CALLS TO PUT TEETH INTO HEALTH-CARE COVERAGE
Lack of dental insurance leaves some British Columbians living in agony
When Gabrielle Peters saw a video last month of federal health critic Don Davies challenging the health minister to improve access to necessary dental care, she wondered if her plea had been heard.
Still sore from having the last four of her teeth pulled on Nov. 20 because she couldn’t afford any other option, Peters, a freelance writer in Vancouver, had taken to Twitter two weeks before the video was posted online to ask people why they felt dental care should be added to publicly funded health-care coverage.
Hundreds of replies poured in from around the globe. People shared stories of working in agony, losing loved ones to infection, draining savings accounts for treatment and being rushed to emergency rooms due to their lack of dental insurance.
A week after Davies’ video was posted, B.C. Premier John Horgan said his government was exploring how it might include dental care in the provincial health system.
Canadians often speak about the nation’s publicly funded health-care system with intense pride, yet its failure to include dental care is a cause for misery for many of the one-third of the population with no dental insurance.
The Canadian Dental Association reported in 2017 that 32 per cent of Canadians have no dental insurance. Its researchers found that those from lower-income families had worse oral health and had untreated disease more often. They visited the dentist less frequently, delayed visits and were more likely to decline recommended care due to cost.
Researchers at the University of Toronto analyzed decades of Statistics Canada surveys and reported in 2013 that only 49 per cent of middle-income Canadians had dental care coverage. About 34 per cent said they faced cost barriers to dental care in 2009, up from 13 per cent in 1996.
It is shameful so many people in a country boasting publicly funded health care live with pain, social isolation and poor nutrition because dental care isn’t part of the system, Peters said.
She believes policy-makers ought to recognize that dental care is health care.
“When we refuse to cover dental care, we are deciding to lower people’s quality of life. We are deciding to take a medical issue and let it snowball,” she said.
“Apply it to anything else: ‘We will cover everything but your left arm.’ People would say that’s ridiculous.”
AN ISSUE FOR MILLIONS OF CANADIANS
A 2015 report by the Canadian Academy of Health Sciences found that about six million Canadians avoid visiting the dentist each year because of the cost.
Canada has one of the lowest rates of publicly funded dental care among OECD countries, at about six per cent, compared to 79 per cent in Finland, said the report.
Those most hurt by lack of access to dental care include people who are low income, Indigenous and disabled.
With this in mind, Davies began pressing the issue of publicly funded basic dental care in 2015.
“I’ve long thought that dental care was a serious omission from our universal health-care system that doesn’t make any sense from a public health or social justice point of view,” the NDP MP for Vancouver-Kingsway said in a recent interview.
“Imagine when you have an open cavity or a rotting tooth or some form of abscess in your mouth, and you’re living with 100-per-cent chronic, daily pain, and you couple that with, essentially, the inability to have healthy teeth in your work and daily life. It’s very debilitating.”
Davies said he hasn’t calculated the cost to fund dental care but believes it would ultimately benefit taxpayers, given that failing to fund preventive visits to the dentist can lead to more serious health problems, including heart disease, some requiring expensive trips to emergency rooms.
He is fighting to “put dental care on the agenda” and for his party to include it as part of its 2019 federal election platform.
“Once in a while you can put your thermometer into the body politic and take the temperature, and this one came out sizzling hot,” he said. “It’s basically a no-brainer.”
Horgan said in a year-end interview on Global News that his government was looking at including dental care in provincial health-care coverage and added, “hopefully we will be able to do something about it in the next budget.”
Soon after, he clarified it won’t be in the next budget, but said that when it comes to improving dental coverage, “we’re working on it every single day.”
At a news conference this month, provincial Health Minister Adrian Dix said he recognizes that dental care is insufficiently covered, and said his ministry is keeping a close eye on the federal NDP’s discussion about a national dental program.
“We’re already moving in that direction in advance of any action by the federal government or anyone else, and I think we’re going to continue to do that,” he said. “That’s certainly the direction we have from the premier.”
He pointed to his government’s recent work to boost dental coverage for children in the Healthy Kids program — generally for families with a net income of $42,000 or less — to $2,000 over two years from $1,400.
‘WE CAN’T REMOVE THE JAW FROM THE BODY’
Dwight Yochim, 56, is a middle-income earner whose private dental plan covers cleanings and basic procedures but doesn’t cover treatment for a painful condition he was diagnosed with two years ago.
Yochim, an executive director for two non-profits in Coquitlam, suffers from temporomandibular joint disorder (TMJ). His jaw is “locked” because of a slipped disc so that he can open his mouth only a few centimetres, he said.
“If I go to eat a burger, I have to squish it down,” he said. “It’s constant pain.”
Yochim said it will cost him about $5,000 out of pocket to treat his condition, according to a recent estimate. He is shopping around for a better price, but in the meantime suffers through occasional periods of agony, which he dulls with acetaminophen.
He considers himself lucky to have any coverage at all but wants to see dental care added to the provincial health-care system. He has emailed Dix asking why this hasn’t been done already.
“It’s your basic health,” Yochim said. “I’m thinking about some of the people who don’t have dental plans. How do they get around and deal with dental pain? Because it’s excruciating sometimes.”
Bruce Wallace, an associate professor at the University of Victoria’s School of Social Work, was lead author of a 2015 study on oral health among people experiencing social and health inequities. He said when he started researching dental healthcare issues in the late ’90s, lack of accessibility to dental care was mostly seen as a problem for the poor. Now that has changed to include middle-income people with insufficient coverage.
“Now, it’s much more that people are looking at the issue as something that’s really affecting millions of Canadians that just don’t have access to employer benefits,” he said.
