-7aNUy8-oiJFRj-E7BAA-6Hfuix-6gnV59-7aSJNu-5o3GKC-7aSJFw-9S5E1T-6HjwyC-6Hfura-7aNUXK-byYJu7">James Box/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>I’m in pain. What do I do?</h2>
<p>Here’s <a href="https://www.qld.gov.au/health/services/oral-eye-ear/emergency-dental">what you can do</a> until you get to a dentist, if you:</p>
<ul>
<li><p><strong>have toothache</strong> — if you have spontaneous, radiating pain or a constant dull ache and/or pain and swelling, over-the-counter pain medication may help. But try to find a dentist as soon as reasonably possible</p></li>
<li><p><strong>chip or break a tooth or filling</strong> — avoid running your tongue over the site and try to get to a dentist as soon as possible</p></li>
<li><p><strong><a href="https://www.iadt-dentaltrauma.org/for-patients.html">knock out an adult (not baby) tooth</a></strong> — hold the tooth by the crown (not the root) and rinse with milk if it is dirty, then try to place the tooth back in the socket. If this is not possible, store the tooth in milk or inside your cheek and find a dentist as soon as possible</p></li>
<li><p><strong>have a dislodged crown/cap</strong> — store the crown in a container; a dentist may be able to glue it back on. </p></li>
<li><p><strong><a href="https://www.aaoinfo.org/system/files/media/documents/OrthoEmergency-FLYER-lgl-17-hl.pdf">have problems with your braces</a></strong> — shift loose wire that sticks out to make it more comfortable, then see an orthodontist or dentist as soon as possible</p></li>
<li><p><strong><a href="https://www.bmj.com/bmj/section-pdf/893386?path=/bmj/350/8001/Clinical_Review.full.pdf">get an abscess</a></strong> — seek immediate dental care, and if this not possible, find a doctor or seek emergency hospital care. An abscess can become life-threatening very quickly </p></li>
<li><p><strong>suffer trauma to your gums, mouth or face</strong> — apply firm pressure to the bleeding site with a clean bandage and seek dental or medical care</p></li>
<li><p><strong>crack or break your denture</strong> — never try to glue the broken pieces back together, but store the lose parts in a container and seek help from a dental prosthetist or dentist as soon as possible. </p></li>
</ul>
<h2>I’m away from home. How do I find a dentist?</h2>
<p>If you are holidaying in Australia, but away from home, ask a local person to recommend a dentist, or if that’s not possible, search online.</p>
<p>Then call. Although most dental practices close over the public holidays, they usually leave a message with contact numbers in case of an after-hours emergency. </p>
<p>If you need after-hours care, be prepared to pay a call-out fee of A$100-500. Often, the call-out fee is used to separate the real emergencies from those that can wait another day before the practice opens. If no help is at hand, the hospital emergency department may be able to help. </p>
<h2>I’m overseas. How can I get help?</h2>
<p>If you have a dental emergency while <a href="https://www.ada.org.au/Dental-Professionals/Policies/National-Oral-Health/2-2-7-Emergency-Overseas-Dental-Treatment/ADAPolicies_2-2-7_EmergencyOverseasDentalTreatment.aspx">overseas</a>:</p>
<ul>
<li><p>contact your travel insurer to understand what documentation is required to make a claim</p></li>
<li><p>contact the Australian embassy, high commission or consulate to help you navigate the health system in the country you’re visiting</p></li>
<li><p>if there is no Australian service, the Canadian embassy, high commission or consulate will help you find a dentist.</p></li>
</ul>
<h2>Don’t forget</h2>
<p>After emergency treatment, ask for a copy of your treatment notes, images and x-rays to be sent to your regular dentist. This is particularly important if you need follow-up care when you return home. </p>
<p>And in the unlikely event you’ll need some emergency dental work, don’t forget to enjoy the rest of your break. Happy holidays!</p><img src="https://counter.theconversation.com/content/124276/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arosha Weerakoon has received funding from Colgate for her research. She is a member of the Australian Dental Association as well as the International Association for Dental Research. She is a Fellow of the Royal Australasian College of Dental Surgeons.</span></em></p>Here’s how to avoid a trip to the emergency dentist this holiday.Arosha Weerakoon, Lecturer, General Dentist & PhD Candidate, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1275732019-11-29T13:13:24Z2019-11-29T13:13:24ZWhy scrapping NHS dental costs won’t make much difference to the UK’s oral health crisis<figure><img src="https://images.theconversation.com/files/302982/original/file-20191121-474-1g8jm3a.jpg?ixlib=rb-1.1.0&rect=78%2C104%2C8596%2C5670&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-dentist-examining-patient-tools-dental-757785106?src=6bc989b3-6bf0-451b-8bf2-6d9b4e79c551-1-26">shutterstock/Jacob Lund</a></span></figcaption></figure><p>The Labour Party announced as part of their general election manifesto that it will introduce <a href="https://labour.org.uk/press/labour-to-offer-free-dental-check-ups-for-all/">free dental check ups</a> in a bid to encourage people to seek dental care and reduce pressures placed on GPs and A&E departments.</p>
<p>The proposal to remove all band one charges for NHS dental care will mean the public will be entitled to a free dental check up, X-rays, scale and polish. At the moment most (or nearly all) patients do not get these services without incurring a cost – though children and pregnant women already qualify for free dental treatment under the NHS. </p>
<p>The introduction of free dental check-ups is undoubtedly a step in the right direction towards reducing barriers to accessing <a href="https://theconversation.com/alzheimers-is-linked-to-gum-disease-but-bad-oral-health-is-not-the-only-culprit-110649">dental care</a>. But unfortunately, the decisions people make regarding whether to see a dentist or not are not this simple. It’s certainly not all about the cost of treatment – and this is something the next government will need to address if they are to tackle the UK’s oral health crisis.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/youre-probably-brushing-your-teeth-wrong-here-are-four-tips-for-better-dental-health-103959">You're probably brushing your teeth wrong – here are four tips for better dental health</a>
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</em>
</p>
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<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=marketing+dentistry+dudley">Research</a>, dating as far back as the 1980s has shown the barriers and decision making behind seeking dental care is a complex area and has a huge impact on <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/cdoe.12268">how people access</a> services. <a href="https://theconversation.com/fear-of-the-dentist-what-is-dental-phobia-and-dental-anxiety-115953">Dental anxiety</a>, the availability of dentists, bad experiences in the past, a confusing NHS dental care system, work and other life priorities are just some of the reasons why people avoid seeking dental care.</p>
<p>And above all that, research shows that a lack of perceived need for dental care plays a prominent role in <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/cdoe.12268">determining whether to see a dentist</a> for a check up. You wouldn’t go and see a GP if we weren’t feeling unwell, so why would seeing a dentist be any different? For some people, dental pain has to be present – often for a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/joor.12333">long period of time</a> – before they will even begin to consider getting help.</p>
<h2>‘Free teeth MOT’</h2>
<p>All this together means that offering someone who is dentally anxious, and not experiencing any current dental pain a free check-up is highly unlikely to result in them seeking care. Equally a free dental check up to someone working long hours, balancing family life alongside work, with no local NHS dentists available simply won’t be enough.</p>
<p>The Labour Party quote that “around 135,000 patients per year are estimated to attend A&E with dental problems”. This is a figure <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/joor.12462">based upon research</a> we conducted at Newcastle University and shows the scale of the problem with dental care.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/302984/original/file-20191121-515-1brxuxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/302984/original/file-20191121-515-1brxuxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/302984/original/file-20191121-515-1brxuxz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/302984/original/file-20191121-515-1brxuxz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/302984/original/file-20191121-515-1brxuxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/302984/original/file-20191121-515-1brxuxz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/302984/original/file-20191121-515-1brxuxz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dental phobia can run in families.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-boy-having-his-teeth-examined-244549708?src=095f50e1-c24b-4d7e-ab26-77f236be6f05-1-56">Shutterstock/wavebreakmedia</a></span>
</figcaption>
</figure>
<p><a href="https://bjgp.org/content/66/646/e329.long">Other research</a> has also found that “around 380,000 patients with toothache chose to head to their GPs who cannot provide dental treatment”. The reasons why people try to get dental care from non-dental professionals, such as GPs, is more complicated than just avoiding a dental charge. Indeed, it relates to knowledge about dental symptoms and healthcare services, and the <a href="https://bjgp.org/content/68/677/e877.long">availability of dentists compared to GPs</a>.</p>
<h2>Oral health crisis</h2>
