2019 • Volume 6 • Issue 7 Providing Care with a Focus on Inclusion People Living with HIV Page 30, 35 PM40064661 Global Public Health The Lancet Oral Health Series P. 22 CDA Secure Send Protecting Patient Data P. 9, 14 Seniors’ Oral Care Resources and Guides P. 29
3 Issue 7 | 2019 | Advertising: All matters pertaining to advertising should be directed to: Peter Greenhough Media Partners Inc. 15 Wade Road, Ancaster, ON L9G 4G1 Display or web advertising: Peter Greenhough pgreenhough@pgmpi.ca • Tel.: 647-955-0060, ext. 101 Classified advertising: John Reid jreid@pgmpi.ca • Tel.: 647-955-0060, ext. 102 CDA Essentials Contact: Rachel Galipeau rgalipeau@cda-adc.ca Call CDA for information and assistance toll-free (Canada) at: 1-800-267-6354 Outside Canada: 613-523-1770 CDA Fax: 613-523-7736 CDA email: reception@cda-adc.ca 2019 • Volume 6 • Issue 7 Director, Knowledge Networks Dr. John P. O’Keefe Managing Editor Sean McNamara Manager, CDA Oasis Chiraz Guessaier, PhD Digital Content Editor, CDA Oasis Kate Palbom Writer/Editor Sierra Bellows Élodie Thomas Coordinator, Publications Rachel Galipeau Coordinator, Electronic Media Ray Heath Graphic Designer Janet Cadeau-Simpson CDA Essentials is published by the Canadian Dental Association in both official languages. Publications Mail Agreement No. 40064661. Return undeliverable Canadian addresses to: Canadian Dental Association at 1815 Alta Vista Drive, Ottawa, ON K1G 3Y6. Postage paid at Ottawa, ON. Notice of change of address should be sent to CDA: reception@cda-adc.ca ISSN 2292-7360 (Print) ISSN 2292-7379 (Online) © Canadian Dental Association 2019 Editorial Disclaimer All statements of opinion and supposed fact are published on the authority of the author who submits them and do not necessarily express the views of the Canadian Dental Association (CDA). Publication of an advertisement does not necessarily imply that CDA agrees with or supports the claims therein. The director reserves the right to edit all copy submitted to CDA Essentials. Furthermore, CDA is not responsible for typographical errors, grammatical errors, misspelled words or syntax that is unclear, or for errors in translations. Sponsored content is produced by Peter Greenhough Media Partners Inc., in consultation with its clients. The CDA Essentials editorial department is not involved in its creation. CDA MISSION STATEMENT The Canadian Dental Association (CDA) is the national voice for dentistry dedicated to the promotion of optimal oral health, an essential component of general health, and to the advancement and leadership of a unified profession. is the official print publication of CDA, providing dialogue between the national association and the dental community. It is dedicated to keeping dentists informed about news, issues and clinically relevant information. @CdnDentalAssoc @JCDATweets @jcdaoasis @CDAOasisLive CanadianDentalAssociation Oasis Discussions CDAADC cda-adc.ca jcdaoasis.ca CDA BOARD OF DIRECTORS President Dr. Alexander Mutchmor President-Elect Dr. James Armstrong Vice-President Dr. Richard Holden Dr. Joel Antel Manitoba Dr. Linda Blakey Newfoundland/Labrador Dr. Heather Carr Nova Scotia Dr. Dana Coles Prince Edward Island Dr.Viktor Dorokhine NWT/Nunavut/Yukon Dr.Tobin Doty Alberta Dr. Mike Prestie Saskatchewan Dr. Lynn Tomkins Ontario Dr. Daniel Violette New Brunswick Dr. Bruce Ward British Columbia
Helping patients aspire to a life without sensitivity starts in your office. Colgate® Sensitive Pro-Relief TM/MC toothpaste can provide instant relief† in your chair, and every day thereafter† †For instant relief, apply directly to the sensitive tooth with fingertip and gently massage for 1 minute. Lasting relief with continued use. Toothpaste also fights cavities. Reference: 1. Nathoo S, Delgado E, Zhang YP, et al. J Clin Dent. 2009;20(Spec Iss):123-130. Clinically proven to provide instant relief†1 Apply toothpaste as directed on pack before procedures Recommend 2X daily brushing, for long-lasting protection Superior sensitivity relief vs conventional sensitive toothpaste with 5% Potassium Nitrate
5 Issue 7 | 2019 | 2019–20_ DENTAL MEETINGS Page 53 2019 DIAC Future of Dentistry Survey Results Page 21 CDA at Work 9 CDA Secure Send Helps Protect Patient Data 11 New Data Show Canada Among Leaders in Dental Care Utilization 14 A Brief History of CDA Secure Send: Secure Transfer of Patient Information 17 ADA FDI World Dental Congress A Snapshot of Global Oral Health News and Events 21 DIAC Future of Dentistry Survey 22 The Lancet Oral Health Series Oral Diseases: A Global Public Health Challenge Q & A with Dr. Paul Allison 27 Food Allergies and Dental Care 29 New Oral Health Care Resources for Seniors and Caregivers CONTENTS CDA Secure Send Helps Protect Patient Data Page 9, 14
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7 Issue 7 | 2019 | Issues and People 30 Access to Care Barriers for People Living with HIV 35 Working at a Dental Clinic Designed to Serve People Living with HIV [article redacted January 2025] 39 Interdisciplinary Collaboration: How Dentists Can Team Up with Social Workers 43 Managing an Employee with an Addiction Problem Supporting Your Practice 47 Veneer Discoloration: Can It Be Avoided? Classifieds 51 Offices and Practices, Positions Available, Advertisers’ Index Obituaries 54 Remembering Dentistry Leaders: Dr. Gordon Nikiforuk CONTENTS Interdisciplinary Collaboration: Teaming Up with Social Workers Page 39 Managing an Employee with an Addiction Problem Page 43 Veneer Discoloration: Can It Be Avoided? Page 47
