Wednesday November 29, 2017

Wednesday November 29, 2017 Full Episode Transcript

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The Current Transcript for November 29, 2017

Host: Anna Maria Tremonti

STORIES FROM THIS EPISODE

Listen to the full episode

Prologue

[Music: Theme]

SOUNDCLIP

VOICE 1: It's painful?

VOICE 2: Very.

VOICE 1: Very painful.

VOICE 2: It's very shocking when it's... When the cold wind hit my face feel like I'm going to pass out.

ANNA MARIA TREMONTI: She's got a bad tooth and a piercing pain she's been trying to ignore. Now she's here at a rolling clinic in Hamilton, Ontario that offers free emergency dental care. For her, a single mom with a part time job and no private dental insurance, the price of repairing or replacing teeth is prohibitive. And she's not alone, an estimated 11 million Canadians have no dental insurance, paying out of pocket isn't always an option. Just ask Brandi who has so many cracked and broken teeth that she's made her own makeshift crown.

SOUNDCLIP

There's a product called Friendly Plastic you boil it and it goes gooey and then when it cools down it hardens. So it created sort of a temporary cap that I've had in there for at this point almost a year.

AMT: Or talk to Dave who's cancer treatment left him with a mouth full of problems and a dental bill he can't afford.

SOUNDCLIP

It started with one tooth breaking and then a few days later another one chipped, a few days later another one cracked part of it came off. That note would be a good way to describe it if you didn't know my situation.

AMT: There have long been calls for a national dental care program as part of our parallel to universal health care. Later we'll be hearing differing views on that. Today we're devoting our entire program to this special edition of The Current filling the gaps dental care in Canada. And we begin in a parking lot in a suburb of Hamilton Ontario. I'm Anna Maria Tremonti and this is The Current.

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Dave Stock beat cancer twice but faces a $10,000 dental bill

SOUNDCLIP

[Sound: Dentist drill]

AMT: You know that sound the sound of a dentist's office. But those sounds are coming from inside of a bus parked outside the community health center on a little street in Hamilton Ontario.

DR. KASH ZAKI: I am Dr. Zaki Nice to meet you. How are you.

VOICE 1: Nice to meet you too. I a fine thank you.

AMT: Dr. Kash Zaki has his own private practice in Toronto. But two days a week he's here with Hamilton Public Health in a rolling full service dental office willing to tackle any dental emergencies.

DR. KASH ZAKI: We see teenagers and we see seniors people who can't access dental care anywhere else for whatever reason. We see some people are homeless. Some people have recently lost their jobs and lost their coverage. Some people haven't seen a dentist in years. We're talking 25-30-40 years and some people have gone to the dentist last year and now they can't go because of cost concerns. [To patient] What brings you here today? What's going on?

CAMELA ROSS: I have a lower jaw tooth that is...you might see it is on the right hand side.

DR. KASH ZAKI: Can you just open for me?

CAMELA ROSS: When the cool wind hit my face. I feel like I'm going to pass out. It's like a freeze. I feel like I can't talk to nobody anymore and my friends would say "you getting red Camela."

AMT: For about the last month Camela Ross has lived with that pain hoping it would just go away. She knows she needs some kind of dental work but she can't afford it she doesn't have insurance. She's raising her nine year old daughter alone and she never gets more than a four hour shift as a personal care assistant. This visit is her last resort.

DR. KASH ZAKI: So you have a big cavity on the side of your tooth. Okay. You aslso have a big cavity on the back of her too. You could try putting a filling in there. Okay. I don't know if it's going to work. OK. Because the cavity looks very big.

CAMELA ROSS: Okay.

DR. KASH ZAKI: If we do that feeling it doesn't work you'll need to have a root canal. Okay. We don't do root canals here. That's something you'd have to do in a private office.

CAMELA ROSS: Just try the filling and see what happens. And if that doesn't work maybe try and figure out how do I get to the root canal.

DR. KASH ZAKI: Well I'm doing the filling. And if it ends up into the nerve right at that point you're going to have to have a recount right away or have the tube taken out. So that's the risk. Yes. I don't want to put you in a position where you know I've started this filling. Right. And then I'm going to send you home and then you're going to be in pain. Right. That's the last thing I want to do.

CAMELA ROSS: Okay let's give it a shot. See what happens. Maybe you can call a family members all over the place and see if they can pitch in.

DR. KASH ZAKI: Any pain there?

AMT: There was a time when the man now sitting in the dental chair would have never believed he need to come to this bus. His name is Bill.

BILL: I had a career in a corporation in Hamilton till 2008 when the economy went up. I had 20 years and I lost all my benefits. I have two teams that were filled before and they're getting older so they both have chipped. One chip about a year ago and one chipped about eight months ago and they're starting to bother me a bit now and because I don't have benefits. This is the only place I can go.

DR. KASH ZAKI: Okay. Well your X-rays look okay. I don't see any impact. On. You. I see where your tooth is broken.

BILL: I know pretty soon it's going to start getting into the nerve. I want to get it before it gets too bad. And I got two chips so because they're chipped the edge the tooth is sharp and it irritates my tongue.

DR. KASH ZAKI: You have a very big filling in that tooth. Yes. We're going to have a closer look. [To interviewer] Bill came to me and his chief complaint or his chief concern was a broken tooth. [To Bill] With the freezing you are going to feel a.

DR. KASH ZAKI: Just turn towards me. And so we were able to fix that for him today. [To patient] Deep breath. [To interviewer] But when people come and I don't just look at that one tooth they have an overall what's going on with their health. And you know he had a gum problem he had to have a good cleaning. He had other broken teeth. He had other cavities. So you know if he doesn't deal with those situations they're going to become an urgent problem and then he'll be back.

[Sound: Dentist's drill]

AMT: People will come and go all day. Some mornings them line up outside even before the bus is ready for them.

DENISE: I'm a retired caretaker.

AMT: With her twenty something grandson in the chair. Denise explains how they came across the bus.

DENISE: He's got a really really bad tooth and we came to the bus thing because kids Google everything nowadays. He googled and found out where the bus was going to be and I brought him up because we don't have the money for a dentist. I don't know what's going on but it's driving him crazy and he's driving me crazy like with pain. He might want to erase that [laughs].

AMT: And even as she jokes Denise gets serious moved in how caring this dental team is.

DR. KASH ZAKI: So you let me know if you have any problems.

[Sounds: Drilling and chatter]

DENISE: I really like to that they treated us equal here you know they didn't look down on us because we're here for the bus which is free. My grandson can't afford a dentist and I can't afford one for him and they didn't look down on us at all. You know we're equal I mean I'm wearing jogging pants and an old coat - clean but old coal.

AMT: This bus hums with the kind of openness and concern Denise has identified. As a dental assistant with Hamilton Public Health. Danielle Di-Angelo has seen some pretty desperate cases.

DANIELLE DI-ANGELO: Some of the worst case scenarios we've seen is people not being able to get the help that's needed. So they've tried to take it in their own hands and take teeth out on their own. Literally going in the garage and grabbing some pliers and trying to remove it to themselves and it doesn't go well at all.

AMT: By this time Dr. Zacky has spent the better part of an hour with Comela.

CAMELA ROSS: So we have changed our treatment plan a little bit.

AMT: They were both hoping they could save her.

