Canada is a federation of ten provinces and three territories of about 32 million inhabitants. Access to and availability of health services and the regulation of occupational health care are the responsibility of provincial and territorial governments. It is estimated that government spending and private health services were 130.3 thousand million in 2004, 5, 9% more than the previous year. Government spending accounts for seven of every ten dollars spent on health.
The goal of the program of health insurance financed by the Government is to ensure that all Canadian residents have fair access to medical and hospital services without direct costs to the patient. Dental surgical services provided in hospitals are also covered.
Approximately 18,300 dentists, 14,800 hygienists, 2,200 auxiliary dental prosthesis, 2,000 dental technicians and 27,000 dental assistants of Dentistry are involved with providing dental services in Canada, mostly in the private sector. There are 57 dentists and 46 hygienists per 100,000 Canadians. The number of dentists rose 6% between 1988 and 1997, while the number of hygienists rose 64% in the same period. There are nine dental specialties recognized in Canada and the experts make up 10% of the population of dentists.
Of 9.28 thousand million spent on oral health in Canada in 2004, about 95% originated payments provided by private insurance or direct payments from patients. Approximately 63% of Canadians are covered by private dental insurance, which are an employment benefit not subject to collection of income tax. This favorable treatment of tax exemption is also available for dental plans purchased by private tutors without employment ties.
People who have dental insurance private dental service use considerably more than those who do not. According to a 2003 survey, 74% of Canadians who have insurance and 48% of those who have not visited the dentist in the previous year. According to figures from the government agency Statistics Canada, approximately 76% of Canadians who have higher incomes visited the dentist in 2003, while only 35% of Canadians with lower incomes visited the dentist.
In a 2006 survey conducted by the Dental Industry Association of Canada, 60% of Canadian dentists (1,011 surveyed) perform dental activities in urban areas, 22% in suburbs, while 18% describe the location of dental practice in rural areas. The majority of respondents (79%) are owners of their own business, and less than half of all respondents (47%) indicated that work without the company of other professionals.
Only half of the dental clinics surveyed had four or more surgeries. A quarter of those surveyed do not employ dental hygienists and other quarter employs a hygienist, while nearly half employ two or more hygienists. The percentage of dental hygienists that employ two or more increased 14% since 1997.
Dental Clinics Canadians are becoming increasingly high-tech. Since 2001, the percentage of offices with computer terminals in the area of care (as opposed to just the reception) increased from 20% to 36% in 2006. Half of the dentists without computers in the areas of care currently say they will acquire such equipment within two years. Currently, 57% of dentists have Internet connection at home or the office. This number more than doubled from 24% in 2000.
The digital radiography has also been adopted by a growing number of professionals. Currently 21% have such a system, compared to 3% in 2000. Approximately 8% of professionals rely on computerized instruments in helping care; similar percentage has lasers for the treatment of soft tissue and hard. In 2000 less than 2% of professionals used such equipment. Resin restorations and dental hygiene services represent the two largest sources of income for most professionals.
The Federal Ministry of Health paid dental services for patients of organized aboriginal communities through service charges in private dental practices. The federal government also organizes dental programs for refugees and their dependents, prisoners in jails, members of the Royal Canadian Mounted Police, Canadian Forces and former members of the Armed Forces.
The publicly funded dental services offered in most provinces and territories are similar in terms of population groups eligible high-risk and the types of services covered. Many of these programs do not pay full insurance. The drinking water in most urban areas, with the exception of Montreal and Vancouver, has fluoride.
As health is administered by the provinces and dental epidemiological surveys are conducted differently in various jurisdictions, there are many gaps in our knowledge regarding the oral health of Canadians. National survey of this approach, the first in 30 years, is currently in the planning stage. Data collection will begin in early 2007.
The newly created Office for the Coordination of Oral Health's mission is to collect epidemiological data on oral health status of Canadians and promote oral health. From the information currently available, it is safe to say that the situation of oral health of most Canadians and the quality of dental services available in Canada are among the best in the world.
The dental profession is self-regulated in Canada, the provincial regulatory authorities are responsible for the licensing of dentists and the control that ensures a high quality of service to Canadians. The regulatory authorities have created an organization, the Canadian Dental Regulatory Authorities Federation (CDRAF), a non-regulatory powers whose aim is to anticipate and address regulatory challenges at the global, national and interprovincial.
Dentists trained in 10 dental schools (eight in English and two French) in Canada, with an estimated 520 graduates per year. While only 25% of Canadian dentists are women, approximately 50% of dental students are female. Education programs offered by these schools receive accreditation from the Commission of Dental Accreditation of Canada (CDAC).
Because of an accreditation agreement between the CDAC and the Commission of Dental Accreditation of the American Dental Association, graduates of dental schools in the U.S. and Canada are eligible for the creation of Certification Exam provided by Canada's National Dental Examining Board (ndeber). Of all the professionals are required to obtain a certificate for ndeber dental practice in Canada.
For graduates from non-accredited programs (currently, only North America is accredited), there is a special way to the exam ndeber. These graduates must complete a qualification program for two years offered by Canadian dental school. The first step is the Qualifying Examination administered by the Association of Canadian Faculties of Dentistry (ACFD).
These examinations of the Royal College of Dentists of Canada are used by many dental authorities of the provinces as part of the requirements for licensing specialist and are known as the National Examination for Dental Specialty (NDSE). Those who seek a license specialist should seek information from the dental authority in the province that intends to make the practice.
In four provinces, the regulatory body functions as an association that promotes the interests of dentists, while in other provinces, the securities association and regulatory body are performed by separate institutions. The Canadian Dental Association (CDA) is the national association that acts as spokesman for all Canadian professional Dentistry. It maintains liaison with the provincial associations, dental schools, other health organizations, industry dental insurance, as well as the federal government to advance the oral health of Canadians.
The CDA is a regular member of the International Dental Federation (FDI) and actively participates in discussions of this global entity. In 2007, the first time, a Canadian, dr. Burton Conrod, will be president of IDF. The executive director of CDA, George Weber, the president of the World Dental Development and Health Promotion of FDI, which administers the Development Committee Dental World and coordinates projects in developing countries. The coordinator of the Oral Health of Canada, dr. Peter Cooney, the chairman of the Section of Public Health of the IDF.
John P. O'Keefe, Cirurgião dentista, E-mail: jokeefe@cda-adc.ca
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