In the second instalment of a Global News series exploring the Canadian health-care system, we look at dental care and the costs that come with it.
Around 86 per cent of Canadians would support providing publicly funded dental care to those without insurance coverage, according to an opinion poll conducted by Ipsos for Global News.
Around one-third of Canadians are currently not covered by any dental insurance, including Stan Thompson. The Calgarian was mugged in Hamilton, Ont., in 2005 — he was stabbed multiple times, kicked in the head and suffered serious damage to his teeth.
“(My teeth) just became worse and worse to the point where I could actually remove them myself by hand,” he recalls. “There was damage to a lot of teeth and things started going downhill from there.”
The professional comedian didn’t have dental insurance coverage and couldn’t afford to repair the damage. He says the pain and difficulty speaking meant he was unable to work and even struggled to eat.
“I went from 170 pounds to 145 pounds,” he says. “It was very depressing. You just lose all confidence.”
Thompson eventually connected with a local charity, CUPS Dental Services, which provides free dental care to low-income Calgarians. They extracted some of his damaged teeth and provided dentures.
“Thank God CUPS was able to come through. I was in a real low point at that particular time, with no real window to look through as to how I was going to get out of it,” he says.
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Dental care in Canada is provided by a patchwork of charities, private plans and government-sponsored programs that typically target low-income families. Many countries across the developed world use a similar multi-faceted model, but Canada’s coverage rate of around 70 per cent lags behind, says Carlos Quinonez, head of the dental public health program at the University of Toronto.
“If you start comparing us to the U.K. or to other European Union countries, coverage there actually reaches close to 100 per cent,” Quinonez says. “I do think we need to move towards achieving universal access to dental care, meaning every Canadian should be able to have some level of coverage for basic oral health care services and that can happen in a variety of different ways.”
Quinonez says there’s a strong financial argument for fixing the system. Preventable dental issues led to more than 60,000 emergency room visits and 230,000 family doctor visits in Ontario in 2014, at a cost of around $40 million.
“The worst case scenario is somebody that goes to a physician’s office and is essentially told, ‘You need to go see a dentist.’ They’re given a painkiller or an antibiotic. Then they eventually end up in an emergency department, where they’re given more painkillers and more antibiotics and they’re told, ‘You need to go see a dentist.’ And then they ultimately get hospitalized because of a serious infection,” he says. “That’s a lot of wasted dollars along the way, when some basic dental care could have essentially solved that problem.”
Anne Thériault knows first-hand how untreated dental problems can spiral. The Toronto writer had a near-perfect oral health record — “I’d only ever had one cavity my whole life,” she says — until she became pregnant nine years ago. In some women, increased hormones during pregnancy can affect the body’s response to plaque and lead to dental problems, such as gum disease and tooth decay. Thériault suffered far worse than most.
“At this point, I’ve had work done on every single tooth,” she says. “I’ve had pieces of my teeth falling out or teeth cracking or breaking in half. It’s been pretty bad and it is quite painful. And it does impact my quality of life.”
Fortunately, Thériault has dental insurance coverage through her husband’s employer. But she says the policy only covers a certain percentage of each dental procedure and includes an annual spending cap, which she has exceeded every year since her pregnancy. As a result, she estimates she’s spent more than $10,000 at the dentist on a wide range of different procedures.
“I’ve joked that other people pay down payments on houses. And I own teeth,” she says.
A couple of years ago, she developed a tooth abscess from an untreated dental cavity. The bacterial infection spread to her lymph system.
“I had swollen lymph nodes and was experiencing health issues from that,” she recalls. “I would see my primary care doctor for my lymph node issues and the dentist for the dental abscess.
“It’s very frustrating to be in need of health care and not be able to afford it or access it, especially in a country that really prides itself so much on having such a strong health care system,” she says.
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Of those Canadians who do not have dental coverage, the Ipsos poll found that nearly half opt not to visit the dentist at all. And despite popular misconceptions, most dental health problems are not the result of poor oral hygiene practices.
“I would love to be able to say it’s as simple as everything is preventable; you brush your teeth, you floss your teeth, you visit the dentist regularly and everything’s gonna be fine, but that’s just not the case,” explains Dr. David Stevenson, president of the Ontario Dental Association.
“From my perspective as a general practitioner, the overall dental health of people’s teeth and gums in Canada is in pretty good shape — it’s in very good shape, actually. But there are some gaps. There are some members of the population that are not getting access to good dental services. And as a country, as a government and as dentists, we all have to be able to address that and acknowledge that and come up with a plan to try to fix that.”
The Ipsos poll was conducted between April 1 to 3, 2019. For this survey, a sample of 1,001 Canadians 18+ was interviewed. The poll is accurate to within ±3.5 percentage points, 19 times out of 20.