Waking up to a severe toothache, Alisha ran to the washroom and hurriedly opened the medicine cabinet. She grabbed the bottle of Ibuprofen and took 400mg, silently hoping the pain would subside soon. Leaning back against the door, she muttered to herself, “How long will this go on? I can’t live on pain meds forever. I have to see a dentist soon”.

Alisha remembered her last visit to a fee-for-service dentist, 5 years before. Since she didn’t have dental insurance, she was given a bill of $1600; $800 for a root canal and an additional $800 for the crown. The total cost was more than the combined cost of her rent, hydro and grocery bills for an entire month. “What do I do?” wondered Alisha, a client at Bramalea CHC, one of five service locations provided by WellFort Community Health Services, a Communiy Health Centre located in Peel Region, Ontario.

Alisha’s story is true not only for a significant number of WellFort clients but also for many residents in the Region of Peel. Many barriers exist preventing a large proportion of our clients from attaining their full oral health and overall health potential; a huge one being the high cost of dental care. Based on the recent 2017 report Oral Health in Peel: Key Findings about Risk Factors and Oral Health Outcomes, 30% of local residents cited cost as a barrier to seeing a dentist.

Dental care in Canada is operated mainly as a private, fee-for-service system. Public spending on oral health care is only 6% of total spending on oral health care. Canada ranks very low among OECD (Organisation for Economic Co-operation and Development) countries for public spending on oral health care. Though there are patchworks of publicly-funded dental programs/benefits across different provinces and territories for some vulnerable populations, these are inadequate and are a band aid solution at best.  

Evidence shows that utilization of upstream approaches to improve population oral health result in better long-term oral health outcomes and therefore offer the best solution. A system where oral health care isn’t a part of the universal health care system minimizes the importance of oral health and puts the onus of oral health care on individuals.

According to World Health Organization, oral health is a fundamental component of overall health and a determinant of quality of life.  Studies have linked poor oral health with many adverse disease outcomes like respiratory diseases, heart diseases, mental health illnesses amongst others. Oral health diseases disproportionately affect vulnerable groups who face barriers accessing oral health care. This includes under-resourced or low-income families, seniors, and indigenous populations among other groups.

As an organization, WellFort is deeply committed to health equity. It is embedded in our vision and mission and is strongly reflected in our organization’s Resolutions for 2017. Our commitment to health equity has led us to focus significant energy on access to oral health care over the past number of years.

In 2011, WellFort established Health n’ Smiles, our CHC’s dental clinic which provides increased access to dental care to various groups that currently have access to oral health care through targeted government-funded programs. This includes children under the age of 18 living in under-resourced families or in the need of urgent care, and qualified seniors over the age of 65.

For those who qualify under current funding from the provincial government, services at Health n’ Smiles include: examinations; x-rays; prevention and oral health education; dental cleanings; sealants; fillings; extractions; partial and full dentures; emergency treatment; and selective root canals. In delivering these services, Health n’ Smiles staff speak English, Hindi, Punjabi, Gujarati, Urdu, Cantonese, Tagalog, Polish and Arabic – helping further increase accessibility.

In 2015-16, Health n’ Smiles provided preventative and treatment services to 3,036 individuals. A total of 6,557 client encounters were made by these individuals during the same year.

While we are very proud of the services we are able to provide through Health n’ Smiles, we also recognize that many more individuals and families are in need, and there remain large gaps in public coverage for necessary oral health care. Therefore, WellFort has also become engaged in several oral health advocacy campaigns to challenge the status quo, aiming to improve oral health policy and funding in our region, our province and across Canada.

In the fall of 2016, as part of the Ontario Oral Health Alliance, we gathered over 250 signatures from local residents and, on November 18, 2016 we presented a petition to our Member of Provincial Parliament, Jagmeet Singh (Bramalea-Gore-Malton) to table in the Ontario Legislature. The petition called on the Ontario government to:

• Ensure that health-care reform includes access to oral health care services for vulnerable people in our communities;
• Extend public dental programs for low-income kids to include low-income adults and seniors within the next two years;
• Deliver new public dental programs through publicly funded dental clinics to ensure cost efficiency and improved access.

Although the Ontario government has promised to expand publicly-funded dental coverage to adults on low incomes, this will not take effect until 2025. This is too long for many people to wait! WellFort clients and Peel residents like Alisha cannot wait for years, in pain, while their health deteriorates further.

As part of the Ontario-wide coalition, WellFort has successfully raised public awareness through local media coverage and we have also used our growing social media presence (Twitter, Facebook, Instagram) to further increase public and political awareness about the impact of gaps in oral health care in Ontario. We will continue this call for action from the provincial government until we have adequate oral health care policy and investment in Ontario.

In addition to our participation in the provincial oral health coalition, WellFort also felt that a more structured community mobilization effort in Peel Region was needed. Research has shown that an effective strategy to improve access to oral health care at the community level is to build a local oral health coalition to engage residents of the community, community agencies and services providers. We believed that a local coalition would better empower our community to advocate healthier public policy and access to necessary services. However, we wanted to make sure that local residents agreed.

In the summer of 2016, WellFort hosted a focus group with community members to identify dental needs in the Region of Peel and to gauge interest in implementing a local oral health coalition. Focus group participants were selected through a convenience sampling method. 23% of focus group participants were between 18-29 years, 55% were between 30-49 years of age, and 22% were between 50-65 years.

Participants agreed that there is a strong need for community members to come together more formally around access to oral health care, and in partnership with public and private sectors. They also highlighted many personal and family experiences with inequities in oral health and access to oral health care.

Based on research and focus group input, WellFort then took the initiative to establish the Oral Health Coalition for the Region of Peel. For an initiative of this nature, we recognized the need for strong leadership and shared ownership. A steering committee was established to guide its development and implementation.

We connected with a number of community partner agencies to actively participate on the committee – organizations and people who we believed were passionate about ensuring equitable access to oral health care and would be committed to the cause of the coalition.

The coalition is still in its early stages, with the steering committee holding its first meeting in January 2017. In addition to WellFort, coalition members to date include East Mississauga Community Health Centre, Caledon Community Health Services, Peel Public Health, Canadian Academy of Dental Hygiene, and Halton-Peel Dental Hygienist Society. We anticipate that other agencies will join over the weeks and months ahead.

WellFort recognizes that the success of the local coalition will be dependent on engagement of policy makers, service providers and community champions. We also recognize the need to raise public awareness of the local coalition and our goals, something we began to do in December 2016 through local media (see page 7 of newspaper) and through our collective social media channels.

WellFort’s vision is:  A healthier community where everyone belongs!  In order to achieve this goal WellFort will continue to call on as many local partners as possible to become involved in the quest for a dental disease-free Region of Peel.