Executive Summary: National Oral Health Research Strategy Development – April 2023
Introduction
Oral health and oral health care in Canada and internationally are at an important watershed moment with significant potential to take significant steps forward. Internationally, it has been recognized that dental decay is the most common non-communicable disease globally and that gum disease and oral cancer, among other oral diseases, also make-up significant global health problems. Furthermore, these diseases and their significant impacts, such as pain, financial burden, time off work or school etc., are distributed unequally in populations, with the poorest, most marginalized groups suffering the highest burden of oral diseases. This pattern of significant and inequitable burden of oral disease is also true in Canada. Unfortunately, the traditional model of dental care is ineffective in managing this situation. Recognizing this, the WHO has decided to develop a global oral health strategy and related action plan. In this action plan, while also promoting “upstream” approaches to address social, commercial and political determinants of health, including oral health, the WHO has called for oral health care to be integrated into medical care and made part of universal health care. Recognizing the significant cost barrier to accessing dental care in Canada, the federal government introduced an interim Canada Dental Benefit in December 2022. This temporary benefit provides support to eligible families who need it most and gives children under 12 the opportunity to get much-needed dental care. The Benefit was the first step towards fulfilling the federal government’s commitment to the development of a long- term, Canada-wide dental care plan for all people living in Canada with an annual family revenue of less than $90,000, including children and adolescents, people with disabilities and elderly people. Budget 2023 announced $13 billion over five years (starting in 2023-24) and $4.4 billion ongoing to Health Canada to implement the Canadian Dental Care Plan, which could benefit up to nine million Canadians.
On top of this, Statistics Canada is currently running cycle 7 of the Canadian Health Measures Survey (CHMS), including an oral health element. Data and sample collection is in process and will be completed by December 2024, with the release of the data and samples for additional analyses due in 2026. This release of data and samples will enable researchers to compare the oral health of Canadians in 2023-24 with that from the last CHMS survey, including oral health measures, in 2007-09. The release of these new data and samples will also permit scientists to address multiple other important research questions, for instance, investigating links between oral and general health and the extent and determinants of inequities in oral health and oral health care.
In the meantime, there are also multiple advances in the world of health and science, as well as societal changes and challenges that need to be incorporated into oral health care and the training of oral health care professionals. Examples include: the integration of artificial intelligence and machine learning in science, health and health care; the use of advanced telecommunications in telehealth; the need to adopt more sustainable strategies and approaches in health care, including dental care, to reduce its impact on the climate; and the need to create more inclusive, equitable governance of health care systems, science and data management.
Given these global changes in health and science, as well as initiatives in oral health and oral health care internationally and in Canada, CIHR’s Institute for Musculoskeletal Health & Arthritis (IMHA) has decided that this is an excellent opportunity to create Canada’s first national oral health research strategy (NOHRS;). In collaboration with key stakeholders (the Association of Canadian Faculties of Dentistry [ACFD], Canadian Association of Dental Research [CADR], Network for Canadian Oral Health Research [NCOHR], Canadian Dental Association [CDA], Canadian Dental Hygienists Association [CDHA], the Denturist Association of Canada [DAC] and the Canadian Dental Therapists Association [CDTA]), IMHA organized an in- person meeting to initiate the creation of this NOHRS in March 2023, in Ottawa. This document outlines the main research themes emerging from that meeting, as well as the next steps towards publishing the NOHRS in March 2024.
NOHRS meeting goals
- Convene a broad community of people committed to better oral health to work toward a national oral health research strategy.
- Discuss potential themes and also priorities for a national oral health research strategy.
- Co-create the next steps and overall plan for a national oral health research strategy to be launched in September 2024Footnote *.
Emerging, draft research themes
The following is a list of research themes emerging from the aforementioned meeting. This list of six themes is initial and draft, not final, i.e. it is recognized that through further consultation over the coming months, this list is likely to evolve. Furthermore, the order of themes in the list does not reflect any form of priority.
