29
Volume1 Issue3
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I
ssues and
P
eople
CDA:
What are the someof thebig issues thatdentistsandphysicians shouldbeawareof
with regard to seniors’ oral health?
Dr.MichaelMacEntee:
Oral healthmatters toeveryone. Todentists, it soundsabit trite;
of courseweknow that itmatters,we spendour livesdealingwith it. But it’snot as clear to
otherpeoplehow itmatters. There’sbeena lotof effort in recent years, for example, topin
downa specificmicroorganism in themouth thatmight contribute toheartdiseaseor low
birth rates.However the searchhasnotbeen successful, and I don’t thinkwe’regoing tofinda
simpleassociation.
Butwecould tryharder toget thepoint across that adirtymouth, likean infected toeor a skin
infection, canhaveaprofoundeffectonhealth,well-beingand longevity. Theevidence for this
is clear.Dentistry shouldbe recognized for its contribution togeneral health—but togain this,
I believewemust changeourwaysofpractise.
CDA:
Howdoyou think thedental professionneeds tochange?
MM:
Byand large,wearevery technicallyoriented, probablymuchmore than isnecessary
forbiological andpsychological success.Moreover,weare focusedmostlyon theneedsof the
moreaffluent segmentsof thepopulation, andgivemuch lessattention toother segments
withessential andpotentiallyvery troublingneeds.Whenpatients showup inemergency
departmentswith severe toothachesand facial swellings, I believewehave failedour social
responsibilitiesasaprofession.
CDA:
Howcan the focusbe shifted towards thosewithessential dental needs?
MM:
Bymakingdentistrymoreaccessible;making itmoreaffordable; by takingamoremini-
mally invasiveapproach todentistry.Wecan, for example, reduce thecomplexityof the treat-
mentsweprovideby recognizing thatnot all teethneed tobe replaced. Peopleneed front
teeth to feel normal and function socially, but theydon’tneedall of theirback teeth to survive
nutritionally. There is lotsof evidence that simplificationcan satisfymostpatients’ needs in
away that isbothaffordableand sustainable, evenwhen theygrow frail anddependenton
others for theirdailyhygiene.
Unfortunately, inmyopinion,wehavedevelopedverycomplicatedways to service theneeds
ofpeoplewhoareprobably in leastneedof our services. For instance, theway inwhichweuse
implants todaywithout regard for long-termmanagement isparticularly irresponsible inour
agingpopulation. TheCHMS shows clearly tome thatwe fail thepeoplewhoare inmostneed
of our care—peoplewithoutdental insurance, peoplewhoare severelydisabled, andpeople
whoneedall thehelp theycanget to retain theirpersonal dignity.
Dr.MichaelMacEntee
is a professor in the division of prosthodontics anddental geriatrics
of the department of oral health sciences at theUniversity ofBritishColumbia.He is also the editor
ofGerodontology, a journal that aims to “improve the quality of life and oral health of older people.”
This edition ofCDAEssentials includes the final installment of his 3-part jcda.ca series on inequity in
oral health care for elderlyCanadians, co-authoredwithDr.ChaoShuYao.
CDAConversations:
DR.MICHAELMacENTEE
MichaelMacEntee
