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3. Access to Dental Care
Update LE POINT SUR
L’ACCES AUX SOINS DENTAIRES |
Committee Recommendations AS AMENDED
That Council:
1. Receive this report for information.
2. Request the Federal Minister of
Health and the Ontario Minister of Health to develop a publicly funded oral
health care strategy that addresses the need for an increased level of publicly
funded dental care to address the needs of all Canadians;
3. Approve
that the report from the City of Ottawa’s Dental Officer of Health entitled “Access
to Dental Care Update” and the report from the City’s Poverty Issues Advisory
Committee entitled “Basic Dental Coverage” accompany the communications of this
motion to the Federal Minister of Health and the Ontario Minister of Health;
4. Approve
that copies be sent to Opposition Party Critics in Parliament and at the
Ontario Legislature, as well as to Ottawa-area Members of Parliament and
Members of the Ontario Legislature; and,
5. Approve
that copies be sent to the Association of Municipalities of Ontario and the
Federation of Canadian Municipalities.
Recommandations MODIFIÉEs du comité
1. reçoive ce rapport à titre informatif.
2. Demande
aux ministres fédéral et ontarien de la Santé d’élaborer une stratégie de soins
de santé buccale financés à même les fonds publics qui tienne compte de la
nécessité d’accroître le financement public des soins dentaires afin de
répondre aux besoins de tous les Canadiens;
3. Accepte
que le rapport du dentiste-hygiéniste de la Ville d’Ottawa intitulé
« Access to Dental Care Update » (Le point sur l’accès aux soins
dentaires) et le rapport du Comité consultatif sur la pauvreté de la Ville
d’Ottawa intitulé « Basic Dental Coverage » (Assurance pour soins
dentaires de base) soient remis aux ministres fédéral et ontarien de la Santé
en même temps que la présente motion;
4. Accepte
que des copies de ces documents soient envoyées aux porte-parole des partis de
l’opposition au Parlement fédéral et à l’Assemblée législative de l’Ontario
ainsi qu’aux députés fédéraux et provinciaux de la région d’Ottawa; et
5. Accepte
que des copies de ces documents soient envoyées à l’Association des
municipalités de l’Ontario et à la Fédération canadienne des municipalités.
Documentation
1. Deputy City Manager's report (Community and
Protective Services) dated 25 June 2008
(ACS2008-CPS-OPH-0009).
2. Extract of Minute, 3 July 2008.
Community and Protective Services Committee
Comité des services communautaires et de protection
Submitted by/Soumis par : Steve Kanellakos, Deputy City Manager/
Directeur municipal adjoint,
Community and Protective
Services/Services communautaires et de protection
Contact Person/Personne ressource : Dr. Aaron Burry, Dental
Officer of Health/
Dentiste-hygiéniste
(613)
580-2424 x, 23666, Aaron.Burry@ottawa.ca
Dr. Isra
Levy, Medical Officer of Health/
Ottawa Public Heath / Santé publique Ottawa
(613)
580-2424 x 23681, Isra.Levy@ottawa.ca
SUBJECT:
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Access to Dental Care Update
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OBJET :
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Le
point sur l’accès aux soins dentaires
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That the Community and Protective Services Committee
receive this report for information.
This report provides information about recent federal funding in the amount of $160,245 received by Ottawa Public Health, for the purchase of new dental clinic equipment. It also provides an update on access to dental care services in Ottawa and the current status of recent provincial announcements.
Earlier this year, Dr. Peter Cooney, Chief Dental Officer, Health Canada announced $3 million dollars in federal funding for Public Health Units in Ontario to purchase dental equipment as part of the Government of Canada’s efforts to support public health agencies in their oral health and dental treatment activities.
The City received a total of
$160,245 toward new dental equipment. This equipment will replace some of the
oldest equipment. The list of new
equipment purchased includes replacement of such items as 30 year old dental
chairs and dental units, older radiographic machines, and provides some new
sterilization equipment and 19 curing lights.