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9 Issue 7 | 2019 | CDA at Work In Winnipeg, where I live and practise, personal health information data breaches have been in the news lately. Patient information has been stolen out of cars. Medical records related to a research study found on an unencrypted laptop had to be destroyed. Thousands of emergency room records were viewed by a hospital employee who wasn’t supposed to see them. These breaches contravene the Personal Information Protection and Electronic Documents Act (PIPEDA), federal legislation that sets rules for how personal information, including medical and dental records, should be handled. Reading about these events made me aware of the frequency and consequences of data breaches, and I’ve grown more concerned about data security and a data breach. It no longer seems like a matter of “if” but “when.” In Manitoba, our provincial dental association conducts office assessments to confirm that dentists are doing things, such as reprocessing dental instruments, according to provincial standards. But these office assessments also include an evaluation of patient record storage, privacy protocols and policies to adhere to PIPEDA. Dentists need to be just as wellversed in patient data protection as infection prevention and control. In this environment of heightened privacy concerns, dentists also need to think about how to communicate safely with colleagues and patients. There was a time when many dentists used email to send referrals and other private patient information to colleagues. However, email does not meet the current security requirements of the PIPEDA legislation. CDA Secure Send is an online service that was created to help dentists protect patient data (p. 14). It allows dentists to securely transfer referrals, radiographs or other patient information to dentists, specialists, dental office personnel, labs, and even to patients themselves. It’s easy to use and at the same time helps offices comply with federal legislation. The service is free with your membership to your provincial or territorial dental association or affiliate membership with CDA. I’ve been fortunate to attend many dental conventions recently and have met dentists from across Canada. Many of you already use CDA Secure Send and have spoken with me about your experiences using the service. Some worried about how to send a referral to a dental group instead of an individual colleague. There’s a solution for that: you can use CDA Secure Send to send materials to office staff or even the front desk. You can also authorize staff to use CDA Secure Send on behalf of your dental office. A few specialist colleagues were concerned that their practice management software wouldn’t support CDA Secure Send. Luckily, this is a misconception. Office staff can easily log in to CDA Secure Send and send and receive files without any changes to your current computer systems. CDA Secure Send can be accessed by any computer with an Internet connection. Its functionality may be similar to email, but it is privacy compliant and secure. Like all practice support services we offer at CDA, it’s been designed to serve your needs. So please, if you haven’t already done so, sign up for CDA Secure Send and start sending your patient health information securely. Don’t let you or your practice be in the next data breach headline. From the President Alexander (Sandy) Mutchmor, dmd president@cda-adc.ca CDA Secure Send Helps Protect Patient Data
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11 Issue 7 | 2019 | CDA at Work After several years without comprehensive questions related to dentistry, Statistics Canada’s 2018 Canadian Community Health Survey (CCHS) collected rich, meaningful, and high-quality data about the utilization of dental care. When this new data is compared to similar Canadian data from 2014, data about dental care use in other highincome countries, and data about use of other kinds of medical care, an exciting and dynamic picture of the successes of the Canadian dental care system emerges. The new data shows that as many—and even slightly more—people visited dental professionals (74.7%) than medical doctors (74%) in a one-year period. Though medical care has public funding and dental care has mixed public-private (largely private) funding, these statistics suggest that both systems are used by equal numbers of Canadians. These numbers may represent a natural peak—it is uncommon to find a population with higher rates of regular health care use. Before these new statistics were released, the expectation was that the use of dental care would have stayed the same in the past 4 years, because of tepid economic growth and cutbacks to employer-provided insurance, which we have heard about anecdotally. Instead, it has grown substantially. Among Canadians aged 12 and over, 66.5% consulted a dental professional