How can providers support oral health?
Healthcare providers and community organizations that support families are important partners in efforts to improve oral health outcomes for all Nova Scotians. As a trusted source of health information in your community, you can help improve awareness of the impacts and root causes of poor oral health and share credible information on effective preventative measures.
Here are a few ways you can support better oral health for your patients, clients and communities:
- Refresh your knowledge of fluoride’s benefits and risks so you can effectively respond to questions and create opportunities to discuss this topic with your patients or clients.
- Seek to dispel myths around fluoride and reinforce evidence-based information.
- Support efforts to maintain or improve access to community water fluoridation in municipalities across Nova Scotia to reach broader populations and reduce health inequities.
- Support policies that address the root causes of poor oral health and create healthier communities.
- Consider oral health as part of overall health, especially when caring for families with young children. Reinforce recommendations for regular dental visits starting within six months of their first tooth’s appearance or by their first birthday.
- Increase awareness of the Children’s Oral Health Program, the Canadian Dental Care Plan and the Non-Insured Health Benefits (NIHB) Program with patients and families.
We encourage you to use the content found on this page and in the Nova Scotia Fluoridation Toolkit for Providers both to enhance your understanding of this important topic, and to find ways to address oral health with your patients and clients. The toolkit includes:
- Information Shared with Municipalities and Local Water System Operators
- Handouts and Resources for Patients and Providers
- Online Oral Health Resources
- Provincial and Federal Dental Coverage
Jump to section:
- How does Public Health support oral health?
- Why is oral health so important?
- What is fluoride?
- What is community water fluoridation?
- Why do Public Health and the dental community support community water fluoridation?
- What do recent reports say on water fluoridation and IQ in children?
- What is dental fluorosis?
- What to recommend for people who are on wells and/or do not have access to community water fluoridation?
- What is the Fluoride Varnish Program?
- What dental services are covered by MSI and federal programs?
- Nova Scotia Fluoridation Toolkit for Providers
How does Public Health support oral health?
Public Health works to improve conditions in communities that help everybody have a fair chance at good oral health, like advocating for community water fluoridation. Public Health also offers a school-based fluoride varnish program in select communities across the province.
Public Health works closely with organizations that support oral health, like the Nova Scotia Dental Association, College of Dental Hygienists of Nova Scotia and the IWK and Dalhousie University dental programs. Together, we develop resources and seek opportunities to share evidence-based information to improve understanding and support for this important public health issue.
For more information, please contact your local Public Health office.
Why is oral health so important?
Oral health is important to overall health and well-being at every age and stage of life. A healthy mouth allows a person to eat, speak, learn and socialize without discomfort or embarrassment.
Tooth decay is the most common childhood chronic disease in Canada that can be prevented. Fifty-seven percent of Canadian children have cavities, which can lead to unnecessary infection, pain, and tooth loss. This can impact children’s growth and development, behaviour, and ability to learn, socialize and play.
What is fluoride?
Fluoride is a mineral that strengthens teeth, making them more resistant to decay. Fluoride is naturally occurring in water, soil, plants and food, and is added to various dental products.
How does fluoride prevent tooth decay?
Fluoride prevents tooth decay in two ways:
- When fluoride in drinking water is consumed, it becomes part of the tooth’s structure as it develops. Fluoride strengthens all layers of the tooth, creating stronger teeth for life. This is a more systemic and foundational benefit than any type of topical fluoride.
- When teeth come in contact with fluoride in drinking water, the tooth enamel is strengthened on the surface. This type of fluoride protection is also available through dental products such as fluoride toothpaste and mouth rinse as well as fluoride treatments, such as fluoride varnish.
Evidence shows that receiving fluoride in multiple ways is safe and offers the greatest benefits for oral health.
What is community water fluoridation?
Almost all water contains some naturally occurring level of fluoride. Community water fluoridation is the process of adjusting the amount of fluoride in our drinking water to a level recommended for preventing cavities.
What amount of fluoride in water is considered optimal for oral health?
Health Canada recommends that communities fluoridate water to 0.7 milligrams per litre (mg/L) to achieve the benefits of cavity prevention. This is less than half the maximum level of 1.5mg/L that has been established by Health Canada and the World Health Organization.
Municipalities in Nova Scotia that adjust the fluoride in drinking water are required to test their water supply daily to make sure recommended levels are maintained at 0.7 mg/L.
Why do Public Health and the dental community support community water fluoridation?
