Dentists needle Barrette over “clown nose” ban

Is it safe … to say dentistry has changed over the years? Fans of the 1976 thriller Marathon Man will get the winky reference in that line. There was a time in recent memory when a trip to the dentist brought dread of pain on the order of that inflicted on Dustin Hoffman’s unfrozen teeth by a Nazi war criminal played by a dental drill-wielding Sir Laurence Olivier.

These days there is very little evidence to suggest dentistry is the last refuge of the sadist, as epitomized so hilariously by the likes of Steve Martin in Little Shop of Horrors. One hopes, but does not know for sure, candidates for dental schools - there are three in Quebec graduating 160 new dentists each year - are subjected to some type of psychological screening before being licensed to insert sharp instruments in patients’ tender mouths.

Thanks, mercifully, to great advances in anesthetic drugs and procedures which render the freezing process virtually painless, there’s been a huge decline in odontophobia (fear of dentists). Still, there are many who squirm in terror at the mere thought of a needle poking them in the mouth. That’s especially true for children.

The reluctance of youngsters to thrill to the dentist’s drill is, bizarrely enough, at the heart of a gnawing political dispute.

Quebec is the rare province to provide free coverage under the Régie de l’assurance maladie (RAMQ) for dental work for children under 10 years of age. As of January, 2017, RAMQ no longer covers the cost of conscious sedation for dental work. The technique was included, for reasons unknown, on the list of user fees charged by medical practitioners Health Minister Gaetan Barrette abolished.

Conscious sedation, pitched to kids as the “clown nose,” because the nasal cup administering the nitrous oxide - laughing gas! - is often round and colourful, has been a godsend for dentists and parents dealing with a child experiencing severe dental anxiety. It zonks them out so they are dozily pliable while the dentist works in peace.

Now that dentists can no longer bill RAMQ for conscious sedation, they have little choice but to recommend general anesthesia. According to Dr. Serge Langlois, president of the Association des chirurgiens dentistes du Québec (ACDQ), dentists may decide to treat patients under conscious sedation, at their own expense, when it is urgent, “but for those who can wait, they are referred to general anesthesia, a procedure that is heavier and more costly for the government."

The ACDQ has been battling Barrette over the issue, claiming he is “unwilling to resolve it.” The association says in a statement “the minister’s lax handling of this matter is forcing parents to resort to general anesthesia when their vulnerable children need to be treated because they do not know when the situation will be resolved. The waiting lists for general anesthesia are long.

“We do not understand why does the Minister include conscious sedation in the list of accessory costs, when he excludes general anesthesia from it, even though both of these procedures help control patients’ behaviour so that they can receive dental care? Double standard?”

The association says it “made a proposal that would have kept care accessible. The ACDQ never received an answer or a formal and complete counter-proposal from the ministère de santé et services sociaux.”

Having failed to get a response from the ministry after a single meeting in February last year, the ACDQ filed a notice of dispute. There was a hearing before the adjudicator last month, and another meeting is scheduled for May.

The fight for conscious sedation is not the only issue raising the profile of Quebec dentists, not normally known as a militant group. The ACDQ’S current media campaign, “200 Diagnoses: It Takes a Dentist” takes subtle aim at the omniscience of medical doctors, reminding folks that every time a dentist probes in your mouth - sedated or not - he or she is on the lookout for a long checklist of oral horrors, from hairy tongue to multiple types of cancer.

A dental clinic, a soothing doctoractor states proudly, is “like a mini-hospital.” Of course, in real hospitals conscious sedation is covered by RAMQ.