in 2014 and 74.7% did so in 2018.1 This shift represents more than 4 million people. Even with a growing number of dentists, an increase of this size in the number of people using dental care is significant. The demographic of people 65 and over has seen impressive increases in dental care use, from 54.8% to 67.5% in four years. Reasons for these increases are multi-faceted, but one can hypothesize that Baby Boomers have greater resources then previous generations of seniors and spend more on health care; people are having more elective dental treatments; and an increase in the number of dentists may create induced demand—economist-speak for when increasing the supply of a good or service makes people use more of it. From a health systems perspective, this data demonstrates that our oral health system provides high levels of dental care use for a large population base at a relatively low cost to government. As well, our system provides minimal wait times, a high quality of care and desirable outcome measures amongst the top in the world (as demonstrated by indicators in the oral health component reports of the 2007–09 Canadian Health Measures Survey). Costa Papadopoulos CHE, MHA Health Policy, Canadian Dental Association 0 20% 40% 60% 80% 100% 65 years and older 50-64 years 35-49 years 18-34 years 12-17 years Total (12 years and older) Percentage reporting a dental visit in the past year (by age group and sex, population aged 12 and older, Canada, 2018) Males Females Note: Respondents were asked to report the last time they visited a dental professional. A dental professional includes dentist, dental hygienist, denturologist, orthodontist, periodontist, dental surgeon or dental therapist. Source: Canadian Community Health Survey, 2018. NEW DATA SHOW Canada Among Leaders in Dental Care Utilization The views expressed are those of the author and do not necessarily reflect the opinions or official policies of the Canadian Dental Association. cpapadopoulos@ cda-adc.ca
12 | 2019 | Issue 7 CDA at Work No health care system can achieve 100% annual population consultation rates for any service, if that is indeed the goal. There will always be people who will not visit a dentist or a physician in a given year. Cost is one important factor. Some people are afraid. Others don’t feel it’s important enough. Yet others find it too much of a commute or an inconvenience, even if services are free. Access through a universal public health system has its own pitfalls; the 2018 CCHS shows that 15.3% of Canadians aged 12 and over (roughly 4.7 million people) don’t have a regular health care provider or family doctor. Three out of four people visiting a dental health professional annually seems to be an upper limit for utilization in many countries. Germany and Denmark, considered dental care systems to emulate in terms of their usage rates, serve about 80% of their population each year.2 If these latest Canadian numbers included children under 12 years of age in the overall count, Canada may inch closer to an 80% rate. Canada is a leader among OECD countries in dental care utilization, even amongst those that have more publicly funded dental health care, as these statistics demonstrate: • Australia: 47% visited a dentist or dental professional within the last year (2015).3 • US: 35.4% of adults (age 19-64) visited a GP dentist within the last year (2015)4 and 66.2% of dentate adults (age 30 and over) visited a dentist within the last year (2011-2014).5 • UK: 51% of adults visited a dentist in the NHS within the last two years (2017).6 • France: 63.7% of people between 15 and 75 visited a dentist within the last year (2014).7 The Canadian mixed private-public dental health care system that has been built over many decades is working very well. There is opportunity and an ethical obligation to improve access for underserved vulnerable groups, which is an ongoing goal for both government and dental health professionals. But an attempt to transform the dental health care system into a fully public universal system may have negative consequences for millions of Canadians who are currently well-served. Further analysis on this data is needed to understand differences and trends in annual dental care use by various population segments. a Statistics Canada Health Fact Sheets: Dental Care, 2018 available at: www150. statcan.gc.ca/n1/ pub/82-625-x/ 2019001/article/ 00010-eng.htm From a health systems perspective, this data demonstrates that our oral health system provides high levels of dental care use for a large population base at a relatively low cost to government. Sources 1. Data from 2014 from unpublished custom tables from Statistics Canada. 2. Data from Eurostat, a Directorate-General of the European Commission. 3. Data from the 2014–15 National Health Survey by the Australian Institute of Health and Wellness. 4. Data from the Medical Expenditure Panel Survey (MEPS) by the US Department of Health and Human Services. 5. Data from National Health and Nutrition Examination Survey (NHANES) 2011-2014. 6. Data from NHS Digital, Government Statistical Service. 7. Data from Baromètre santé 2014, L’Institut national de prévention et d’éducation pour la santé (INPES).