<p><a href="https://www.independent.co.uk/news/uk/politics/general-election-labour-party-manifesto-pledge-dental-check-ups-nhs-england-a9206001.html">The Conservative Party’s response</a> to Labour’s proposal, that “dental check-ups are already free for those who don’t have the means to pay”, also doesn’t solve the problem and shows a lack of understanding. Indeed, many who are eligible for free dental care do not realise that they are. Or don’t claim free treatment at the fear of being fined.</p>
<p>If any of the parties wish to fully address the ongoing oral health crisis then simplistic changes, such as a free check-up, won’t suffice. The British Dental Association have produced <a href="https://www.bda.org/missingpiece">their own manifesto</a> on what the next government needs to change regarding dental care, including improvements with dental workforce, current NHS contracts, dental regulation, national campaigns and investment in high quality national research. </p>
<p>Although arguably even more needs to be done to overcome the range of complicated barriers the public face when seeking dental care. A free dental check-up may be the first part of this complex jigsaw, but it’s certainly not enough. </p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/300097/original/file-20191104-88382-xr3pj3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/300097/original/file-20191104-88382-xr3pj3.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=140&fit=crop&dpr=1 600w, https://images.theconversation.com/files/300097/original/file-20191104-88382-xr3pj3.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=140&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/300097/original/file-20191104-88382-xr3pj3.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=140&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/300097/original/file-20191104-88382-xr3pj3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=176&fit=crop&dpr=1 754w, https://images.theconversation.com/files/300097/original/file-20191104-88382-xr3pj3.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=176&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/300097/original/file-20191104-88382-xr3pj3.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=176&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em><a href="https://theconversation.com/uk/newsletters/the-daily-newsletter-2?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKGE2019&utm_content=GEBannerC">Click here to subscribe to our newsletter if you believe this election should be all about the facts.</a></em></p><img src="https://counter.theconversation.com/content/127573/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charlotte Currie receives funding from the National Institute of Health Research (NIHR) Doctoral Research Fellowship (DRF‐2017‐10‐022). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.</span></em></p><p class="fine-print"><em><span>Chris Vernazza is funded by a National Institute for Health Research (NIHR), Clinician Scientist Award. This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.</span></em></p><p class="fine-print"><em><span>Justin Durham and Simon Stone do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s not all about the cost of treatment – and this is something the next government will need to address.Charlotte Currie, Clinical Fellow, Newcastle UniversityChristopher Vernazza, Senior Lecturer in the School of Dental Sciences, Newcastle UniversityJustin Durham, Head of school, Professor of Orofacial Pain, Hon Consultant Oral Surgeon, Newcastle UniversitySimon Stone, Senior Clinical Lecturer/Honorary Consultant in Restorative Dentistry (Endodontics), Newcastle UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1213102019-08-26T19:58:51Z2019-08-26T19:58:51ZHow often should I get my teeth cleaned?<figure><img src="https://images.theconversation.com/files/289016/original/file-20190822-170951-avvckq.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6016%2C4016&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Teeth cleaning at the dentist can remove plaque that regular brushing and flossing can't.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>If you went to your dentist for a check-up and dental clean in the last year, give yourself a pat on the back. Not everyone loves the dentist, but <a href="https://www.aihw.gov.au/reports/dental-oral-health/dental-attendance-patterns-oral-health-status/contents/table-of-contents">research</a> shows people who visit at least once a year for preventative care are happier with their smile.</p>
<p>Regular dental visitors are also <a href="https://journals.sagepub.com/doi/abs/10.1177/0022034509356779">less likely</a> to need a filling or have a tooth removed.</p>
<p>So how often do we need to go to the dentist? Most of us can get away with an annual trip, but some people at higher risk of dental problems should <a href="https://www.ncbi.nlm.nih.gov/pubmed/29984691">visit more often</a>.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/child-tooth-decay-is-on-the-rise-but-few-are-brushing-their-teeth-enough-or-seeing-the-dentist-92113">Child tooth decay is on the rise, but few are brushing their teeth enough or seeing the dentist</a>
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<h2>Why do I need to get my teeth cleaned?</h2>
<p>While we all do the best we can on our own, professional teeth cleaning removes plaque, the soft yellowish build-up, and calculus (hardened plaque) we can’t get to. This soft build-up is made up of billions of different types of bacteria that live and reproduce in our mouth by feeding on the food we eat.</p>
<p>Most bacteria live in our bodies without causing too much trouble. But certain bacteria in dental plaque, when they grow in numbers, can lead to cavities (holes in the teeth) or gum disease. </p>
<p>A dental clean will reduce your chance of getting cavities or gum disease by <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-051X.2004.00563.x">significantly reducing</a> the amount of plaque and calculus in your mouth.</p>
<h2>So how often?</h2>
<p>As a dentist, my patients often ask me how regularly they should get their teeth cleaned. My response is usually: “That depends”.</p>
<p>Most private health insurance schemes cover a dental check-up and clean once every six months. But there’s no hard and fast evidence, particularly if you’re a healthy person who is less likely to get a cavity or gum disease. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/50-shades-whiter-what-you-should-know-about-teeth-whitening-102474">50 shades whiter: what you should know about teeth whitening</a>
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<p>However, some people are at higher risk of getting dental cavities or gum disease – and this group should get their teeth cleaned more often.</p>
<h2>Hole in one</h2>
<p>We know certain <a href="https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-018-0585-4">health and lifestyle factors</a> can affect a person’s risk of developing cavities. Here are some yes/no questions you can ask yourself to understand whether you’re at a higher risk:</p>
<ol>
<li> is your drinking water or toothpaste fluoride-free?</li>
<li> do you snack a lot, including on sweets?</li>
<li> do you avoid flossing?</li>
<li> do you brush your teeth less than twice a day? </li>
<li> do you visit your dentist for toothaches rather than check-ups?</li>
<li> do you need new fillings every time you visit the dentist?</li>
<li> is your dentist “watching” a lot of early cavities?</li>
<li> do you have to wear an appliance in your mouth such as a denture or braces? </li>
<li> do you suffer from a chronic long-term health condition such as diabetes?</li>
<li>do you suffer from a dry mouth?</li>
</ol>
<p>If you answered “yes” to most of these questions, you’re likely to need to see your dentist or hygienist at least every six months, if not more often. </p>
<p>As well as removing the bug-loaded plaque and calculus, people prone to cavities <a href="https://www.sciencedirect.com/science/article/abs/pii/S0002817714615269">benefit</a> from the fluoride treatment after scaling. </p>
<p>Evidence shows professional fluoride treatment every six months can lead to a <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002280.pub2/full">30% reduced risk</a> of developing cavities, needing fillings or having teeth removed.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/two-million-aussies-delay-or-dont-go-to-the-dentist-heres-how-we-can-fix-that-113376">Two million Aussies delay or don't go to the dentist – here's how we can fix that</a>
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<h2>Dental health is related to our overall health</h2>
<p>Some people with <a href="https://www.scielosp.org/scielo.php?pid=S0042-96862005000900004&script=sci_arttext&tlng=es">chronic health issues</a> such as heart conditions or diabetes will need to see their dentists more frequently. This is because they are <a href="https://www.tandfonline.com/doi/abs/10.1586/erc.10.109">more prone to gum disease</a>. </p>
<p>People taking blood thinners and other medications, such as pills and infusions for <a href="https://asbmr.onlinelibrary.wiley.com/doi/full/10.1002/jbmr.3191">osteoporosis</a>, may need to visit the dentist more regularly too. These medications can complicate the process of an extraction or other dental work, so regular checks and cleans are best to help detect problems before they become serious.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/289018/original/file-20190822-170906-1oobsfd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/289018/original/file-20190822-170906-1oobsfd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289018/original/file-20190822-170906-1oobsfd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289018/original/file-20190822-170906-1oobsfd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289018/original/file-20190822-170906-1oobsfd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289018/original/file-20190822-170906-1oobsfd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289018/original/file-20190822-170906-1oobsfd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People who visit the dentist regularly are less likely to need a filling or have a tooth removed.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>People with bleeding gums should also see their dental practitioners more often. This is <a href="https://www.ncbi.nlm.nih.gov/pubmed/26698003">especially important</a> if you have been diagnosed with advanced gum disease, known as periodontal disease.</p>
