CALLS TO PUT TEETH INTO HEALTH-CARE COV­ER­AGE

Lack of den­tal in­sur­ance leaves some British Columbians liv­ing in agony

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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.”

Anita Si­mon lost most of her teeth af­ter suf­fer­ing chronic ill­nesses. She has a top den­ture but is in need of thou­sands of dol­lars for a bot­tom bridge.

“Joy’s pretty hard to choose right now,” says Anita Si­mon, who suf­fers chronic pain from her teeth.

Dwight Yochim’s pri­vate den­tal plan cov­ers clean­ings and ba­sic pro­ce­dures, but not the tem­poro­mandibu­lar joint dis­or­der (TMJ) in his jaw.

Maria Botero, left, with ex­ec­u­tive di­rec­tor Ni­cole LeMire, is man­ager of the REACH Den­tal Clinic on Com­mer­cial Drive, part of a non-profit com­mu­nity health cen­tre that of­ten gets calls from peo­ple ask­ing about prices, many de­cid­ing not to get their den­tal prob­lems ad­dressed.

Anita Si­mon pre­pares a meal with a blender in her Chilli­wack home. Si­mon is forced to eat a lot of liq­uid meals due to the state of her teeth.

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