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14 | 2019 | Issue 7 CDA at Work A Brief History of CDA Secure Send SAFE TRANSFER OF PATIENT INFORMATION In 2017, CDA worked with its corporate member provincial dental associations to launch CDA Secure Send, an easy-to-use and encrypted system that enables dentists to send referrals and other documents containing protected patient data, including radiographs. Since then, electronic referrals and the need to exchange patient data electronically has continued to grow. At the same time, data breaches have become a threat to all health care providers, including dentists. “Most cyber-attacks are not targeted at a person or company but rather to any unprotected device or easy login credentials connected to the Internet,” says Dean Smith, manager of Information Technologies at CDA. “Trends in cyber security paint an unwelcoming picture and the risk to your office will increase over time.” Until recently, email may have seemed to some like an easy way to transfer patient data. But dental offices have legal obligations to protect patient information and data. “Emailing patient data is a practise that should be stopped immediately,” says Smith. Dr. Sandy Mutchmor, CDA president, speaks about Secure Send at wp.me/p2Lv6A-7iu As easy as email. Live support at 1-866-788-1212. Secure and confidential. Share files with dentists, labs, specialists and patients! $ave your bottom line. Free with provincial dental association & affiliate CDA membership. SIGN UP NOW services.cda-adc.ca Dentists protect oral health. protects patient data.
15 Issue 7 | 2019 | CDA at Work 6 CDA Secure Send is not only secure, it’s also an improvement over email in other ways. To minimize privacy risk and maintain system efficiency, messages are deleted automatically 30 days after being sent. Any messages and attachments that dental offices want to keep should be saved to the dental office’s internal record keeping systems. The technical team at CDA have developed the Secure Send service for integration into practice management software so that it’s easy to use. Dental offices across Canada use the service to send secure information to specialists, patients, labs and other external sources. By spring 2019, nearly 8,000 dentists had subscribed to CDA Secure Send. In the month of May, CDA Secure Send delivered 18,000 messages—electronically, securely and efficiently. Myth Busting about CDA Secure Send Myth: A third-party secure email services is a better deal. Reality: CDA Secure Send is free with your provincial or territorial dental association membership. It represents possible cost-saving for your office. Myth: It isn’t as easy to use as email. Reality: CDA Secure Send is actually easier than email because it’s connected to CDA’s directory of dentists and specialists. You can search for other dentists or specialists by name, specialty or location. Myth: I can only use CDA Secure Send to communicate with dentists who also use the service. Reality: You can actually use CDA Secure Send to send a message to anyone with an email address, including your patients. Myth: I’m a specialist so CDA Secure Send won’t be compatible with my software. Reality: CDA Secure Send can be integrated into all kinds of practice management software and can be accessed by any computer with an Internet connection. “Your office staff can easily log in to the website and send and receive files without any changes to the current computer system that your office uses,” says Smith. “Once a message has been downloaded, patient files can be saved into your existing practice management software. This functionality is the same as email, but legally compliant and secure.” Myth: I’m too busy to sign up. Reality: Signing up is as easy as 1-2-3. Go to services.cda-adc.ca. Log in to your CDA account. Subscribe to CDA Secure Send. Myth: If I’m not a computer person, I won’t be able to figure it out. Reality: Help is always available! You can click on the ‘Help’ button or call us at 1-866-788-1212. a Top 6 reasons why dentists, specialists and dental office staff use CDA Secure Send as the preferred method of sending referrals and sharing patient files: ❶ Transmit patient data securely and quickly ➋ Comply with patient privacy laws ❸ Protect against data breaches ➍ Find contacts in the Canadian Dentist Directory or enter any email address manually ➎ Recipients don’t need a CDA Secure Send account to receive files securely ➏ Zero extra costs Your office staff can easily log in to the website and send and receive files without any changes to the current computer system that your office uses. ➜
