This new year has brought more challenging developments for all of us, especially health-care professionals across our province and beyond. Hospitalizations in Ontario have reached pandemic highs, and there is criticism about the pace of vaccination in the province. Our children are learning from home again as we all experience another lockdown.
So this is perhaps a strange time to raise concerns about the longer-term impact that the pandemic may have on the future provision of health-care professionals. But the ongoing restrictions on teaching clinical skills need to be addressed now to prevent a potential longer-term decline in the availability of key health workers.
Health-care educators in Ontario had a moment of relief last month after the minister of colleges and universities extended the number of health-profession students who can be trained in practical settings from 10 people to 50 people (if they can remain physically distanced). This decision allows more students to be taught essential clinical skills in instructional spaces in a safe manner.
The minister noted that these decisions were made for “programs that support the health-care workforce response to COVID-19.”
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Why, then, did the government leave dentistry off this list?
Dentists are always essential to maintain the health of the people of Ontario, but especially during a pandemic. Oral infections are significant health concerns. Periodontitis (gum disease) is the sixth-most prevalent disease in the world, according to the Journal of Dental Research. There is a critical need to ensure optimal oral health, especially for those with other medical conditions. Dentistry can also be essential for patients about to undergo cardiovascular surgery or cancer treatments.
This all requires a great deal of hands-on training, arguably no less than any of the other health professions listed in the minister’s announcement.
Since the start of the pandemic, the University of Toronto has adapted to convert teaching and learning online for our lectures and seminars. However, even the best online training cannot help students develop the psychomotor skills to use dental instruments safely and effectively, which is essential before they can start to treat patients later in their program. The simulation lab where these skills are developed is a very large instructional space that can function exactly as the government requires of other health-care trainers. In fact, teaching in our simulation lab was a safe and successful part of the government’s pilot project as campuses began to reopen this summer.
The recent decision is even more puzzling given that, in 2012, Ontario’s chief medical officer of health published a report emphasizing that “oral health is an important part of overall health, and a determinant of quality of life.” This is even more important today, as patients with other diseases are more vulnerable when contracting COVID-19.
The public clinics at U of T are Canada’s largest and served more than 90,000 patient visits annually before the pandemic. The patient population is disproportionately made up of the working poor, who have challenges accessing dental care elsewhere.
In the context of COVID-19, this report published in the Journal of the American Geriatrics Society — and a number of others — have shown the impact of poor oral health on mortality in the elderly, in particular those in nursing homes and intensive-care units. Studies such as this have also shown that frequent professional dental care reduces the progression or occurrence of respiratory diseases among the high-risk elderly in these same settings.
These are not optional services by dentists. These are essential services.
The Ontario government has been working hard to enact measures that are in the interests of everyone’s health and safety. The minister’s recent change of approach is in line with this objective, with one striking omission. The perception that dentistry is not an essential health service is, simply, wrong. The health of the people of Ontario is best served by having the minister treat dentistry in the same way as other essential health services.