The City is mandated under the Health Protection and Promotion Act, (HPPA) Section 7 to provide public health dental services as outlined in the Ontario Public Health Standards as follows:
In general, access to dental care is through a private system of individual dental practices that is financed by the individual. Since the 1980’s there has been continual growth in the number of Canadians and their families who have dental health benefits as part of their employment. These plans defray a significant part of the cost of dental care. Despite considerable improvements in overall oral health of Canadians, a significant portion of the population continues to suffer from dental disease and has limited access to care. There is currently a patchwork of initiatives and care programs for select groups in need that vary greatly across the country.
Government Roles
Over the past few decades the government role has concentrated on four areas:
1) Water fluoridation in the municipal water supply;
2) Prevention Programs – specific targeted programs for school age children and low-income groups;
3) Treatment Programs – a variety of limited treatment services and benefits for select targeted populations, primarily children on social assistance and families on disability assistance programs;
4) Education/Awareness/Advocacy – Resource development of educational material, teacher in‑service opportunities, Dental Education Week, health fairs, etc.
Municipal and Provincial Roles
At the municipal level the role is as follows:
1)
to
deliver provincially mandated programs and targeted prevention and treatment
programs;
2) to cost-share with the
province on the mandated programs (80% Province of Ontario / 20% City for
Ontario Disability Support Plan (ODSP)/Ontario Works Program (OW) and 75%
Province of Ontario / 25% City for The Children In Need of Treatment (CINOT) Dental Program);
3) to balance the service level between programs;
4) to determine what discretionary care will be provided;
5) to provide specific prevention and education services to high-needs groups.
In Ontario, the Ministry of Community and Social Services and the Ministry of Health Promotion are responsible for dental issues. Mandatory dental programs are available for families on the Ontario Disability Support Plan (ODSP) and for children up to age 18 on the Ontario Works Program (OW). This is a defined benefit program that provides a basic level of coverage at a private dental office with frequency limitations and excludes denture services. Dentists who participate in this plan accept lower fees that are approximately 69% of the customary fee. Ontario Works children under age 18 have a basic dental level coverage provided at either a private dental office or City clinic.
CINOT is a school based dental screening program that identifies children with urgent dental needs up to grade 8. This program provides limited services to identified children with no dental insurance and who financially would be unable to purchase treatment services in the private market. Some preventive services are offered such as fluoride application and pit and fissure sealants to targeted children. In addition to the services mentioned above, municipalities are obligated to provide some coverage for Ontario Works adults. The service level is at the discretion of the municipality and varies across the province of Ontario.
Provincial Announcement
In March 2008, the Ontario
provincial government has announced a commitment to provide $45 million dollars
in annual funding for dental services
to low-income families. Effective
January 2009 the Children In Need of Dental Treatment (CINOT) will be expanded
to include children up to age 18 (previously to 14 years). The province has requested and received
submissions from various groups relating to the remaining $35 million dollars. A plan for Ottawa has been prepared in
partnership with local Community Health Centres (CHC’s) that would target high
risk young children (0-4yrs) and their parents. Discussion with various partners within the dental community such
as Dr Ian McConnachie, past president of the Ontario Dental Association who is
a local pediatric dental specialist has been done regarding interventions that
may be included in this initiative. The
potential scope of services being considered could include assessment,
education, preventive services and referral for dental treatment and would
depend on the level of funding received.
Adults on Ontario Works have no checkups, no cleanings and no ongoing care. This target group of low‑income adults needs more dental care but receives less. Over time, their oral health declines and their needs increase resulting in increased demand for emergency services. The limited range of services provided in the City of Ottawa clinic however, is often higher than found in other municipalities. The three city clinics have emergency walk-in times each morning and afternoon. Their goal is to treat the pain at this appointment. There is no access to advanced procedures. The city is increasingly being asked to assist more low-income residents to access treatment and to provide higher level benefits above the current limited emergency level procedures for adults.
