Author: hadi0023

Lack of Funds, Hurts Your Gums!

Figure 1: Senior Citizen and Care Provider (Sunnybrook Foundation, n.d.)

Today we’re going to be discussing the lack of funding for oral care in dependant seniors. Seniors in Canada are a population that are increasing at a rapid rate making up for a large portion of our total population, “In 2014, over 6 million Canadians were aged 65 or older, representing 15.6 percent of Canada’s population. By 2030—in less than two decades—seniors will number over 9.5 million and make up 23 percent of Canadians” (Social Development Canada, 2019, p.1). Seniors make up such a significant part of our population and given the many risk factors and obstacles present regarding oral health in this population, regular oral health care is vital. Some of the obstacles that this population faces include:

·      Anxiety and fear of new situations or procedures may affect willingness to seek dental care (Marvin, 2001, p.1).

·      Compromised immune systems (Darby & Walsh, 2014, p.263).

·      Decreased cognitive ability, medications and limited ability to tolerate procedures may reduce the desire for care (Marvin, 2001, p.1).

·      Decreased salivary flow (often a side effect of many common medications) (Darby & Walsh, 2014, p.263).

·      Dietary habits (Darby & Walsh, 2014, p.263).

·      Existing esthetic factors, including missing teeth, may contribute to a reluctance to go out in public (Marvin, 2001, p.1).

·      Gingival recession (Darby & Walsh, 2014, p.263).

·      Knowledge deficit (Darby & Walsh, 2014, p.263).

·      Socioeconomic status (Darby & Walsh, 2014, p.263).

·      Lack of funding (Darby & Walsh, 2014, p.263).

·      Lack of water fluoridation the early years of life resulting in higher predisposition to cavities (CDC, 2016).

·      Limited dexterity resulting in insufficient oral hygiene technique and plaque removal (Darby & Walsh, 2014, p.263).

·      Poor overall health can restrict access to care (Marvin, 2001, p.1).

·      Seniors may be unable or unwilling to be transported off-site to a treatment centre (Marvin, 2001, p.1).

For several of the reasons listed above, the need for regular dental visits in this population is crucial. “Unfortunately, Canada also has one of the lowest rates of publicly funded dental care in the world, and since almost all dental care is funded privately through employer-based insurance (or out of pocket), non-coverage becomes an issue as people age and retire” (Fowler, 2019, p.1). For many in this population oral care is no longer a service they can afford. Often retired seniors are no longer receiving nearly as much of an income, if they are even lucky enough to be receiving a pension. Along with a reduced income, seniors that did have dental insurance during their working years are no longer covered. With the reduced income they now having to survive off of sadly oral health care often doesn’t make the cut despite the need for it. Arlene Henderson, a low-income senior resident, reports losing several teeth and now requiring major dental “I had to have some dental work done, but I can’t get it done because it’s too expensive,” (CBC, 2018, p.1). Unfortunately, Arlene’s situation is far more common than we would like to think, her $1,000 monthly income makes it difficult to afford basic human needs let alone additional dental care that will only get worse the longer it goes untreated (CBC, 2018, p.1).

When looking at dental care for the population of Ontario as a whole, there are several government funded programs allocated to other populations such as Healthy Smiles for children or ODSP Adult (Ontario Disability Support Program). “The Healthy Smiles Program is an Ontario government-funded basic dental program providing preventive and early treatment services for children and youth in low income families, who are 17 years of age or under.  If eligible, your children will get regular dental services at no cost to you” (Health n’ Smiles, n.d., p.1).

All of the above leads us to the question, when will dependant seniors receive the funding they need? Thankfully due to the support and advocacy on behalf of this population it looks like change is on the horizon. On Tuesday, April 23, 2019

Ontario announced “it will be investing $90 million in dental care for seniors 65 and over. If you’re a senior earning less than $19,300 per year or a couple earning a combined income of $32,300 or less without dental benefits, you will qualify for the Ontario Seniors Dental Care Program” (Settlement Ontario, 2019, p.1). What exactly this program will cover is still yet to be confirmed, however we’re beyond excited to see a step in the right direction.

