Surveillance Spotlight: Current Concepts in Oral–Systemic Health
The International Centre for Oral–Systemic Health, based at the University of Manitoba's faculty of dentistry, was launched in January 2008. The centre is proud to partner with JCDA to provide summaries of contemporary literature and news in oral–systemic health that may affect modern dental practice.
Accumulating evidence continues to indicate that oral–systemic relationships involve linkages with chronic inflammatory diseases, increased severity of overall disease burden and adverse pregnancy outcomes through elevations in whole body inflammation.1 This has led to increased interest in basic preventive oral health interventions (especially in high-risk populations) as an easy and reliable approach to reduce systemic inflammatory load and improve overall health. Recent studies have linked basic preventive oral health services to reductions in overall medical spending in people with diabetes, respiratory disease and cardiovascular/cerebrovascular disease.2-4
Tangible demonstrations of the desire to apply this body of knowledge to new models of population health and to make substantive changes within the Canadian health care system have begun to take place. For instance, in September 2009 the Winnipeg Regional Health Authority, in collaboration with the University of Manitoba, established interprofessional training experiences in community clinics. This involves dental and hygiene students working in conjunction with students from other health professions (i.e., medicine, nursing and pharmacy) to co-manage patients. Within this interprofessional approach, all health professions participate in the comprehensive care of patients. Furthermore, oral health interventions designed to reduce oral inflammation are integrated appropriately into treatment planning, case management and follow-up care. In March 2010, a meeting of representatives from the public and community health sectors was co-hosted by the Ontario Agency for Health Protection and Promotion and the University of Toronto faculty of dentistry. This symposium and workshop highlighted the importance of oral health in public health outcomes, with the goal of developing a comprehensive public health strategy that would include preventive oral health within overall prevention and wellness approaches.
So where does oral health fit within the public health care system in Canada? In Manitoba, there is currently no provincial legislation allowing for publicly financed oral health services. However, there are some existing social assistance programs for children, indigent and Aboriginal peoples. Discussions with health authority and government officials are currently underway to establish an oral health budget at the provincial level that would provide basic preventive oral health services to high-risk populations (i.e., people with diabetes, cardiovascular/cerebrovascular or respiratory disease and pregnant women). The underlying rationale for such funding is that a small investment in oral health services can improve overall health outcomes and quality of life and result in a significant reduction in annual medical spending. In Ontario, a public role in oral health care is legislated through the Health Protection and Promotion Act. The legislation allows for direct involvement of the Ontario Agency for Health Protection and Promotion, which incorporates oral health within primary public health prevention strategies.
Similar initiatives and discussions will likely occur in other provinces or at the federal level in the near future. The outcome of present and future programs will certainly help to shape the landscape of the Canadian health care system going forward. It is possible that the first substantive system changes that reconnect the mouth to the rest of the body and make oral health part of comprehensive health care will soon take hold in Canada.
- Iacopino AM. What is the role of inflammation in the relationship between periodontal disease and general health? J Can Dent Assoc. 2008;74(8):695.
- Albert DA, Sadowsky D, Papapanou P, Conicella ML, Ward A. An examination of periodontal treatment and per member per month (PMPM) medical costs in an insured population. BMC Health Serv Res. 2006;6:103.
- Ide R, Hoshuyama T, Takahashi K. The effect of periodontal disease on medical costs in a middle-aged Japanese population: a longitudinal worksite study. J Periodontol. 2007;78(11):2120-6.
- Sjögren P, Nilsson E, Forsell M, Johansson O, Hoogstraate J. A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomised controlled trials. J Am Geriatr Soc. 2008;56(11):2124-30.