Stop the rot

On a recent community visit, I met an 80-year-old recipient of food aid who was completely toothless and without dentures. She could not chew food and just swallowed it. As a result, she was avoiding high-fibre foods like vegetables, as they were harder to swallow; not surprisingly, she suffers from constipation.

This elderly woman is not alone in facing dental problems. In a study conducted by the Hong Kong Council of Social Service last year, 25per cent of grass-roots elderly had no teeth at all, and 33per cent had only one to 10 of their own teeth.

The sample was 328 people aged 65 or above, with monthly incomes equal or below the HK$3,300 median monthly household income for the elderly in Hong Kong.

More than 60 per cent of the respondents had faced oral health problems in the past year; the most common one was pain, followed by sensitivity to hot or cold food and drink, unstable teeth, tooth decay, bleeding gums and abscesses.

The findings echo those of the Census and Statistics Department's thematic household survey, which shows that low-income groups and those aged 65 and above had their dental checks less frequently than higher-income groups and the young.

Why do the grass-roots elderly face such serious dental problems, and why do low-income groups not see the dentist as often as they should? Isn't there a public dental service to look after them? The answer is that there is. But the provision is very minimal - to the extent that it should be a matter of shame for the community.

The current government policy on oral health mainly stresses public education - which is why it is called 'prevention-based'. Apart from the dental care service for primary school children and that for civil servants, the only dental service provided for the public caters to emergency cases.

Indeed, it covers only pain relief and extraction. The Department of Health provides only 13.5 half-day sessions a week in 11 government dental clinics. That is supposed to serve the needs of the entire population.

In the Council of Social Service study, the survey team visited four public dental clinics in the early morning. We found that at the Kwun Tong clinic, which allocates consultation tickets starting from 7.30am, patients had started queuing as early as 3am to make sure they got a ticket. What is more, if they need more than one tooth extracted, they have to visit the clinic again, as it performs only one extraction per visit.

It is clear that the existing so-called 'emergency dental service' offers miserably little in terms of time, capacity and range of treatment. It is not comparable to other medical services in Hong Kong, and it is probably not a coincidence that we have no policy on oral health in Hong Kong.

Hong Kong lags far behind international standards. For instance, Japan mounted an '8020' campaign aiming to ensure that over-80s have at least 20 of their own teeth (the number often reckoned to allow an acceptable level of function).

In Australia, the National Oral Health Plan (2004-2013) aims to improve the oral health of the population and to reduce the burden of oral disease. The plan tries to help all Australians retain as many of their teeth as possible, practise good oral health as part of their general health maintenance, and have access to affordable and quality oral health services.

The Community Care Fund recently announced a pioneer project to subsidise low-income elderly people for dentures and other necessary dental services. However, the target number of beneficiaries is only 11,000.

We hope that the next administration will take a serious look at these shortfalls in policy and provision. The community need is evident, and short-, medium- and long-term solutions exist in the form of proposals. For instance, the government has been urged to increase the service quota and hours of operation of public dental clinics, to learn from other developed countries to set oral health objectives, and to formulate a clear and comprehensive dental health care policy.

We hope that a campaign similar to '8020' could serve as a starting point for discussion to work out an effective and affordable dental policy for Hong Kong.

Mariana Chan Wai-yung is chief officer, policy research and advocacy, at The Hong Kong Council of Social Service