Presenter Disclosure:

Maria van Harten has no potential for

conflict of interest with this presentation

Dr. Maria van Harten

Public Health Dentist

Dental Consultant

Oral Health

and

Lorde, Pen V, Varnish, and Taxes

Lorde

• 16yr old songstress from New Zealand

• Critical of mainstream culture & artists

• Songs referring to teeth:

– Royals

– Team

– White Teeth Teens

Obsession with teeth?

• Clean teeth, white teeth, jewels between

teeth, teeth cut on wedding rings

• Songs refer to class divides

• Oral health just like general health occurs on

a gradient – amplified by non-universal dental

care “system”

Canary in the coalmine

Through CASE MANAGEMENT

Individual FOR HEALTH ISSUES

– Diabetes, obesity, mental illness, substance

dependencies

Through SCHOOL-BASED SCREENING

Community FOR SOCIAL ISSUES

– Immigration, poverty, unemployment

Pen V

DRUGS OF CHOICE

Tooth Pain

– “Throbbing”: OTC ibuprofen max dosage NOT

acetominophen

– “Dull, achy”: OTC acetominophen

Tooth abscess and/or cellulitis PEN V

≤ 12yrs: 25-50mg/kg q6-8h for 7d, max 3g/d

>12yrs: 500mg q6h for 7d

Or Clindamycin 8-25mg/kg in 3-4 doses for 5d (≤ 12yrs), 300mg q12h for 7d (>12yrs)

Focus of infection

Drugs offer temporary relief

Treatment options:

– Fill tooth (restoration)

– Remove tooth (extract)

– Do nothing, endure pain, wait for tooth death;

repeated cellulitis, abscess, drainage

Focus of infection must be removed for resolution!

How did we get here?

– Dental disease is preventable!

– No such thing as “weak teeth” unless hypoplastic

conditions happen during tooth development

Caries prevention

Fluoride varnish

Fluoride varnish

• Applied at primary medical care visits can

reduce decay rates by one-third

• Controlled substance but not controlled act

• Especially for high-risk and generationally

low-income families

– Inexpensive preventive measure to curb future

high costs to publicly funded programs

– Lack of access to care is persistent challenge

Why can’t OHIP reimburse physicians?

Fluoride varnish in London & Middlesex County

• Private dental offices – Majority don’t see children <3yrs of age ? Too late

• Health Unit programs – School-screening begins in kindergarten ? Too late

– PrevOH program ? Can’t access without hardship

– Pilot project with HBHC program ? Voluntary

– Pilot project at high-risk schools ? Buy-in from schools

Why can’t OHIP reimburse physicians?

What does this have to do with taxes?

Canadian Centre for Policy Alternatives’ Putting our money where our mouth is: the future of dental care in Canada (2011).

Public funded share for dental services

$5.67 per person

Canadian Centre for Policy Alternatives’ Putting our money where our mouth is: the future of dental care in Canada (2011).

IntelliHEALTH Ontario (2012).

Referring to Health Unit for dental

• Children & youth 17 years of age and younger who • Have no access to private insurance • Cannot afford dental care

• We may be able to offer no-cost coverage for care • We see eligible children at the 50 King Dental Clinic

for some services

• We see OW adults and parents of HSO children at the 50 King Dental Clinic for cleanings only

Publicly funded care

WHO HAS PUBLIC DENTAL COVERAGE • First Nations people with band card (NIHB) • OW adults (breadth depends on municipality) • OW child-dependents (emergency, preventive, treatment) • Ontario Disability Support Plan recipients • Children and youth whose parents declare financial

hardship • Children and youth whose parents prove AFNI is lower

than threshold income for Healthy Smiles Ontario

WHO DOES NOT HAVE PUBLIC DENTAL COVERAGE • Working adults and seniors • Non-resident low income children and youth

Aug2016

Thanks for your attention

Artwork by

Adriana van Harten