Access to pediatric dental specialists continues to be limited. The number of young children with early childhood caries continues to increase. For young children requiring dental treatment under general anaesthetic, the wait time at CHEO averages 15 months. Due to a change in mandate at the CHEO dental clinic, they will no longer accept referrals for children aged 6 or more unless they have a medical condition. Therefore, we have a growing number of children with urgent dental problems that cannot be treated at a general dentist level who have no access to pediatric dental specialist care. Access to other private pediatric offices is very limited.
In June 2007, Ottawa Public Health (OPH) hosted a meeting of local pediatric dental specialists called “Future Trends in Pediatric Dentistry in the Ottawa Region”. This meeting provided a forum to raise awareness of what is happening across the region relating to access to pediatric dentistry. Following the meeting, OPH developed a one-year pilot project to target young children at high risk. Early childhood caries is a preventable disease and earlier identification, education and treatment with both child and parent could reduce future demands on pediatric level services.
As part of this initiative, two dental hygienists were reassigned to this project. The hygienists provided screening in many community settings such as municipal daycares, family shelters, English as a Second Language classes, St. Mary’s Home, Youville Centre, Learning Earning and Parenting (LEAP) sessions, Minwaashin Lodge, Odawa Native Friendship Centre, Early Years Centres, Community Development Clinics, Health Fairs and worked closely with Carlington Community Health Centre to access their network of families.
In Ottawa, dental services to low-income residents is currently delivered through a combination of private dental offices and Public Health Dental Clinics. The City has three City-run dental clinics that provide access to emergency dental treatment for adults and basic level treatment for children located at 40 Cobourg Street (Le Patro Community Centre), 2525 St. Laurent Boulevard and 1580 Merivale Road. The City also provides a limited denture services program for ODSP and OW adults. See Appendix 1 for details of City of Ottawa dental services.
Dental treatment services were provided 60% at private offices versus 40% at city run clinics in 2007 across all programs. The current plan administration provides both cost effectiveness and plan coordination across various dental plans thereby eliminating duplication. The program also supplies their expertise to others on a cost recovered basis and these services further reduce the actual cost of running the program. Ottawa has been recognized by other agencies as a benchmark for effective and effecient dental service delivery of a publicly funded dental plan and is widely respected as having best practices in place for Ontario and even for Canada.
This model operates using a
series of community partnerships with the private sector, and overall is
designed to ensure that residents have access to dental services that will
provide dental assessment for urgent problems, information and education
related to oral health and to provide the maximum amount of dental treatment
services for the lowest cost. This
approach provides access to service to deal with urgent dental problems such as
pain, swelling, infections and oral trauma. The Public Health Branch, Dental
Services Programs’ expertise in managing dental benefits and in coordinating
patient care is recognized as a strong benefit to the community.
In the area of seniors oral
health, a proposal to provide an oral health assessment and education to
isolated seniors is being submitted to the Champlain Local Health Integrated Network. This project is in partnership with local
CHC’s health services initiative and provides a link between oral health,
isolated seniors and chronic disease prevention.
The City works in partnership with the dental community and has established strong links to deliver and support dental services to low-income residents. The Ottawa Hospital Dental Clinic has been completely renovated and is now a state of the art dental clinic. This was achieved through extensive fundraising within the dental community. The Ottawa Dental Society regularly donates toothbrushes and toothpaste annually to local community events. CHEO Dental Clinic, dental specialists, private dental offices, laboratories, and the Ottawa Orthodontic Society all work together to provide access to care.
Ottawa Public Health will continue to be actively involved in the community to maximize all opportunities to ensure residents benefit from significant initiatives to improve oral health. This report has outlined two examples of federal and provincial funding initiatives. Ottawa Public Health will report back as new information is available.
There was no consultation undertaken in the preparation of this report.
There are no financial implications associated with this report.
Appendix 1 - Ottawa Dental Services: Developed to Ensure Access to Dental Care for Low-Income Residents of Ottawa
Community and Protective Services Department will action any direction received as part of consideration of this report.
Appendix 1
Ottawa Dental Services:
Developed to Ensure Access to Dental Care for Low-Income Residents of Ottawa
The City of Ottawa Dental Services was set up in
1969 as a public health preventive service.
