The Canadian Collaboration for Immigrant and Refugee Health recently released clinical practice guidelines for primary care physicians regarding health conditions common to newly arriving immigrants and refugees to Canada.
More than 85 health experts came together to develop the document Evidence-based Clinical Guidelines for Immigrants and Refugees, which includes a section on dental disease. The primary recommendations for physicians related to oral health are:
- Screen all immigrants for dental pain (asking, “Do you have any problems or pain with your mouth, teeth or dentures?”). Treat dental pain with nonsteroidal anti-inflammatory drugs (NSAIDs) and refer patients to a dentist.
- Screen all immigrant children and adults for obvious dental caries and oral disease (examine mouth with penlight and tongue depressor). Refer patients with obvious dental disease to a dentist or oral health specialist.
Dr. Mary McNally, head of the division of preventive dentistry and oral health promotion at Dalhousie University’s faculty of dentistry and JCDA associate editor, led a group of oral health researchers on this guidelines project.
“We were fortunate to bring together a strong group of researchers and public health experts from across Canada to conduct the systematic review for dental guidelines,” says Dr. McNally. “Because physicians and nurses typically provide the first point of contact for newly arriving immigrants and refugees into the Canadian health care system, we focused on early detection, prevention and treatment of common dental conditions that would be most meaningful and useful for this group.
“We were pleased to find evidence to suggest that physicians are becoming more willing to screen for oral disease and that active referrals by physicians increase the likelihood that people will attend a dentist for care,” adds Dr. McNally.
Immigrants and refugees from developing countries were found to be at higher risk for dental disease and would have little exposure to the preventive benefits of fluoride and restorative care. Therefore, in addition to guidelines focused on screening, referral and treatment of pain, high quality evidence supporting the use of fluoridated toothpaste twice daily and application of fluoride varnish was also included.
The 102-page guideline is published in the CMAJ at:
www.cmaj.ca/content/early/2011/07/25/cmaj.090313.
A detailed summary of the dental disease evidence review is available at:
www.cmaj.ca/content/suppl/2010/06/07/cmaj.090313.DC1/imm-dental-16-at.pdf