<h2>What about the budget?</h2>
<p>The <a href="https://www.choice.com.au/health-and-body/dentists-and-dental-care/dental-treatment/articles/dental-fees">average cost</a> of a check-up, dental clean and fluoride treatment is A$231, but the cost can vary from A$150 to A$305. You can contact your local dentist to find out what they charge. Your dentist may offer you a payment plan.</p>
<p>If you can’t afford this, you may qualify for <a href="https://www.ada.org.au/Your-Dental-Health/Home">free or discounted treatment</a> if you hold a concession card. Children from families that receive a Family Tax Benefit A may be eligible for free dental treatment through the <a href="https://www.humanservices.gov.au/individuals/services/medicare/child-dental-benefits-schedule">Child Dental Benefits Schedule</a>. </p>
<p>People with private health insurance with extras or ancillary cover will also have some or all of their dental treatment covered.</p>
<h2>Protecting your smile</h2>
<p>So you don’t really get cavities or have gum disease, but would prefer to see your dentist every six months? Great. <a href="https://www.nature.com/articles/sj.bdj.2010.796">Some people</a> prefer to go twice a year to reduce the chance of a nasty toothache. </p>
<p>Parents often wish to set a good example for their children by making regular check and clean appointments for the whole family.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-care-is-getting-cheaper-unless-you-need-a-specialist-or-a-dentist-103893">Health care is getting cheaper (unless you need a specialist, or a dentist)</a>
</strong>
</em>
</p>
<hr>
<p>There are many benefits to regular checks and cleans. Visiting your dentist regularly helps reduce the chance of needing more complex and expensive dental treatment later on. </p>
<p>And touching base with your oral health practitioner provides that nudge we all need now and again to eat healthily, brush better and floss more often.</p><img src="https://counter.theconversation.com/content/121310/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arosha Weerakoon is a self-employed dentist in private practice. She has received funding from Colgate for her research. She is a member of the Australian Dental Association and a Fellow of the Royal Australasian College of Dental Surgeons. </span></em></p>Do you really need a dental clean every six months? Most healthy people will probably be OK if they go anually. But some people are at higher risk of cavities or gum disease, and should go more often.Arosha Weerakoon, Lecturer, General Dentist & PhD Candidate, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1156242019-07-24T22:23:05Z2019-07-24T22:23:05ZPeople living with HIV struggle to access much-needed dental care<figure><img src="https://images.theconversation.com/files/284926/original/file-20190719-116573-yf7d0w.jpg?ixlib=rb-1.1.0&rect=175%2C325%2C1991%2C1321&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Only three per cent of HIV organizations in British Columbia offer basic dental care to those who need it.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Nearly <a href="https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics">37 million people were living with Human Immunodeficiency Virus (HIV)</a> globally in 2017, according to the World Health Organization. </p>
<p>In Canada, <a href="https://www.canada.ca/content/dam/phac-aspc/documents/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2017-43/ccdr-volume-43-12-december-7-2017/ccdr-43-12-ar01-eng.pdf">84,409 cases of HIV</a> have been reported since 1985. The province of Ontario accounted for the most HIV cases reported in 2016 (37.6 per cent), followed by Quebec (25.3 per cent) and Alberta (12 per cent). There are around 2,344 new HIV infections in Canada every year, and this number is rising.</p>
<p>Although there is no cure for HIV to date, <a href="http://doi.org/10.1016/j.antiviral.2009.10.002">the use of antiretroviral therapy (ART) has greatly reduced deaths and co-morbidities from the virus</a>. </p>
<p>However, despite the improved outcomes offered by new drug therapies, people living with HIV still face numerous psycho-social challenges and barriers to accessing care — especially dental care services. </p>
<p>When it comes to dental care, vulnerable populations such as people living with HIV are most profoundly affected. They are at particular risk from oral lesions caused by immunosuppression resulting from uncontrolled HIV-infection. These opportunistic infections have <a href="https://doi.org/10.1111/j.1752-7325.2011.00284.x">plagued people living with HIV since the early epidemic of HIV-infection</a> and continue to impact their overall <a href="https://doi.org/10.1177/2325957416686192">well-being and quality of life</a>. </p>
<h2>The services HIV organizations offer in British Columbia</h2>
<p>Until 2016, there was no data on the availability of oral and general health services or the unmet oral health needs of people living with HIV in Canada. I conducted a two-part study through the University of British Columbia Faculty of Dentistry in a first attempt to <a href="https://doi.org/10.14288/1.0377756">classify the types of services available for those living with HIV in British Columbia, Canada.</a> </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/284931/original/file-20190719-116596-1detxbf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/284931/original/file-20190719-116596-1detxbf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/284931/original/file-20190719-116596-1detxbf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/284931/original/file-20190719-116596-1detxbf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/284931/original/file-20190719-116596-1detxbf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/284931/original/file-20190719-116596-1detxbf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/284931/original/file-20190719-116596-1detxbf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People sit on the sidewalk along East Hastings street in Vancouver. When it comes to dental care, people of lower socioeconomic status are most profoundly affected.</span>
<span class="attribution"><span class="source">(THE CANADIAN PRESS/Jonathan Hayward)</span></span>
</figcaption>
</figure>
<p>I identified a total of 104 HIV organizations within the six health authorities in the province. Of the 51 cities I examined across B.C., 40 housed one or more organizations providing HIV-related services. </p>
<p>The <a href="http://www.jcda.ca/j1">study identified the following available services</a>: </p>
<ul>
<li><p>59 per cent offered preventive services including sexual-health education.</p></li>
<li><p>15 per cent offered treatment services for HIV-related conditions.</p></li>
<li><p>38 per cent offered support services including social assistance.</p></li>
<li><p>Three per cent offered basic dental care, mostly educational in nature. </p></li>
</ul>
<p>This points to a lack of services related to social support, such as housing and food services, and lack of basic dental services. </p>
<h2>Living with tooth decay and bleeding gums</h2>
<p>The second part of my study was a self-reported survey to identify unmet oral health treatment needs and patterns of dental service use by people living with HIV in B.C. </p>
<p>More than 75 per cent of participants reported untreated dental conditions such as decay, bleeding gums and tooth sensitivity. Approximately 50 per cent of participants avoided recommended dental treatment due to cost. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/284927/original/file-20190719-116569-wpvve0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/284927/original/file-20190719-116569-wpvve0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/284927/original/file-20190719-116569-wpvve0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/284927/original/file-20190719-116569-wpvve0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/284927/original/file-20190719-116569-wpvve0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/284927/original/file-20190719-116569-wpvve0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/284927/original/file-20190719-116569-wpvve0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">With specilized training, dentists could help people living with HIV feel safe and welcomed in their offices.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The following were identified as the <a href="https://doi.org/10.1111/jphd.12304">main factors preventing people from seeking dental care</a>: </p>
<ul>
<li><p>46 per cent experienced discrimination by dental professionals.</p></li>
<li><p>66 per cent experienced dental anxiety.</p></li>
<li><p>50 per cent did not have dental insurance. </p></li>
<li><p>62 per cent were experiencing difficulties with housing, transportation and food. </p></li>
</ul>
<h2>The need for trauma-informed care</h2>
<p>Three quarters of the surveyed population reported having bleeding gums, tooth sensitivity and tooth decay. Significant numbers of respondents reported they had unmet dental treatment needs and felt discriminated against by dental care providers. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/women-need-health-and-dental-care-to-stay-out-of-prison-84897">Women need health and dental care to stay out of prison</a>
</strong>
</em>
</p>
<hr>
<p>At minimum, this highlights the need for more training for dental care providers about how to better serve this vulnerable population. Non-dental professionals — such as physicians, nurses and nutritionists — also need to promote better oral health for HIV-positive clients. This is especially the case in remote locations where accessing a dental-care provider can be a challenge.</p>
<p>The data also highlights that people living with HIV are lacking supports in several areas. They may be struggling with poverty, homelessness, drug use or lack of social support and could be encountering a variety of interconnected barriers in accessing dental-care services.</p>
