Luxury bones – Why we need universal dental care, and why it needs to be public

KJIPUKTUK (Halifax) – As we head towards a federal election, we’ll hear – as we do every 4 years or so – politicians pay lip service about access to dental care. To some of us, it may seem baffling that the bones in our mouths don’t receive the same consideration as the rest of our bones. Canadians take pride in our public health care system, so naturally we should also care about the health of our mouths.

Where we are today

Since dental care is not included in Medicare, people rely primarily on work related insurance and out of pocket payments to access care. In fact, 95% of dental spending in Canada is private and only 5% goes towards public dental programs. The share of public dental spending in Canada is even less than the US at 10% and not even close to the UK at 46%. Due to the current structure of dental care in Canada many people lack access to care.

In 2018, approximately 1 in 3 Canadians lacked any dental insurance and over 1 in 5 avoided the dentist due to financial constraints. For people who lack access to dental care, preventive and routine care is neglected in order to focus resources on dealing with pain and infection, which results in a population with poorer oral health. This has many consequences on individuals and society as a whole.

For individuals, poor oral health has been shown to cause or worsen many general health conditions including: cardiovascular disease, diabetes, having a low birth weight infant, aspiration pneumonia, erectile dysfunction, osteoporosis, metabolic syndrome and stroke. Further, having visible decay or missing front teeth can affect employability and one’s self esteem.

For society, there is increased healthcare spending for a society with poorer oral health. One reason for the increased spending on healthcare is due to the effects of poor oral health on overall health. Further, hundreds of thousands of Canadians end up in an emergency department each year seeking treatment for dental pain, a problem that is estimated to cost over $150 million per year.

Even before the pandemic, access to dental care in Canada was poor and getting worse. Due to changes in the economy, fewer people have dental insurance. Many people are retiring and losing work related dental insurance and an increasing number of people are working in the precarious ‘gig economy’ that does not provide benefits like dental insurance tied to their labour. With the financial hardship caused by the COVID-19 pandemic, even more people are struggling to access dental care.

How we can implement it

The federal NDP has proposed a plan to provide dental insurance to uninsured families making $90,000 per year or less. The plan is desperately needed and is expected to help over 6 million Canadians with a cost of only $1.5 billion per year. Don Davies, the federal NDP health critic has stated that he sees this plan as an interim measure while we work towards integrating dental care into Canada’s universal health care system.

Ultimately Canadians need to confront the fact that dentistry is big business, with corporate ownership of dental clinics rapidly growing in Canada. Fortunately, confronting the profit motive in dental care will allow serious gains in public health.

Saskatchewan had a public dental program that ran out of schools in the 1970-80’s that  showed the benefit of taking the business end out of dentistry. The program used dental therapists which are providers that can do fillings and simple extractions at a fraction of the cost of a dentist.  Due to the easy accessibility of the clinics, the focus on prevention and cost efficient use of dental therapists the program was a huge success, lowering the need for fillings and extractions in children by half. Further dentists that worked in the program could focus on more complex procedures that only they were trained for. It is important to learn from this model and allow government funding to bring clinics like this into our communities. For example, with proper funding clinics like the North End Community Health Centre could be expanded to provide dental care to the community. Currently the clinic relies on local dentists to donate their time, but this is not enough to meet population needs. 

It is clear that the status quo for dental care is inadequate. Maintaining a minority parliament this election is an opportunity to start expanding Medicare to include services like dental care. When Medicare was originally implemented, it was with the intention of including dental care at a later date. Now, over half a century later, it is time to follow through with this vision.

Kevin Payne is the 2021 federal NDP candidate for the riding of Dartmouth-Cole Harbour. Brandon Doucet is a practicing dentist.