MH

References

CBC News. (2018, May). ‘I just can’t afford it’: Low-income seniors struggle to find dental care, face 2-year wait for city clinics | CBC News. Retrieved from https://www.cbc.ca/news/canada/toronto/lowincome-seniors-dental-care-toronto-1.4657320

CDC. (2016, October). Community Water Fluoridation | Division of Oral Health | CDC. Retrieved from https://www.cdc.gov/fluoridation/index.html

Darby, & Walsh (2014). Dental Hygiene: Theory and Practice 4th Edition. St. Louis: Elsevier Canada. Retrieved from https://reader.texidium.com/dist/#/book/5523

Fowler, K. (2019, March). Senior Dental Care in Canada. Retrieved from https://www.aplaceformom.com/blog/senior-dental-care-in-canada/

Government of Ontario. (2019, April). Backgrounder Putting Seniors and Their Families First. Retrieved from http://budget.ontario.ca/2019/bg-seniors.html

Health n’ Smiles. (n.d.). Healthy Smiles Ontario (HSO). Retrieved from https://www.healthnsmiles.ca/programs-and-services/programs/healthy-smiles-ontario.html

Jones, A. (2019, April). Free dental care for low-income seniors to be announced in Ontario budget. Retrieved from https://globalnews.ca/news/5146021/dental-low-income-seniors-budget/

Marvin, M. (2001). Access to Care For Seniors — Dental Concerns. Journal of the Canadian Dental Association, 67(9), 504-506. Retrieved from https://www.cda-adc.ca/jcda/vol-67/issue-9/504.html.

Settlement Ontario. (2019, April). Ontario is Investing in Dental Care for Low-Income Seniors. Retrieved from https://settlement.org/news/ontario/ontario-is-investing-in-dental-care-for-low-income-seniors/

Sunnybrook Foundation. (n.d.). [Senior Citizen and Care Provider]. Retrieved from https://sunnybrook.ca/foundation/media/item.asp?c=3&i=1767&f=peter-cipriano-centre-for-seniors-health

Social Development Canada. (2019, March). Government of Canada – Action for Seniors report. Retrieved from https://www.canada.ca/en/employment-social-development/programs/seniors-action-report.html

Root Caries: Let’s Get to the Root of This Problem

Figure 1: Root Caries. (Bird, Robinson, 2015).

Today I’ll be talking about a large concern for oral health in the population of dependant seniors, root caries (caries is another word for cavities). First and foremost, what are root caries? According to Darby & Walsh “Root caries is dental caries involving the tooth root, cementum, or cervical area of the tooth. Root caries is found most frequently in the elderly population, in whom root exposure is common because of gingival recession” (Darby & Walsh, 2014, p.263)

To better understand the significance of root caries/cavities you need the basic knowledge of what a cavity is and how they form.  A cavity forms on a susceptible tooth when there are cavity causing bacteria called cariogenic bacteria present. The bacteria consumes carbohydrates from your diet and create acid. These acids as a result wear away and weaken the tooth creating a cavity (Darby & Walsh, 2014, p.261). Caries are a bacterial infection where the bacteria slowly wears away at the tooth structure and starting from the outermost layer called enamel into the second layer called dentin and eventually into pulp chamber if not treated in time (Darby & Walsh, 2014, p.261). Once the cavity progresses into the dentin some sensitivity to hot, cold or sweets may be felt (Darby & Walsh, 2014, p.267). If the cavity progresses to the pulp chamber pain may be experienced because this is where the nerves of the tooth are found (Darby & Walsh, 2014, p.267). Unfortunately, this disease is only reversible at the very first stage of progression and without regular dental visits for seniors the opportunity to stop the disease from progressing often gets missed.