<p>Therefore, the next generation of dental professionals should receive a robust training in cultural sensitivity and trauma-informed care to make people living with HIV feel safe and welcomed in their dental offices. </p>
<p>Now based in Saskatchewan, I will be continuing to explore the issues of stigma and discrimination related to the unmet dental treatment needs of people living with HIV in this province.</p>
<p>[ <em><a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=thanksforreading">Thanks for reading! We can send you The Conversation’s stories every day in an informative email. Sign up today.</a></em> ]</p><img src="https://counter.theconversation.com/content/115624/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Abbas Jessani does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research shows that many people living with HIV struggle with tooth decay, bleeding gums and tooth sensitivity – due to the costs of dental care and discrimination by dental professionals.Abbas Jessani, Assistant Professor of Dentistry, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1195882019-07-11T11:06:47Z2019-07-11T11:06:47ZHow did people clean their teeth in the olden days?<figure><img src="https://images.theconversation.com/files/283592/original/file-20190710-44487-1w6qbdw.jpg?ixlib=rb-1.1.0&rect=450%2C24%2C5013%2C3612&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People worked for healthy teeth long before nylon brushes hit the market.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-shot-toothbrush-257979776?studio=1">Mila Davidovic/Shutterstock.com</a></span></figcaption></figure><figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=293&fit=crop&dpr=1 600w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=293&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=293&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=368&fit=crop&dpr=1 754w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=368&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=368&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em><a href="https://theconversation.com/us/topics/curious-kids-us-74795">Curious Kids</a> is a series for children of all ages. If you have a question you’d like an expert to answer, send it to <a href="mailto:curiouskidsus@theconversation.com">CuriousKidsUS@theconversation.com</a>.</em></p>
<hr>
<p>Dental hygiene has come a long way since the days of wine-soaked toothpicks and the <a href="https://www.nocavitykids.com/blog/the-crazy-and-disgusting-history-of-mouthwash/">urine mouthwash</a> once thought to disinfect mouths and whiten teeth.</p>
<p>Some of the <a href="http://www.ancientpages.com/2018/06/22/ancient-history-of-dentistry/">earliest tooth-cleaning artifacts</a> archaeologists have found are ancient toothpicks, dental tools and <a href="http://healthdrip.com/chinese-history-of-dentistry/">written tooth care descriptions</a> dating back more than 2,500 years. Famous Greek doctor Hippocrates was one of the first to recommend cleaning teeth with what was basically a dry toothpaste, called a <a href="http://www.greekmedicine.net/hygiene/Greek_Oral_Hygiene.html">dentifrice powder</a>.</p>
<p><a href="https://www.ada.org/en/about-the-ada/ada-history-and-presidents-of-the-ada/ada-history-of-dentistry-timeline">Ancient Chinese and Egyptian texts</a> advised cleaning teeth and removing decay to help maintain health. Some of the early techniques in these cultures included chewing on bark or sticks with frayed ends, feathers, fish bones and porcupine quills. They used materials like silver, jade and gold to <a href="http://dental-polishers.com/679/dentistry-in-ancient-egypt">repair or decorate their teeth</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/283593/original/file-20190710-44472-1ax4q7h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/283593/original/file-20190710-44472-1ax4q7h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/283593/original/file-20190710-44472-1ax4q7h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/283593/original/file-20190710-44472-1ax4q7h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/283593/original/file-20190710-44472-1ax4q7h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/283593/original/file-20190710-44472-1ax4q7h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/283593/original/file-20190710-44472-1ax4q7h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/283593/original/file-20190710-44472-1ax4q7h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A miswak fights bacteria and physically cleans off teeth.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/miswak-sticks-siwak-salvadora-persica-old-1090684829?studio=1">ustun ibisoglu/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>People in the Arabian Peninsula, North Africa and the Indian subcontinent traditionally <a href="http://museumofeverydaylife.org/exhibitions-collections/previous-exhibitions/toothbrush-from-twig-to-bristle-in-all-its-expedient-beauty/a-visual-history-of-the-toothbrush">cleaned their teeth with chew sticks</a> made from the <em>Salvadora persica</em> tree. They’re called miswak. Europeans cleaned their teeth with <a href="http://museumofeverydaylife.org/exhibitions-collections/previous-exhibitions/toothbrush-from-twig-to-bristle-in-all-its-expedient-beauty/a-visual-history-of-the-toothbrush">rags rolled in salt or soot</a>.</p>
<p>Believe it or not, in the early 1700s a French doctor named Pierre Fauchard told people not to brush. And he’s <a href="https://www.ada.org/en/about-the-ada/ada-history-and-presidents-of-the-ada/ada-history-of-dentistry-timeline">considered the father of modern dentistry</a>! Instead, he encouraged cleaning teeth with a toothpick or sponge soaked in water or brandy.</p>
<p>In the late 1700s, <a href="https://www.mouthhealthy.org/en/az-topics/t/toothbrushes">Englishman William Addis</a> was the first to sell toothbrushes on a large scale. He got the idea after making a toothbrush from bone and animal bristles while in prison.</p>
<p><a href="https://www.mouthhealthy.org/en/az-topics/t/toothpaste">Before modern-day toothpaste was created</a>, pharmacists mixed and sold tooth cream or powder. Early tooth powders were made from something abrasive, like talc or crushed seashells, mixed with essential oils, such as eucalyptus or camphor, thought to fight germs. Their flavors came from oils of cinnamon, clove, rose or peppermint. Many contained other chemicals such as ammonia, chlorophyll and penicillin. These ingredients fight the acid-producing bacteria that can cause tooth decay and bad breath.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/283369/original/file-20190709-44441-1s4psrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/283369/original/file-20190709-44441-1s4psrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/283369/original/file-20190709-44441-1s4psrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=331&fit=crop&dpr=1 600w, https://images.theconversation.com/files/283369/original/file-20190709-44441-1s4psrq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=331&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/283369/original/file-20190709-44441-1s4psrq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=331&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/283369/original/file-20190709-44441-1s4psrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=416&fit=crop&dpr=1 754w, https://images.theconversation.com/files/283369/original/file-20190709-44441-1s4psrq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=416&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/283369/original/file-20190709-44441-1s4psrq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=416&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A 1919 ‘White Toothbrush Drill’ in Alabama.</span>
<span class="attribution"><a class="source" href="https://www.loc.gov/item/2005688941/">Tennessee Coal, Iron & Railroad Company. Library of Congress, Prints & Photographs Division, LC-USZ62-63674</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>By the 1900s, <a href="https://www.si.edu/spotlight/health-hygiene-and-beauty/oral-care">children of immigrants to the U.S.</a> were taught oral hygiene as a way to help “Americanize” them and their families. <a href="https://www.si.edu/spotlight/health-hygiene-and-beauty/oral-care">Factories examined and cleaned their workers’ teeth</a> to keep them from missing work due to toothaches. </p>
<p>Daily tooth brushing became more common thanks to World War II, when the American army required soldiers to brush their teeth as part of their daily hygiene practices. The first nylon toothbrush was made in 1938, followed by the electric toothbrush in the 1960s.</p>
<p>Nowadays, there are dozens of kinds of tools and potions to help keep your mouth healthy. As a professor of dental hygiene, I believe it’s most important to clean your mouth daily, no matter how you choose to do so. Well, maybe stay away from the urine mouthwash.</p><img src="https://counter.theconversation.com/content/119588/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Cotter does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People have probably always wanted clean and healthy teeth. What they historically used to achieve dental hygiene might surprise you.Jane Cotter, Assistant Professor of Dental Hygiene, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1161692019-04-29T20:14:15Z2019-04-29T20:14:15ZToo many Australians miss out on timely dental care – Labor’s pledge is just a start<figure><img src="https://images.theconversation.com/files/271410/original/file-20190429-194637-10d6637.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Forgoing dental care causes more pain and costly treatments down the longer term. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-dentist-her-patient-the-netherlands-267905414?src=e2xzYyAS2yNJIQmWfHNZKg-1-1">Gertjan Hooijer/Shutterstock</a></span></figcaption></figure><p>Opposition leader Bill Shorten declared on Sunday that Labor has a “vision of universal access to dental care in Australia”. </p>
