Street dentistry: A commentary on Canada's new dental coverage and expansion opportunities for dental schools, health agencies, and not‐for‐profit

Like other nations, such as Sweden and Brazil, that have publicly funded dental care, the Canadian federal government announced the Canadian Dental Care Plan (CDCP) in 2023.1 For example, in both Sweden and Brazil, there have been "improvements in oral health, especially among young groups [… and] a decline in disparities in utilization [among all age groups]".2 This is particularly important because the earlier an oral health care program is initiated, the higher the likelihood it will promote sustained oral health improvements into adulthood.3 The CDCP will cost the government $13 billion in five years and $4.4 billion on an annual basis via an insurance regime providing primary oral care for uninsured citizens with an income below $90,000 per household.1 It is estimated that the CDCP will provide coverage to more than 9 million Canadians, first opening to seniors in 2024 and the insurance process fully operationalized to all eligible Canadians in 2025.1 The coverage offered under the CDCP plan will be comprehensive for millions of Canadians who have not visited a dental office for years. For example, the program will cover scaling, polishing, sealants, varnish, radiographs, restorations, crowns, dentures (complete or partial), endodontics, periodontics, and oral surgery.1 This is particularly important because many chronic illnesses have been linked to dental health neglect. For example, poor oral health has been linked to diabetes (type 2), pneumonia, heart disease, stroke, and Alzheimer's disease.4 Moreover, previous research has highlighted the association between access to oral care and better diet, mental health, self-esteem, and improved grades in school.4 This is particularly important for underserved, homeless, and at-risk inner-city populations who have been disproportionately affected by many healthcare disparities. In effect, the concept of outreach health care in the inner cities has been established for decades in many North American urban centers where free health care has been tailored to homeless and at-risk groups.5 Therefore, this commentary highlights not only street medicine but the potential for 'street dentistry' in the context of the federal government's expansion of dental care for low-to-middle-income Canadians. The concept of urban health outreach was coined as 'Street Medicine' by Jim Withers, a physician at the University of Pittsburgh, where medicine was practiced outside the traditional hospital for the first time.5 Street medicine has proven highly successful because the stigma faced by homeless persons and people living in poverty has prevented access to medical care in the traditional format. Thus, healthcare services are made available via street medical services.5 The increased accessibility of street medicine has contributed to increased demand for its services linked to its preventative nature, thus reducing costly and severe health complications related to social determinants of health.5 The Street Medicine programs involve effective health care being delivered via mobile clinic vans, inter-health-community collaboration within the community clinic providers that allow tracking a patient for follow-up, and the provision of electronic medical records that are intertwined with the social support services.6 Therefore, street medicine programs provide efficient health care for underserved, homeless, and at-risk groups, improving health outcomes in impoverished neighborhoods.5 While street medicine has been practiced since the 1990s, 'street dentistry' is not well established in all jurisdictions, although used under different terms such as 'mobile dentistry', 'Onsite Dental', 'Dentistry on Demand', and 'Flossbar'. Sandesh and Mohapatra7 first mentioned the term' street dentistry' in the Indian Journal of Dental Research to highlight the fraudulent work of unlicensed "dentists" in India's rural and remote places. The work by the noted fraudulent dentists who often visit rural villages "on their bicycle with a bag consisting of some pliers, screwdrivers, dividers, self-acrylic materials" is usually caused by the severe shortage of dentists in rural parts of India (e.g., more than 90% of health professional are available in urban settings while 10% serve the rural population).7 While 'street dentistry' has been used in the context of fraudulent dentists in India, the concept of 'street dentistry' is being introduced in the context of its potential for closing the gap in dental care in the inner-city and urban underserved populations in line with the introduction of street medicine in the 1990s. Street Dentistry in the context of publicly funded dental care can potentially reduce tooth caries, abscesses, periodontal disease, and chronic illnesses linked to oral health due to early prevention work for at-risk and vulnerable populations. Previous research has highlighted how stigma and other social determinants of health issues may prevent patients from visiting dental offices.4 Easy access to hygienists, dentists, and other dental professionals (e.g., oral surgeons and other dental specialists) being provided via 'street dentistry' can potentially reduce oral disease and tooth loss compounded by various social determinants of health factors.4 Outreach of street dentistry can be facilitated via the current federally funded government dental program when the non-profit, local health agencies and dental schools invest in installing dental equipment (e.g., chairs, handpieces, radiograph units, and sterilization equipment) in similar-sized trucks/vans that have been utilized for street medicine, mobile vaccination clinics, and other mobile health units. Simple tooth preparation and restoration can be conducted via non-invasive techniques and materials already used in retirement homes, rural areas, and private homes. These non-invasive may include atraumatic restorative treatment and interim therapeutic restoration materials.8 Moreover, community placement of dental hygiene, dentistry, and graduate specialty students in the street dentistry program would facilitate more significant learning and clinical skills in complex treatment planning. In addition, the community placement via the' street dentistry' program will provide learning opportunities on social justice, social determinants of health, and health inequity issues for many students and dental residents, which will reduce the stigma in oral care that has been reported in previous research.4, 9, 10 Finally, with the expansion of government-funded dental care for low—to middle-income Canadian households by 2025, many non-profit dental clinics may experience reduced demand because many patients can now choose their clinics based on convenience. This potential drop in the patient pool may prove detrimental for many dental schools across Canada, which have relied on low fee costs to supplement their students with education opportunities. The street dentistry program may address the need for a new potential patient pool for education in many dental schools. However, it will not make a huge difference in patient volumes needed to replace or offset the tens of thousands of dental visits in dental school-leading clinics yearly. Previous research has urged the governments to provide publicly funded dental care for many uninsured Canadians based on human rights principles due to the severe consequences of lack of access to oral care.4 Finally, Canada is increasing its public share in dentistry in line with other nations, such as Sweden and Brazil, providing oral care via publicly funded programs. While Street medicine has been practiced for decades, the concept of 'street dentistry' could offer new potential for closing the gap in oral care accessibility for many underserved, at-risk, and vulnerable Canadians. Street dentistry could also provide innovative ways for non-profit companies, local health agencies, and dental schools to expand oral health to inner-city urban neighborhoods in vans and mobile clinics already utilized in some limited settings. Finally, street dentistry programs could enhance oral health students' education, training, and comprehensive understanding in an increasingly shrinking pool of patients for dental schools in the future. While this new Canadian program may increase the potential of this type of dental delivery system, in the United States, it is already widely used by many dental schools, including New York University, Columbia, and the University of California, Los Angeles, as well as many not-for-profit organizations, hospital dental programs and city and state departments of health. Not applicable. The authors declare no conflict of interest. No funding was received for this commentary. Not applicable.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.