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17 Issue 7 | 2019 | CDA at Work “With over 30,000 participants from around the world, the ADA FDI World Dental Congress was one of the largest and mostattended joint dental meetings in recent history,” said Dr. Kathryn Kell, FDI president. The FDI Congress consists of a Scientific Program, Trade Show Exhibition, World Oral Health Forum and Parliamentary Meetings. At the latter, over 300 FDI delegates representing national dental associations debate oral health issues that impact global dentistry. Dr. Alexander (Sandy) Mutchmor, CDA president, led the Canadian delegation at this year’s meetings. CDA primarily attends the FDI World Dental Congress for three strategic purposes: to influence international policy statements on oral health, to gather intelligence and information on trends and issues in global oral health, and to build alliances with likeminded national dental associations and other groups. Along those lines, CDA participated in the annual meeting of the Perth Group which brings together representatives from seven countries (Australia, New Zealand, Britain, Japan, South Korea, USA and Canada). The CDA delegation also attended a series of bilateral meetings with the leadership of other like-minded national associations. The Parliamentary Meetings convenes voting delegates from FDI member countries for discussion on official FDI policy statements. Among the policy statements considered this year were Access to Oral Healthcare Among Vulnerable and Underserved, Antibiotic Stewardship in Dentistry, and Infection Prevention and Control in Dental Practice. The final versions of all 2019 policy statements will be available on the FDI website, once finalized. The CDA delegation also participates in the FDI elections for council and committees and the position of FDI President-Elect. This year, Dr. Jack Cottrell, CDA past-president (2005–06) of Port Perry, Ontario, was one of three candidates in the running for this prestigious position. When the voting was completed, Professor Ihsane Ben Yahya of Morocco was elected to the position. “CDA congratulates and thanks Dr. Cottrell for his many years of service to the FDI as a Council Member for 6 years and as Treasurer for two terms,” says Dr. Mutchmor. “Jack has made valuable contributions to enhancing the standing of FDI from a strategic, governance and financial perspective.” ADA FDI World Dental Congress A Snapshot of Global Oral Health The 2019 FDI World Dental Congress took place in San Francisco, California, in September, in conjunction with the American Dental Association (ADA) annual meeting.
18 | 2019 | Issue 7 CDA at Work Oral Health Around the World The FDI Congress is an opportunity to consider how Canada fits into the larger picture of dentistry worldwide and to track how global forces are affecting oral health at home and abroad. Among the work FDI does to promote oral health on a global scale, the organization produces many resources, including FDI Vision 2020. Tooth decay is the most common chronic disease and childhood disease in the world, and it represent a major global public health problem affecting individuals, health systems and economies. Tooth decay is entirely preventable and is caused by exposure to sugar and other risk factors. According to FDI, “Excessive sugars intake causes serious dependence and quitting sugars consumption leads to withdrawal symptoms similar to withdrawal from morphine or nicotine.” Over the past 50 years, worldwide sugar consumption has tripled, and is expected to continue to grow, especially in emerging economies. “Poor oral health remains a major issue in all countries and major inequalities in oral health exist both within and between countries, despite the fact that most oral disease is readily preventable through simple and effective means,” according to FDI Vision 2020. Reasons for these disparities include an unequal geographical distribution of qualified professionals worldwide and within countries, lack of oral health literacy, and the fact that for millions of people dental care is financially out of reach. Oral diseases are the fourth most expensive to treat. In the US, each year US$110 billion is spent on oral health care. In the EU, annual spending on oral health care was estimated at €79 billion in the years 2008–2012, which is more than was spent on cancer care or treating respiratory diseases. There are vulnerable and underserved people in both high-income countries and medium-to-lowincome countries. The direct risk factors for oral disease are the same everywhere: an unhealthy diet, particularly one rich in sugars; tobacco use; harmful alcohol use; and poor oral hygiene. But the socio-economic determinants of oral health are more complicated. In many mid-to-low income countries resources are often put toward urgent rather than chronic health problems and there are very few dental professionals. In highincome counties, often the poor and uninsured have difficulty accessing care, and there is an emphasis on treating rather than preventing oral disease. a The Canadian delegation at the 2019 FDI Congress: (L. to r.) Dr. Alexander (Sandy) Mutchmor, CDA president; Dr. James (Jim) Armstrong, CDA presidentelect; Dr. Michel (Mitch) Taillon, CDA immediate past-president; and Dr. James (Jim) Tennant, former CDA Board of Director, NWT/ Nunavut/Yukon.
