Issue
Oral health is a key part of overall well-being and can directly impact a person’s quality of life. The Canadian Dental Association outlines oral health as a state that is linked to a person’s physical and emotional well-being (Canadian Dental Association, 2010). Good oral health means being free of mouth and facial pain, cavities, periodontal disease, and any other negative issues that impact our mouths (World Health Organization). Two of the most common oral health diseases are tooth decay (cavities) and periodontal disease (gum disease). In Canada, 57% of children, 59% of adolescents and 96% of adults have been affected by tooth decay.
Oral health has a direct as well as an indirect impact on a person’s overall health and quality of life. At a community level, complications from poor dental health may also have serious consequences for our healthcare system including unnecessary oral health related trips to our hospital emergency departments further adding to the existing long waits in the emergency rooms. In Ontario, over 60,000 emergency department visits were related to tooth pain. The Ontario medical system spends at least 38 million dollars per year treating oral health problems in emergency departments and physician’s offices. Prevention is critical to good health. Tooth decay and gum diseases are almost always preventable, with preventive oral health services/strategies that should be available to all individuals in our community. In Ontario, the majority of oral health care services are not publicly funded, which means that Ontarians are responsible for the costs of their own dental care. Ontario provides public dental coverage to children of low income families, but there are very few options for adults with low income, including seniors (Wellesley Institute, 2015).
Windsor-Essex County’s Oral Health 2016 report highlighted the oral health profile of our community and also made recommendations to improve the oral health status and access to oral health care in our community. Despite all these efforts, the oral health status of our community continues to remain a public health concern.
Background
Oral health and general health should not be thought of separately; oral health is one important component of overall health (Seto et al.2014). In recent years an increasing amount of research has shown an important link between oral health and overall health. Oral health issues have been linked to respiratory infections, cardiovascular disease, diabetes, as well as a potential link between maternal periodontal disease and babies with low birth weights.
Many of the same social and economic determinants of health (e.g., income, employment, education, access to health services, social support networks) also impact the oral health of people and communities. The World Health Organization states that oral health is an important determinant of the quality of life.
Oral Health Services in Windsor and Essex County:
There a many programs that operate in Windsor-Essex County with the aim of improving oral health, primarily among children. These include programs and services offered in collaboration between public health, school boards, primary care and others. The Windsor-Essex County Health Unit (WECHU) provides clinics in both Leamington and Windsor serving children and youth from 0-17 under the Healthy Smiles Ontario program (HSO). HSO is a government-funded dental program that provides free preventive, routine, and emergency dental services for children and youth 17 years old and under from low-income households. Over the past several years WECHU has seen an increase in the number of individuals requiring treatment as well as an increase in the wait times associated with services. As a result, the WECHU has increased their staffing and clinics with additional funding from the Ministry of Health and Long Term Care in order to address some of the increasing need. The WECHU has also worked closely over the past few years with the dental community and its community partners to increase oral health education including the introduction and implementation of the baby oral health program and fluoride varnish pilot.
Unlike those for children, there are very few publically funded programs available to adults, including seniors, in Ontario. Ontario Works and the Ontario Disability Support Program offer services to some adults, but are limited to very basic dental services (which are at the discretion of the municipality that funds these programs). In Windsor-Essex County there are two options available for adults and seniors who do not have insurance or the resources to pay for dental services (cleanings only). St. Clair College offers full mouth scaling by dental hygiene students. A second program offering dental services (cleanings only) is Street Health, a program of the Windsor Essex Community Health Centre. Operation Smile is an event that is hosted by the Essex County Dental Society, in partnership with the St. Clair College dental clinic. The yearly one-day event is designed to promote oral health in the community and offers basic restorative and surgical services to people that might not otherwise have access to such services.
Oral Health Assessment and Surveillance Reporting in Windsor-Essex:
The Windsor-Essex County Health Unit (WECHU) provides programs and services under the guidance and direction of the Health Promotion and Protection Act (HPPA) and the Ontario Public Health Standards (OPHS). The OPHS include a requirement for the assessment, surveillance and reporting of oral health data including information collected through school based screening conducted in accordance with the Oral Health Protocol. The information collected through school screening includes the number of decayed, missing and filled teeth (DMFT) for each child in JK, SK and grade 2 and is recorded in the Oral Health Information Support System (OHISS). The WECHU began reporting DMFT in OHISS in the school year 2011/2012 and has continued to screen and report since that time.
