It's Sona Regonda's first time in a dental chair, but she's handling it like a trooper.
The fourth grader smiles politely as Margaret Callon, dental hygienist and faculty member at the Canadian Institute of Dental Hygiene (CIDH, which has recently closed), explains what will happen next.
Callon and her student gently recline the chair. They give Sona a pair of dark glasses so the light won't hurt her eyes.
It's an experience her family would have difficulty paying for otherwise. Her father Reddy, a computer operator working on contract without dental benefits, says the institute's Summer Smile Clinic makes it possible.
He brought Sona and her little brother to it because it's affordable, he said.
"They treat her well."
Free for children aged six to 12, the recent clinic serves a dual purpose. It is a training opportunity for the student dental hygienists at the school on King Street East. And for kids like Sona, it helps bridge a painfully expensive gap.
The 2012 suggested dental fee guide from Ontario Dental Association is widely used by dentists and insurance companies. Dentists can, and often do, adjust the fees based on a patient's ability to pay. But the basic suggestion in the guide is $54 for 15 minutes of teeth cleaning, or up to $216 per hour.
A simple tooth extraction typically costs about $128. A root canal on a back tooth can cost as much as $847, and a porcelain crown $663 plus a $200 lab fee.
For many low-income families, particularly newer Canadians, it's more than they can afford, says Stacey Krestell-Goodman, the city of Hamilton's program manager of dental services.
While Krestell-Goodman doesn't have the exact number of Hamiltonians who can't afford dental care, she knows how many use the city's services.
In 2011, 1,700 Hamiltonians went to the city's Community Health Bus for free dental care. Another 1,600 attended the city's Public Health Services Dental Clinic to see a dentist, and about 1,250 saw a dental hygienist.
More use the two provincial programs offered locally — Healthy Smiles Ontario (for children from families with no dental coverage or who make less than $20,000 per year) and Children in Need of Treatment, which provides emergency care for kids from low-income families.
Demand is great
Given that the city bus and public health clinic can only see about eight to 10 patients per day, there is often a line up, Krestell-Goodman said.
"The day is not as long as there are clients who require service."
While the public health clinic does emergency and preventative care, the Community Health Bus deals mainly with emergencies.
Patients often have large cavities or active infections. They have sores from ill-fitting dentures. There may be nerve issues, or the patient may need a root canal. In those cases, the tooth is extracted since root canals are so expensive.
Good teeth are not just a matter of vanity, Krestell-Goodman said. Of the 15,922 children screened in local elementary schools each year, about 10 per cent have urgent dental needs, such as intense pain or large cavities.
That can impact every area of the patient's life. Untreated dental problems can impact speech development in children. It can lead to poor nutrition and poor self esteem, and in adults, lack of employability, Krestell-Goodman said.
Putting food on the table
But uninsured families often forego dental care for more pressing needs.
"If you have to weigh putting food on the table for your children or taking them to get their teeth checked, when you think of the priorities, obviously a family will choose to feed their children," she said.
Callon is pleased with the role her students take in filling a need. The Summer Smile Clinic is for children, but the CIDH also offers a low-fee dental clinic patients can access by paying $20 per year.
Not everyone who attends the clinics is low income, although many of them are. Through the dental clinic, CIDH staff and students see children and adults, and senior citizens who are retired and no longer have dental insurance.
"They feel they can come and help (the students), and yet the fee is low," Callon said.
The Summer Smile Clinic provides cleaning, mouth guards and sealant application.
Ontario funding lowest in Canada
On July 11, Hamilton's board of health accepted a report about oral health care. Citing an April report by Dr. Arlene King, Ontario's Chief Medical Officer of Health, it recommended reviewing and aligning publicly funded oral health programs in Ontario, including those serving low-income residents.
Ontario, the report says, spends the lowest per capita in Canada for dental care. The national average is $19.54, whereas Ontario spends $5.67.
"The precariousness of access to dental preventative and treatment services, especially for low income Ontarians, makes little sense," King said.
Ontario dentists do what they can to make dental care affordable, said Dr. Arthur Worth, president of the Ontario Dental Association.
In the preamble of the suggested fee guide, it recommends dentists look at a patient's ability to pay and adjust the fee accordingly, he said. They also participate in public health clinics such as the ones in Hamilton.
"Many of our members see low-income patients on a regular basis," he said. "I know I do."