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21 Issue 7 | 2019 | News and Events Responses from dentists in 2019 reveal: • For the first time, dentists treated an average of less than 10 patients per day (9.8), compared to an average of 12.4 patients over the last ten years. Ninety seven percent of respondents treated fewer than 15 patients a day (compared to 89% in 2018, 83% in 2017, and an average of 78.6% over the last five years). • A trend towards increasing numbers of dentists per practice continues, with only 34% of practices identifying as sole practitioners. • Practices have more operatories, with 70% having four or more operatories (22% have five or more). Almost one-quarter of respondents plan on adding at least one more operatory in the next two years. • The number of chairside days continues to increase. One-third (35%) of respondents spent 200–249 days chairside, while between 2010 and 2018 an average of 30% spent that amount of time chairside. • There is a continuing trend towards slightly longer times to set up practices, with 20% of respondents setting up their practices in the first year (down from 26% in 2017 and a high of 44% in 2010). However, respondents are not waiting much longer than a year; 60% had set up in 2 to 5 years (up from an average of 50% over the previous 8 surveys). • Respondents said patients ask most often about cosmetic dentistry (the top reply in five of the previous eight years), implants and whitening. • The top challenge that respondents intend to address was “getting more patients/keep busy/less patient visit,” followed by “staffing issues/keeping staff/vacation time/finding associate.” a In total, 454 practising Canadian dentists—with proportional distribution across all regions of the country—responded to the survey. The survey results have an accuracy of +/- 4.6% 19 times out of 20. News DIAC Future of Dentistry Survey Average Number of Patients Treated Per Day Drops Below 10 The number of dentists is growing faster than the populations they serve, which affects many facets of how dentists practise, according to the 23rd Annual Future of Dentistry survey conducted by the Dental Industry Association of Canada (DIAC). 34% sole practitioners 20% set up practices in first year 9.8 patients treated per day (average) 5% <100 days 8% 100-149 days 31% 150-199 days 35% 200-249 days 19% 250 days + 2% No response Dentist chairside days (per year)
22 | 2019 | Issue 7 News and Events Q & A Dr. Paul Allison ORAL DISEASES: A Global Public Health Challenge The Lancet Oral Health Series Key Series Facts: � Richard Watt from University College London (London, UK) and colleagues from ten countries (including Dr. Paul Allison, president of the Canadian Academy of Health Sciences and former dean at McGill University Faculty of Dentistry) detail why oral diseases have persisted globally over the past three decades, despite scientific advancements in the field, and why prevalence has increased in low-income and middle-income countries, and among socially disadvantaged and vulnerable people, no matter where they live. � They show that oral diseases, including tooth decay, gum disease, and oral cancers, affect almost half of the global population, with untreated dental decay the most common non-communicable disease worldwide. Lip and oral cavity cancers are among the top 15 most common cancers in the world. � In addition to lower quality of life, oral diseases have a major economic impact on both individuals and the wider health care system and are the third most expensive condition in the European Union (EU), behind diabetes and cardiovascular diseases. � Despite this substantial burden, oral health has been woefully neglected. The Lancet Oral Health Series calls for radical reform of dental care systems, whose treat-over-prevent model has failed to combat the global challenge of oral diseases. It also calls for greater prominence of oral health on the global health agendas campaigning for non-communicable diseases and universal health coverage. Key Findings: � Untreated tooth decay is the most common non-communicable disease across the globe � Extreme health inequalities exist for the most marginalized and socially excluded groups � The power and influence of Big Sugar The Lancet views itself not just as a medical research journal that publishes findings of medical and health-related research, but also as an agent of change. Part of achieving that change is discussing and disseminating information about the important areas of health and disease and health policy across the globe.