<p><a href="https://www.alp.org.au/policies/pensioner-dental-plan/">Labor’s pensioner dental plan</a> would would give aged pensioners up to A$1,000 of subsidised dental care every two years.</p>
<p>The policy is a welcome advance, but both sides should go further. The current system is a mess. It leaves many Australians without timely access to dental care, which only causes more painful and costly problems down the track.</p>
<p>Australians should demand their politicians introduce a universal dental care scheme. As with Medicare, this would ensure all Australians have access to subsidised basic dental care, including check-ups and treatment for tooth decay. </p>
<p>The Labor scheme is just a start on this road, covering pensioners over 65 and Seniors’ Health Care Card holders.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/two-million-aussies-delay-or-dont-go-to-the-dentist-heres-how-we-can-fix-that-113376">Two million Aussies delay or don't go to the dentist – here's how we can fix that</a>
</strong>
</em>
</p>
<hr>
<h2>The mess we’re in</h2>
<p>Dental care is a glaring gap in our health system. When Australians need to see a GP, Medicare picks up all or most of the bill. When they need to see a dentist, most Australians are <a href="https://www.aihw.gov.au/reports/health-welfare-expenditure/health-expenditure-australia-2016-17/contents/data-visualisation">on their own</a>. </p>
<p>The result is that about <a href="https://theconversation.com/two-million-aussies-delay-or-dont-go-to-the-dentist-heres-how-we-can-fix-that-113376">two million Australian adults</a> each year don’t get dental care when they need it because of the cost.</p>
<p>There have been various attempts to expand Commonwealth support for dental care over the years. But most have been abolished – whether because of cost overruns, a budget crunch, or change in governmental priorities.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/271422/original/file-20190429-194627-c3899w.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/271422/original/file-20190429-194627-c3899w.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/271422/original/file-20190429-194627-c3899w.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/271422/original/file-20190429-194627-c3899w.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/271422/original/file-20190429-194627-c3899w.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/271422/original/file-20190429-194627-c3899w.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/271422/original/file-20190429-194627-c3899w.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/271422/original/file-20190429-194627-c3899w.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Note: There have been three National Partnership Agreements: ‘Treating More Public Dental Patients’ (1 January 2013-30 June 2015); ‘Adult Public Dental Services’ (1 July 2015-31 December 2016); and ‘Public Dental Services for Adults’ (1 January 2017-30 June 2019). The CDBS commenced under the Abbott government but was developed and legislated by the Gillard government. Grattan Institute</span></span>
</figcaption>
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<p>Australia does offer some public dental care for adults, but the system is woefully inadequate. All state and territory governments operate means-tested public dental schemes, generally restricted to pensioners and concession card holders. </p>
<p>About five million adults fit the eligibility criteria, but the schemes aren’t funded anywhere near enough to provide services to all eligible people who need care. Only about one-fifth of eligible adults receive care in the public system each year.</p>
<p>In most states and territories, most people who seek public dental care <a href="https://www.pc.gov.au/research/ongoing/report-on-government-services/2018/health/primary-and-community-health">have to wait</a> more than a year to be seen. The wait is sometimes more than two years.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/271455/original/file-20190429-194616-33d42d.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/271455/original/file-20190429-194616-33d42d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/271455/original/file-20190429-194616-33d42d.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=439&fit=crop&dpr=1 600w, https://images.theconversation.com/files/271455/original/file-20190429-194616-33d42d.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=439&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/271455/original/file-20190429-194616-33d42d.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=439&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/271455/original/file-20190429-194616-33d42d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=552&fit=crop&dpr=1 754w, https://images.theconversation.com/files/271455/original/file-20190429-194616-33d42d.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=552&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/271455/original/file-20190429-194616-33d42d.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=552&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption"></span>
<span class="attribution"><span class="source">Notes: NSW did not provide data; that state's system of triage, prioritisation and waitlist management differs from other states. Different criteria for patient classification and measurement between states make direct comparisons unreliable. Victoria's data are for 2015-16. NT's data were not published due to quality concerns. The figures refer to the time between going on the waiting list and receiving an offer of public dental care. Productivity Commission 2019/Grattan Institute</span></span>
</figcaption>
</figure>
<p>The states and territories spend A$836 million a year of their own money on public dental care. The Commonwealth chips in another A$108 million under a <a href="http://www.federalfinancialrelations.gov.au/content/npa/health/national-partnership/Adult_Public_Dental_Services_NP_2017-4.pdf">National Partnership Agreement</a> that’s set to expire next year.</p>
<p>The total is well short of what’s needed. By way of comparison, the <a href="https://grattan.edu.au/report/filling-the-gap/">federal government spends more than A$700 million each year</a> subsidising dental care through the private health insurance rebate.</p>
<h2>From little dental problems, big problems grow</h2>
<p>The situation is a little better for children. More than half of Australian children are covered by the <a href="https://www.humanservices.gov.au/individuals/services/medicare/child-dental-benefits-schedule">Child Dental Benefits Schedule</a> (CDBS), a federal government initiative in place since 2013. </p>
<p>The scheme covers children who live in low- and middle-income households – those that receive Family Tax Benefit Part A or another Commonwealth payment.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dental-report-card-fail-half-of-adults-and-one-third-of-kids-dont-brush-twice-a-day-93288">Dental report card fail: half of adults and one-third of kids don't brush twice a day</a>
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</p>
<hr>
<p>The main problem with the child dental scheme is that not many children use it. </p>
<p>When the scheme was introduced, the Commonwealth expected about 80% of eligible children would use it. In the event, only 35% did so, and the figure has barely budged since then.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/271457/original/file-20190429-194600-1k23vcm.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/271457/original/file-20190429-194600-1k23vcm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/271457/original/file-20190429-194600-1k23vcm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=482&fit=crop&dpr=1 600w, https://images.theconversation.com/files/271457/original/file-20190429-194600-1k23vcm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=482&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/271457/original/file-20190429-194600-1k23vcm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=482&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/271457/original/file-20190429-194600-1k23vcm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=605&fit=crop&dpr=1 754w, https://images.theconversation.com/files/271457/original/file-20190429-194600-1k23vcm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=605&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/271457/original/file-20190429-194600-1k23vcm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=605&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><span class="source">Health budget statements, various years/Grattan Institute</span></span>
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</figure>
<p>It may be that usage is so low because many parents just don’t know that the child dental scheme exists and that their children are eligible for care under the scheme. </p>
<p>Whatever the reasons, the Commonwealth should work with the states to promote the scheme and boost uptake – and in the process, rigorously determine which strategies are most effective in getting kids to the dentist.</p>
<h2>Filling the gap in Australia’s health system</h2>
<p>As we recommended in a <a href="https://theconversation.com/two-million-aussies-delay-or-dont-go-to-the-dentist-heres-how-we-can-fix-that-113376">recent Grattan Institute report</a>, the Commonwealth government should fill the gap in Australia’s health system by moving towards a universal dental care scheme. </p>
<p>This scheme should build on the child dental scheme, which provides a useful model that could be expanded to ultimately cover everyone.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/grattan-orange-book-what-the-election-should-be-about-priorities-for-the-next-government-115563">Grattan Orange Book. What the election should be about: priorities for the next government</a>
</strong>
</em>
</p>
<hr>
<p>A universal scheme should allow care to be delivered by either private dentists or public clinics, just as the child dental scheme does. Consultations should be bulk-billed, meaning patients have no out-of-pocket costs. </p>
