CDA Essentials 2018 • Volume 6 • Issue 1

32 | 2019 | Issue 1 S upporting Y our P ractice A third participant spoke at length about the relation between his dental care and perceived employability. He explained that he had been away from the work force for 8 years because of a disability, but after recovering he was ready to work again. He described his time out of the labour force as a “big strike against” him and his odds of regaining employment as poor. He felt he was going to have to fight hard for a job. Before dental treatment, he doubted he would have had the confidence to do so. However, with treatment, he felt stronger and more confident. As he described it, it was easier for him to feel like he was the right person for the job. “ I’m optimistic now—more than I would have been — to be able to interview properly and give it my best shot.” Although the literature shows a relation between dental appearance and employment, there are still questions about its nature. The experiences of participants in this study highlight some of the complicating factors, including whether individuals with poor dental appearance pursue employment opportunities in the first place, the types of opportunities they seek out and their confidence in these pursuits. Discussion Although limited in terms of number of participants, this study nevertheless yields valuable insights into the social impact of dental treatment that improves individuals’ appearance. The participants spoke eloquently and powerfully about the ways in which their treatment improved their lives. People who felt diminished and stigmatized by their poor oral health were able to overcome these feelings. They experienced a boost in confidence, which manifested itself in a more favourable self-concept, heightened willingness to interact with others, strengthened familial relationships and increased confidence in relation to employment. Given the potential for dental treatment to have such overwhelmingly positive and life-altering effects on people’s lives, the study begs the question of access. This is a question that study participants themselves raised, without solicitation. For all of the participants interviewed, dental treatment was possible only because of a charitable organization that provides free dental care to adults with low incomes. In the absence of this assistance, and in the context of lives where people may be struggling even to house and feed themselves, dental treatment was viewed as “an unaffordable luxury.” An estimated 6 million Canadians avoid dental treatment annually for financial reasons. 11 Although the Canada Health Act has as its goal overcoming barriers that prevent equal access to health care, oral health is excluded from policy. 11 The Canadian Academy of Health Sciences investigated the status of oral health and care in Canada, looking specifically at “vulnerable populations,” including people with low income, elderly people in institutions, refugees, immigrants and those with disabilities. These vulnerable groups tend to have poor oral health, including untreated dental decay, pain and gum diseases. However, because of cost barriers, these populations commonly seek dental care only in emergency cases. 11 The current status of the Canadian oral health care system has been described as exemplifying “the inverse care law” because those who have the greatest need of dental care receive the least amount of treatment. 11 The subjective nature of interview-based research puts inherent limitations on the conclusions that can be drawn from my findings. Because of the logistics of recruitment, the time frame of the research project and the narrow target population of people who have recently gained access to dental care, the sample size in this study is small. This introduces additional limitations to the generalizability of my findings. However, the results of this study complement and reinforce the findings of large-scale, quantitative surveys. Although the self-reporting method does not result in objective findings, it does provide valuable insight into the patient perspective. My results provide a glimpse into how the lives of people whose appearance is affected by the lack of proper dental treatment are impacted in such a far-reaching way. They also show how extensive the benefits of receiving treatment can be and should prompt a more urgent conversation about access to dental health in this country. a More Online Full article and references available at jcda.ca/i4