23 Issue 7 | 2019 | News and Events Dr. Paul Allison joined The Lancet’s ten-country team that created this series of articles and he talked with CDA Essentials about the series’ key findings and what he believes should be next for oral health policy in Canada. Q: Why is The Lancet Oral Health Series so important at this time? Dr. Paul Allison (PA): It’s really the system we have to think about. There’s a big debate going on in the world at the moment about universal health care. And the authors of the series strongly believe that dentistry has to be part of universal health care. Dentistry has to stop being siloed out on the side, but rather should be part of mainstream health care. Q: What are the series’ key findings and messages? PA: While much of what we said in the articles is fairly well known in the dental community, it’s not well known in the general medical and health care community. So we were very much speaking to the broader health care/health policy community across the globe with these articles and wanted to make it very clear that dental disease is very common. The epidemiological evidence indicates that dental decay is the most common non-communicable disease on the planet. And that fact, I think, was news to many—certainly to the editorial team at The Lancet and I think it’s also news to many Lancet readers. Q: Do you expect the series to stir debate? PA: We want this to be widely read and to promote debate about how we should move things forward. This is a very complex situation, but I think we really do have to start thinking about how the profession needs to change things, looking at issues like how much influence the sugar industry has on the dental industry writ large across the globe. For instance, are there conflict of interest issues that we can change, to make sure that we’re explicit on how we’re dealing with the sugar industry. Credit: The Lancet
24 | 2019 | Issue 7 News and Events Q: What is the impact of globally pervasive oral health disease? PA: The burden of oral disease is considerable in terms of the prevalence of the conditions, but also in terms of the burden of pain, sepsis and infection, and costs. We presented a figure which used data from the EU where they compared the costs related to different disease groups across 28 countries in Europe in 2015. The costs for dental care was third in that list behind diabetes and cardiovascular disease, but ahead of cancer and mental illnesses. Clearly the cost is enormous. When you consider the indirect cost of things like days off work and school, the burden is extremely significant. In Western and developed countries like Canada, there are significant inequalities with the burden of disease being felt far more strongly in the poorer parts of society. Richer parts of society have a low level of decay or gum disease or other oral conditions. The message we wanted to get through to the readers of The Lancet was that the causes of these conditions are just the same as all the other conditions people are dealing with. In other words, it’s free sugars consumption, it’s smoking, it’s tobacco, it’s excess alcohol consumption. Q: Can you talk about how industry is having an impact on oral health around the world? PA: In this series, we wanted to highlight the commercial determinants of health and in particular with the tobacco and sugar industry, and how they have a very strong influence. The series data shows that Coca-Cola is going to invest almost $12 billion in Africa to market its products. For comparison, the entire budget of the World Health Organization for one year is $4.4 billion. These companies are extremely powerful and are involved with a range of organizations, including dental research organizations. This can result in far less research being done on the consumption of sugar and how we can reduce sugar consumption, which of course is something they don’t wish to investigate. Q: Is the dental health care system in Canada and globally prepared to manage the burden of oral health disease? PA: At the moment, with this mega-burden of disease and dental care as it is provided in the world and predominantly in developed countries, we are not going to be able to deal with dental disease. Current models have yet to reduce the burden of disease in developed countries and so, it certainly won’t be able to do so in developing ones. Even in the richer countries like Canada, we won’t be able to deal with the burden due to our larger problems of inequality. Q: What systematic and policy changes does this series recommend? PA: This is a very complex situation. It’s not easy, but I think we really have to start thinking about how we need to change things, working and looking at things like how the sugar industry influences the dental industry across the globe. I think we can also look at how we’re training our students in our dental schools. Globally speaking, the training of dental students has not changed fundamentally for decades. Most training still focuses on treating periodontal disease and dental caries once they’ve occurred. We need to be training students to focus more of their activities upstream to help prevent disease in individuals, families, communities and populations Q: In your opinion, how can changes be made in the Canadian dental health care systems? PA: I truly believe that we need to start looking at more upstream approaches, meaning population-based approaches and reducing sugar consumption. This goes beyond continuing to treat people. Many of your readers have heard me talk about the fact that we need to re-examine the essentially private dental care system in Canada. In this country, 95% of dental care is provided through the private sector. That sector is very good for Canadians who can access care at dental offices, but it’s not good for the approximately 25% people who cannot. We need to take a strong look at how we can begin to bring some dental care into Canada’s public health care system and make it cheaper for the people who are the patients after all, it is those with the highest levels of disease who have the greatest barriers to dental care. Q: Where can our readers find more information about The Lancet Oral Health Series? PA: The series is open access. Your readers can find all of the articles at thelancet.com/series/oral-health a Listen to the full interview with Dr. Allison on CDA Oasis wp.me/p2Lv6A-78i
