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Eliminating barriers to dental hygiene – A community health centre’s effort to provide free, accessible oral health care

Submitted by Heather McLeod, Windsor Essex Community Health Centre

I Introduction

II RNAO Best Practice Guideline and WECHC Street Health Program

III Community Partnerships

IV Conclusion


I Introduction

Imagine trying to eat with decaying, broken, abscessed teeth, or no teeth at all.  Worse yet, not being able to visit a dentist or not having access to preventative measures to improve your oral hygiene.  Overall, your physical and emotional well-being suffers.  This is a daily reality for individuals living in poverty with little or no dental coverage.

For years Canadians have been advised of the important role oral health plays in the contribution to positive overall health. Dental professionals regularly stress the importance of routine brushing, flossing and dental checkups, not only in correlation to appearance and sense of well-being, but also because of clinical studies unveiling the direct connection between good health and oral state. 

Health Canada’s website explores these studies through a series of reports examining the link between poor oral health and many serious long term health conditions such as heart disease, diabetes, respiratory disease and women delivering pre-term, low birth rate babies.  These studies support that oral health goes beyond the confines of one’s mouth and carries ties with some of the leading health issues facing Canadians today.  

For individuals living without access to affordable dental care, even the smallest of tooth irritations could develop into a severe infection.  These infections, originating as cavities and the early stage of gum and tooth decay, could be easily prevented with the practice of regular dental hygiene.  For Windsor’s homeless and at-risk of homelessness population however, these infections often result in emergency room visits, placing unnecessary strain on an already burdened health care system.

Despite the proven link between poor oral health and the development of other serious illnesses and diseases, receiving oral health care continues to be an out-of-pocket expense for those without medical benefits.  According to the Statistics Canada, Canadian Community Health Survey, 2009–2010, 33 per cent of the general population in Windsor-Essex fall into this category as they do not have dental insurance. This statistic increases among immigrants, who make up 23 per cent of the population in Ontario’s southern most county, with 45 per cent living without dental insurance. 

Professional dental care is perceived by many as a luxury and with little to no money to spend on ‘extras’, individuals living below Canada’s poverty line are often forced to go without dental care.  This occurs despite the possible onset of long-term health effects which could result through neglecting oral hygiene. 

II RNAO Best Practice Guideline and WECHC Street Health Program

Through the implementation of the Registered Nurses’ Association of Ontario’s (RNAO) Best Practice Guideline, Oral Health: Nursing Assessment and Interventions and the introduction of the Dental Program at the Windsor Essex Community Health Centre (WECHC) Street Health Program, this is changing. Adults and seniors living in poverty are decreasing their chances of developing related health risks associated with poor oral health while experiencing the benefits of improved well-being and self confidence. 

For over 10 years Street Health, located in Windsor’s downtown core, has offered a variety of medical and supportive services for individuals who are homeless or at-risk of homelessness in an effort to remove barriers to health care.  With over 7,500 active clients the community-based health care model offered at Street Health has proven to be a need for many living in Windsor.  With a higher than average unemployment rate due to the downturn experienced by the local economy in recent years, the need for the barrier free health and supportive services offered at Street Health has increased.  Over the years Street Health has excelled in several areas of practical health care and with the implementation of the Oral Health Best Practice Guideline and introduction of the dental program, 2010 was no exception. 

As a member of the Association of Ontario Health Centres, the WECHC believes that Every One Matters.  For the WECHC’s inter-professional team, this motto encompasses one’s health in its entirety; unfortunately the providers at Street Health continue to see clients suffer everyday from the lack of accessible preventative dental services.  Until 2010, no affordable dental programs were available in Windsor-Essex County for adults 18 years and older that provided free, accessible dental care to the priority population served at Street Health.    

Prior to the dental clinic opening, Street Health clients were asked to visit unfamiliar, off-site locations.  Lack of transportation and heightened anxiety experienced from sitting in the waiting room of a mainstream dental office created multiple barriers preventing individuals from receiving the dental hygiene required to prevent the onset of infection and other associated health risks.  After years of struggling to offer any type of dental service to their clients, staff at Street Health now offer free, onsite dental services on a regular basis.  With the creation of the Dental Program teeth cleaning sessions, dental assessments and procedures such as fillings and extractions are among the services now available to clients on a weekly basis. 

Despite being a completely unfunded program, the dental clinic at the WECHC`s Street Health Program has proven to be an ongoing success.  This is greatly attributed to following a model created with a number of the recommendations set out in the RNAO’s Best Practice Guideline Oral Health: Nursing Assessment and Interventions.

III Community Partnerships

The development and nurturing of community partnerships has proven vital in increasing capacity among program providers.  A steering committee comprised of representatives from the WECHC, the City of Windsor’s Social Services Department, the Windsor Homeless Coalition, St. Clair College Dental Hygienist program, University of Windsor Nursing Department, the Windsor-Essex County Health Unit, the Windsor Essex County Dental Hygienist Society and community Dentists work to deliver collaborative practice models that improve the oral health care provided to Street Health clients.  In addition to strengthening the calibre of services offered through the dental program, the community partnerships established through the program’s steering committee has assisted in over 60 community referrals being made, allowing program staff and volunteers to assist clients to efficiently navigate available local health and supportive services.   