DR. KASH ZAKI: The original plan was to try and put a filling in there, but after I gave her the freezing and started to take up the decay. We found the decay was too deep and it was into the nerves. So that at this point, it's either you go get root canal right away or you have to take the tooth out. So we've decided to take that to go.

CAMELA ROSS: I cannot afford the root canal right now. And it is very painful. And I don't think I have much of a choice at this moment.

AMT: Someone with money or insurance would likely consider an implant. She's just going to have a hole there.

CAMELA ROSS: Will I be able to chew and eat properly still?

DR. KASH ZAKI: Well you're just going to be missing one tooth I don't know. I mean you will learn it, you will learn to chew, yes.

AMT: Camela sits in the dental chair a wad of tissues in her hand. The gauze still in her mouth where her back lower tooth used to be. [To Camela] You were hoping to keep that tooth today.

CAMELA ROSS: Yes I am very sad to lose my tooth. I was hoping they can fill and just try and see what happen. But then he talks about the pain. If the pain come back bad and he's not around. Like what do I do? We have to pay the rent. We have to pay for food, clothes, a lot of things, you know. And every month a lot of us were cut off. We don't have enough people need teeth. You know it is aesthetics, it adds to your confidence. It makes you feel good about yourself. It's health because you've got to eat.

AMT: You know there are people who say we should have dental care coverage he way we have health care coverage what do you think?

CAMELA ROSS: Yes we should. I think. That's 100 percent. Everybody should have. A teeth is very important.

[Background clinic noise]

AMT: What stays with you when you're when you're through a usual day on this bus?

DR. KASH ZAKI: Yeah. What stays with me is - People come here we're dealing with you know their toothaches. But that's just a symptom of the overlying problem, like this is not just dental or a tooth problem. This is like a socio-economic problem. And that's what sticks with me. Like why are these people coming to the dental bus? Like Why can't they access dental care anywhere else? Like how did you end up in this situation? That's what sticks with me.

[Music]

AMT: A dentist's office on a bus like the one in Hamilton doesn't roll around often so most people who can't afford dental care often find themselves in pain and without options. The Current producer Willow Smith went to Welland Ontario to meet Brandi Jasmine, a self-employed artist. She needs thousands of dollars’ worth of dental work and can't pay for any of it. So she's taken matters into her own hands.

BRANDI JASMINE: [00:10:54] Going from left to right on the top there's only three molars left and one of them is broken in the middle. And I told you that I had created this plastic thing because I can't afford to even get the broken tooth fixed. So what I'm doing I'm just getting a little bit of tooth paste here and then I have to kind of pop out the.. just brush it, just like you know most people do with their dentures. And then you just pop it back in and away I go. I'm an artist and I am - it just sounds so arrogant to say - but I'm very clever at finding my own solution so there's a product called Friendly Plastic and it's heat sensitive so you boil it and it it goes gooey and then when it it cools down it it hardens. So I created sort of a temporary cap that I've had in there for at this point almost a year . I have had to have it because otherwise the tooth would be cutting the side of my mouth. So this is one of my art pieces it's a guitar. It's beaded. I call it Starburst Zodiak. [Sound: Guitar] It really wasn't intended to be played. If you see it it's completely covered with beads all the way up the neck of the guitar. I've been doing this kind of artwork for about 10-12 years now and had some success at it. It's just not enough to pay all the bills. These are all different kinds of beeds I have gotten from different places. I get them from dollar stores. The last time I'd had it assessed that I could afford to see a dentist at all, he did this list all the things that need to be fixed and there are 12 teeth. I think there's five of them that need to be pulled and the rest could be recovered at that time but at this point in time I don't even know if those teeth can be recovered, because it's been over a year and I'm sure there's more damage. In total it was somewhere between five and six thousand dollars including getting dentures made. Just having your teeth done was around 2500. I can't even afford to have one tooth pulled at this point. I'm struggling just to make ends meet and you know pay the grocery bills and pay the you know like there's two bills that are coming due tomorrow and I don't know if there's going to be money for them. Even $150 is too much for me to spend on this. And so I just- you know the pain comes and goes it's not there all the time. Only most of the time or if you bite into something the wrong way or if there's a cold breeze hits the wrong way or you know laughing. And it the pain in the front of my mouth goes all the way from the tooth area all the way up my nose and sometimes even up to as far as my eye. It'll go away for a week or two and then it'll flare up for two or three days and I won't even be able to think. You know the pain will be just so bad that I can't get anything done. [To her cat] Hey honey, come on say hello. [Sound: Cat mews]Oh baby you love your momma? She's shy so there she goes. It affects me emotionally in a variety of ways. I have challenges with anxiety and depression. You know at times in my life I've been on medications for them, and staying what I would call it balance or equilibrium is extremely hard not just because of the pain - which is bad enough - but also the feeling of being abandoned by my people by my government is I mean [sobbs] you feel like you're being tortured every time it happens and it's happening over and over and over again. And you just feel like you can't - there's no way out of it, there's nothing you can do about it. All you have to do is take it. And like I don't take it personally or anything like that. And I know there's a lot of other people in that same situation. And I wonder when I'm having that moment what their lives are like and how many other people are out there having the same experience. And that really gets to me too. So it's - I just don't understand why people are suffering like this for the want of something so simple as a tooth extraction. I'm not asking for root canals and the Hollywood teeth here. I'm just "please God. Can I get these out of my mouth.

[Music]

AMT: Like Brandi Jasmine, Dave's Stock has lived with excruciating dental pain although after going through two bouts of cancer he never imagined his teeth would be the thing to cause him so much misery. Our producer Suzanne Dufresne visited Dave and his family in Winnipeg.

DAVE STOCK: Should we call Zoe for dinner?

AMANDA STOCK: I think we are good to go.

DAVE STOCK: Zoe, dinner. Come on kid.

ZOE: Coming.

DAVE STOCK: Garlic ribs and some rice and probably broccoli.

AMT: The bustle of dinnertime as Dave and Amanda Stock get ready to eat with their six year old daughter, Zoe. It wasn't too long ago that sitting down for a regular meal like this would have been unimaginable for Dave. Massive doses of chemotherapy and a bad reaction to a bone marrow transplant ravaged his teeth and left his family with a crushing dental bill they can't afford. Like many other Canadians in that position, they had to turn to friends, family, even strangers to raise money. Here are Dave and Amanda stock.

DAVE STOCK: So in 2011 I was diagnosed with large lymphoma non-Hodgkin's, started chemotherapy, actually the day my daughter was born I'm also a very large person. And so it was a lot of medication that I had to go through to take in. But luckily I went through it all and I beat it and was deemed cured, for the most part. A year and a half later I started to get really ill. And we thought it was just a cold. It turns out that I had contracted, as a result of the chemotherapy, leukemia.

AMANDA STOCK: So we've spent about six months in the hospital on and off. He needed a bone marrow transplant. So the first thing we saw was he lost all of his skin. He lost all of his hair. But that's - you know with chemo that happens. Then he started to show signs of graft versus host disease. It's when the new bone marrow starts overriding the old bone marrow what's left and there's a war going on inside your body. So with Dave his saliva glands stopped working. So not only were his teeth brittle from the chemo but he had dry mouth because his saliva wasn't working, and it caused his teeth to just completely decay. He would eat a sandwich and his teeth would break.