In keeping with population assessment and surveillance requirements identified in the OPHS and associated protocols, in 2015 the WECHU devised a plan to report oral health data to community stakeholders, the general public, and target populations for the purpose of knowledge exchange, informing healthy public policy and health service planning. This plan included the development of the first Oral Health Report released in 2016 with the intent to update every five years. The 2016 Oral Health Report provided a comprehensive view of the oral health status of residents in Windsor-Essex using the most current data available and accessible by the health unit for the past five years. In the beginning of 2016, Ontario made changes to all provincially funded oral health programs combining them into a newly launched Healthy Smiles Ontario (HSO). Due to the changes in how eligibility is assessed and services are provided under HSO it was determined that reporting data up to 2016 was a natural starting point for the Oral Health survey ensuring the five-year cycle from 2016 to 2021 would represent five years under the new HSO system.
Requests for Oral Health Assessment and Surveillance Data and Response:
In 2013 the City of Windsor council made a decision to discontinue the fluoridation of the water supply. This decision affected the communities of LaSalle, Tecumseh and the City of Windsor. Specifically, the council decision was as follows:
That City Council PASS a by-law DIRECTING the Windsor Utilities Commission to CEASE the fluoridation of the City of Windsor water supply while ensuring continued regulatory compliance, and that the savings from this action BE DIRECTED to oral and health nutrition education in Windsor and Essex County, for a period of 5 years, to be spent at the discretion of the Community Development and Health Commissioner.
At that time the WECHU had agreed to look at its oral health data and that of the community for a period of five years beginning in 2013 and bring back a report on the oral health of the community in 2018. Since this time, the WECHU has continued to collect and analyze its oral health data and has consulted with experts in oral health research to best determine what is able to be reported given the data available and the time frame of collection. The Oral Health Report (2018, update) provides 6 years of school screening data and allows the WECHU to look at overall oral status of the community, compare with Ontario averages and determine the trends for oral health outcomes across Windsor-Essex.
Based on the findings detailed in the Oral Health report (2018 update) the WECHU recommends:
- Windsor-Essex municipalities continue to or introduce community water fluoridation as a key prevention strategy for dental caries
- Continued support for oral health education and awareness in the community
- Improve access to oral health services within Windsor-Essex
- Advocate for improved funding and expansion for public dental programs such as Healthy Smiles Ontario
Amended Motion
Whereas Oral health is an essential part of overall health, and
Whereas the Ontario Public Health Standards require the assessment, surveillance and reporting of Oral Health data to community partners including municipalities, and
Whereas municipalities are in the position to create healthy public policies and bylaws that impact resident’s health and overall wellbeing, and
Whereas the Oral health of residents in Windsor-Essex is much worse than Ontario and comparable communities and continues to worsen, and
Now therefore be it resolved that the Windsor-Essex County Board of Health receive the Oral Health Report (2018) and supports the accompanying recommendations for:
- The City of Windsor to reintroduce fluoridation in the water system.
- The County municipalities to reintroduce fluoridation in the water system.
- Ongoing support for oral health education and awareness in the community.
- Improved access to oral health services within Windsor-Essex.
- Advocacy efforts for improved funding and expansion for public dental programs such as Healthy Smiles Ontario.
FURTHER THAT the Windsor-Essex County Board of Health share the Oral Health Report (2018) and this resolution with municipal and community partners, stakeholders, the general public and identified target groups, and
FURTHER THAT the Windsor-Essex County Board of Health request through delegation to present the Oral Health report, its findings and recommendations at the whole of City of Windsor Council and the County of Essex Council in May/June of 2018, and
FURTHER THAT the Oral Health Report (2018) and this resolution be shared with all other health units in the province of Ontario, the Minister of Health and Long Term Care, the Ontario Dental Association and local members of parliament.