Community water fluoridation is supported by evidence to be an important, safe and effective measure to improve the oral health of Nova Scotians. Water fluoridation is one of the most cost-effective and equitable public health interventions available to reduce tooth decay because it reaches everyone in a community regardless of their age, income, or access to dental care services or supplies.
Public Health recommends community water fluoridation alongside more than 90 other provincial, national, and international professional organizations, associations and governments. This includes Health Canada, the Nova Scotia Department of Health and Wellness, IWK Health, Dalhousie University Faculty of Dentistry, Nova Scotia Dental Association and the College of Dental Hygienists of Nova Scotia.
What do recent reports say on water fluoridation and IQ in children?
Recent systematic reviews have been published that look at high fluoride levels and developmental outcomes in children, including IQ scores. While some reports show an association, the evidence in these reports is not conclusive and does not show that high fluoride (>1.5mg/L) causes lower IQs in children.
In the studies showing an association, high fluoride levels are defined as greater than 1.5 mg/L, which is double the standard for drinking water in Canada and Nova Scotia of 0.7 mg/L. Evidence continues to support the safety and benefits of water fluoridated at optimal levels using current guidelines in Canada.
Nova Scotia Health continues to monitor new research to inform recommendations on community water fluoridation.
What is dental fluorosis?
Repeat exposure to high levels of fluoride (above the maximum level of 1.5 mg/L) has been shown to increase risk for dental fluorosis.
Dental fluorosis is a cosmetic issue that affects the tooth enamel, leading to white flecks or brown pitting. Dental fluorosis is not associated with any long-term health or oral health concerns.
What to recommend for people who are on wells and/or do not have access to community water fluoridation?
People who are on well water should follow the guidelines for water testing every two years. You can find out more at: Test your well water - Government of Nova Scotia, Canada.
In addition to testing your water, it’s recommended to follow the usual best practices for oral health:
- Brush twice a day with a fluoride toothpaste
- Floss daily
- See a dentist at least once a year
- Talk to your dentist or healthcare provider if you have any additional questions or concerns
- If your child is under three years old, refer to this information sheet for more detailed guidance: Supporting Oral Health for Families with Young Children
If you get your drinking water from a registered or municipal water system and are unsure if your water is fluoridated, you can call you’re the operator of your water system.
What is the Fluoride Varnish Program?
High levels of early childhood cavities and limited access to dental care are major concerns in our province. Access to dental treatment is often sought after problems arise and may be financially out of reach for many people.
School-based fluoride programs are offered in many areas across Canada because they are a safe and effective way to deliver additional topical fluoride to children to help prevent tooth decay. Nova Scotia Health Public Health offers a Fluoride Varnish Program for pre-primary to grade six students in select communities that would benefit most from an additional layer of protection.
School-based fluoride programs complement other ways children receive fluoride, such as through their dental provider and water fluoridation. Children benefit from access to multiple sources and applications of fluoride and can safely receive up to six applications of fluoride varnish a year.
What dental services are covered by MSI and federal programs?
MSI covers basic dental care for children, starting from birth and continuing until they turn 15 years of age. Children should have regular dental visits within six months of their first tooth’s appearance or by their first birthday.
Once a year, the MSI Children’s Oral Health Program covers:
- One routine dental exam
- Two routine x-rays
- One preventive service (for example, brushing and flossing instruction)
- One fluoride treatment
- Scaling (1 unit for children 10 and younger; 2 units for children 11 to 14)
- Fillings and necessary extractions
- Nutritional counselling
As well, MSI covers sealant application on permanent molars. In some cases, MSI also covers a second fluoride treatment. Parents/guardians should check with their dental office to see if their child qualifies for a second fluoride treatment paid for by MSI.
Additional coverage is offered to Canadians who meet specific criteria through the Canadian Dental Care Plan, including:
- Seniors aged 65 and over
- Children under the age of 18
- Adults with a valid federal Disability Tax Credit certificate for 2023
People must meet the four following criteria to be eligible:
- They do not have access to dental insurance
- They/their spouse/common-law-partner (if applicable) must have filed tax returns in Canada so that their family income can be assessed for the previous year
- Their adjusted family net income is less than $90,000
- They are a Canadian resident for tax purposes
Finally, the Non-Insured Health Benefits (NIHB) program provides eligible First Nations and Inuit clients with coverage for a range of health benefits that are not covered through other social programs, private insurance plans, provincial or territorial health insurance. This includes dental care.
The NIHB program was established in response to Jordan's Principle, a human rights principle established by the Canadian Human Rights Tribunal to make sure that First Nations children do not face gaps, delays, or denials in accessing government services because of their identity as First Nations children.