DAVE STOCK: It started with one tooth breaking and then, a few days later another one chipped, a few days later another one cracked part of it came off. [unintelligible] would be a good way to describe it if you didn't know my situation. Like when your smile has more gaps and teeth and cracks. Tt's not very nice to look at.

AMANDA STOCK: It's heartbreaking to have to watch someone you love go through this and all you want to do is find ways to help. You know he probably lost a good 25 pounds just in those months from only being able to eat liquids.

DAVE STOCK: So after examining my mouth my dentist determined that we I needed implants the dentures would not work. So far the total expenditure on my teeth has been around $10,000. Half of that from a charity and the rest from our insurance and the kindness of my dentist and also my Go Fund Me helped a lot.

AMANDA STOCK: I created the Go Fund Me page without Dave's knowledge because he probably wouldn't let me do it if I told him about it, but he needed to eat. I didn't know what else to do.

AMANDA STOCK: When I found out Amanda had put the Go Fund Me up I was I was mad. But then I started to see even the numbers rising on the page and ended up bringing in around three and a half thousand dollars, something like that, I can swallow my pride didn't get much fixed [laughs]. So that's what I did. And very thankful for everybody who donated and I don't know what to happen for the bottom part. Bottom teeth should cost about the same as the top. So around nine to $10,000.

AMANDA STOCK: People don't think cancer will lead to dental issues. Once you're done with the cancer there's nothing really to cover what happens next. And when you're on disability we're getting about a third of what Dave used to make which is hard enough, but then to have his mouth fall apart and this extraordinary bill to fix it. You know it's like what people in the states have to deal with. I don't know how they deal with that. Dave's medical bills would have cost about over ten million dollars, if we were in America. We're lucky that you know we're only having to fight about a you know $15000 dental bill. But it's a $15,000 dental bill at least.

DAVE STOCK: To me, if it was one thing - if I needed to have my teeth fixed because I was ignorant and silly and I didn't brush them I ate candy and pop and didn't brush my teeth and they rotted, and I need help, or I was doing illegal drugs or whatever. Yes, I should have to pay for it. But when your teeth are snapping and breaking as a side effect from a medical treatment I think that should be covered as the medical treatment was because it's the same thing.

AMT: We'll pick up on that idea around what dental care should be covered and why it's considered separate from other medical care. In our next half hour. To see before and after photos of Dave Stock's teeth, or Brandi Jasmine and her homemade cap or crown, or my visit aboard the dental bus in Hamilton check out our website cbc.va/thecurrent. You'll also find a look at the costs and gaps, big and small, in dental care in this country. And we want to hear from you. Do you need dental work you can't afford? What have you had to do to pay off your dental bills? Where do you see gaps in the system or is the system working for you? Let us know. Find us on Facebook or on Twitter @TheCurrentCBC, send us an email, go to our website cbc.ca/thecurrent and click on the Contact link. The CBC News is next and when we return: Should dental care be part of universal health care? I'm Anna Maria Tremonti and you're listening to a special edition of The Current, Filling the gaps: Dental care in Canada.

[Music]

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Overall health includes oral health: Should dental be part of universal healthcare

Guests: Larry Levin, Paul Allison

AMT: Hello. I'm Anna Maria Tremonti and you're listening to a special edition of The Current, Filling the gaps: Dental care in Canada.

[Music: Theme]

SOUNDCLIP

VOICE 2: It started with one tooth breaking and then another one chipped another one cracked.

VOICE 2: I'm not asking for root canals and the Hollywood teeth here. I'm I'm just "please God can I get these teeth out of my mouth"

VOICE 3: I am sad to lose my tooth. It is aesthetic. It adds to your confidence. It's healthbecause you got to eat.

AMT: Painful stories of people who cannot afford to get the dental care they need. One third of Canadians do not have dental insurance. Even those who do are not always covered for all the work they need. We are dedicating today's program to looking at the gaps in dental care. We'll also get some perspective on how far dentistry has come and how new technology will change the dental visit of the future. But first the debate over calls for universal dental care. And we start with a visit to the dentist at a private practice in Toronto.

SOUNDCLIP

[Sound: Dental drills and dental tools]

JOHN GLENNY: We're lucky with Catherine because she opens wide. You see how that tooth is broken? I'm John Glenny I'm the dentist. Today we're doing a crown preparation on tooth number one six. Hopefully Catherine has the tooth the rest of her life.

[Sound: Dental drill]

JOHN GLENNY: If I go to the dentist as a layperson and I'm told a procedure is going to cost, let's say for the crown, let's say it's a thousand dollars I think "Why on earth does this cost so much?" But in general I find people are very understanding when they ask and then they see for example today "okay how long this procedure is taking? What are the materials involved?" The background support for these procedures think of the staff. You know how many people support this crown? The laboratory is making the crown so there's staff at the lab. There's a driver that picks up the case and takes it to the lab. I think when people understand you know what goes on behind they think "gee whiz, actually it's high but more or less it might make sense."

[Sound: Dental drill]

AMT: Those costs set up for the dentists running a practice, for insurers and for patients but dentists are not the only health care professionals seeing patients with tooth pain. Costs spill over into the rest of the health care system. Hasan Sheikh is an emergency room physician at the University Health Network in Toronto. He says that pain often builds up for those Canadians who can't afford to get regular dental care and that's when they end up in the E.R.

HASAN SHEIKH: I see patients come into the emergency room with dental complaints probably once or twice a week and people are miserable. You can barely have a conversation with the person because of how much pain they're in. They want anything that they can in that moment to take away the pain. When patients come in they know that they actually do need to see a dentist but they come into the emergency room because they have nowhere else to go. And we do our best to diagnose the issue but unfortunately I'm not a dentist. I don't have the skill set to make a lot of the diagnoses or or even if I can to know how to do the treatments that patients need. So what we end up doing is sometimes we have to treat patients with antibiotics and then the rest of it is really just about pain control. Plain acetaminophen and ibuprofen often aren't enough. And so we're left with this discussion of do we prescribe a stronger opiate painkiller. There are dangerous medications that we really want to keep off the streets. I don't want to suggest that the lack of publicly funded dental care is a major driver of the opiate crisis but it certainly is not helping.

AMT: Dr. Shiekh would like to see big changes changes that could make dental care as accessible as the emergency room.

HASAN SHEIKH: In the emergency room we have a window into the healthcare system and our social safety net systems overall and people invariably end up in the emergency room when they fall through the cracks. And dental care is one of these frustrating issues that keep coming up where we see the same thing over and over again. And we don't have really anything to offer these patients and we feel like we're not doing right by them. What I'd like to see happen is an understanding that oral health care and overall health care are one ofthe same. And if we're going to start with that assumption, it just makes sense that we bring dental care under the umbrella of our publicly funded health care system.

AMT: Some dentists have built a practice of trying to reach patients who would otherwise have trouble getting dental care. Dr. Yu Kwong Li is the director of the Service Dentaire Mobile MDC in Montreal. Pulling along a cart full of tooth care tools Dr. Li visits patients with mobility issues or dementia in their long term care homes. But Dr. Lee's practice is not a publicly funded program. It's a business.

DR. YU KWONG LI: Bonjour.

VOICE 5: Bonjour.

DR. YU KWONG LI: Je m'appelle Dr. Li, je suis le dentiste. [To interviewer] How are the teeth in the patients that I treat? Not very good, unfortunately. One of the first things to go is his daily oral hygiene. So if the patient is not able to take care of their teeth like they used to. And there's nobody around who was able to do that for them. And you can imagine these will decay fairly quickly.

