Universal public dental coverage is essential
Those who need care the most are the least able to afford it, write Christophe Bedos and Belinda Nicolau.
Public dental coverage became a major issue in the recent Quebec election. It is high time to make this a reality. Millions of Canadians, and approximately 25 per cent of the population of this province, are unable to receive the dental treatment they need. We, dentists and dental public health professionals, call for the introduction of universal dental coverage in Quebec.
This idea is not new. In 1964, the Hall Commission recommended public medical insurance that would include dental care, but unfortunately, it was not included when Medicare was introduced in the 1960s.
As things stand, only five per cent of Canadian dental care is paid for by public government funds, compared to 70 per cent of health care overall. The result is that most people have to pay for dental care through private coverage linked to their jobs or out of funds from their own pockets. Hundreds of thousands simply cannot afford care and do not visit the dentist. Indeed, surveys indicate that six million Canadians currently avoid visiting the dentist every year because of the cost. Even among those with a work benefits plan, dental care is often prohibitively expensive.
Furthermore, research clearly shows that the people with the highest levels of disease are also those who are least able to afford to visit a dentist and are the least likely to have private coverage through their work. Hence, the people in the most pain and with the most infection cannot see a dentist, while those of us who are fortunate to have very low levels of disease and often have private insurance are best able to consult a dental professional. Private services increase inequalities; public services help reduce them.
This situation is unacceptable. How can we tolerate a dental care system from which millions of Canadians are excluded, leading to infection and tooth pain that, for some, is unrelenting ? Have we forgotten that the oral cavity is part of our body and that oral health is part of general health? Diseases of our teeth and gums are linked to those of other organs. For instance, gingival disease can exacerbate diabetes and poor oral hygiene in the elderly can lead to pneumonia. The mouth is an important portal of entry for infections that may spread to other parts of our body. Conversely, systemic diseases of the body can affect our oral cavity.
This situation runs counter to our fundamental values of equity, solidarity and human rights. For example, a 2009 Health Canada survey showed that 47 per cent of lower-income Canadians needed dental treatment, compared to 26 per cent in the high-income group. How can we allow such striking inequalities? Why do we accept that the Canadians that need dental care the most are precisely those who tend to be excluded from the dental care system?
Just as our hearts, legs, livers, lungs, fingers and other parts of our bodies are covered by Canada’s medical care system, we strongly believe our teeth and mouth should be, also. Including teeth and mouth care in Canadian Medicare will enable those who need care to access it and have their disease treated. Timely treatment will, moreover, help prevent future disease and unneeded suffering.
We call on the newly elected Quebec government and the members of the National Assembly to implement universal public dental coverage. We very much look forward to working with them to help make this necessity a reality. It is time.
Christophe Bedos is an associate professor with the Faculty of Dentistry of McGill University and adjunct professor with the school of public health of Université de Montréal. Belinda Nicolau is an associate professor in dental public health at McGill University. This article is co-signed by: Élise Bertrand, public health dentist; Stéphane Caron, Hospital and community dentist; Aimée Dawson, professor in dental public health; Félix Girard, professor in dental public health; and André Lavallière, Public health dentist.