Many Canadians view the perfect smile as a sign of status rather than an indicator of one’s health, as the provision of dental care is based on one’s ability to pay rather than their need.
In fact, six million Canadians avoid the dentist each year due to financial constraints and, as a result, many live with treatable chronic pain and a lower quality of life.
There is a solution to this problem: a universal dental care plan.
Why is oral health excluded from the rest of the body in the Canadian healthcare system? A primary reason is the strong opposition from organized dentistry. Maintaining oral health was framed by dentists as an individual responsibility. Fighting back against a public dental care system, they speculated that tooth decay was so prevalent that treating it would be too expensive and that there would not be enough dentists to handle the rate of cases.
The Canadian healthcare system diverged from many of its European counterparts in this way. Governments in both France and the United Kingdom, for example, guarantee basic dental insurance to all of their citizens. Meanwhile in Canada, one in three people lack dental insurance, leaving them to pay out of pocket if they can afford it all. When people cannot afford all necessary treatment, dental services are rationed. Preventative cleanings and minor fillings are neglected, and money goes to emergency care. This is seen disproportionately among seniors, the poor, and the precariously uninsured.
In Canada, poor oral health is intimately related to the cycle of poverty. People who neglect dental care are often missing front teeth and living with chronic pain, making it harder to find work while battling the stigma associated with poor oral hygiene. When dental health is neglected, the problems only compound and become more costly.
Many Canadians who cannot afford emergency dental care end up at physicians’ offices and emergency departments. One study found that in 2014, Ontario medical clinics were visited every three minutes and emergency departments every nine minutes by patients seeking treatment for dental pain. Using minimum estimates, this costs taxpayer $38 million per year in Ontario alone.
These estimates hide the total cost of a healthcare system without dental care. Imagine a patient with an untreated tooth infection. At the low end of a hospital visit, a trip to the ER for dental pain costs the healthcare system $124, but if the person needs to be hospitalized, that cost jumps to $7,367 per visit. This is hard to justify, considering this could have been treated earlier at a fraction of the cost if the infected tooth was removed.
Doctors typically give patients an antibiotic and pain medication for their dental pain, leaving the underlying infection untreated as medical doctors are not equipped to treat teeth. Leaving dental infections linger in this systematic way is a public health concern. Untreated dental infections can be fatal if they spread to the brain or compresses the airway.
These problems described here are only expected to get worse in coming years. As the baby boomer generation retires, they lose dental insurance tied to employment. Meanwhile, younger generations are increasingly working in the precarious ‘gig economy’, which provides temporary employment and does not provide dental insurance tied to their labour. This results in more Canadians who lack dental insurance, greater neglect of dental care, and further strain on the healthcare system.
Over the last 50 years, some provincial governments have tried to patch holes in dental care access with little success. Some governments created targeted programs to provide some dental care for groups like children of low-income families, those on social assistance, recognized Indigenous peoples, and military veterans. These targeted programs only insure a small fraction of Canadians who lack private dental insurance. Coverage also varies widely across the country, with some still experiencing significant co-payments and low annual caps to dental care expenses, despite attempts at means-tested assistance.
Targeted programs still leave the people who receive assistance vastly underinsured. When funding for these programs is cut or does not keep up with inflation, there is little backlash. Patients relying on targeted programs that are chronically underfunded become a low priority for dentists, as they pay only a fraction of what higher-income patients pay for dental care.
Under a universal dental care plan, certain procedures would be deemed medically necessary and the dentists would be paid the same amount for these procedures, regardless of the patient’s income. This incentivizes dentists to set up clinics in low-income areas, treating more patients who need these procedures.
Canada’s Conservative and Liberal politicians argue that we cannot afford universal dental care, however, private dental care is not cheap either. In 2010, Canadians spent $309 per capita on dental care whereas dental spending per capita in the UK and France was $141 and $175 respectively.
Providing universal, public dental insurance allows many avenues to cost savings. Preventative services would be distributed to everyone who need them. It removes the profit incentive for basic dental insurance and removes wasteful spending on things like advertising and CEO salaries of insurance companies. The government can also negotiate lower prices for dental supplies by purchasing them in bulk.
Progressives need to do more work to organize the public on the benefits of public dental care, because there is popular support for it. A 2019 Ipsos poll found that 86% of Canadians surveyed support government funded dental care for those without insurance. Abacus found 66% of Canadians surveyed support expanding public healthcare to include prescription drugs, dental and vision care. If progressives were better organized, we could make strides in pushing for a universal dental care plan that not only covers everyone, but also saves money.
The lack of organization likely led to the NDP’s means-tested program that was promoted during the last election, providing dental insurance coverage only to households with income less than $70,000 per year. The NDP claims this would extend public dental care coverage to 4.3 million Canadians, but means-tested coverage will not lower per capita dental spending and will not guarantee dental insurance as a right.
Successive governments could easily weaken such a program, if it were ever put in place, by deindexing household income cut-offs from inflation. This type of program could also be dismantled by lowering dental procedure fee guide well below the private counterpart that disincentivizes dentists to treat patients under the public option, effectively widening the gap in a two-tier system. A universal dental care plan would be more robust from cuts, because an attack on it would affect everyone, not just a select few. A means-tested dental care program will not provide what a universal program can.
Brandon Doucet is a practicing dentist currently based in Newfoundland.