The first dental treatment clinic was added in 1972 and expanded in 1981
to three clinics to provide treatment to social assistance clients. The program downsized in 1996 and in 1997,
the City was asked to manage the Ottawa Children’s Aid Society dental benefit
plan.
In 1997, a pilot project at Island Lodge, Long Term
Care facility provided important insight into the needs and issues in providing
urgent dental services to institutionalized seniors. In 1998, new Ontario social assistance legislation came into
effect and Ontario Disability Support Plan (ODSP) and Ontario Works (OW) programs
came into effect. Part of this implementation
resulted in the Ottawa Public Health Branch, Dental Services Program becoming
the administrator of the OW Dental Benefits Programs for Ottawa.
A dental suite was set up in the new Peter D. Clark
Centre in 2001.
Children under OW can access
care in a private dental office or at a City clinic. Adults are limited to services at the three city clinics. Schools are linked into the clinics for
emergency situations and for action relating to children at risk. Coordination of benefits and care is provided
to seniors in Elizabeth Bruyère Health Centre and St. Vincent Hospital along
with other long-term care facilities.
In 2004, a pilot project to provide medical/dental
preventive services for street kids at the Youth Services Bureau was
implemented and these services continue thanks to a collaborative effort
between the University of Ottawa, School of Medicine and Algonquin College
Dental Hygienist Program.
In 2007, the city dental clinics provided 19,500
visits and operated five days per week.
Denture services were provided to 1,800 patients. The clinics caseload is 75% adults and 25%
children. Due to the rotating nature of
the Ontario Works caseload, over 57,000 individuals were eligible for services
in 2007. As the administrator for the
Ontario Works dental plan the city deals with private dental offices that
accept these plans.
School based dental screening is provided each year
by three dental hygienists who screen approximately 29,000 children. Urgent problems are identified in 7% and of those
4% have no dental insurance and no financial ability to pay for services. Each school screened is rated as high risk,
moderate or low risk depending on the number of kids identified as having
urgent dental needs. Children can also
be screened at any of the three city clinics.
Each year some cases are referred to the Children’s Aid Society for
follow-up action.
Within the public health mandate for oral health
promotion, the city has two dental hygienists dedicated to oral health
issues. Education sessions are offered
to teachers, daycare centres, multicultural parenting groups and various other
targeted high-risk groups. Oral health
resources have been developed and are available in many languages. Articles on dental issues are placed in
community newsletters and magazines.
Promotion and educational activities are provided such as Dental Health
Month activities and participation in community health fairs.
Access to Dental Care Update
LE POINT SUR L’ACCES AUX SOINS DENTAIRES
ACS2008-CPS-OPH-0009 CITY WIDE / À
L'ÉCHELLE DE LA VILLE
Dr. A. Burry, Chief Dental Officer,
spoke to a PowerPoint slide presentation, which served to provide the Committee
with a brief overview of the staff report.
A copy of this presentation is held on file with the office of the City
Clerk. He introduced other staff
members and guests, which have made this program work and so important.
·
Bonnie
Fortin, Dental Program Assistant, Public Health
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Lyne
Lafrance, Dental Hygienist, Public Health
·
Dr.
Harry Ames, Associate Director, Dental Branch, Health Canada
Dr. Ames introduced himself and
spoke further on the PowerPoint presentation.
He stated that one of the top reasons kids wind up in emergency wards is
due to dental disease. There needs to
be a preventive focus that the City of Ottawa is bringing forward. He works at one of the City clinics once a
week and knows the need.
Dr. Burry stated that the City of
Ottawa had received $160,000 of Federal funding for new equipment, which was
greatly appreciated and needed thanks to Dr. Ames.
Councillor Feltmate thanked the
presenters for their report. She
inquired on new legislation that allows hygienists to practice independently
and if this can expand services to low income people.
Dr. Burry stated that hygienists can
have an independent practice and are regulated by a separate college and they
are a regulatory agency rather than partners.