The volunteer participation of six registered dental hygienists, two local dentists and the dental hygiene students at St. Clair College have ensured that clients participating in the Street Health Dental Clinic are receiving the most appropriate dental techniques, treatments, medications and professional consultation available.  Having these services provided by highly skilled and qualified dental professionals as part of an inter-professional team ensures program participants receive the highest quality of care by the most appropriate providers.     

IV Conclusion

“The Dental Program has had a profound impact on our clients,” attests Liz Atkinson-Plato, Community Health Educator and Team Leader at the WECHC’s Street Health Program.  “In addition to providing pain management, disease prevention and reducing further damage, the services offered by our team of volunteer Dental Hygienists has helped improved the social functioning or our clients, increased their self-esteem and improved their chances of securing employment as a result of their new healthy looking smile.”

The numbers speak for themselves, in the program’s first ten months alone 629 cleanings were conducted by the volunteer hygienists.  In addition to these cleanings, pain management was offered to 66 clients, 180 dental assessments were conducted and 118 clients showed signs of decaying teeth, 71 of which required extraction.    

The success of the dental program can be measured in numerous ways beyond the number of clients cared for.  Despite operating on a budget sustained by community and corporate donations, professional grade equipment has been purchased through donated funds.  Most notably the recent acquisition of a digital x-ray machine which, once installed, will expand the program’s onsite services, further reducing the clients need to visit unfamiliar dental clinics. 

While just wrapping up its inaugural year, the dental program has already received provincial recognition for the commendable work being done.  At the Association of Ontario Health Centre’s annual conference the program was presented the Innovator of the Year Award and received further recognition when selected as the focus of a breakout session at the same conference. This platform gave providers from Community Health Centre’s from across Ontario the opportunity to hear how the dental program was successfully implemented in Windsor.        

While oral health affects everyone, studies indicate that seniors, individuals with a history of substance abuse and persons with mental illness are more susceptible to common dental problems which often lead to further complications and discomfort. These individuals may have their oral health compromised, not only by their age, situation or illness, but also from certain medications used in treatment.  Coincidently as members of our communities’ priority populations, the majority of clients utilizing the services offered at Street Health can be classified into one or more of these categories.

“The greatest accomplishment of the dental program,” explains Atkinson-Plato, “Is the program’s recognition of the need and necessity of professional oral health care for all in our community.”  Poor dental health affects a person’s quality of life, not to mention the way a person speaks, eats and socializes.  Oral health needs to be addressed at the same level as our other health care needs. “By preventing further tooth decay, educating clients on proper brushing techniques and providing clients with the proper dental supplies to adequately care for their teeth, we are helping prevent the onset or reduce the severity of oral related illness and disease.”             

The ramifications of poor oral health support the ideology that preventative oral health care and treatment needs to be available for everyone in our community, not just those who can financially afford regular visits to the dentist. Through preventative care and education we have the potential to reduce wait times in our emergency rooms by treating tooth irritations before they become gum infections. We’d have the ability to improve overall health by allowing individuals to eat healthy foods and experience a full night’s sleep free of tooth pain and obstructions. We could screen for oral cancer in the early stages and help break the cycle of homelessness as a healthy, confident smile increases the likelihood of obtaining employment opportunities. Through the creation of dental programs like that created in Windsor, we can eliminate the economical, emotional and geographical barriers which often prevent the homeless and at-risk population from accessing the adequate dental services required to maintain positive overall health.  For individuals who go without professional dental care, oral hygiene means more than a friendly smile.  With the creation of accessible programs through community partnerships and professional collaboration we are capable of further improving the well-being and quality of life of thousands living without dental coverage.  

Resources

Health Canada website includes information and resources about oral health at http://www.hc-sc.gc.ca/hl-vs/oral-bucco/index-eng.php

Best Practice Spotlight Organizations (BPSOs) are health-care and academic organizations selected by the Registered Nurses’ Association of Ontario (RNAO) through a request for proposals process to implement and evaluate the RNAO's best practice guidelines. It is a dynamic partnership that focuses on making a positive impact on patient care though evidence-based practice. Available at http://www.rnao.org/Page.asp?PageID=1224&SiteNodeID=302

Oral Health: Nursing Assessment and Intervention Guidelineis available on the Registered Nurses’ Association of Ontario website at http://www.rnao.org/Page.asp?PageID=122&ContentID=1567

Windsor Essex Community Health Centre website includes information about resources, services and points of services at http://www.ecchc.ca/. Information about Street Health services is available at http://www.ecchc.ca/wps/wcm/connect/thc/wechc/homeless/homelessness