Here’s something to smile about: Canadians’ oral health has improved significantly over the past 40 years, and we rank fifth in the world in terms of access to dental care, according to the Canadian Dental Association.
Still, the same report estimates that more than four million adult working days are lost each year due to dental sick days and dentist appointments, and one per cent of annual emergency room visits are for dental emergencies. Unattended dental issues can lead to serious medical problems such as sepsis, heart attack and stroke, and a third of Canadians don’t have insurance to cover standard care like checkups and cleaning, X-rays, fillings and crowns.
The federal government is hoping to fill the gap with its new $5.3-billion national dental care program for families with a household income of $90,000 or less.
No matter who is paying the bill, dental care is a joint, lifelong responsibility between individuals and their dental care teams, say experts at the University of Alberta.
To cap off Oral Health Month, Folio asked registered dental hygienist and clinical professor Alexandra Sheppard and pediatric dentist and clinical associate professor Ida “Tinka” Kornerup for their top tips on how best to keep our smiles bright.
The ideal time for your child’s first visit to the dentist is before they are even born, Kornerup suggests, because a mother’s health during pregnancy can affect the baby’s teeth later.
“Vitamins are important for the development of teeth, things like folic acid and vitamin A,” says Kornerup, who likes to counsel women when they are considering getting pregnant.
The next visit should be as soon as the baby’s first tooth appears and no later than one year of age. She says many parents mistakenly wait until the child goes to school, but preschool children are actually at greater risk than older kids of developing undetected tooth decay.
In Alberta, dental hygienists visit classrooms to check teeth and teach kids about good dental care, but the time to learn is really before they go to school. “Research shows the best prevention is supervised tooth brushing and flossing,” she advises.
Parents should help their children with these tasks until they are nine or 10 years old, when they have the dexterity to do it themselves.
Watch what (and when) you eat
Kornerup advocates for letting kids indulge on Halloween night. “Let them eat all their Halloween candy in one night, brush their teeth and move on,” she says.
That’s because snacking regularly — especially on sugary foods — can be really bad for your teeth. Sugars cause your saliva to become more acidic for up to 20 minutes after you eat, says Sheppard, who is a board director of the Canadian Dental Hygienists Association.
Bacteria in your mouth use the carbohydrates to produce plaque which, left in place, will eventually lead to tooth decay and gum disease. Rinsing with water or finishing your meal with foods that slow the formation of cavities, like cheese or nuts, can help, but brushing and flossing are the best ways to get rid of that acidity.
Another unexpected source of sugar is liquid medications, whether for children or adults, so it’s important to rinse or brush after taking them as well, warns Kornerup. And don’t ignore sweetened beverages, including protein shakes and energy drinks, which are popular with teenagers. She says the risk of cavities goes up during the teen years, partly because of dietary changes and also because brushing habits may slip then.
“They are rebels at that age,” she says. “They don’t want to brush just because you tell them to. They’d rather listen to whatever their peers tell them to do.”
Know your risk factors
It may seem like dental problems run in families, but genetics aren’t the only contributing factor. Parents can unwittingly transfer bacteria to their children by sharing spoons or putting soothers in their own mouths to “clean” them.
“When you test the oatmeal on your spoon and then give it to junior, you’re recolonizing the bacteria from your mouth to the baby,” Sheppard explains.
Smoking is a high risk factor, as is poorly controlled diabetes. Living in a community with fluoridated water can provide some protection. So does regular use of an antibacterial oral rinse.
Establish lifelong good habits
The best defence against tooth decay, gum disease and bad breath is brushing regularly, including the inside of your cheeks and your tongue, and using dental floss or a water flosser. Sheppard recommends twice a day, morning and night, rather than immediately after meals. Using soft or extra soft bristles prevents damage to the gums and teeth by over-brushing.
“It’s especially important to brush right before you go to sleep because your metabolism is slowing down and there’s not as much salivary flow, so anything that’s stuck in between your teeth is a problem,” she notes.
Sheppard sees reason for hope in the fact that more Canadians are keeping their teeth for longer.
“We have a generation coming up with the baby boomers who have their teeth and implants and have spent a lot of time and money on dental care,” she says. “That’s a more educated population that has a big investment in their teeth.”
This aging population will likely increase demand for specialized dental services such as those provided at the Glenrose Rehabilitation Hospital by collaborative teams of U of A dental hygiene and dentistry students.
“The dental hygiene students provide dental care to people in long-term care who are in wheelchairs or on stretchers,” she says. “It’s just impossible for them to go to a regular dental practice because they don’t have the equipment to lift a patient or have the room to bring in a stretcher.”
See the dentist before it hurts
Eighty-six per cent of Canadians visit the dentist at least once every two years for preventative, diagnostic and restorative care. Dental teams now screen not only for tooth and gum disease, but also for oropharyngeal and other oral cancers.The percentage of children with tooth decay has dropped from 74 per cent to 24 per cent over the past four decades.
Sheppard expects those numbers to improve even more as access to care increases, especially for young people, seniors and people living with disabilities or homelessness. She sees potential benefits from a national dental care program for the overall health of Canadians and for the health-care system.
“We are spending the money anyway, but it’s being spent on physicians providing the care on an emergency basis,” she says.
Both Kornerup and Sheppard say they are proud of the work done at the U of A to provide affordable dental care through programs like the School of Dentistry Oral Health Clinic, which is open to the general public, and the SHINE (Student Health Initiative for the Needs of Edmonton) Dental Clinic, a student-run clinic that provides free dental services to Edmonton’s underserved populations.
“We get to see all those patients who don’t have any other access to care, and those patients are good educational cases for our students, so it’s a great collaboration,” says Kornerup.