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27 Issue 7 | 2019 | News and Events After the story of a young girl with a severe dairy allergy who died after using a toothpaste recommended by her dentist appeared in the Royal College of Dental Surgeon’s of Ontario (RCDSO) Dispatch News1, oral health professionals were reminded of the risks of lethal food allergies. Although extremely rare, the girl’s anaphylactic reaction to MI Toothpaste, was caused by RecaldentTM (casein phosphopeptide-amorphous calcium phosphate), an ingredient in MI toothpaste that incorporates a milk-derived protein. Food Allergies and Dental Care What dentists need to know about food allergies Food allergies reported by your patients can have implications during dental treatment. For example, patients with allergies to certain foods, such as avocado, kiwi, pineapple, and banana—foods known to contain the same proteins found in latex—can increase a patient’s risk of being allergic to latex. Dental products such as fluoride, prophy pastes, sealant materials and even gum may also contain allergens including fruit flavouring, pine nuts, traces of peanuts, clove oil, gluten, and milk protein. This story heightened awareness of the dangerous consequences of food allergies and their link to dental care. In response, the RCDSO released information about food allergies and their link to dental treatment to help dentists obtain a thorough medical history and to cautiously consider each of their patient’s positive answers about allergies, medications and existing medical conditions. Managing allergies in your practice • Carefully review medical history with your patients to identify any potential allergic or adverse reaction to foods in addition to allergies to medications, substances, or products. Thoroughly review and probe further when patients provide an affirmative (allergic) or unclear response to establish the history, type, and severity of any reported allergic reaction. • Review the contents and/or ingredients of dental materials and products used and identify potential allergens associated with a patient’s reported allergy. If necessary, postpone treatment and consult with the patient’s physician to request an allergy test. • Ensure allergies, precautions, and medical alerts are clearly indicated in the patient’s chart along with up-to-date progress notes. Train your clinical staff to recognize the sign and symptoms of anaphylaxis and how to respond to a medical emergency. • Maintain an adequate and current emergency kit containing readily accessible sources of oxygen, diphenhydramine and epinephrine. a Reference 1. Royal College of Dental Surgeon’s of Ontario. Food Allergies: Their Relevance to Dental Care. Available: rcdso.org/en-ca/rcdso-members/dispatch-magazine/articles/5141 Related Resources rcdso.org ‘Medical History Recordkeeping Guide’ and other food allergy resources cda-adc.ca/en/services/ essentials/2016/ issue6/#27 CDA Essentials article “Managing Medical Emergencies: Anaphylaxis”
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29 Issue 7 | 2019 | News and Events New Oral Health Care Resources for Seniors and Caregivers The Ontario Dental Association (ODA) has developed several oral health care brochures and guides for seniors and their caregivers, including those who work with residents of long-term care (LTC) facilities. Canadians are living longer, healthier lives, and seniors are a rapidly growing demographic. There are oral health challenges specific to seniors such as decreased daily oral care routines, limited access to professional care, and medications that affect oral health. “Our seniors entering care now are different from seniors of previous generations,” says Dr. Janet Leith of Nepean, Ontario, chair of ODA’s Health Policy and Government Relations advisory committee. “Gone are the days when seniors largely had full dentures, rendering mouth care very simple. These days, seniors will often have a full or at least partial dentition that can include advanced dentistry such as dental implants, fixed bridges and partial dentures. They require more advanced mouth care that involves some special skills and tools.” Research shows links between oral disease and other health problems, particularly respiratory illness in older adults. It also shows many health, social and psychological rewards to making good oral health part of the aging process. “The most critical information provided in these resources is that oral health has a critical impact on overall health,” says Dr. Leith. “Developing infections or complicated oral health issues when a senior is in long-term care or declining health can often be difficult to manage.” ODA’s brochures and guides offer instructions for, and explain the significant benefits of, senior oral care in an accessible format. The guide for personal support workers in LTC facilities provides step-by-step directions for oral health routines illustrated with photographs of techniques, tools, and oral health problems that may require intervention from a dentist. “It will be necessary to rethink existing oral care programs within overall nursing plans,” says Dr. Leith. “Education and planning will be critical to maintain our seniors’ oral health as part of their overall health.” Access these resources at oda.ca/seniors97/ tips-for-caregivers The resources include: Brochures • Oral Health Care for Older Adults • Caring for Dentures: Tips for Seniors and Caregivers • Oral Inspection Tips for Caregivers • Caring for Natural Teeth: Tips for Seniors and Caregivers Webinars • Part 1: Importance of Good Oral Health • Part 2: Daily Mouth Care Personal Support Workers’ Guide • Seniors’ Oral Care: Providing Oral Hygiene Care to Residents of Ontario Long-Term Care Homes: A Guide for Personal Support Workers These materials were produced with the help of external partners, including the British Columbia Dental Association (BCDA) who created the original brochures and webinars and allowed the ODA to adapt them. a
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