Government won’t pay $30K so woman can chew
Ministry more focused on ‘cost containment’ than patient care: expert
Judy Perrin-Royer’s dental surgeon described her as an oral cripple in need of dental implants, but the provincial government won’t pay for the $30,000 procedure.
The 59-year-old Saskatoon woman cried when she heard herself described as an "oral cripple," but she said it’s true.
Her upper jaw has deteriorated to the point that it no longer holds her dentures. They even move around while she talks.
The family support worker said she’s approaching retirement and can’t really afford to fix her teeth on her current income.
“We just had to set up financing in order to do it. And it's a necessity. I had no choice.”
'I won’t be able to eat'
When she was in her 20s, Perrin-Royer had a bone graft and dental implants on her lower jaw. She said she’s never been sure exactly what’s wrong with her.
“Just really unhealthy teeth. I am not certain whether it was lack of calcium during my mother’s… pregnancy.”
Regardless of the reason, she had to pay the $10,000 bill back then to fix her bottom teeth.
Now it’s three times that amount for her upper teeth.
For months before the surgery, Perrin-Royer was in discussions with the ministry, asking the provincial government to cover the procedure.
However, her surgeon was told she didn’t qualify for government funding.
So in September she decided to go ahead and get it done on her own because the situation was urgent.
Her surgeon grafted bone from her hip to her upper jaw and then drilled titanium posts into the bone, which will enable her new teeth to stay in place.
“If I don’t have it done, then at some point, I won't be able to eat,” she explained.
In a letter she delivered to the Ministry of Health, her surgeon, Dr. Myles MacLennan, explained Perrin-Royer’s jaw had deteriorated to the point where it was “impossible… to even place a traditional denture.”
And so he recommended dental implants “so that she can have teeth to chew food and speak.”
Perrin-Royer said her doctor saw this surgery as a health-care necessity, not cosmetic.
“This is not an instance of ‘I need pearly whites’. I need them to eat.”
New program covers some dental implants
Saskatoon-based oral surgeon Frank Hohn thought that was unacceptable and pushed the government for change.
“At the time, the Ministry of Health stopped all funding once it became a dental issue and that didn’t satisfy the needs of the patient,” Hohn said.
Hohn worked with the government to set up a new program that would pay for dental implants in cases where no other method of treatment is appropriate.
The ministry says that since the program began, it has received about 130 applications and approximately 60 per cent of them have been approved.
The government explains the implants will only be covered in the case of “tumours and congenital defects” (cleft palate and metabolic disorders).
Perrin-Royer denied coverage
So he didn’t formally apply for funding.
Because there was no formal application, executive director of Saskatchewan Medical Services Branch Shaylene Salazar said the claim was not technically denied.
However, she did confirm that, in effect, the claim was denied and she said the ministry is now having another look at Perrin-Royer’s case.
“Every case that we get that we deny we evaluate it against the policy and see if the policy needs to change. We do that with all coverage decisions,” Salazar said.
Program needs review
Hohn said he’s happy the government has a program for dental implants, but he thinks it’s in need of change.
For starters, he said the fact that government officials decide who gets covered, not oral surgeons, is problematic.
“If individual cases were brought forward and adjudicated by the proper people, not bureaucrats, I think the program would be better,” Hohn said.
He said independent dental experts should be evaluating applications “on their individual merits as opposed to just a cookie cutter ‘it covers this that and the other thing and no more.’”
Hohn said there’s another problem with the system.
As the former president of the Canadian Association of Oral and Maxillofacial Surgeons, where he worked closely with colleagues from across the country, it became clear to him that Saskatchewan’s program “is underfunded” when compared with other provinces.
“This program has really become a cost containment program as opposed to a patient-centred program,” Hohn said.
Salazar defended the province's program saying “our coverage in Saskatchewan is fairly comparable to other provinces across Canada.”
And she said it is being constantly evaluated with an eye to improving it.
Dental care underfunded across Canada
The dean of the College of Dentistry at the University of Saskatchewan argued it's not just Saskatchewan that underfunds dental care.
Gerry Uswak said it's a national problem that becomes evident when you compare what Canada spends on a per capita basis to other G8 nations, including the United States.
"We are basically at the bottom of the barrel in terms of our public funding of oral health and dental care," Uswak said.
As for Perrin-Royer, she had the titanium pins installed in September. The new teeth haven’t been installed yet and likely won’t be for a few months yet.
She said soon she’ll be getting a temporary denture.
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With files from Roxanna Woloshyn