Many Canadian seniors are suffering the health and social effects of tooth loss because they can't afford even the expert-agreed minimum standard of care when it comes to false teeth.
All too often, experts and patients say, financial considerations are forcing seniors to endure less-effective treatment that can profoundly affect their quality of life.
"It's unfortunate: There is a disproportionate number of people who have no teeth who also have no money," says Dr. Duncan Chambers, president of the Association of Prosthodontists of Canada.
"They never had the money to take care of their teeth in the first place, and now they're being punished again because they don't have the money to replace the teeth they had removed."
Edentulism — complete tooth loss — might not exactly roll off the tongue, but it is one of the most common ailments afflicting Canada's seniors.
The latest federal figures indicate more than one in five Canadians over the age of 60 — more than one million people — have no natural teeth, a situation the World Health Organization considers a physical handicap.
The standard treatment has long been upper and lower dentures. And with dentures comes a whole new set of problems.
"Little did I know," says Glenn Dougherty, 77, of Hamilton.
"I got to the point where I could eat hardly anything. It was mostly liquid foods."
After a lifetime of problems with his teeth and costly dental treatments he could ill afford, Dougherty had his teeth pulled more than 20 years ago and replaced with standard dentures.
He quickly discovered the lower denture would not stay in place, a problem that can be exacerbated by the loss of bone that inevitably occurs once the lower teeth are lost.
Denture implants 'changes your life'
Almost a decade ago, an international experts symposium in Montreal agreed that the minimum standard of care should be the implant of two titanium screws into the lower jaw onto which lower dentures can be anchored.
Even this minimal standard comes with a hefty price.
At the low end, a set of lower dentures on just two implants will quickly top $10,000. At the high end, a complete set can run close to $60,000.
"You run into this time and time again where someone doesn't have the means and so they suffer," says David Barrick, a denturist in Burlington, Ont.
Tooth loss is primarily caused by cavities, gum disease and trauma. Hundreds of medications can damage teeth.
Normally, public or private insurance covers extractions, especially if they're deemed medically necessary.
In most cases, any coverage disappears along with the teeth on the grounds that dentures — with or without implants — are cosmetic, despite numerous studies to the contrary.
According to Health Canada, the loss of all natural teeth can lead to changes in eating patterns, nutrient deficiency and involuntary weight loss as well as speech difficulty.
While Alberta does provide some denture funding for low-income seniors, most Canadians are left to fend for themselves.
"The majority of dental implants, which are artificial tooth roots, are used for aesthetic enhancement," said David Jensen, a spokesman for Ontario's Ministry of Health.
"Ministry policy is that the cost of this together with the artificial teeth that would be affixed to the implants is the responsibility of the patient."
Federal figures show more than half of adults between 60 and 79 years of age have no dental insurance at all. Those who have private insurance usually discover implants aren't covered.
Denturists say people who want even a minimal implant are forced to do without, take out loans or borrow from family.
Others spend years saving, sometimes only to discover bone loss has made implants no longer feasible.
With the help of a Christian benevolent organization to which he belongs, Dougherty was able to come up with $12,000 he needed three years ago to have implants done.
"It changes your life," he says. "These teeth are just like normal teeth — they don't move."