The180·the 180

Publicly funding dental care could help ease the fentanyl crisis, and more

ER doctors have trained for most of what they see at work. But there's one type of common malady that Dr. Hasan Sheikh and his colleagues aren't trained for: dental emergencies. He's calling on governments to fund dental care, so patients will see the experts they need.
(CBC)
Listen8:10

If dental care was publicly funded, fewer people would become addicted to opioids. 

That's just one of the reasons Dr. Hasan Sheikh, an emergency room physician in Toronto, is calling on governments to expand medicare. 

Another reason? Doctors don't know how to fix teeth. 

But because not all Canadians can afford to go to the dentist, some people end up in the ER with toothaches. 

Because dental care is one of these things that we have not included in our publicly funded health care system...these patients end up in the emergency room, because they say 'I don't know where else to go, I don't know what else to do.'- Dr. Hasan Sheikh

Dr. Sheikh says he sees a patient with dental issues every one to two shifts, and it's a frustration his colleagues share.

"Whoever picks up that dental chart lets out kind of a groan,  and says 'Aahh, I never know what to do with these patients.'"

Those visits cost taxpayers, and the patients don't even get the care they really need — doctors do what they can to help with pain, but they can't fix the root of the problem. And sometimes, helping with the pain involves prescribing opioids, which brings on a whole new set of problems. 

The following is an edited and condensed transcript of Dr. Hasan Sheikh's interview with Jim Brown. 

Hasan Sheikh is an emergency room physician with Toronto's University Health Network. (submitted)

So, if I have an explosive toothache, and I simply can't function anymore, and I go to ER and I see you, what can you do for me?

(sighs) So this is the difficulty, is I would love to give you a definitive diagnosis, but I'm trained in certain things around the teeth, but not everything, so sometimes the diagnosis is quite difficult. Often we're left with trying to implement stop-gap measures to try and get patients some relief until they can see a dentist.  That may mean that we prescribe a course of antibiotics, which can lead to bacterial resistance, can lead to stomach aches, cramps, diarrhea, and actually really bad infections sometimes like C. difficile.

And it's not going to do anything quickly for my pain. 

It's going to do anything quickly for your pain, and you still need to see the dentist. 

The other things we can try and do to get patients some pain relief is use things like anti-inflammatories, but often patients don't find that that provides enough pain relief. So we're left with, really, the least worst option which is sometimes a narcotic painkiller, and these are dangerous medications that can lead to addiction, and abuse, and we're currently facing a national opioid crisis that, we're desperate to try and get these drugs off the street.

Some low-income Canadians don't see dentists, because they can't afford it. (Keith Burgess/CBC)

So what's your solution to this problem? 

So I think that, I would love to have a publicly funded national dental program, but I think at least, at the very least, we should be starting with expanding our public dental programs to vulnerable patients that desperately need it. It's a bit of a patchwork of policies across the country. In Ontario, at least, we have a program called Healthy Smiles, that covers children from low-income families, and some patients on disability or welfare, and I would say that, at least the first step would be to expand that program to all children, all low-income patients, the working poor, and seniors. 

Now, I don't have to tell you that health funding is one of those hot-button policy issues. What do you think it's going to take to convince a government to fund, or more fully fund, dental care? 

Well, I think, that's kind of the whole point of the health-care system we have, and making good public policies, it's about anticipating how to best serve the needs of the population. When it comes to dental care, these are patients that we're paying for anyway right now. 

In Ontario alone in 2015, there were 61,000 visits to the emergency department for dental related issues. We're paying $31 million by some estimates, a year, for those visits. Yet we're not really getting much value, and we're not providing much service for these patients. So, it's one of those things that, you know, if we can fund dental programs up front, we're hoping that will lead to better care for patients, and cost-savings down the line. 

"If we can fund dental programs up front, we're hoping that will lead to better care for patients, and cost-savings down the line." - Dr. Hasan Sheikh

Now, you've connected this to the opioid crisis. Could this be what it takes, to catch government attention about this issue? 

I certainly hope so. I think that we need examples of interconnectedness of the health care system, in order to make the case that we need to have broad, system-level thinking, and good public policy and planning. And I think ,the more things that you can link it to, because really the health-care system is this interconnected web, I think the better chance we have of making the case. 

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