Family Dental Health in Ontario: A snapshot of community stories Lomotey, J., Hatzipantelis, M., Janzen, R., & Curie, C. Abstract Ontario is widely regarded as a province that provides its citizens with a relatively high quality of life and access to health services with state-of-the-art technology. Along with this notion is a commonly held perception that the province has a well functioning dental system that provides services to a majority of Ontarians with the exception of the very few people who fall between the cracks. The purpose of this participatory action research project was to assess the social inclusiveness of dental policy in Ontario, document family dental health needs, and make recommendations for policy change. Family dental stories suggested that a significant number of families in Ontario “fall between the cracks” with regards to dental services, particularly the working poor, low income families, and new immigrants. High cost of services, the stigma of accessing services through social assistance, fear of dentists, and cultural barriers hinder access to dental services. Factors found to aid access to dental services were financial resources, awareness and individual priority, and the availability of dentists in a community. Participants recommended that Ontario needs a dental policy that will streamline existing dental programs to promote equal access to services and ultimately achieve universal dental care.

Findings The purpose of the project was: 1.To determine: The social inclusiveness of current dental health policy Barriers to accessing dental health services The impact of lack of access on families 2.To develop recommendations for a policy that is socially inclusive, creates oral health awareness and promotes access to dental health services. Steering Committee  Family members  Community outreach workers  Dentists  Other dental professionals  Civil servants Methods  Key Informants(10)  Focus Groups (5)  Mail-in Survey(243)  Current dental policy  Family dental health concerns  Barriers and factors facilitating access to dental services  Impact of lack of access to dental services  Policy suggestions Who Has Access ?  People with dental plans / insurance.  People who give priority to oral health and can afford to pay for services.  People who qualify for national and provincial dental programs. “[Our family’s dental health] is very good because we all look after our teeth when we are at home. The kids are always watching us when we brush our teeth to see and learn how to do it themselves.” -- Parent / Caregiver “We see a dentist every year but find it hard to find transportation. We have full dental coverage from Union benefits.” -- Parent / Caregiver “For over one year we did not have any coverage by an insurance plan, so we did not go to see a dentist. We were lucky enough not to have any major problems, the four of us, though we needed cleaning. It was a stressful time. We had debts and were apprehensive at the idea of spending lots of money at the dentist.” -- Parent / Caregiver “It is very hard to get in to a dentist when you are on social assistance … I called 25 dentists before a dentist would take me.. It is too embarrassing. After the third one, I was like, do I really want to keep calling? I feel stupid. They are not taking me because I am in this class.” -- Focus group participant “[Our family’s dental health] is terrible. I worry about being able to provide my children with the kind of proper care that I had when growing up. Teeth are very important and poor care can cause not only physical problems but emotional [ones as well].” -- Parent / Caregiver Personal Stories “My teeth are decaying. I have no four front teeth and one filling. If my teeth hurt, I scream and cry because the pain is so bad.” -- [parent on behalf of child] Age 3 “I know this doctor that has put quite a few kids under [anaesthesia] to do major work. My girlfriend’s child had 13 fillings and a root canal done. She was 5 years old.” -- Focus group participant “It ranges right from who is going to look after your child while you are at the dentist because then … you are going to have to pay for babysitting while you are at the dentist, your transportation to and from the dentist and then pay for the dentist.” -- Focus group participant “My mom pulled my teeth out at the back because we couldn’t afford it.” -- Child “For someone who is living with a limited income, dental hygiene on a regular basis is unaffordable.” -- Parent / Caregiver “The kids aren’t sleeping. The parents aren’t sleeping. There is a lot of stress in that house.” -- Focus group participant “When I am in public I cover my mouth with my hand.” -- Focus group participant “For the working poor, for seniors, for the community as a whole, there is no particular policy --- well, I guess there is a policy – there is a policy not to have any.” -- Key Informant Preventing Poor Oral Health  Emphasize the link between oral health and the broader social determinants of health “It comes down to the biggest influencing factor on oral health, which in our opinion is poverty.” -- Key informant  Emphasize prevention through oral health education and preventive dentistry:  Support oral health education in schools  Involve medical professionals in raising oral health awareness  Organize provincial oral health awareness campaigns  Enhance access to preventive dentistry services Enhancing Access to Services  Develop a socially inclusive dental policy that:  Pr omotes access to community-based services that do not stigmatize users  Enhances access to restorative & maintenance services  Allows users of services to have a choice of dental service providers “Policy will change if the public asks for it. Policy responds to public demand at least we like to think that. If they can’t hear the demand in a way that makes them think it is important then they won’t treat it as important. It must come from more than just public health dentistry …” -- Key informant “You know it is in your best interest to have a dental check-up 2x/year but if you don’t have the resources to do that, then it does not do you any good to know that.” -- Key Informant Initiated by: The Ontario Coalition of Community Action Program for Children (CAPC) / Canada Prenatal Nutrition Program (CPNP) Sponsored by: Health Canada via the Catholic Family Counseling Centre (Waterloo Region) Conducted by: The Centre for Research and Education in Human Services ( Introduction Issues Explored Methodology Policy Suggestions Who Doesn’t Have Access ?  The working poor / low-income families  Seniors  People in long-term care facilities  Small businesses’ employees / the self- employed  People who are homeless  The unemployed / underemployed  People who have lost coverage  New Canadians Barriers to Access  High cost of dental services  Fear of dentists from previous negative experiences  The stigma of accessing services through social assistance  Additional costs associated with accessing services (e.g., transportation)  Cultural barriers  Lack of / insufficient dental services  Lack of awareness of the importance of good oral health Family Dental Stories: Determining the social inclusiveness of dental health policy in Ontario By: Jonathan Lomotey, Maria Hatzipantelis, Rich Janzen, Caroline Currie Centre for Research and Education in Human Services ( Kitchener, Ontario Personal Stories This family dental health project was one of the Ontario Social Inclusion Initiatives sponsored by Health Canada to mobilize communities towards finding solutions for problems affecting them. It was a unique project that highlighted the dental health experiences of families participating in CAPC/CPNP family support programs across Ontario.