The signs and symptoms of a cavity greatly depend on the location and extent of cavity progression. In the beginning stages of cavity formation symptoms may go unnoticed however as it further progresses some sign and symptoms may include:

  • Toothache, spontaneous pain or pain that occurs without any apparent cause (Mayo Clinic, 2017).
  • Tooth sensitivity (to hot or cold) (Mayo Clinic, 2017).
  • Mild to sharp pain when eating or drinking something sweet (Mayo Clinic, 2017).
  • Visible holes or pits in your teeth (Mayo Clinic, 2017).
  • Brown, black or white staining on any surface of a tooth (Mayo Clinic, 2017).
  • Pain when you bite down (Mayo Clinic, 2017).

You might be wondering to yourself why are root caries such a predominate issue in the dependant senior population? You may be surprised by many of the factors that make this population so at risk. Dependant seniors are particularly a high risk population for root caries due to several reasons including more frequent root exposure as a result of gingival recession, decreased salivary flow which is often a side effect of many common medications, compromised immune systems, dietary habits, knowledge deficit, socioeconomic status, lack of regular dental visits/funding, and limited dexterity resulting in inefficient oral hygiene technique and plaque removal (Darby & Walsh, 2014, p.263). One of the largest factors to take into consideration is that the current population of dependant seniors did not fully experience the benefits of water fluoridation “one of the 10 great public health achievements of the 20th century” (CDC, 2016) as it only began in 1945 and has been attributed to a 25% decrease in cavities in both children and adults. (CDC, 2016).

Unfortunately tooth structure cannot restore itself so it is important for us to try to preserve the tooth structure to the best of our ability and focus on a preventative approach. Root caries can be prevented through regular oral hygiene home care (proper brushing and flossing), regular dental visits, fluoridated water/products/treatments, avoiding frequent snacking (minimizing acid attacks), consuming a non-cariogenic diet and using antibacterial treatments such as mouth rinses (Darby & Walsh, 2014). It is important for us to preserve tooth structure for several reasons including aesthetic purposes which are often linked with self-esteem, freedom from pain that may arise with the progression of the cavity, saving time as practicing proper oral hygiene care daily can prevent the need for treatment of cavities and cost – preventative care such as regular oral hygiene practice can alleviate the need for restorative treatment.

Once the cavity has progressed past the initial stage, known as an incipient lesion, it becomes irreversible. The treatment for caries is having the dentist remove the decayed portion of the tooth and restore the void area with restorative dental material, most commonly known as a filling. The filling may be made of the following materials:

  • Gold (Darby & Walsh, 2014, p.671)
  • Porcelain (Darby & Walsh, 2014, p.671)
  • Silver (Darby & Walsh, 2014, p.671)
  • Amalgam (Darby & Walsh, 2014, p.671)
  • Composites Resin fillings (Darby & Walsh, 2014, p.671)
  • Glass ionomer (Darby & Walsh, 2014, p.671)

Another factor to take into consideration is the financial burden that comes along with restorative dental treatments. Regrettably, often dependant seniors do not have the means, funding or access to the dental care they may require and quite frankly it often is not a priority despite the many implications that arise as a result of cavities.

A few steps that can be taken by family members and nursing staff are: reminding seniors to practice proper oral hygiene care, providing seniors with the proper oral hygiene aids (taking manual dexterity and physical limitations into consideration), helping them perform oral hygiene, providing them with transportation to dental appointments and getting educated to know what to signs and symptoms to look for and when booking an appointment to the dentist is necessary.

MH

REFERENCES

CDC. (2016, October 4). Community Water Fluoridation | Division of Oral Health | CDC. Retrieved from https://www.cdc.gov/fluoridation/index.html

Darby, & Walsh (2014). Dental Hygiene: Theory and Practice 4th Edition. St. Louis: Elsevier Canada

Mayo Clinic. (2017, July 19). Cavities/tooth decay. Retrieved from https://www.mayoclinic.org/diseases-conditions/cavities/symptoms-causes/syc-20352892

Rabb-Waytowich, D. (2009). Water Fluoridation in Canada: Past and Present. JCDA, 75(6), 451-454. Retrieved from https://www.cda-adc.ca/jcda/vol-75/issue-6/451.pdf.