Nick Noorani Website

A low priority in some homelands, tooth care then often becomes an unaffordable extra in Canada
“It seems incredible now,” says the website of Scotland’s National Health Service, “but it was routinely expected that people would come in to the surgery to have all their teeth taken out” in the early days of the health service.

That was 60 years ago. Healthy teeth or not, it was all the same. They got yanked.
“Sixty years ago, the dentist was the engineer who did everything that had to be done; he did the practical thing,” says Doris Brown, who immigrated to Calgary in 1979.
“There were no hygienists, there was absolutely nothing about dental education,” Brown says. “There were assistants who handed the dentist his tools, but there was no preventive treatment that I can remember at all.”
Britain was coming off the war years then.
“There was a whole thing in Britain at that time; a general feeling about North Americans was that they had nothing hard in their lives, that they made lots of money so they could take time out to make sure their teeth were white and clean and even, and there were lots of jokes made about it.
“There was an underlying scoffing, an amusement at North Americans who had big, white, clean teeth.”
By 1960, Brown was married, and she
remembers how she and her husband, Peter, laughed about their dentist’s mouth full of bad teeth.
“The dentist wouldn’t use any sort of pain alleviation, an injection or anything,” she says.
“He didn’t think they were good. Peter and I both went along with that. We assumed he knew what he was talking about. I had a couple of fillings and I’m sure Peter had the same. I remember it hurting, but not so much I couldn’t handle it.”
Fast forward to Calgary, circa 1980.
“The first time I went to the dentist here, there was a hygienist,” Brown says. “She did whatever was necessary to prevent things happening in the future, and taught about rinsing out your mouth and so on.”
Like immigrants from countries around the world, the Browns live with the legacy of their early years of inadequate care, even though they floss and brush religiously now.
At least when they arrived they spoke English and had good jobs lined up. Not so for many immigrants and refugees experiencing a dramatic change in culture when they arrive in Canada.
The first years are particularly hard.
New immigrants tend to work at low-paying jobs, usually during the hours that free clinics are open. They can’t afford to go on their own.
Limited by social and gender roles, some may have no transportation or child care.
Newcomers may lack the English skills to express their medical history. They may not understand the health-care system.
And they simply may not see dental care as a priority compared to everything else they need to manage, perhaps because oral care isn’t emphasized in their homeland.
Then there’s the so-called “healthy immigrant effect.”
People arriving in Canada enjoy a level of health above that of the average Canadian, but find within a few years they’ve declined to a level below.
The original superior health level is attributed to the fact that people who want to emigrate are likelier to be healthy, and to Canada’s screening process, which disqualifies people with serious medical conditions.
Then, employment problems, financial constraints and lack of a supportive social network all take a toll on well-being, say researchers in Statistics Canada’s health analysis and measurement group, writing in a study called “Dynamics of Immigrant Health in Canada: Evidence from the National Population Health Survey.”
Poor oral health is concentrated within low-income earners and other disadvantaged groups, including new immigrants and those without dental insurance coverage.
Members of those groups have dramatically higher rates of tooth loss.
A separate study of data from the National Population Health Survey found that
although only 40 per cent of immigrants living here less than five years had been to a dentist in the previous year, that rate jumped to more than 60 per cent for immigrants who had lived in Canada more than 10 years.
Immigrants are twice as likely as to have a university degree as native-born Canadians, but are four times as likely to be unemployed, and it takes five years to narrow the gap.
Perhaps the lack of preventive care catches up to people about the same time they begin to overcome language and income barriers.
Immigrants were more likely to visit for restorative treatment and native-born Canadians for preventive care, including braces, says McMaster University geography professor Bruce Newbold.
“That could be due to a lack of services in the region of origin or a lack of prior dental education,” Newbold says in “Use of Dental Services by Immigrant Canadians,” a Canadian Institutes of Health Research project.
As Brown says, early teachings linger.
“My mindset tells me I can’t do much about my bad teeth, that it’s not worth spending money on them. My mindset tells me that it is not a worthy cause, even now.
“I admire North Americans with all your straight, white teeth,” she says wistfully.
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