IQ7: The benefits of universal screening to refugee oral health


In this episode, we continue our look at refugee oral health: specifically, the benefits of universal screening and how to optimize collaborations between primary care providers and dentists. Dr. Carlos Quiñonez, an associate professor of dental public health at the University of Toronto, returns as our guest expert.

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Rick Harp: Welcome to Episode 7 of Infectious Questions, a public health podcast produced by the National Collaborating Centre for Infectious Diseases. At NCCID, we help those with infectious disease questions connect to those with answers. Hello, I’m Rick Harp.

Shivoan Balakumar: And I’m Shivoan Balakumar. In this episode, we continue our look at refugee health, more specifically, their oral health.

Harp: Last episode, we addressed the oral health status of refugees as compared to other foreign-born populations, along with refugee-specific risk factors.

Balakumar: This time around, we explore the question of universal screening. Here to help us once again is Dr. Carlos Quiñonez, an associate professor of dental public health at the University of Toronto.

Harp: The Director of its Specialist Training Program, he’s a past president of the Canadian Association of Public Health Dentistry. Doctor, welcome back to Infectious Questions.

Dr. Carlos Quiñonez: Thank you, Rick.

Harp: Now, according to guidelines issued by the Canadian Medical Association and the Canadian Pediatric Society, all newcomers should undergo dental screening as a best practice. What would be the specific benefits to refugee oral health of such universal screening?

Quiñonez: Screening for oral diseases and oral conditions, I think, is important for everybody. For many of the reasons that we spoke about in the previous broadcast, in terms of the burden of disease and particular risk factors in these populations, it becomes that much more important. So it’s important for primary healthcare providers to look into people’s mouths and to see if they have any active infections, that they see if they have any cavities or any other type of conditions. Because it allows them to then provide appropriate referral to an oral healthcare provider.

But more importantly, it also gets the primary healthcare community to try and… to start understanding the importance of this because, as we now know, oral disease is now much more intricately and intimately linked to a variety of systemic issues or diseases or conditions like diabetes, like cardiovascular disease. Alongside its importance for things like nutrition and self-esteem, and so on.

So it’s very important for public health practitioners to understand, as it has been recognized by the Canadian Medical Association and the Canadian Pediatric Society, that this is a fundamental part of people’s lives and well-being and health, and that they play a role in assessing not only for risk but assessing for the presence or absence of disease, and then figuring out ways to get these individuals appropriate care if necessary.

Balakumar: Dr. Quiñonez, what could be done to optimize collaborations between primary care providers and dentists?

Quiñonez: I think education. I think dentists need to understand that primary healthcare providers play a fundamental role in the stuff that is generally considered our remit. And it’s not just dentists too, it’s dental hygienists, it’s the larger oral healthcare provider community. I think, on the other side, primary healthcare providers, whether it be nurse practitioners or physicians, also need to be educated on the importance of oral health but also understanding that there are screening instruments available here in Canada. A classic one in Canada is the Rourke Baby Record—so, for those in the primary healthcare community, they’ll be well aware of that—or the Nipissing [District] Developmental Screen. There are tools that are available for them to sort of learn about and make this process easier.

The other thing that we need: dentists to reach out as much as primary healthcare providers reaching out, so that there’s a bridge built, so that there’s clear lines of communication. Because if I’m a primary healthcare doc, and I look into a refugee’s mouth and I see a bunch of disease, if I or my institution doesn’t have a strong relationship with the dental provider community, that referral’s not really going to mean a lot. Simply because then you’re putting the burden on the individual to then go seek out and secure oral health care. I think it’s much better… I think in the literature, or in the world, it’s called a ‘warm hand-off.’ I think if we can actually move people from, you know, body to body, practitioner to practitioner, in a direct way, I think that just results in much better outcomes in terms of people actually being able to get the care that they need.

Harp: Dr. Quiñonez, thank you.

Quiñonez: Thank you.

Balakumar: That’s it for this episode of Infectious Questions. To share your public health questions about refugee oral health, email them to Or call us toll-free at 1-844-847-9698 and record your question there.

Harp: Infectious Questions is a production of the National Collaborating Centre for Infectious Diseases. Production of this podcast has been made possible through financial contribution from the Public Health Agency of Canada.

Balakumar: Note that the views expressed here do not necessarily represent those of the Agency. The host organization of NCCID is the University of Manitoba. Learn more at


A public health podcast produced by NCCID, Infectious Questions connects those with infectious disease questions to those who have answers. Subscribe on iTunes, Stitcher and SoundCloud.