We have, in Canada, created a wonderful health-care system (warts and all). But it is, to quote Minister of State for Public Health Carolyn Bennett, a "health-care system where the mouth is not considered a part of the body."
In our predominantly publicly funded and publicly delivered health system, oral health is in a strange world where virtually all dental care is privately delivered and privately funded (principally through employer-sponsored dental benefits.)
According to Statistics Canada, about 63 per cent of Canadians over the age of 12 have had "contact with a dental professional in the past 12 months." But a closer examination of that number provides a sobering look at the disparities that would exist in our health system without medicare.
Access to dental care varies widely between urban and rural areas, and between have and have-not provinces -- only 44 per cent of residents of Newfoundland and Labrador have been to the dentist in the past year, compared to 67 per cent of Ontarians.
But the biggest gulf is between the insured and the uninsured. According to the Canadian Dental Association, about two-thirds of Canadians have private dental benefits. Among those with dental insurance, 72 per cent have been to the dentist in the past year, and only 7.3 per cent have not been for five years.
Among the uninsured, however, only 47 per cent have had dental care in the past 12 months, while 17 per cent have gone more than five years without visiting a dentist, and 3.3 per cent have never been to a dentist.
Why does that matter?
Oral diseases, ranging from low-grade gum disease such as gingivitis to oral cancers, can have a significant impact on daily functioning and quality of life. Once thought of as merely nuisances, dental problems are now being taken seriously by health researchers.
Evidence is mounting that the health of our teeth and gums is a bellwether for the rest of the body.
Cavities are, after all, the result of bacterial infection. (In fact, after the common cold, cavities are the world's most-common infection, affecting more than five billion people.)
There are more than 600 species of organisms in the human mouth -- bacteria, viruses, funguses and protozoa. Bacteria that multiply in the presence of sugar cause cavities. Others use the mouth as an easy point of access and a breeding ground before heading off to wreak havoc elsewhere in the body.
This has a lot of serious scientists wondering aloud if treating seemingly routine gum disease and tooth decay can prevent heart disease, diabetes, lung disease, premature births and some forms of cancer.
While this may seem far-fetched on the surface, there is growing evidence this could be the case. The common link is inflammation.
Gum disease is a low-grade infection that causes swelling and bleeding of the gums. Fighting off bacteria and viruses elsewhere in the body provokes the same kind of immune response and this inflammation, particularly in places like the arteries, can have serious consequences, such as exacerbating the symptoms of heart disease or diabetes.
The research in this area is fascinating.
It shows that people with gum disease are far more likely to have heart attacks and strokes. Pregnant women with gum disease are far more likely to have premature and low-birth-weight babies. Diabetics with poor oral health have more symptoms. And some scientists think rotten teeth may even be a factor in cancers; after all, the bacterium H. pylori, which causes ulcers, is a key factor in stomach cancer.
What has not been demonstrated is cause and effect. But there is definitely an association. Maybe people who don't brush or floss have poor dietary habits as well, and that is the reason for their higher rates of these other diseases. They are certainly poorer, and the link between poverty and chronic diseases is well-established.
Regardless, good oral health is clearly not strictly an issue of vanity. There are potentially important public-health implications that could be derived from better dental care. Healthy habits could ultimately prove to be cheap and effective prevention measures for a host of serious chronic diseases.
We should also view regular dental visits as a routine part of good health, particularly for children. A thorough oral exam can reveal nutritional deficiencies, microbial infections, immune disorders, injuries and oral cancers.
Regular preventive visits to the dentist should not be viewed as a luxury, but as a means of improving overall health and reducing long-term health-care costs.
We can't continue to treat the mouth like it is not part of the body. Routine dental care should be an integral part of our medicare system. As a society, we cannot afford to have one-third of the population uninsured for such an important medical service.