[Grunting Patient]

DR. HASAN SHEIKH: And a lot of the patients that I treat can suffer from some form of dementia. They do have issues with cooperation. [To patient] Fermez les dents ensemble. [To interviewer] Dentistry is interesting in which it is a health care profession but it's also business. In office, I could see maybe 20 30 patients, when I'm doing mobile dentistry I'm going to nursing home because the procedures take longer. I see between six to eight patients. Very small percentage have dental insurance. Generally they will have enough savings to pay for that care. The basic dental care that we provide is not expensive. I'd say in the past two years I've had cases where two social workers have approached me and said "look the the patient really has no money and he is in pain. Is there anything you can do?" I said "No problem. I'll take care of them at no fee." Do I think if dentistry should be part of the public health system it would be a great idea. But is it feasible? I don't think it is. It's too expensive. If it was feasible then why aren't the government doing it now? [To patient] Merci Monsieur.

AMT: Well we have two people with us today to talk about what gaps need to be filled in dental care in Canada and how best to fill them. Dr. Paul Allison is the dean of the faculty of Dentistry at McGill University. He was the chair of a panel for the Canadian Academy of Health Sciences that produced a report in 2014. And that report was called improving access to oral health care for vulnerable people living in Canada. Dr. Paul Allison joins us from Montreal. Dr. Larry Levin is the president of the Canadian dental association. He is a practicing dentist in Hamilton, Ontario. He joins me in our studio in Toronto. Hello gentlemen welcome.

PAUL ALLISON: Good morning.

LARRY LEVIN: Thank you.

AMT: Paul Alison let's start with you. We've been hearing stories from people who have had trouble getting their teeth fixed. How easy is it for Canadians to get the dental care they need?

PAUL ALLISON: Well for many people for the majority it is relatively easy. They have good dental insurance. They have good dentists. They can get access to good quality dental care in a conventional dental office. But there's a very significant minority 20 to 30 percent of the population that have great difficulty accessing dental care across the country. There's about six million people who have avoided visiting the dentist in the last year because of the cost of the care and the problem is, the really big problem in this area, is that it's the same people who have the greatest levels of disease that have the greatest barriers getting into care. So many of us who can go to our dentist really actually have very low levels of disease. But the people who can't get to the dentist are actually the people with the highest risk of disease. So the highest levels of disease and at the same time they've got the greatest barriers. So that's where really the problem is lying with access to care.

AMT: Larry Levin we heard from Dave Stock earlier. He has private dental insurance. He still couldn't get all the work done. He couldn't afford to do all the work that he needs to fix his teeth. His dental problems were the result of cancer treatment. What needs to happen to address the needs of people such as him?

LARRY LEVIN: People need to have targeted specific plans that will help them at different stages of their life. And so for that specific area people that have cancer treatment, people and people that have medical treatment and need help if they fall into the category that needs it the help should be there to help them. We strongly support the formation of plans that will help people who have those specific areas; people who have lower incomes; people with disabilities; children in those categories; seniors and of course some medical compromised people as well. The focus has to be on identifying who needs the help. And then; as a supportive Canadian society; providing the help that those people need. No one should have to go to bed at night worried about a dental issue causing them trouble that they can't meet or having pain to interfere with with their life.

AMT: There is a bit of a disconnect here though. Why is it that our teeth the one part of our body that doesn't fall under our health care plan? It's like if you took another piece of our body and said 'no if you do that to your hand we're not going to fix it.' Why do we have that separation of teeth and body?

LARRY LEVIN: I think this historically dentistry has evolved from a different stream and it hasn't fully merged into health care today the way I understand it, and I think that more and more it is coming into the same realm and understanding the dental issues can impact your health and you should be seen as a whole person no matter what the issue is. So having a focus on your dental health is important for all Canadians. But the real thing that we're concerned about is the support for people that need it the most. And these are the disadvantaged groups that we've talked about earlier that you've highlighted in the the preamble to this show. There's no dentist who doesn't feel very sad to hear these stories. And we partner with governments to provide the services that these people need. But in many cases, as a society, government hasn't gotten the message that these plans are important and that they need attention and they need to be funded and they need to be well constructed, so that the people who need the help are the ones who are getting the help. As Dr. Allison said the majority of Canadians are well served with the model we have for providing dentistry but that targeted group is not. And we must do better for.

AMT: Dr. Paul Allison is it solely that now lower income people or people with catastrophic health issues or what do you see in the middle class?

PAUL ALLISON: Well that's the increasingly we're seeing that the middle classes are having problem accessing care. The nature of jobs and the nature of dental insurance is changing so that more and more people have part time jobs. They have several jobs and when you have those sorts of jobs the benefits that come with those jobs are less. And then that includes the health and dental insurance. And so we're seeing that the health and dental insurance that comes with those jobs is covering less care. So more and more we're seeing this problem of accessing care due to cost is coming into the middle class groups. So it's just going to keep increasing.

AMT: So Paul Allison should Canada bring in some kind of dental care coverage for everyone similar to our medical care?

PAUL ALLISON: Yes I believe we should have dental care with part of that universal health care system. We should be able to define at least a minimal level of care to get people out of pain, to get people get rid of disease and to give them some preventive care so that they can be out of pain. Dental problems are not going to kill people but they're very common. So we've just been hearing a few examples in the preamble to this show but there are very common problems. Amongst young children, dental dental operations were the most common operation for children going into hospital to be put to sleep. Thirty percent of all general anaesthesia for kids under five across Canada, in a recent study, was for dental operations. So this is a really common condition and it should be part of the universal system.

AMT: Larry Levin would would Canadian dentists support moving to a universal system?

LARRY LEVIN: I think Canadian dentists would support looking at the areas that need help and focusing on those to give them the help they need. I think that so much of the dental plan is working that we don't need to try and deal with that part. We need to focus on the area that isn't working. We know that for example prevention can make an enormous difference in the child's life. If you see a child from the very start from when their first tooth comes in their mouth and you're working with the mothers and the children to help improve their oral health, they can have a mouth that's healthy their whole life and that's going to save millions of dollars for Canadian health care. If we only focus on treatment then we'll never be able to catch up. So focusing on people who have the problem now is something that's extremely important, with the dental plans that we need to focus with governments to put in place. But a focus on prevention to make sure our future is much brighter than it is today. And those dental plans vary so much across Canada. You can have a child in one province that has much better chance of getting care than in another province.

AMT: Well that's why I'm asking should you have a system where everybody gets it? You mean you're saying that it works but it only works for people with a plan and then the plans don't always work. In the same way that not everything is covered in health care, cosmetic surgery, other things, should there be should there be something that is covered across the board for everyone?

LARRY LEVIN: I think we would and we would encourage a pan Canadian model that has targeted support for people who need it so that the is a specific basket of care that they could all access, so that no one should have to say. No one should have something that interferes with their going to sleep at night. There's a basket of procedures and treatments that everyone should have access to who finds himself in that difficult scenario of not being able to achieve it. Most Canadians can and we don't need to worry about those at this point. We're talking about the specific group that have trouble accessing the care, whether it's because of financial reasons or emotional reasons or medical reasons. Whatever it is they should be able to feel that they can get the care they need at that level and there shouldn't be barriers to being able to access that care. Dentists across Canada have offices ready and willing to see all of these people. We just need the plans in place that will allow them to go into the offices and receive the care they need.

