Vulnerable adults may include individuals with low income, low levels of education, the homeless, those who are uninsured/underinsured and seniors.
Good oral health means more than just a nice smile – it is an important part of being healthy. Dental cavities are one of the most common chronic diseases. Cavities can affect our overall health and can cause infection, pain, chewing problems and contributes to poor nutrition, and chronic bad breath. Research shows a connection between poor oral health and diabetes, heart disease, and respiratory disease. Knowing this, it is crucial that vulnerable adults in Ontario are able to access the dental care that they need.
To help understand and confirm the oral health disparities in our region, the Northwestern Health Unit (NWHU) conducted a study about the current oral health needs of vulnerable adults and the barriers associated with accessing dental care services in our area. It was the first study of its kind in Northwestern Ontario and provided great insight into the current state of this population’s oral health. The structure of the study was adapted from a similar oral health study of homeless people in Toronto. NWHU’s study, along with Toronto’s, sourced questions mainly from the oral health component of the Canadian Health Measures Survey (CHMS)1
.How was the survey conducted?
In just over seven days, a convenience sample of individuals took place within Fort Frances, Dryden and Kenora in March and April 2015. The NWHU had hoped to recruit 100 participants and were elated to find out that they had more than tripled their goal, with a total of 337 individuals participating in the study.
NWHU dental staff recruited participants in numerous ways. Staff asked local organizations that serve vulnerable adults to inform clients about the study. Health unit staff put posters up in strategic locations in communities, and asked clients of the health unit to participate. All participants received a dental care package and a $20 Subway gift card for participating in the study.
The study had two parts. First, health unit staff conducted a verbal survey with each participant to collect demographic information and self-reported health information. Next, each participant received a dental examination performed by a World Health Organization (WHO) calibrated dental hygienist. Information from the examination was recorded and a non-identifying photo of the participants’ teeth was taken.Who were the Participants?
Average age of participants was 41.17 years
Ages ranged from 18-86 years
78.9% of participants were unemployed
62.9% of participants earned less than $12,000 per year
56.6% of participants did not have a high school diploma
8.0% of participants had a college or university degreeWhat were the results?43% of the NWHU study’s participants had visited a dentist in the last year.
Making regular visits to a dental professional is one of the recommended steps to maintain good oral health and good overall health. According to the CHMS1
, on average 75%
of Canadians visit a dental professional every year.31% of NWHU study’s participants reported having a toothache in the past month.Toothaches can negatively impact a person’s quality of life. Untreateddental problems can affect sleep, concentration, mood, and
nutrition2. Of those who reported having a toothache, only 35% sought care for it.30% of NWHU study’s participants said they have avoided going to the dentist in the past year due to the cost.
Costs associated with seeing a dentist can include planned dental treatment, fees for previously missed appointments, and/or services not included in their coverage. For many participants, dental-related costs are not a feasible way to spend their very limited budget, as basic needs like food and shelter are usually priorities. Untreated dental conditions can lead to infection and abscesses and in extreme cases can cause severe disability or even death.
25% of the NWHU study’s participants said their oral health was ‘good’.
This is alarmingly low compared to the CHMS1
which indicated that 84%
of Canadians felt their oral health was ‘good’. The connections between poor oral health and certain conditions emphasizes why it is important to maintain good oral health throughout life.After receiving the dental exam from NWHU, only 15% of participants did not require any further dental treatment.
According to the CHMS1
, 66% of their participants did not require further dental treatment post-exam. For NWHU study’s participants who required treatment (84.9%), Table 1 shows the type of treatment needed. Some participants required more than one treatment.Table 1: Type of treatment needed after oral examWhat did we learn?What did we learn?
Similar to the results of the Toronto adult homeless population study, the vulnerable low-income adults in Northwestern Ontario have a much higher degree of dental needs and a lower rate of utilization of dental services when compared to the general Canadian population.
Overall, the majority of the participants had poor oral health, significant oral health treatment needs, and a lack of access to dental care. There are many barriers influencing the high-rate of poor oral health. The results from the NWHU’s study indicates that there is a vast need for expanded adult public dental programs in our communities. Currently there are limited or no affordable dental care options for uninsured low-income adults, seniors, or homeless people. It is hoped that these findings can help improve access to adult dental care in our region.What are the next steps?
The results of the study will be used to support efforts and enhance adult public dental program funding to serve low-income vulnerable adults. The study provides evidence for continued regional and provincial discussion with private and public policy makers regarding the oral health disparities and access to care for low-income vulnerable adults.
The Northwestern Health Unit offers free dental services for children and adults who qualify. Please contact us at 1-855-407-6453 for more information about our programs or results of the study.1 Summary report on the findings of the oral health component of the Canadian Health Measures Survey, 2007-2009. (2010). Ottawa: Health Canada.2 Canadian Academy of Health Sciences. (2014). Improving Access to Oral Health Care for Vulnerable People Living in Canada. Ottawa: Canadian Academy of Health Sciences.