REPORT ON THE FINDINGS OF THE ORAL HEALTH COMPONENT of the CANADIAN HEALTH MEASURES SURVEY 2007–2009 Health Canada is the federal department responsible for helping the people of Canada maintain and improve their health. We assess the safety of drugs and many consumer products, help improve the safety of food, and provide information to Canadians to help them make healthy decisions. We provide health services to First Nations people and to Inuit communities. We work with the provinces to ensure our health care system serves the needs of Canadians. Published by authority of the Minister of Health. Report on the Findings of the Oral Health Component of the Canadian Health Measures Survey 2007–2009 is available on Internet at the following address: www.fptdwg.ca/English/e-documents.html Également disponible en français sous le titre : Rapport des résultats du module sur la santé buccodentaire de l’Enquête canadienne sur les mesures de la santé 2007-2009 This publication can be made available on request on diskette, large print, audio-cassette and braille. For further information or to obtain additional copies, please contact: Publications Health Canada Ottawa, Ontario K1A 0K9 Tel.: (613) 954-5995 Fax: (613) 941-5366 E-mail: [email protected] © Her Majesty the Queen in Right of Canada, represented by the Minister of Health, 2010. This publication may be reproduced without permission provided that its use falls within the scope of fair dealings under the Copyright Act, and is solely for the purposes of study, research, criticism, review or newspaper summary. The source must be fully acknowledged. However, reproduction of this publication in whole or in part for purposes of resale or redistribution requires the prior written permission from the Minister of Public Works and Government Services Canada, Ottawa, Ontario K1A 0S5 or [email protected]. HC Pub.: 100183 Cat.: H34-221/2010E-PDF ISBN: 978-1-100-15660-6 Acknowledgements This report would not have been realized without the Many thanks also go to our colleagues on the Federal, help of many individuals and organizations. I would Provincial and Territorial Dental Working Group who like to take a moment to thank and to acknowledge all provided us with examples of oral health programs and those who have provided their time, assistance and initiatives throughout the summary report and to the experience to the Oral Health Component of the members and six federal departments on the Federal Canadian Health Measures Survey. Dental Care Advisory Committee who provided valuable advice. To begin with, I would like to acknowledge the tireless support provided by the members of the Oral Health A special word of thanks must go to all those at Steering Committee who helped craft the survey tools, Health Canada and Statistics Canada for their the examiner manual and the final reports. contributions to the reports, to our U.S. colleagues at the National Health and Nutrition Examination The survey would not have been possible without the Surveys, to Dr. Jim Leake and Dr. Patricia Main from dedicated efforts of Dr. Helen Whelton who travelled the University of Toronto, to Dr. Jean-Marc Brodeur from Ireland to calibrate the examiner dentists to from the University of Montreal and to Dr. Mary World Health Organization (WHO) standards, McNally from Dalhousie University. and the hard work of Dr. Harry Ames (Office of the Chief Dental Officer) and Dr. Natalie Morin I am particularly grateful to the staff in the Office of (Department of National Defence) who were trained the Chief Dental Officer and in particular to Amanda as both trainers and examiners to the WHO standards. Gillis and Lisette Dufour as well as to Kelly Langlois at Statistics Canada who went beyond the call of duty I would also like to thank the Canadian National to finalize these products. Institute of Health, Algonquin College and the City of Ottawa who graciously provided us with dental chairs Finally, I would like to thank all those who participated for patient examinations during calibrations. Health in focus group testing and calibration sessions, and give Canada extends a sincere thank you to Colonel Scott a special note of thanks to the 6,000 Canadians, who Becker and the Department of National Defence by participating in the survey, made all of this possible. who provided dentists and assistance throughout the two-year survey time frame. Sincerely, Peter Cooney, BDS, LDM, DDPH, MSc, FRCD(C) Contributions to the reports and encouragement Chief Dental Officer provided by The Canadian Dental Association, Health Canada The Canadian Dental Hygienist Association, The Canadian Dental Regulatory Authorities Federation, and the Canadian Association of Public Health Dentistry are also gratefully appreciated. i Table of Contents Acknowledgements . i Executive Summary Oral Health Component of the Canadian Health Measures Survey . 1 Introduction and rationale . 7 Chapter 1: The context of health care in Canada . 9 The nation . 9 Demography and economic status . 9 Responsibility for health care . 9 The context of dental care in Canada . 10 Source of dental expenditures . 10 Numbers of providers . 11 Private dental insurance . 11 Public programs . 12 Access to dental care . 13 Chapter 2: Measuring oral health in populations . 15 Household interview surveys . 15 Examination surveys . 16 Examination surveys in Canada . 16 Oral health surveys in other countries . 17 Previous reports on the oral health of Canadians . 17 Chapter 3: The Canadian Health Measures Survey (CHMS) . 19 Brief description . 19 Survey operations . 19 Sampling strategy . 19 Household interview . 20 Visiting CHMS Mobile Examinantion Centres . 20 Outcomes . 20 Oral health module . 20 iii Data collection . 21 Equipment and infection control . 22 Quality control of data-entry . 22 Quality assurance of output . 22 Response rate . 22 Sample weighting . 23 Analytical techniques . 23 Chapter 4: Findings . 25 Introduction . 25 Orientation to detailed tables . 25 Sample size . 26 Determinants of insurance . 27 Self-reported outcomes . 27 Time lost and dental visits . 28 Preventive dental behaviours . 30 Clinically assessed oral health . 30 Child (6–11 years old) oral health . 30 Coronal caries . 30 Sealants . 32 Trauma . 32 Adolescent (12–19 years old) oral health . 32 Coronal Caries . 32 Sealants . 33 Trauma . 33 Adult (20–79 years old) oral health . 33 Number of teeth and edentulism . 33 Implant and denture use . 34 Coronal caries . 34 Untreated coronal and root caries . 35 Root caries . 36 Periodontal conditions . 37 Trauma . 40 Other findings . 41 Dental enamel fluorosis . 41 Oral lesions . 41 Occlusal conditions and orthodontic treatment . 42 Intact restorations of amalgam and other materials . 42 Reasons for exclusion from periodontal probing . 43 Need for care . 43 iv Chapter 5: How does our oral health compare? . 45 Children . 45 Adolescents . 46 Adult oral health . 47 Tooth loss . 47 Inadequate natural dentition . 48 Periodontal status . 48 Coronal caries . 48 Root caries . 49 Visiting behaviours . 49 Chapter 6: What have we discovered from the CHMS Oral Health Component? . 51 Conclusion . 54 References . 55 Glossary . 60 Appendices . 62 Appendix 1 – CHMS sites and oral examiners . 62 Appendix 2 – Canadian Health Measures Survey Oral Health Steering Committee . 63 Appendix 3 – Variable definitions; selected characteristics . 64 Tables . 69 v List of text tables Chapter 1 Table 1 .1 Direct costs of treatment of diseases in Canada, 1993 and 1998 . 10 Table 1 .2 Indicators of growth in dental care expenditures, Canada, 1960–2008 . 11 Table 1 .3 Indicators of growth in dental care providers, Canada, 1960–2008 . 11 Table 1 .4 Comparison of effects of factors determining utilization of dental care with their effect on utilization of medical care, Canada, 1994 . ..