<p>Prices should be set out in a tightly controlled schedule, much as in Medicare, with reasonable and closely monitored caps on usage. </p>
<p>Dental practices that participate in the scheme should make public a range of data so the government – and taxpayers – can monitor their performance and the oral health outcomes of their patients.</p>
<h2>Steps towards a universal dental system</h2>
<p>It would be impractical to adopt a universal scheme overnight. We calculate <a href="https://theconversation.com/two-million-aussies-delay-or-dont-go-to-the-dentist-heres-how-we-can-fix-that-113376">it would cost about A$5.6 billion</a> a year.</p>
<p>The development of such a scheme would entail reshaping of Commonwealth-state relations, and would require more dentists and other oral health professionals than we currently have in Australia. </p>
<p>Because of these challenges, we recommended the Commonwealth outline a ten-year plan for a universal scheme and start progressively expanding the number of people who are eligible for publicly funded care.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/child-tooth-decay-is-on-the-rise-but-few-are-brushing-their-teeth-enough-or-seeing-the-dentist-92113">Child tooth decay is on the rise, but few are brushing their teeth enough or seeing the dentist</a>
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</em>
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<hr>
<p>The Labor policy broadly fits with our recommendations. It builds on the child dental scheme and uses the public-private model we recommended. </p>
<p>The extra funding – <a href="https://www.alp.org.au/policies/pensioner-dental-plan/">A$2.4 billion over the next four years</a>, according to Labor – would represent a very big increase in public funding for dental care. </p>
<p>Importantly, Labor sees this policy as a step towards a universal system. Once implemented, this pensioner dental scheme and the existing <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/childdental">Child Dental Benefits</a> arrangements will still leave a lot of Australians without subsidised Commonwealth dental cover. </p>
<p>The next step is setting out a plan to get to provide that cover. When will coverage be extended to other Australians who need care? How will we expand the oral health workforce to ensure we can provide care to everyone who needs it? </p>
<p>Australians should demand answers to these sort of questions – from both Labor and the Coalition.</p><img src="https://counter.theconversation.com/content/116169/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The Grattan Institute began with contributions to its endowment of $15 million from each of the Federal and Victorian Governments, $4 million from BHP Billiton, and $1 million from NAB. In order to safeguard its independence, Grattan Institute’s board controls this endowment. The funds are invested and contribute to funding Grattan Institute's activities. Grattan Institute also receives funding from corporates, foundations, and individuals to support its general activities as disclosed on its website.</span></em></p><p class="fine-print"><em><span>Stephen Duckett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>All Australians should have access to subsidised dental care, not just pensioners and children.Stephen Duckett, Director, Health Program, Grattan InstituteMatthew Cowgill, Senior Associate, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1133762019-03-17T18:51:37Z2019-03-17T18:51:37ZTwo million Aussies delay or don’t go to the dentist – here’s how we can fix that<figure><img src="https://images.theconversation.com/files/264047/original/file-20190315-28471-t2tksr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When did you last visit the dentist?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/girl-opened-mouth-167442623">By Concept Photo/Shutterstock</a></span></figcaption></figure><p>Dental care in Australia is a policy anomaly; for some reason, the mouth is treated very differently to other parts of the body. <a href="https://www.aihw.gov.au/reports/health-welfare-expenditure/health-expenditure-australia-2016-17/contents/data-visualisation">About 58% of dental costs</a> are met directly from patients’ pockets, compared to 11% for medical primary care, and 12% for prescriptions. </p>
<p>As a result of these large out-of-pocket costs, <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4839.0%7E2017-18%7EMain%20Features%7EDental%20professionals%7E4">two million Australians each year</a> defer visits to a dentist or miss out on dental care. Poorer people are more likely to miss out.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/264052/original/file-20190315-28499-1wb1l6e.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/264052/original/file-20190315-28499-1wb1l6e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/264052/original/file-20190315-28499-1wb1l6e.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=447&fit=crop&dpr=1 600w, https://images.theconversation.com/files/264052/original/file-20190315-28499-1wb1l6e.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=447&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/264052/original/file-20190315-28499-1wb1l6e.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=447&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/264052/original/file-20190315-28499-1wb1l6e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=562&fit=crop&dpr=1 754w, https://images.theconversation.com/files/264052/original/file-20190315-28499-1wb1l6e.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=562&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/264052/original/file-20190315-28499-1wb1l6e.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=562&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
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<span class="attribution"><span class="source">Source: ABS Patient Experiences in Australia 2016-17</span></span>
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</figure>
<p>Every few years <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp0809/09rp01">the Commonwealth government introduces a new dental scheme</a> to fill the dental gap in our health system, and then a few years later the scheme is abolished with a change of government. </p>
<p>This start-stop nature of dental policy has to change. What’s required is a long-term vision to reunite the mouth with the rest of the body.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/child-tooth-decay-is-on-the-rise-but-few-are-brushing-their-teeth-enough-or-seeing-the-dentist-92113">Child tooth decay is on the rise, but few are brushing their teeth enough or seeing the dentist</a>
</strong>
</em>
</p>
<hr>
<h2>The architecture of a universal scheme</h2>
<p>Medicare is widely embraced as the central pillar of Australia’s health system. There is no logical reason why this coverage should not be extended to oral health. </p>
<p>But we should learn from the Medicare experience. The expansion of dental access should be based on a <a href="https://grattan.edu.au/health">new, better model</a>. Here’s how this can be done.</p>
<p><strong>1. Like Medicare, a universal dental scheme should be based on a mix of public and private services</strong>. </p>
<p>State public dental services are struggling valiantly to meet demand, with <a href="https://www.pc.gov.au/research/ongoing/report-on-government-services/2018/health/primary-and-community-health">waiting times of more than a year in most states</a>. </p>
<p>Investing money into these schemes – as the Commonwealth has done for the past few years – has made almost no dent in the waiting lists. And the risk remains that extra investment will be discontinued with changes of government, as has happened in the past. </p>
<p>Even if Commonwealth funding increased to adequate levels, it’s unlikely the state schemes could be expanded sufficiently to provide the amount of care needed. </p>
<p>Nor would a monolithic public-only scheme, with no choice of provider, be consistent with the way the rest of health care is provided. </p>
<p>A mixed public-private scheme could harness the existing investments by private dental practices, as has been done in the existing <a href="https://www.dhsv.org.au/public-dental-services/childdental">Commonwealth Child Dental Benefits Scheme</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/264054/original/file-20190315-28483-1100t24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/264054/original/file-20190315-28483-1100t24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/264054/original/file-20190315-28483-1100t24.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/264054/original/file-20190315-28483-1100t24.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/264054/original/file-20190315-28483-1100t24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/264054/original/file-20190315-28483-1100t24.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/264054/original/file-20190315-28483-1100t24.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Over time, a universal dental scheme would encourage all Australians to prevent dental problems and seek treatment early.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/kdoaOFGE9QM">Daniel Frank</a></span>
</figcaption>
</figure>
<p><strong>2. A universal scheme should be ‘opt-in’: it should be based on dental practices agreeing to be part of the scheme.</strong> </p>
<p>Practices would be allowed to participate only if they agreed to certain conditions, most notably that they will bulk-bill all patients – thereby removing the financial barriers to dental care. </p>
<p>Participating practices would also be required to provide information on the results of their care, and to participate in approved programs to improve the quality of their care.</p>
<p><strong>3. Quality care should be rewarded.</strong></p>
<p>Although the universal scheme would initially make fee-for-service payments to participating practices, in a similar way to Medicare paying GP clinics when you visit a doctor, the payment system should become more sophisticated over time. </p>