AMT: Paul Allison what do you think?

PAUL ALLISON: Well I think part of the problem as well is, as Larry just referred to you, people need to get to the offices and that's actually part of the problem. Again many of these people we're talking about have no money to get even a bus to to an office. They don't know where the office is as well. And so we need to be thinking about where are we setting up the dental care. Not only in private offices. We need we need to think about having dental offices with community health centres , with the physicians, with the general healthcare team. We all agree that oral health and general health is part of one and the same they shouldn't be separated. So we should be working in the. Dentistry at the moment is basically outside the system. So we had the example of Dr. Yu Kwong Li who goes round from centre to centre, that's another example. We should be training more dentists that can provide mobile dental care, going into sensors for the elderly, going into people's homes, going into other community settings. So a lot of it is also about the actual geographic and physical location of dental services being better available to those people who most need it because many of these people cannot or have great difficulty getting into office.

AMT: Well I have another clip here that I'd like to hear. Dr. John Glenny the Toronto dentist we heard from earlier treat some people who are covered by public dental care programs listen to what he says.

SOUNDCLIP

JOHN GLENNY: Some of the most vulnerable in the community, children and youth from low income families are covered by Healthy Smile's Ontario. But the reimbursement rates are so low, as low as 27 percent for the feeds. So when we treat these patients that are covered by these government programs it's actually costing us for every single procedure. We still have to pay for the supplies and the overhead and so on. They're not even paying you know what's needed to cover the cost.

AMT: Larry Levin, should the government be paying full price to cover dental care for those cases?

LARRY LEVIN: I don't think dentists have ever asked for full fee. When these plans were initially set up for example in Ontario, the government came to dentists and said "would you accept 90 percent of your regular fee to look after these people?" And the dentists said "yes we would be happy to do our socially responsible part." And so the fees were established at that level and then a few years later they came back and said "well would you take 85 percent?" And then a few years later 80 percent. And Anna Maria What do you think it's at this point?

AMT: What is it.

LARRY LEVIN: It's about 40 percent, overall. And so when the cost of delivering the care is 65 or 70 percent, every time you do a procedure the dentist is having to reimburse the system, if you will, themselves. And dentists don't want to be in that position. There are still a lot of dentists doing it but increasingly dentists are saying that that's not a fair way for society to arrange its affairs. Canadians are a caring group. We want to look after each other and we want to have a dental plan that will support someone in need at that time in need in their life. We want to as a society say "we have your back and if you have a dental problem you can go to the dentist of your choice and we're going to reimburse a portion of that enough for the dentist to be satisfied to render the care," that's the model we want. We want that across Canada and we're ready and willing to sit down tomorrow morning, with any level of government that wants to focus in on how to provide better care for our Canadian citizens.

AMT: I have another clip I want you to hear before we continue on that wider issue. Inuit and First Nations people have some dental coverage from the federal government. T he health of their teeth is still worse than the Canadian average. We have a clip here of Chief Leo Friday of the Kashechewan first nation in Ontario.

SOUNDCLIP

Dental care is really really hard in our community and it's just basically our kids and our elders that cannot move around. Like in the past I guess dentists use to come regularity in our community and all of a sudden it started to decline for some reason. I can't even recall. I don't know when it's the last time that I saw or hear a dentist in my community. It's really frustrating sometimes we have to wait months and months before we can get out of the community to get their teeth fixed.

AMT: Okay, so that is Chiefly Leo Friday of the Kashechewan First Nation in Ontario. Paul Allison the federal government spends more than 200 million dollars a year on dental programs for First Nations and Inuit people. How do these programs need to change in order to get the right care to the people they're meant to help?

PAUL ALLISON: Well I think we really need to think about other ways of reimbursing dentists to do their work and we need to think about what sort of health care professionals should be doing the work. So you know we focus very much on paying people in the health system by the act. There are other ways. You can salary people, you can pay them through capitation system. There are different ways you can pay them and you can incentivize different sorts of behavior by paying people in a different way. So I think we have to be open to that as well.

AMT: Well I'll just pick up on this with Larry Levin. You know there are as you mentioned, there are provinces that cover dental care for children for other things that they cover for children across the board others offer coverage for low income children. Should all provinces and territories cover dental care for all children?

LARRY LEVIN: Unquestionably for children who are in need, who can't access care in the stream that we've talked about earlier, they need targeted help. So all children should have dental care that will keep them pain free and comfortable regardless of income or accessibility.

AMT: Should it be for all kids without a dental plan, like without their parents having to go and buy a dental insurance plan just like across the board?

LARRY LEVIN: I think it should be for kids who need that kind of help and government and society has to decide at what point where that line is, where the social assistance ends and your own personal responsibility begins. Because we know that governments of funds aren't bottomless so targeted funds will help the people that need it is the most expedient way to get there. Now I was at an Inuit clinic in Ottawa last week and I saw firsthand the dental treatment and care being provided. This is a national program to support our indigenous First Nations Inuit people. And it's a wonderful service that's provided but we can't drill and fill our way out of this problem of the number of kids who are having these kinds of decays and problems. Prevention is the only way to stop this tide of problems so that we can get it corrected for the future. Community water fluoridation that lowers the decay rate for people.

AMT: And we see a real fight against that in a lot of municipalities.

LARRY LEVIN: You do see that and yet we're asking municipalities to cover the costs for these low income children. And yet we don't want to give them the tools, something as simple and safe and effective as community water fluoridation to lower that burden.

PAUL ALLISON: Paul Allison, and we're almost out of time I'll just get you to weigh in on that briefly.

PAUL ALLISON: Well I agree that prevention needs to be part of it but I think we need to remember that a public system, one of the fantastic things about a public system, is it reduces inequalities in the status of health and access to healthcare. There are far fewer inequalities access to general health care in the medical system compared to the dental system in Canada. So I do think we really need to think about bringing in dental care into the public system.

AMT: We have to leave this conversation there. Gentlemen thank you very much. We'll continue as we keep going and we're looking for feedback as well.

PAUL ALLISON: Thank you.

LARRY LEVIN: Thank you.

AMT: Dr. Paul Allison dean of the faculty of Dentistry at McGill University. He is in Montreal Dr. Larry Levin is the president of the Canadian Dental Association as well as practicing dentist in Hamilton, Ontario. He joined me in our Toronto studio. We did request interviews with the Federal Health Minister, as well as Canada's chief dental officer, neither was available to us today. In our next half hour why do we have so many problems with our teeth anyhow? It has to do with evolution. We'll look at some of the horrors from dentistry's past and at how dental work will be more high tech and comfortable in the future. I'm Anna Maria Tremonti. You're listening to a special edition of The Current, Filling the gaps: Dental care in Canada.

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From tooth pullers to dentists: Dental care's 'really painful' history

Guests: Peter Ungar, Colin Jones

AMT: [Music]

AMT: Hi I'm Anna Maria Tremonti and you're listening to a special edition of The Current.

[Sound: Dental drill]

AMT: Filling the gaps: Dental care in Canada. So far we've heard stories from Canadians who can't afford the dental care they need and are living in pain because of it. We also heard about why these gaps exist and some different perspectives on whether taking care of teeth should be part of Canada's health care system. If you've missed any of this, if you want to see photos of the people we've met visit our website cbc.ca/thecurrent. You can also listen on our podcast or on the CBC Radio app if you want to catch more of this. We've talked about how much care and treatment our teeth need. But it wasn't always that way.