In terms of public health, the City of Ottawa has been ahead of the
curve. In terms of dental hygienists
working independently in long term care facilities; the City was there 10 years
ago. The challenge is that some of the
clients need a higher level of service than can be covered by basic cleaning.
Many are in dire need of dental work.
Councillor Feltmate commented that
we have had that discussion. There are
limited resources, enough for basic treatment, prevention and promotion, but in
terms of the balance of that such as for adults, staff is battling with what
has to be done rather than what could be done.
Dr. Burry said it is the age-old
problem in terms of investment; care needs far outstrips what you’ll get in
terms of prevention dollars.
Councillor Feltmate noted that
studies have shown that it is less costly to do it on a prevention basis
because society will save money in the long-term.
Dr. Burry stated that this is what
Dr. Ames and Health Canada are working on now.
Dr. Ames said that there have not
been a lot of studies that have done that kind of research, but believes that
they we can show that.
Councillor Feltmate stated she would
like to see more assistance for poor adults before they get to be seniors.
Dr. Burry stated that the focus was
on low-income families with children, and to focus on prevention and
education. Now they are working on
medical issues and dental together.
They have spoken with different levels of government about working in
partnership. Work needs to be done with
low-income adults to bring them to a higher level.
Councillor Cullen stated that the
information presented is useful for us and other levels of government. He was
reminded of a presentation made a year ago by Cliff Gazey of the Poverty Issues
Advisory Committee on the need for publicly funded dental care program. At that time the Committee adopted motion to
lobby the Federal Government. He said
that this presentation is a timely issue. We have the opportunity to reaffirm
this with local MP’s, MPP’s, Provincial and Federal Ministers of Health.
Moved by Councillor A. Cullen
That the Community and Protective
Services Committee recommend to Ottawa City Council the following:
WHEREAS Ottawa City Council recently
received a report from its Dental Officer of Health entitled “Access to Dental
Care Update”, indicating the lack of access to appropriate dental care for low
income adults, causing increased demand for emergency services;
AND WHEREAS on February 23, 2007,
Ottawa City Council adopted a recommendation from its Poverty Issues Advisory
Committee to lobby the federal and provincial governments to develop a publicly
funded oral health care strategy that addresses the need for an increased level
of publicly funded dental care to address the needs of all Canadians;
THEREFORE BE IT RESOLVED THAT Ottawa
City Council request the Federal Minister of Health and the Ontario Minister of
Health to develop a publicly funded oral health care strategy that addresses
the need for an increased level of publicly funded dental care to address the
needs of all Canadians;
And be it further resolved THAT the report from the City of
Ottawa’s Dental Officer of Health entitled “Access to Dental Care Update” and
the report from the City’s Poverty Issues Advisory Committee entitled “Basic
Dental Coverage” accompany the communications of this motion to the Federal
Minister of Health and the Ontario Minister of Health;
And be it further resolved THAT copies be sent to Opposition
Party Critics in Parliament and at the Ontario Legislature, as well as to
Ottawa-area Members of Parliament and Members of the Ontario Legislature;
And be it further resolved THAT copies be sent to the
Association of Municipalities of Ontario and the Federation of Canadian
Municipalities.
CARRIED
That the
Community and Protective Services Committee:
1. Receive this report for information.
2. Recommend Council request the Federal Minister
of Health and the Ontario Minister of Health to develop a publicly funded oral
health care strategy that addresses the need for an increased level of publicly
funded dental care to address the needs of all Canadians;
3. That
the report from the City of Ottawa’s Dental Officer of Health entitled “Access
to Dental Care Update” and the report from the City’s Poverty Issues Advisory
Committee entitled “Basic Dental Coverage” accompany the communications of this
motion to the Federal Minister of Health and the Ontario Minister of Health;
4. That
copies be sent to Opposition Party Critics in Parliament and at the Ontario
Legislature, as well as to Ottawa-area Members of Parliament and Members of the
Ontario Legislature; and,
5. That
copies be sent to the Association of Municipalities of Ontario and the
Federation of Canadian Municipalities.
CARRIED as amended