“The oral health-care system might look like it’s working well for the general public, but what we also know is that the single model of dentistry that we have — the private business model — is not working well for most people who have low incomes and who might face other barriers to health care.”
Wallace believes B.C. should move publicly funded dental-care programs away from the Ministry of Social Development and Poverty Reduction and to the Ministry of Health, as well as integrate services with primary health care.
“We can’t remove the jaw from the body,” Wallace said. “I don’t think we can remove oral health care from our health-care system. The blood that runs through our jaw and our mouth goes to the rest of our bodies, through our heart and our organs, and that could impact our overall health care.”
Study co-author Dr. Annette Browne, a professor at the University of B.C.’s School of Nursing, is impressed that Horgan is discussing covering dental care.
“It’s the working poor, people who live in relative poverty who are piecing together part-time jobs, often with no dental benefits, who frequently have no dental insurance coverage,” she said.
“It’s that group of people who are most often reporting poor oral health and visits to dentists only in emergencies.” SOCIAL AND ECONOMIC IMPACT
The staff at REACH Dental Clinic on Commercial Drive in Vancouver, part of a nonprofit community health centre, constantly receive calls from people asking about prices, said clinic manager Maria Botero.
About 40 per cent of the clinic’s 3,300 patients have private insurance, which helps subsidize care for its 60 per cent of patients who don’t have such coverage.
“Some of the patients, they come, they get an estimate, but they can’t do it,” she said.
“Or they do just one thing that is really urgent and then the next time they come, it’s for something really urgent again. Many times, they get extractions because it’s too late. When that happens, it’s very sad.”
Botero said people who lose teeth can’t chew, eat, speak and socialize like they could before, and often suffer from lower self-esteem.
Anita Simon of Chilliwack, 48, understands the connection between dental health and self-esteem.
When she became sick a few years ago with chronic health issues, including post-traumatic stress disorder and conversion disorder, strong medications and a lack of dental care destroyed most of her teeth.
“I’m walking around with broken teeth, abscessed teeth, in chronic pain,” said Simon, who doesn’t have dental benefits through her job as a parttime taxi dispatcher.
People make assumptions about her lifestyle because she is missing teeth, leaving her feeling ashamed and angry about her situation.
“I don’t want to be a cranky person. My mantra has always been to choose joy,” she said. “Well, joy’s pretty hard to choose right now.”
Simon is on disability assistance and while the ministry put $480 toward her dentures after she had to have her upper teeth extracted, she had to pay the remaining $1,800, she said.
She needs to come up with another $2,000 for a bottom bridge.
Before the bridge is installed, she needs to pay for two extractions and several fillings. Until she can afford those procedures, she will remain on a liquid diet and take expensive supplements to avoid causing further damage and to meet her nutritional needs.
She is urging government to immediately fund public dental care.
“I’m a single person on a very limited income, really struggling to do this,” she said.
“But even if you are a two-person family working on this, it is a huge expense for anybody. And it’s not cosmetic, like people think. It is really for your health. Your heart health is affected by your teeth and, I don’t care what anybody says, your mental health is, too.”
The B.C. Poverty Reduction Coalition has met with people on income assistance who face the stigma that comes with poor dental health when they try to pull themselves out of poverty through work, said Trish Garner, a community organizer with the group.
“Many of those folks are expected to look for work and if you don’t have dental care, and your teeth look a certain way, then that really impacts your employability,” she said. “Your career horizons are definitely thwarted.”
While people on income assistance may qualify for basic dental coverage, the fees that government will pay for treatment don’t always align with the prices dentists charge, Garner said.
For example, the B.C. Dental Association’s suggested fee guide recommends $456 for a single root canal, $102 for a basic filling and $44 for a new patient exam, while the government’s fee allowances for the same treatments are $254, $54 and $24, respectively. People on income or disability assistance typically get up to $1,000 in coverage every two years.
“We would definitely support the province and federal government in taking on dental care as a significant issue and bringing it into our idea of the provision of universal health care,” Garner said.
Dr. Ray Grewal, president of the B.C. Dental Association, said 65 per cent of British Columbians have some sort of dental coverage and the association is striving to improve things for the other 35 per cent.
The association is working with the province to support non-profit clinics, some of which are staffed with volunteer dentists, and it is pushing for fluoridated water to combat dental decay, Grewal said.
When it comes to expanding publicly funded coverage, he said B.C.’s most vulnerable patients — people with disabilities, children, seniors and those living in poverty — should be prioritized.
“The premier’s comments were great, but I think now we’re trying to figure out where we are with those comments,” he said.
“I think it’s really to just focus on specific groups (for whom) we can really improve their overall oral health.”
TEETH EXTRACTION ‘DEVASTATING’
Peters has some coverage for dental care through B.C. disability assistance, but it didn’t cover the treatments that might have saved her last four teeth.
She suffers from an autoimmune disease that requires her to take strong medications and causes gastrointestinal dysfunction, including reflux that brings stomach acid into her mouth.
She had most of her teeth extracted in 2010.
“By the time it became clear that this was a serious problem, the option that was left for me, with the coverage that I have, was extraction,” she said.
“It’s devastating. It’s hard to describe.”
Peters recently led work with the City of Vancouver’s Active Transportation Policy Council to increase sidewalk accessibility, and pushed the city’s park board to install a mat to make the beach at English Bay accessible for wheelchairs.
But after losing her teeth, she’s uncertain she’ll continue her public work and volunteerism.
“I’m ashamed and embarrassed, and I don’t even know why I’m ashamed, because I don’t know what I could have done differently,” she said.
“I’m even more angry that I’ve been put in this position.”