SOUNDCLIP

The wisdom to interfered with the tooth in front of it and caused a lot of havoc with that tooth in front. And he wants to cut his head off. So we called around and you're looking at at 800 hundred bucks for a dentist just to get it pulled. Why they call them wisdom teeth. I have no idea because they're pretty stupid teeth [laughs].

AMT: If you've had your wisdom teeth pulled you probably agree with Denise from Hamilton. You'll remember her from our first half hour talking about her grandson's painful crowded mouth. And while many of us think of our wisdom teeth as the source of feutile misery, Peter Ungar says the problems we have with them reveal a fascinating story about how humans came to be. He's a paleo-anthropologist at the University of Arkansas and the author of Evolution's Bite: A Story of Teeth, Diet and Human Origins. He joins us from Fayetteville, Arkansas. Hello.

PETER UNGAR: Hi.

AMT: If we go back a few thousand years what did the teeth of our ancestors actually look like?

PETER UNGAR: Well generally speaking before the onset of agriculture, our teeth looked a lot better than they do today. We had fewer cavities. We had very little dental crowding and that includes wisdom teeth. There were no problems whatsoever in the jaw.

AMT: And you meant you make the point of Agriculture. Why do you bring up agriculture?

PETER UNGAR: Well because once you get agriculture, you start to eat mushy foods, soft foods. And soft foods are what causes the problem in the first place. It causes the the jaw to be too short to accommodate the teeth which is why we have impacted wisdom teeth and why they influence the other teeth.

AMT: So it's a it's a bit weird because we take care of our teeth today we floss, we brush, we check, we go to the dentist but essentially we have problems that our ancestors never had.

PETER UNGAR: That's right. That's largely because we're eating the kinds of foods that our ancestors never really had access to, or actually more precisely we're not eating the kinds of foods that our ancestors ate.

AMT: Okay well let Before we get to that let's go back to the wisdom teeth, why did they cause so much trouble today?

PETER UNGAR: Well they caused so much trouble today, not because our teeth are too large to fit into our mouth, but because our jaw is too short to accommodate our teeth. If you look at prehistoric peoples, even people that are alive today that live in traditional societies, like the few remaining hunter gatherers that we we have around. Their jaws are actually much longer. Their teeth are the same size as ours but their jaws are longer so they accommodate the teeth better.

AMT: And why are the jaws longer?

PETER UNGAR: Well it's largely because when our jobs are developing, when we're young children, you and I and others in our societies don't put enough pressure or stress on our jaws to grow them to their potential length and prehistoric peoples and modern hunter gatherers do.

AMT: Okay so part of that is because we feed children pablum, baby food, mushy food.

PETER UNGAR: Exactly. It's a matter of basically eating mush today. Whereas if you'll look at living hunter gatherers, their children are consuming a lot more a lot a lot tougher foods when they're toddlers and when they're small children. We tend to cut our kids meat up into tiny little slivers in pieces and we feed them you know basically Farina and other sorts of softened foods, to avoid them choking which is perfectly reasonable in retrospect, but it doesn't do a great deal for our mouth.

AMT: Now you mentioned there are people in modern society, or at least in modern times, who don't have the same problems. How do they take care of their teeth?

PETER UNGAR: They don't take care of their teeth all that well to be honest with you. I work with a group of hunter gatherers called the Hadzabi. These are are the last remaining true foragers on the African continent in Tanzania. And their teeth, as far as the orthodontics goes, as far as impacted wisdom teeth go, as far as crowding of the upper and lower teeth go, they don't have the same issues that you and I have. The teeth from perfectly, beautiful arches, the teeth are not crowded or nor they twisted around and the third teeth are in and actually chewing, the third molar teeth that is our wisdom teeth. And that's largely again because they're eating much tougher or harder foods while they're growing up there. They're exercising their jaws and growing them to their full length potential.

AMT: And so it's not that how they take care of the teeth, it's how they use their jaws.

PETER UNGAR: Exactly.

AMT: Okay. Our prehistoric ancestors did not have a lot of cavities. Why not?

PETER UNGAR: Well they didn't have a lot of cavities because they were not consuming the kinds of refined carbohydrates that we do today. As we started to consume more carbohydrates, the key food for the plaque bacteria that build up on your teeth, and those bacteria as as they grow and you get more and more of them they poop. And that poop effectively is what erodes your teeth- the acids from from that waste process. And so the more carbohydrates you consume, the more plaque bacteria you have the more cavities you get.

AMT: When you look at people with problems with their teeth today then, are there people working trying to figure out our jaw patterns or what we do with our jaws to maybe reverse some of them?

PETER UNGAR: Sure. Absolutely. The old theory was that it was not a matter of our jaws being too small but a matter of our teeth being too large. We used to believe that because we're not wearing our teeth down enough they don't fit properly into the jaw. And as a result, a lot of orthodontists would remove teeth or carve them down in order to get a nice beautiful arch. Now what people are starting to do, what the clinicians are starting to do, is they're starting to actually grow your jaw. They're putting spacers in to children's jaws for adults. They're separating the jaw and allowing the bone to grow in the areas that have been separated. So it's a new sort of approach. A new strategy that actually results in a longer jaw rather than removing tooth tissue.

AMT: When you look at teeth, first of all how many teeth have you studied over the years?

PETER UNGAR: Oh my gosh I can't even count. Hundreds of thousands.

AMT: You've been quoted as saying basically the tooth is already fossilized. It's like It's the perfect fossil.

PETER UNGAR: Exactly. Exactly. It's 97 percent mineral. So it's the hardest part of the body and it's great because it's the only part of the digestive system that comes into contact with food that actually preserves over time. And it's it's clearly our window to the diets of our ancestors.

AMT: Peter Ungar this is so interesting. Thanks for sharing all this with us.

PETER UNGAR: Absolutely thank you.

AMT: Peter Ungar is a paleo-anthropologist at the University of Arkansas in Fayetteville, Arkansas. His book is called Evolution's Bite: A Story of Teeth, Diet and Human Origins. And as humans and human teeth evolved, so did the need to fix them, which brings us to the practice of dentistry.

SOUNDCLIP

JIM POLUNS: This is our dental museum. It is basically three rooms full of dental memorabilia.

KARIN MARLEY: [Laughs]

JIM POLUNS: [Unintelligible] Garage sale.

KARIN MARLEY: What are those jars full of teeth?

JIM POLUNS: Yes. Those are teeth. those are like lot of extract mainly wisdom teeth and things that Dennis always collect for educational purposes. So they'll use those, they'll send them off to dental schools and new dentists and students can practice doing the cavity preparation.

AMT: Dr. Jim Posluns assistant dean of clinics at the University of Toronto's faculty of dentistry. He's taking our producer Karin Marlye on a tour of their dental museum. Really an old office, overcrowded with dental knickknacks from the past. And judging by some of the tools on display, it's pretty clear why many people throughout history have been terrorized by the very thought of being in a dental chair.

SOUNDCLIP

DR. JIM POSLUNS: These are known as keys. They're used for taking teeth. And so you need to know which way the tooth kind of wants to roll out of the job. And so you take this little hook and put it on the inside of the tooth and then roll that to the side and pull it our.