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Access to oral health care
This theme includes but is not limited to topics such as evaluation of the new federal government national dental care program, developing and testing innovative approaches to providing care for marginalized groups such as Indigenous peoples, the elderly and those with disabilities, and integrating oral health care into medical care.
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Artificial intelligence and big data
This theme includes but is not limited to topics such as how best to create, use and manage a wide range of administrative, surveillance, research and other datasets to better understand oral health and disease and improve oral health care and systems.
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Aging, sex, gender, identity and health
This theme includes but is not limited to topics such as investigation of the causes and determinants of differences and inequalities in health status related to a range of identity indicators, including age, sex and gender, and ethnic and racial background, including Indigenous status.
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Microbiomics, proteomics, other omics and oral health
This theme includes but is not limited to topics such as how our oral microbiome may be related to our oral and systemic health, and how our oral environment may have markers of a range of diseases.
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Knowledge mobilization and implementation science to improve oral health and oral health care
This theme includes but is not limited to topics such as identifying more efficient mechanisms to integrate research findings into routine oral health care and policy development, and how to better engage the community in driving important research questions and approaches. We need to promote and support more “intervention research” to develop and test a wide range of interventions to improve oral health, oral health care and policy and other related outcomes.
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Sustainable oral health care system/solutions
This theme includes but is not limited to topics such as investigating the Canadian oral health care system's carbon footprint, waste and recycling opportunities, as well as developing interventions to support Canadian oral health care delivery becoming more sustainable. Examples: minimally invasive dentistry, teledentistry, preventive oral health care solutions.
Next steps
This draft list of research themes for the NOHRS is a starting point towards a final document in March 2024. Going forward, we anticipate the process to include the steps outlined below, although we will likely adjust the plan as we receive feedback, create the teams preparing the NOHRS and move forward over the coming months:
- Creation of two documents following the meeting held in Ottawa on March 29-30th:
- a “what we heard” report of the discussions that occurred at the meeting; and
- this “executive summary” document outlining the context and the research themes discussed in Ottawa
- Timeline – end of April 2023
- Distribution of this “what we heard” report and “executive summary” to all attendees at the Ottawa meeting, plus other stakeholders and members of the community. This distribution message will outline the next steps in the process towards developing the NOHRS.
- Timeline – end of April 2023
- Using the steering group that planned the Ottawa meeting as a starting point, we will create a NOHRS steering committee, whose role will be to oversee the creation of the NOHRS. We anticipate members of the steering committee to be representatives of the following groups:
- IMHA
- ACFD
- CADR
- NCOHR
- A professional association
- Timeline – end of April 2023
- The steering committee will discuss and then agree on individuals who will lead the drafting and writing of the NOHRS. In principle, this will involve two individuals leading the preparation of the overall document with an additional two individuals identified to lead the drafting and writing of each of the theme-relates sections, i.e. presently, we have six themes, so we would identify a total of 12 individuals, with two leading each section.
- Timeline – end of May 2023
- Once the writing team is identified, they can create consultation groups to begin to prepare their sections
- Timeline – summer 2023
- Further consultation activities
- Timeline – autumn 2023
- Drafting of NOHRS sections
- Timeline – autumn 2023
- Draft final NOHRS document
- Timeline – January 2024
- Broad distribution for feedback
- Timeline – January 2024
- Finalizing of NOHRS
- Timeline – March 2024
- Activities around the publication and activation of the NOHRS linked to the ACFD biennial meeting hosted by the Faculty of Dentistry at Dalhousie University, Halifax, NS, in June 2024
Addendum: In line with the plan detailed in the next steps, a steering committee was convened in April 2023, co-chaired by Dr. Leigha Rock and Dr. Paul Allison, with representatives from CIHR- IMHA, CADR, ACFD, NCOHR and the national oral health professional members’ associations: Dr. Raj Bhullar, Ondina Love, Dr. Belinda Nicolau, Dr. Robert Schroth, Dr. Sonica Singhal, Dr. Ana Miriam Velly, Iona Worden-Driscoll, Dr. Karim Khan, Dr. Dawn Richards, Dr. Hetty Mulhall, Dr. Rosie Twomey
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