'I'm not asking for root canals and Hollywood teeth': Just how doable is universal dental?
'Our mouth should be part of the rest of our body,' says McGill dental dean
Brandi Jasmine only has a few teeth left — some molars and a handful of front teeth, chipped and stained. The pain they cause is piercing, flaring up when she eats, laughs, even when a cold breeze hits.
"I won't even be able to think," she told The Current. "The pain will be so bad that I won't be able to get anything done."
The Welland, Ont., artist still needs to get five or six pulled, leaving her with fewer teeth. But being self-employed, she can't even afford to get one pulled.
So she's become her own dentist; shaping putty-like plastic into a temporary cap. It prevents a sharp tooth from grinding and cutting the inside of her cheek.
"I just don't understand why people are suffering like this for the want of something so simple as a tooth extraction," Jasmine said. "I'm not asking for root canals and Hollywood teeth here. I'm just asking, please God, can I get these teeth out of my mouth?"
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Dental as health care?
Jasmine is among the nearly one-third of Canadians without dental insurance. Unlike health care, dental is mostly covered by private insurance. And that barrier is causing all sorts of bad teeth.
Hasan Sheikh, an emergency room doctor for Toronto's University Health Network, said he sees a few patients a week coming in with dental issues — including low-income patients, those on disability and seniors, all without coverage.
"They have nowhere else to go," he said. "We don't have really anything to offer these patients and we feel like we're not doing right by them." There were around 58,000 dental trips to Ontario emergency rooms in 2012, according to a Association of Ontario Health Centres report, costing at least $30 million.
The solution, Sheikh believes, is bringing dental care under the umbrella of Canada's publicly funded healthcare system. Public spending on dental care in Canada sits at just 6.2 per cent; it is mainly covered by private insurance or out-of-pocket.
Country comparison: government contribution to total annual spending on dental care
Source: Canadian Academy of Health Sciences
There are a few countries with more-universal, wide-ranging public dental coverage: Austria, Germany, Mexico, Poland and Turkey, among others. And even then, some dental procedures are covered and others — like crowns and implants — aren't necessarily.
The model varies between Canadian provinces and territories, with some covering dental bills for kids and seniors. Sheikh suggests widening the programs that so all children, seniors and patients with low income are covered across the country — he calls these groups the "biggest holes."
Paul Allison, dean of McGill's dentistry program, goes even further, suggesting at least minimal coverage for everyone "so everyone can have access to care that gets them out of pain."
"There's a societal obligation to really look at this as a need," he said, calling on any level of government to step up and invest. "Our mouth should be part of the rest of our body."
Cost adds up for patient, doctor
But it's not that easy. Dr. John Glenny, who took over his father's Etobicoke, Ont., dentistry practice more than a decade ago, said people don't think about how much it costs to run a practice.
There's lab fees, licences and mandatory classes to keep up to date with training. "We go through gloves like there's no tomorrow," he said. "You're changing them so many times." The small bottle of bond he uses for every white filling costs $265 a piece.
All these costs add up and Glenny doesn't think a publicly funded model would be able to handle it.
He cites his experience with Healthy Smiles, an Ontario government-funded dental program that covers kids and youth. He said the reimbursement is "so low" he loses money on every single procedure.
"Extrapolating beyond that to try to think about the entire province being covered, I don't know how that would be possible, because they seem unwilling even to properly cover the programs they do cover now."
'This is a socioeconomic problem'
Other programs, like the roaming dental bus run by the city of Hamilton, can only offer patients so much. The bus gives free emergency dental services like fillings and X-rays to those who are low income and without dental coverage.
Many clients are in pain and are desperate, A dental assistant said some patients try to remove their own teeth, including one who used pliers from their garage.
"This is not a dental or a tooth problem," said Dr. Kashif Zaki, a dentist from the bus. "This is a socioeconomic problem and that's what sticks with me. Why are these people coming to the dental bus? Why can't they access dental care anywhere else?"
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Jasmine keeps looking — this time she might have found some money through the United Way.
But she's hopeful sharing her story may help politicians put a face to the problem.
"It is hard to believe that this is happening in Canada, of all places," she said. "Anytime there's pain, people should be helped."