KARIN MARLEY: I am cringing here.

DR. JIM POSLUNS: But in the odd case it would take the tooth in part of a jawbone with it. It was pretty nasty stuff. And then there's other instruments that we can use to go and get the roots. So they look almost like corkscrews and you just twist this. This is the old way of doing that. The way you do now, you essentially twist down the length of the root and then just pull up.

KARIN MARLEY: So kind of like opening a wine bottle.

KARIN MARLEY: Not nearly as much fun.

KARIN MARLEY: What do we use instead of this now?

DR. JIM POSLUNS: Well an excellent anesthetic which goes a long way. This is your [unintelligible.

KARIN MARLEY: So we're looking at a drill here?

DR. JIM POSLUNS: Yes, back in the day they were run essentially with a foot pedal was like a big sewing machine trying to get the revs up high enough. So something like this turns very slowly. There's no water. So it's essentially like taking on of those old school like auguries where you want to drill a hole in a piece of wood, and you just kind of turn it around. It's a little bit better than that. So I can imagine just sitting in a chair waiting for the next discomfort.

KARIN MARLEY: And so the dentist would be simultaneously drilling and pumping this thingy with his foot.

DR. JIM POSLUNS: The earliest ones. That's right. It would be something foot driven. And then the later ones were electric.

KARIN MARLEY: So what do we have here?

DR. JIM POSLUNS: So this is a pelican. This is a very old and very barbarous instrument and some of these go back as early as the 14th century. And essentially they do the same thing with that the turnkeys gave you, a lot of leverage to go in and roll the teeth out of the jaw and you can imagine something this size and this way it could do some serious damage.

KARIN MARLEY: I can see why people were scared of dentists?

DR. JIM POSLUNS: I'm scared of dentists.

KARIN MARLEY: [Laughs] Still?

DR. JIM POSLUNS: Always [laughs].

AMT: You can see what those contraptions look like for yourself on our website if you dare, cbc.ca/thecurrent. Colin Jones is a professor of history at Queen Mary University of London. He's looked at the history of medicine and dentistry. He's the author of The Smile Revolution in 18th Century Paris. And Colin Jones joins us from London England. Hello.

COLIN JONES: Hi there. Well we just heard about some of the kind of creepy or scary tools the dentists have used in the past. How painful is the history of our teeth?

COLIN JONES: Well it's really really painful. Don't forget that aesthetic only really came in in the middle of the 19th century. So really everything before then was the bad old days in some ways. But then also in the 18th century and particularly in France actually, you see a change coming through and you can see they sort about the roots of modern dentistry effectively emerging in that period and particularly with an emphasis on preventive dentistry, rather than essentially extraction. The word dentist wasn't used until the 18th century.People before that were with tooth pullers.

AMT: Some of them did it with their fingers. Why was that?

COLIN JONES: Well you've got to remember that a lot of dentistry in the earlier period was, surprising and this may seem, a sort of form of show business. It was normally done in public by troops of people who put on a show. In fact many of them were quite good actors. They were in the commedia dell'arte tradition. From the late 17th century, particularly in Paris, you've got these very suave operators who make the sort of great trick of you know great florid gesture while they cut their fingers firmly around the tooth and pull it out, you know as a sort of miraculous thing. It must be said, a lot of teeth particularly in older people, would be very loose then. So I think that that's sort of demonstrative, performative aspect of dentistry which we find absolutely extraordinary. We would not now have our dentistry done in the open with people looking at us.

AMT: No. And like 'ta da da da' like they even had musicians didn't they?

COLIN JONES: Had musicians. They had tightrope walkers. They had just about everything going on.

AMT: Before the era of modern dentistry how much of a difference was there in the tooth care available to the rich and the poor?

COLIN JONES: Well you know King Louis the Fourteenth you know, the sun king, the greatest monarch of early modern Europe probably, but he has very bad teeth. He has a number of roots stuck in his upper jaw. He brings in essentially one of these people I'm talking about, an operator or a tooth puller, who comes and probably uses a pelican in fact like your colleague was talking about, pulls out the stumps of the tape but also takes a big chunk of the king's palette as well. And he's got this great big hole in the top of his mouth. When he's famously sort of eating soup it all sort of comes down his nose onto the soup. It was absolutely revolting sort of the fountain, Versailles fountain of rather grizzly kind. But then his surgeons realize that actually this is getting infected. He's going to get a very very serious illness and could possibly die from this. So they take what is a heroic radical surgery and essentially get a big chunk of red hot iron and cauterize the top of his mouth. Then the guy's coming towards him with this red hot iron, he says to him "treat me like a peasant." And really there is no other way. However much wealthier, you could be the wealthiest the most powerful king in Europe. You're on the same level as a peasant when it comes to tooth care. Now that starts to change it starts to change particularly in Paris in the 18th century.

AMT: So dentistry becomes a science around that point.

COLIN JONES: It definitely tries to enter into the sort of scientific field. It's a sub-branch, the tooth pulling group, if you like, almost like a guild or sub guild within the Parisian surgical college.

AMT: What state where people's teeth in the 18th century when modern dentistry was born?

COLIN JONES: InWestern Europe, teeth are probably worse than any other time in more or less the history of humanity, because it's from that period the sugar coming in from particularly the Caribbean is entering into the middle class, but also the urban working class and peasant diet as well. So in some ways I think you know because the the norm is bad teeth and falling out teeth. So preventive dentistry, white teeth becomes a mark of distinction. You can actually pay for dental care and someone can look after your teeth. They can drill them. They can fill them. There's a sort of cult of tooth transplantation as well. You take the tooth usually out of a little chimneysweep or something like that and put it in the mouth and hope it'll take. A lot of false teeth come out.

AMT: is really like let's exploit the children even more [laughs].

COLIN JONES: Absolutely. So very amusing and very sad.

AMT: Well speaking of little white teeth, that brings us to the history of the smile. How is the history of the health of our teeth tied to the history of the smile?

COLIN JONES: What I discovered was, that at the end of the 18th century in western portraiture for the first time, you can smile and show teeth without that being seen as negative. If you did that before, if the Mona Lisa had done for example rather than smile in the way that she did, if she opened her mouth to show even a little toth, people would have said A: She's lower class. B: She was probably insane or C: She must be in the grip of some extraordinary emotion. So people didn't open their mouth to be represented. They didn't show off or flash their teeth in the way you know which obviously becomes very common now. What I argue in the book is that one of the strands leading to this and the end of the 18th century is better dentistry available for the Parisian middle and upper classes. But I also argue that there's a movement of sensibility which stress a new kind of facial expression, an expression of sympathy and pleasantness. And of course that's very familiar with us. You know you stand in front of a camera now you say "cheese" and that's smiling you somehow the you that you think you want out there in the world.

AMT: How long did it take for dental care to become the norm for the majority of people in industrialized countries?

COLIN JONES: You've got this emergence at this period and then it sort of falls away. That's sort of leading edge of the new type of preventive dentistry falls away and it's only very slowly across the nineteenth century that you professionalized dentistry and get those more systematic more scientific approach. That's actually the Americans who lead here. Of course then you also get to coming into advertisement as well and the smile can sell anything essentially and has helped effort everything under the sun really not just toothpaste.

AMT: What do you expect to see in dentistry for the future?