<p>This could include rewarding dentists and practices that get the best results for their patients, by supplementing fee-for-service payments with <a href="http://www.acffglobal.org/wp-content/uploads/2019/02/Towards-paying-for-health-in-Dentistry-Policy-Lab-Report.pdf/">performance-related payments</a> based on following evidence-based practice and achieving better dental <a href="https://www.ichom.org/portfolio/oral-health/">outcomes</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-need-more-than-a-website-to-stop-australians-paying-exorbitant-out-of-pocket-health-costs-108740">We need more than a website to stop Australians paying exorbitant out-of-pocket health costs</a>
</strong>
</em>
</p>
<hr>
<p><strong>4. Not all aspects of oral health care should be covered under the universal scheme.</strong> </p>
<p>The priority should be to ensure the scheme funds primary dental care and treatments that are aimed at preventing problems and disease from developing. This includes check ups, treatment for tooth decay – <a href="https://www.ncbi.nlm.nih.gov/pubmed/30107377">which now may not involve drilling</a> – and dentures.</p>
<p><strong>5. The funding arrangements for the universal scheme should be designed to encourage reform and expansion of the dental workforce.</strong> </p>
<p>A universal dental scheme will require a bigger dental workforce. All oral health professionals should be encouraged to work to the top of their expertise and qualifications. </p>
<p>Under the new scheme, for example, oral health therapists would be able to perform many of the services now performed by dentists.</p>
<h2>How much will it cost?</h2>
<p>A universal dental scheme would cost about an extra A$5.6 billion a year. That sort of money could not be found overnight. Nor could the number of professionals required to staff such a scheme. </p>
<p>Instead, the federal government should announce that Australia will move to a universal dental scheme over the next decade – and it should produce a roadmap to get there.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/waiting-for-better-care-why-australias-hospitals-and-health-care-are-failing-104862">Waiting for better care: why Australia’s hospitals and health care are failing</a>
</strong>
</em>
</p>
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<p>The first step should be for the Commonwealth government to assume funding responsibility for oral health care for pensioners and health care card-holders – the group covered by existing state public dental schemes. </p>
<p>The Commonwealth funding should be on the basis of the mixed public-private model described above.</p>
<p>This initiative would cost an extra A$1 billion a year. That is a more affordable price tag – and sufficient dental professionals are already available to meet the anticipated extra demand. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/264055/original/file-20190315-28483-1g3htk9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/264055/original/file-20190315-28483-1g3htk9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/264055/original/file-20190315-28483-1g3htk9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/264055/original/file-20190315-28483-1g3htk9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/264055/original/file-20190315-28483-1g3htk9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/264055/original/file-20190315-28483-1g3htk9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/264055/original/file-20190315-28483-1g3htk9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Waiting times for state dental services are often a year or longer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/757785106?size=huge_jpg">Jacob Lund/Shutterstock</a></span>
</figcaption>
</figure>
<p>Offsets against this extra funding could come from savings elsewhere in the health system. Previous Grattan Institute reports have identified opportunities in both <a href="https://grattan.edu.au/home/health/hospitals/">hospitals</a> and <a href="https://grattan.edu.au/home/health/pharmaceuticals/">pharmaceuticals</a>, or from the introduction of a tax on sugar-sweetened drinks, as recommended in <a href="https://grattan.edu.au/report/a-sugary-drinks-tax-recovering-the-community-costs/">another Grattan report</a>.</p>
<p>An A$1 billion a year investment in expanding access to dental care for pensioners and health care card-holders would eliminate the waiting lists for existing public dental services, address a key inequity in health care, and set the stage for the big reform: <a href="https://grattan.edu.au/home/health/">a universal dental scheme for Australia</a>.</p><img src="https://counter.theconversation.com/content/113376/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grattan Institute began with contributions to its endowment of $15 million from each of the Federal and Victorian Governments, $4 million from BHP Billiton, and $1 million from NAB. In order to safeguard its independence, Grattan Institute’s board controls this endowment. The funds are invested and contribute to funding Grattan Institute's activities. Grattan Institute also receives funding from corporates, foundations, and individuals to support its general activities as disclosed on its website.</span></em></p>Unlike health care for the rest of our body, dental care mostly comes out of our own pocket – and it’s not cheap. Many Australians go without and their health suffers.Stephen Duckett, Director, Health Program, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1048622018-10-30T02:58:44Z2018-10-30T02:58:44ZWaiting for better care: why Australia’s hospitals and health care are failing<figure><img src="https://images.theconversation.com/files/242387/original/file-20181025-71038-17bngcx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Health is the largest single component of state government expenditure.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/245905492?src=jhlWisgjKa449M1gf5-h5A-1-61&size=huge_jpg">Shutterstock/hxdbzxy</a></span></figcaption></figure><p><em>This week we’re exploring nine different policy areas across Australia’s states, as detailed in Grattan Institute’s State Orange Book 2018. Read the other articles in the series <a href="https://theconversation.com/au/topics/state-of-the-states-2018-61464">here</a></em>.</p>
<hr>
<p>Australia has a good health system by international standards, but it has to get better. Half of all patients across Australia wait more than a month for an elective hospital procedure, such as a hip replacement. This is in addition to waiting for an outpatient visit so they can be added to the elective procedure wait list. </p>
<p>“Elective” here doesn’t mean the patient can do without the procedure – they may be in pain or having trouble moving around while waiting. Elective simply means it doesn’t have to be done immediately and can be scheduled.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/to-keep-patients-safe-in-hospitals-the-accreditation-system-needs-an-overhaul-101513">To keep patients safe in hospitals, the accreditation system needs an overhaul</a>
</strong>
</em>
</p>
<hr>
<p>About 9% of people in New South Wales and about 25% in South Australia wait more than a year for public dental services, such as fillings, extractions and root canals. </p>
<p>Physicians report nearly one-third of patients with an acute mental illness wait more than eight hours in hospital emergency departments.</p>
<p>The Grattan Institute’s <a href="https://grattan.edu.au/report/state-orange-book-2018/">State Orange Book 2018</a> charts the performance, maps a route to improvement, and recommends penalties for states that fail to meet waiting list targets. </p>
<h2>Why hospitals are always key state election issues</h2>
<p>Health is the largest single component of state government expenditure in every state of Australia, and <a href="https://grattan.edu.au/report/budget-pressures-on-australian-governments-2014/">has been growing rapidly</a>. About two-thirds of <a href="https://www.aihw.gov.au/reports/health-welfare-expenditure/health-expenditure-australia-2015-16/contents/summary">state government health spending</a> – excluding transfers from the Commonwealth – is on public hospitals. </p>
<p>Just over half the population does not have health insurance and so relies on public hospitals for all their care. Even for people with private insurance, public hospitals are their principal source of emergency care. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/242391/original/file-20181025-71017-1e527cl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/242391/original/file-20181025-71017-1e527cl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=449&fit=crop&dpr=1 600w, https://images.theconversation.com/files/242391/original/file-20181025-71017-1e527cl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=449&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/242391/original/file-20181025-71017-1e527cl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=449&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/242391/original/file-20181025-71017-1e527cl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/242391/original/file-20181025-71017-1e527cl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/242391/original/file-20181025-71017-1e527cl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Even Australians with private health insurance use public emergency departments.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/270431723?src=CRCnZ-2UKKWBIUb0mQBTmg-1-12&size=huge_jpg">Annette Shaff/Shutterstock</a></span>
</figcaption>
</figure>
<p>State governments are responsible for public hospitals, so hospital care is always a key issue in state elections. It is therefore no surprise state governments love to tell us how much they are doing for public hospitals, and election campaigns are often jam-packed with promises of new or expanded hospitals.</p>
<p>The politicians, at least in states with growing populations, are right that more beds are needed. What matters for the public, though, is not how many beds there are, but whether there are enough. One way of measuring that is waiting times, and here the picture isn’t as rosy as campaigning politicians would like us to believe.</p>
