A Dentist’s Plea for Truly Universal Health Care

In Canada, the perfect smile is seen as a sign of status rather than a sign of good oral health. This is because dental care was not originally included in medicare, despite plans to include it at a later date. Now, over half a century later many low- and middle-income Canadians are living with the consequences of this decision.

People rely primarily on work-related insurance to access dental care. Those without have to pay out of pocket or see if they qualify for meagre safety-net programs set up by provincial governments. Many relying on the dental safety net are often underinsured and struggle finding a dentist who will accept them. As a result of this private system, over one-third of Canadians lack dental insurance and 6.8 million people avoid the dentist each year due to financial constraints.

The number of Canadians without dental insurance has been increasing due to shifts in the economy. Younger people are working increasingly in the precarious gig economy that does not provide dental insurance tied to their labour. Also, older people are retiring in large numbers and losing work-related dental insurance.

The COVID-19 pandemic has made things worse. The economic downturn associated with the pandemic has significantly increased unemployment and caused many people to work reduced to no paid hours. As a result, people are losing work-related dental insurance and they have less income to pay for these services out of pocket.

When people are unable to access dental care, they turn to their physician to access care. In 2014, Ontario’s doctors’ offices were visited 222,000 times and emergency departments 67,000 times by patients seeking treatment for dental pain. As more people struggle accessing dental care, these numbers will certainly rise.

Poor oral health is intimately related to the cycle of poverty. First, it is difficult to find a well-paying job when you have visibly decayed or missing teeth. When chronic dental pain becomes too much to handle, people are left paying for necessary care on the credit card.

People are also left with poorer overall health when lack of money causes them to neglect their dental needs. Poor oral health has been associated with the following health conditions: cardiovascular disease, diabetes, having a low birth weight infant, aspiration pneumonia, erectile dysfunction, osteoporosis, metabolic syndrome and stroke. Research has also shown that providing oral health care to people being treated for drug addiction led to a greater likelihood of completing treatment, increased employment, decreased relapses and reduced homelessness. If everyone can gain access to dental care, people will be healthier and the government will spend less in other areas of health care.

As a dentist myself, I see how so many are left out by our current dental-care system. People neglect preventative cleanings and small fillings as they need to focus money on emergency care. I see people who need all of their teeth extracted because they did not have the money to get treated sooner and cavities were left to grow. Given the social and economic consequences of our current dental-care system, it is time we rethink how these services are delivered in Canada.

Right now, many people rely on private insurance to access care — an expense that others can’t afford. Integrating dental care into medicare would provide all Canadians with dental insurance. People would not have to worry about losing insurance when they become unemployed, retire or leave a partner when they are covered by their insurance. Providing dental insurance to all frees up organized labour to bargain for other demands.

Further, we need to break up dentists’ monopoly on care by making dental therapists mainstream in Canada. Dental therapists are mid-level dental providers that perform simple procedures like fillings at a fraction of the cost of a dentist, while still maintaining the same quality of work.

Dentists have long been opposed to dental therapists, but integrating dental care into medicare is the perfect opportunity to overcome this hurdle. Dental therapists provide an opportunity to treat patients who have historically been neglected, such as people in poor, rural and Indigenous communities. Having dental therapists working in school-based and community clinics ensures people, even when insured, can access dental care.

Expanding medicare also presents an opportunity to shift the costs of these services towards the wealthy. Inequality in our society has been rising for decades and the richest have managed to profit off the COVID-19 pandemic while most people are struggling. Creating a wealth tax and cracking down on the use of tax havens could pay for universal dental care while being fair to less wealthy Canadians.

It is time we complete Tommy Douglas’s dream of universal health care from head to toe. Expanding medicare to include dental care is a key step that will alleviate unnecessary pain and suffering.

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Please contact Coalition for Dentalcare via email if you are interested in learning more about universal dental care.