COLIN JONES: Now there you have asked an extremely good question and one that I'm completely puzzled about myself, because the end of my book - it came out in hardback in 2015 - I said "well smile is in" and you know it doesn't seem to have that total hegemony in Western culture. Other cultures seem to be picking it up all the time, you know smiles going from strength to strength. But then in fact, someone suggested to me that this might be a little optimistic and what the point that I which I thought was really interesting is what about the duck face? You know that smoochy sort of pouty type of thing.

AMT: But how does that translate to dental work?

COLIN JONES: Very good question. I think also there's a lot of extra stuff going on in the mouth. The Hollywood smile those classic, glacia like white teeth; all identical and all white and all perfect. A lot of people are using different types of tooth work, the inserts, the use of gold and silver and diamonds and things like that that sort of move towards piercing is also affecting the way in which the smile is seen as well. So I think it's quite complicated at the moment and it's quite difficult to say whether the smile will pull through if you like, and carry on and still have that massive significance that it had in the 20s and early 21st century, or whether something sort of quite different is going on.

AMT: Colin Jones thanks for your perspective on this.

COLIN JONES: Not at all. Nice talking to you.

AMT: Colin Jones is a professor of history at Queen Mary University of London. His book is called the Smile Revolution in 18th Century Paris. Well let's go back to the University of Toronto's faculty of dentistry museum for one more look. This time at a set of teeth you might see sitting in a glass around the house. This is Jim Posluns, assistant dean of clinics, on the history of dentures.

SOUNDCLIP

DR. JIM POSLUNS: So around 1790 or so, dentures looked sort of like pretty much the way they are today but the teeth themselves and the bases were made out of ivory and they're quite heavy. Like if you feel it you can feel like they have quite a weight to them.

DR. JIM POSLUNS: Oh! Yes.

DR. JIM POSLUNS: But they did not fit very well. So the idea was that they were for show only and when you wanted to eat you actually to take them out. So you never saw high society female eating anything in public. They on't look like much but it's a wild great story behind it. These were called Waterloo dentures. And the idea was that, originating out of the battle of Waterloo, essentially like there'd be a lot of dead soldiers around I guess - not [chuckling] laughing but I can just sort of picture that - then the grave robbers would come in afterwards and take all the teeth out and sell them back to the dental industry. So this is an example of one that got the gold base ivory teeth in the back, human teeth in the front.

KARIN MARLEY: Oh. Not voluntarily given human teeth.

DR. JIM POSLUNS: No, but supposedly it was a good business.

AMT: Well OK then you heard Karin Marley's reaction there. I'm in line with her.

[Music]

AMT: Given that history of dentistry we have a lot to be grateful for when it comes to new tools of the trade. Technology is moving to make the dental office of the future more comfortable and more efficient, meaning less time in the dentist chair.

[Sound: Dental drill]

AMT: In fact scientists are working on new ways to treat cavities. They hope to do away with drilling and filling, the developing techniques to allow teeth to repair themselves. And there was a first in China in September of this year when a robot performed dental surgery, [Robot noises] implanting two 3D printed teeth in a patient without any human help. The hope is that robots, or at least robot assistants, will lead to more precise surgeries with fewer complications. Last week at the trade show of the Greater New York Dental Meeting, there was a lot of excitement about 3D scanners and machines that carve out replacement teeth on the spot. Some of the technologies can be used to replace damaged teeth. They were on display at the booth of the Henry shine company, a worldwide distributor of dental care technology.

SOUNDCLIP

VOICE 1: This is the future. We're here. We're standing in the. We're at the point right now where if you lose your tooth, today, and I take it out, but I pre-planned it with digital technology, I can put back your tooth within a 45 minute interval and you will not notice anything and there will be absolutely no bleeding. Seamless dentistry done with digital technology. That's where we're at today. So what I'd like to show you now is an [unintelligible] scanner there's a real movement towards digitalization in the dental practice. Rebecca here is going to scan actually this model, so you can see we've got a real Dexter dental head with teeth. So what was once upon a time you'd have a patient bite down into this rubber material, there's a lot of gagging, it's very uncomfortable. It would sit in the mouth for about anywhere from three to five minutes. This full art scan as you can see here being done in about - there's a clock in the left hand corner there - I think it's up in 14 seconds. And this is a very very high strength ceramic material. And you can see that it's in this block format. It goes into this machine.

VOICE 2: It's a robot.

VOICE 1: It is. The patient goes home with what was a problem tooth and now has a brand new tooth.

AMT: But not all the industry developments are high tech or expensive. A simple new treatment could make a big difference for children's teeth. You know what sends kids in Canada to hospital for day surgery more than anything else? Tooth decay. Now there's something called Silver diamine fluoride that could help change that. It's cheap. You just dab it on the cavity, no drills, no needles, no squirming. There is one downside. It dies the cavity area black. Robert Schroth is a dentist and an associate professor and clinician scientist at the University of Manitoba.

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By applying silver diamine fluoride, we can actually stop the cavity from progressing. It does turn the cavity back but it actually hardens up the tooth decay. And I think a great sort of game changer for the sense that you know it may not necessarily be the end of treatment for many kids, but theoretically if we can get children who show early signs of tooth decay and big cavities, we could theoretically paint this on the children's teeth, have the tooth decay harden up and become arrested and then offer treatment perhaps when the child's a little bit older, in an outpatient setting rather than needing to take the child to the operating room.

AMT: Well that is Doctor that is Robert Schroth, a dentist and associate professor and clinician scientist at the University of Manitoba. So now over to you. Whether it is the future past or present of your dental needs, we want to hear from you. Do you have dental work you're avoiding because you can't bear the idea of being in a dental chair? Or because you cannot afford it? Or don't have a dentist where you live? Do you think dental care should be part of our universal health care system or not? Find us on Facebook or on Twitter where @TheCurrentCBC.Send us an email from our website cbc.ca/thecurrent. That's our program for today. Stay with Radio 1 for Q. We're going to give the last word today to the gap-toothed first graders of The Current family. Isla Blamire, Vera Remerowski and Petra and Miro Goddard. Here they are with their thoughts on dental care. They have the tooth fairy top of mind. I'm Anna Maria Tremonti. Thank you for listening to this special edition of The Current, Filling the Gaps: Dental Care in Canada.

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[Music]

ISLA: The tooth fairy takes my teeth and she gives them to people who have damaged teeth and they needed to get them out, so then she gives to those people.

VERA: I think she gathers up all the teeth and then and then she builds a house for another tooth fairy. There might be two fairies. If there are two who blew their tooth on one time, one tooth fairy can't go to two places at the same time [laughs].

MIRO: I don't know what she looks like? Do you know what the tooth fairy looks like?

RICHARD GODDARD: What do you think you would say to her if you saw her?

MIRO: I love you.

PETRA: I think she is a tooth that has wings and wears a pretty dress and has a wand. I love the dentist because at the end they give me a prize. Once I got a Hello Kitty bracelet.

ISLA: My least favorite thing about the dentist is when I stick like that tool, that like skinny sharp tool on your teeth. I don't like it because sometimes it hurts my gums.

ISLA: I do not want really want to be a dentist because I mean like there are so many other good jobs out there.

RICHARD GODDARD: What's the worst part about going to the dentist?

MIRO: None.

RICHARD GODDARD: Like going to the dentist is amazing?

MIRO: Yes.

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