Waiting for Pain

The politics of oral health in British Columbia

The Canadian Dental Association defines oral health as “a state of the oral and related tissues and structures that contribute positively to physical, mental and social well-being and to the enjoyment of life's possibilities, by allowing the individual to speak, eat and socialize unhindered by pain, discomfort or embarrassment.”

What is Oral Health?

What are the most common oral diseases?

Dental caries, also known as tooth decay or cavity A disease where bacterial by-products damage hard tooth structures, causing holes in the teeth. Untreated, caries lead to pain, tooth loss, infection, and, in severe cases, death. Caries are one of the most common diseases in the world.

What are the most common oral diseases?

Gingivitis: irritation of the gums caused by bacterial plaque between gums and the teeth, and calculus (tartar) on the teeth.

Irritation & inflammation causes deep pockets between the teeth and gums and loss of bone around teeth, known as periodontitis.

The loss of bone from periodontitis can cause teeth to become loose and fall out or need to be extracted because of acute infection.

Proper maintenance above and below the gum line to remove plaque and tartar helps remove the cause of inflammation and helps prevent infection & tooth loss.

Ten oral health problems your dentist can see that you can't:

Deterioration in fillings, crowns and other restorations.

Root cavities — decay on roots of teeth exposed by receding gums.

Periodontal pockets caused by gum disease.

New decay under the gum line. Cavities under existing fillings. Hairline tooth fractures. Impacted wisdom teeth. Early signs of gum disease. Early signs of oral cancer. Signs of other problems that could affect

your general health

The Mouth is a Window...Average number of filled or decayed

teeth per adult = 15.8 (out of 28-32 teeth)

Untreated tooth decay averages 20% across class (concentrated in working class)

20 % young adults would benefit from orthodontic treatments

98% of the middle and upper classes have their natural teeth while 25% of those with low income are edentate (have no teeth)

The Mouth is a Window to ClassMany Barriers Exist to Accessing Dental

Care: 63% of Canadians have some private dental

coverage The poor are concentrated in the 37 % that

lack insurance – only 1 in 4 has any insurance versus 3 in 4 in higher income earning brackets

Those without insurance lack funds for dental care

Many workers are unable to take time Majority of services are in English w/o

translation Many dental clinics are inaccessible to the

disabled Lack of transportation and childcare Maintaining good oral health isn’t a

choice – it is a luxury!

The Mouth is a Window to Class In 2005 63.7% of Canadians

consulted a dentist: 12 – 19 years = 78.6% 75 years + = 40.8%

Total dental expenditures in 2006 were almost 10 B with only 5% as public expenditures – the Federal and Provincial programs are completely inadequate or non-existent

The Poor are “Waiting for Pain” Working class people wait until there is

trouble to access dental care, with the result that we’re more likely to suffer: Loss of teeth Chronic infections Chronic pain and all it’s many complications Heart disease Diabetes Stroke Preterm and low birth-weight babies

We Should ALL Smile with Dignity!Poor oral and dental health impacts our: Self-esteem and sense of self-worth Employment Access to education Nutrition and the pleasure of eating Emotional expression Communication and relationships Participation in community activities Quality of life Human dignity

Oral Health is a Human Right!“Just as we cannot separate the jaw

from the body, we cannot separate oral health care from health care. And yet, throughout the year, citizens, policy makers, and governments engage in critical debates about universal health care in Canada, and absolutely ignore oral health.”

Bruce Wallace, VIPIRG Research Coordinator

Dental Access Funds Dental access funds are one way communities

addressed access Administered by a Health Unit, Community

Health Clinic, or charitable organization Has increased access in some communities, and

has encouraged some dentists to offer reduced rates or some pro bono work… however:

Disempowering as charitable, patients must have a referral and / or be means tested to receive funds

Funds available are very small – inadequate to cover all needed treatment

Very few are able to be served this way – long wait lists

Volunteer Charitable Clinics “Mandated to relieve pain with a focus on

extractions” A few clinics offer limited cleanings or restorative

work Majority clinics target the homeless, those

struggling with addictions, and those with mental health issues

Volunteer dental staff – inconsistent care results Charity model which can be very disempowering

for people Hours very limited – patients turned away every

day Oral health MUST INCLUDE PREVENTATIVE

SERVICES! Extractions can negatively impact ability to chew

as well as having cosmetic implications Substandard services for the poor is

fundamentally unjust

Social Enterprise & Subsidized Clinics Offer lower cost dental, 10 – 100% below

standard fee guide Those with insurance fund those who don’t have

insurance Clinics still rely on fee for service from patients Full services available, not just extractions Very limited capacity to meet the need for low

cost dentistry 10-30% reduction of fees is not nearly enough to

make preventative and restorative work affordable for many low income people

Sometimes recommended treatment plans are not ideal b/c dentist knows patient is low income

Very long wait lists to get an appointment unless very urgent

Teaching Clinics Resembles social enterprise clinic – reduced fees

60% BCDA guide fees Offer orthodontics to children assessed to be in

need but still this work is >$1000 (60% reduction from private fees)

Not easy to access as on campus (at UBC) Long wait times at the clinics Students doing the work Some dental hygienist programs offer discounted

cleanings Many of the same disadvantages of the

subsidized clinics, and more… Not anywhere near adequate to meet the needs

in BC!

Universal Dental Care for All!

Access to dental care determined by ability to pay not by need

We are one of few industrialized nations without an oral health strategy

Oral health is completely excluded from our human right to universal health care

We should not accept stop-gap measures! Structural issues undermining

equality in oral health must be addressed!

Include basic dental care services in our BC Medical Services Plan!

We’re tired of Waiting in Pain!

After more than two years of reaching out in the Mount Pleasant community, and many years of doing popular education and participatory action in East Van, the APH is ready to launch a campaign for universal dental care…

1. What demands do we want to make to the Ministry of Health?

2. What slogans and catch phrases can we brainstorm to represent those demands?