SGEM Xtra: See A Dentist – Because I’m an Emergency Physician

Date: October 9th, 2019 Guest Skeptic: Dr. Hasan Sheikh is an emergency and addictions physician in downtown Toronto and a graduate student studying public policy at the Harvard Kennedy School of Government. This is an SGEM Xtra and the result of Dr. Sheikh's recent Canadian Association of Emergency Physicians (CAEP) Position Statement on Dental Care in Canada. It calls for the expansion of publicly funded and publicly delivered dental care in Canada. The Canadian Association of Emergency Physicians believes that every Canadian should have affordable, timely, and equitable access to dental care. You can down load a PDF of the CAEP Position Statement on Dental Care in Canada. For other positions statements from CAEP click on this LINK. You can also listen to the SGEM Xtra podcast on iTunes to hear us discuss the following: Dr. Sheikh's elevator pitch summarizing the position statement The Association between oral health and overall health How the current dental care system in Canada is inconsistent with the principles of the Canada Health Act A brief description on the history of dental care in Canada and the current situation How the current dental system impacts the individual How the current dental system impacts the emergency department What are the organizations that support public dental care in Canada What are the barriers to adopting a public dental care system How CAEP thinks the goal of affordable, timely and equitable access to dental care will be achieved CAEP Position Statement on Dental Care in Canada Executive Summary: Oral health is an important part of an individual’s overall health; however, dental care is not included in the Canadian public health care system. Many Canadians struggle to access dental care, and six million Canadians avoid visiting the dentist each year due to cost (1). The most vulnerable groups include children from low income families, low income adults, seniors, indigenous communities, and those with disabilities (1–5). The lack of affordable, equitable, and accessible dental care puts undue strain on Emergency Departments across the country, as patients desperately seek the care of a physician when they actually need the care of a dental professional(6). Emergency physicians do not have the same expertise or equipment as dentists, and in most cases are only able to provide temporary symptom relief. This results in an increased reliance on prescription opioids that would otherwise be unnecessary if patients could access the dental care they required. The Canadian Association of Emergency Physicians supports the expansion of publicly funded dental care in Canada, starting with the most vulnerable groups including children, low-income adults, and seniors. The Canadian Association of Emergency Physicians also supports the expansion of publicly delivered dental care in Canada via Community Health Centres, Aboriginal Health Access Centres, and Public Health Units, given the failures of the private sector model and the preferences of those who currently have the most difficulty accessing care (1,7). Oral Health and Overall Health Oral health is a critical component of an individual’s overall health. There are a number of associations between poor oral health and poor general health, including cardiovascular disease, diabetes, having a low birth weight infant, erectile dysfunction, osteoporosis, metabolic syndrome, and stroke (8–15). There is increasing evidence, however, that poor oral health can actually cause or worsen other general medical conditions due to chronic inflammation (16). Treating periodontal disease in diabetics has been shown to improve blood sugar control to a similar degree as adding another oral diabetes medication (17). Providing oral care in long-term care settings has been shown to reduce the risk of developing aspiration pneumonia (18).