Improving Access to Dental Care in Canada
After Cambodia, Sherri Stokes knew what to do. She’d travelled through Guatemala, Peru and Cambodia offering free dental clinics to impoverished people. Then two years ago the registered dental assistant moved to Calgary and signed on with The Dental Bus, a mobile dental health unit serving low-income Calgarians.
“I’d travelled a lot in developing countries offering dental care, but I knew there was a lot of need in our own backyard.”
Dental care, along with vision care and a number of other health services, falls outside of the Canada Health Act. With no national coverage, health providers employ a patchwork of approaches to help the most vulnerable across the country. The Dental Bus, run by a non-profit community health centre (The Alex Centre), is a prime example. The program is cobbled together with some provincial funding, corporate and private donations, a small staff, a team of volunteers and charitable status.
The Dental Bus team treats about 20 low-income kids a day, providing an option for financially stressed families. “Their parents often have to make the choice between going to a dentist or putting food on the table,” says Stokes.
It’s the kind of decision that Dr. Carlos Quiñonez, dentist, associate professor and President of the Canadian Association of Public Health Dentistry, sees many families making. Quiñonez explains why dentistry was never included in our universal health plan.
"Politicians were watching the pocketbook. Britain had just introduced a national health care plan that included dentistry. The take up was massive. And costly."
Then there was fluoridation. “At that time it was actually believed to be the ‘silver bullet’ for dental disease. For a while, we actually did think fluoridation of community water supplies was going to remove the need for large-scale systems of dental treatment.”
Dentists actively lobbied against being brought into the public healthcare system. At the time, there was a shortage of dentists to meet potential demand.
But one of the biggest arguments stemmed from social expectations of the day about the role of the individual. Just as it was your responsibility to keep your home clean, get your kids to school and eat a healthy diet, you had the responsibility to brush your own teeth.
Quiñonez points out that the argument can be made that we have individual responsibility to eat a healthy diet and get adequate exercise. Yet many of us smoke, eat poorly and remain sedentary. Many of us end up with heart attacks or diabetes.
“And somehow as a society we don’t mind paying for those services. To a certain extent people will say, ‘Well dental disease won't kill you,’ but that's actually not true. It can kill you in unique circumstances. We’re starting to understand that it may not kill you quickly like a heart attack. But it might kill you slowly over time based on what we're now starting to learn about the connection between oral health and your systemic health.”
Over the last 20 years, research has begun to uncover links between oral health and a number of diseases, particularly diabetes and pneumonia.
Not only can dentists see the effects of diabetes in people’s mouths, but a mouthful of cavities and gum disease impacts people’s ability to control diabetes. “Infection has implications for your ability to keep your blood sugar stable.”
Oral health problems are bi-directional. That is, they can be a red flag for problems throughout the body, but they can also cause problems in our various systems.
Take pneumonia, for instance. When older, vulnerable people have poor oral health they build up bacteria in their mouths and end up inhaling it over time.“If you have a gunky, dirty mouth full of bacteria, you’re inhaling bad bacteria all the time. You’re at a higher likelihood of getting pneumonia, which is a big killer in that population.”
For Quinonez, the evidence suggests that our public policy is out of date. It hasn’t kept up with our knowledge of the implications of oral health built up over the last few decades. He isn’t advocating bringing all of dentistry under health care coverage. He is advocating for a national plan to take care of those who can’t afford a dentist or insurance, for a system that’s more flexible and compassionate than the one we now have.
Back in Calgary, Sherri Stokes rolls out again with the Dental Bus. Here, keeping the system on the road literally demands flexibility. Apart from being the dental assistant, she also has to drive the bus.