<h2>Waiting for elective hospital procedures</h2>
<p>It’s bad enough half of all patients across Australia wait more than a month for an elective procedure from the time they were booked. What’s worse is that about 10% wait more than six months. </p>
<p>In our smallest state, Tasmania, 10% of patients wait about a year. In the biggest state, NSW, the situation is almost as bad. </p>
<p><strong>This graph shows the waiting time (days) for elective procedures, 2012-13 to 2016-17, for the 10% of patients who wait longest (orange) and the median (maroon):</strong></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/242860/original/file-20181030-76384-o3lxkt.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/242860/original/file-20181030-76384-o3lxkt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/242860/original/file-20181030-76384-o3lxkt.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/242860/original/file-20181030-76384-o3lxkt.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/242860/original/file-20181030-76384-o3lxkt.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/242860/original/file-20181030-76384-o3lxkt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=494&fit=crop&dpr=1 754w, https://images.theconversation.com/files/242860/original/file-20181030-76384-o3lxkt.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=494&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/242860/original/file-20181030-76384-o3lxkt.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=494&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Grattan Institute/Australian Institute of Health and Welfare</span></span>
</figcaption>
</figure>
<p>Publicly reported data focus on elective procedure or elective surgery waiting times, but there is another important wait: from the time a patient is referred to the hospital to the time they are seen in an outpatient clinic. This is sometimes called the <a href="https://theconversation.com/getting-an-initial-specialists-appointment-is-the-hidden-waitlist-99507">“hidden waiting list”</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/getting-an-initial-specialists-appointment-is-the-hidden-waitlist-99507">Getting an initial specialists' appointment is the hidden waitlist</a>
</strong>
</em>
</p>
<hr>
<p>For the patient, the wait for an appointment with an outpatient clinic matters – it delays diagnosis and treatment. Yet these waits are not publicly reported in NSW, Western Australia, the Australian Capital Territory or the Northern Territory. And the states that do report outpatient clinic wait times do not use consistent measures. </p>
<p>Our state and territory governments should strengthen hospital accountability to reduce combined outpatient and inpatient waiting times. There should be clear consequences and penalties for failure to meet targets.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/242392/original/file-20181025-71026-19w3hop.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/242392/original/file-20181025-71026-19w3hop.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/242392/original/file-20181025-71026-19w3hop.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/242392/original/file-20181025-71026-19w3hop.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/242392/original/file-20181025-71026-19w3hop.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/242392/original/file-20181025-71026-19w3hop.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/242392/original/file-20181025-71026-19w3hop.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">First you have to wait to get on the waiting list. Then you get booked in for your procedure.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/counting-down-days-calendar-110130863?src=e7fmSXAl-CJ1LfyBpfMKeg-1-2">Shutterstock/cvm</a></span>
</figcaption>
</figure>
<h2>Waiting for public dental care</h2>
<p>The <a href="http://www.coaghealthcouncil.gov.au/Portals/0/Australia%27s%20National%20Oral%20Health%20Plan%202015-2024_uploaded%20170216.pdf">COAG Health Council</a> (made up of Commonwealth, state and territory health officials) says current funding for public dental services allows for treatment of only about 20% of the eligible population. </p>
<p>The remaining 80% have to wait for long periods, pay for relatively expensive care in the private sector, or go without care entirely.</p>
<p>Waiting times vary significantly among states. And in several states, notably Vic and SA, <a href="https://www.pc.gov.au/research/ongoing/report-on-government-services/2018/health/primary-and-community-health">waiting times have got longer in recent years</a>.</p>
<p>Boosting public dental services will improve people’s health and reduce the strain on hospitals. </p>
<p>In 2015-16, there were <a href="https://www.aihw.gov.au/getmedia/acee86da-d98e-4286-85a4-52840836706f/aihw-hse-201.pdf.aspx?inline=true">67,266 hospital admissions for potentially preventable dental conditions</a> – more than one-fifth of all hospital admissions for potentially preventable acute conditions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/poor-and-elderly-australians-let-down-by-ailing-primary-health-system-100586">Poor and elderly Australians let down by ailing primary health system</a>
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</em>
</p>
<hr>
<p>Unforgivably, our state governments have not delivered on a 2012 commitment to monitor waiting times for public dental care through a National Healthcare Agreement performance indicator. Data inconsistencies mean it is <a href="https://www.aihw.gov.au/getmedia/df234a9a-5c47-4483-9cf7-15ce162d3461/aihw-den-230.pdf.aspx?inline=true">not possible to reliably compare public dental waiting lists</a> across states and territories. </p>
<p>NSW does not provide data on public dental waiting lists at all, citing concerns about the potential for misleading comparisons. The only comparable data we have is from an Australian Bureau of Statistics sample survey, which shows more than 10% of patients across the country wait more than a year for public dental care. </p>
<p><strong>This graph shows the proportion of people who waited more than a year for public dental services:</strong></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/242862/original/file-20181030-76402-11wzj6r.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/242862/original/file-20181030-76402-11wzj6r.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/242862/original/file-20181030-76402-11wzj6r.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/242862/original/file-20181030-76402-11wzj6r.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/242862/original/file-20181030-76402-11wzj6r.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/242862/original/file-20181030-76402-11wzj6r.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=491&fit=crop&dpr=1 754w, https://images.theconversation.com/files/242862/original/file-20181030-76402-11wzj6r.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=491&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/242862/original/file-20181030-76402-11wzj6r.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=491&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Notes: The figures in smaller states should be regarded as approximate; the percentages are of those who have been seen, and do not include those still waiting at the time of the survey.</span>
<span class="attribution"><span class="source">Grattan Institute/Australian Bureau of Statistics</span></span>
</figcaption>
</figure>
<h2>Waiting for mental health care</h2>
<p>Campaigners say Australia has reached a “tipping point” on access to mental health care. Physicians report nearly one-third of patients with an acute mental illness wait more than eight hours in emergency departments. </p>
<p>We know this does damage: long waits for access to community mental health services can result in poorer outcomes for patients, as a condition may be harder to control the longer it persists. Long waits may also place additional pressure on families or friends who face the consequences of their friend or family member’s behaviour. </p>
<p>Yet there is no information about the adequacy of community mental health services in Australia. The 2017 <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/mental-fifth-national-mental-health-plan">National Mental Health and Suicide Prevention Plan</a> only tracks the use of services, not their adequacy. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-australians-can-stay-healthier-and-out-of-hospital-heres-how-55746">More Australians can stay healthier and out of hospital – here's how</a>
</strong>
</em>
</p>
<hr>
<p>In contrast, Canadian governments have agreed that a <a href="http://www.highperforminghealthcaresystems.com/content/25550">wide range of mental health and addictions indicators</a> will be collected and reported from 2019. </p>
<p>Australian voters should demand their state governments do the same thing. We should wait no longer for a better health system.</p><img src="https://counter.theconversation.com/content/104862/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grattan Institute began with contributions to its endowment of $15 million from each of the Federal and Victorian Governments, $4 million from BHP Billiton, and $1 million from NAB. In order to safeguard its independence, Grattan Institute’s board controls this endowment. The funds are invested and contribute to funding Grattan Institute's activities. Grattan Institute also receives funding from corporates, foundations, and individuals to support its general activities as disclosed on its website. The State Orange Book 2018, from which this article draws, was supported by a grant from the Susan McKinnon Foundation.</span></em></p>Australians are waiting too long for elective surgery, dental care and treatment for mental health. It’s no wonder health is a vote-changer.Stephen Duckett, Director, Health Program, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.