In Canada, dental care is not part of medical care. Approximately six per cent of dental care is paid for by public funds, with the rest being paid through private insurance (56 per cent) or out-of-pocket (38 per cent).
This contributes to significant inequalities in oral health and dental care, with the poorest Canadians having both the greatest burden of oral disease and the most difficulty accessing dental care.
While Canada’s medical care system has its problems, the fact that it is free at the point of service substantially helps all Canadians access it. The teeth and mouth are part of the body, and this false segregation of care systems costs individual Canadians and the country as a whole money we can ill afford. Writing as a researcher in the field of dental public health, it is my opinion that dental care should be part of medical care.
When health care is discussed as an issue in the federal election, dental care should be part of the discussion.
Irony and inequality
There is an awful irony that dental decay is among the most common non-communicable diseases globally, but treating it is not part of our public health-care system. The burden of oral disease for those individuals suffering the pain, difficulty eating, embarrassment smiling or talking and time off work or school is enormous.
Furthermore, 22 per cent of the population (approximately eight million people) reports avoiding the dentist due to cost. As a result, the public medical system ends up treating oral disease but often in inefficient and inappropriate ways.
For example, from 2010 to 2012, treatment of dental decay was by far the most common reason for one- to five-year-old children receiving general anesthesia, accounting for 31 per cent of all general anesthesia care in that age group. In addition, this procedure was much more common among Indigenous children, the poorest families and those living in rural areas. These children often have several severely decayed teeth because their parents are unable to afford dental care.
On top of this, increasing numbers of Canadians have precarious jobs with lower wages and fewer workplace benefits so have to pay for dental care out of pocket. This results in more people consulting physicians and/or emergency departments for dental problems, but often receiving sub-optimal care as those facilities are not equipped to provide the necessary treatment.
Oral care is health care
To add to these issues directly related to oral disease and dental care, we also know that the body’s systems do not segregate the mouth from the rest of the body. There are important examples of direct links between oral health and general health.
For example, worsening gum disease can result in deterioration in diabetes, and vice versa. And this burden of disease and difficulties accessing dental care is experienced very unequally among Canadians. The poorest groups, Indigenous people, recent immigrants, those with disabilities and those living in rural and remote Canada having significantly more problems. These inequalities are also greater among women than men in Canada.
However, there is something that can be done to improve this situation. This has been recognized by the World Health Organization, and is increasingly recognized in Canada. This year, the WHO passed a resolution paving the way for improved oral health care globally with the observation that:
“… oral health should be firmly embedded within the noncommunicable disease agenda and that oral health-care interventions should be included in universal health coverage programmes.”
The current federal election provides the opportunity to bring this issue to the forefront of the discussion on health care in Canada. In December 2019, the prime minister’s mandate letter for the Minister of Health requested her to “work with Parliament to study and analyze the possibility of national dental care.”
In October 2020, the federal Parliamentary Budget Office published a cost estimate for a federal dental care program for uninsured Canadians. This was based on the NDP proposal for Canadians earning less than $90,000 annually receiving care. The total cost was estimated to be $1.5 billion per year to cover care for approximately 6.5 million Canadians.
However, another recent report compared the costs of a “Denticaid” system providing public insurance to all children under 12 and others without private insurance, versus a “Denticare” system in which dental care is covered for all, just as with the medicare system. The report concluded that the net costs of the “Denticare” system were less, so Canada should adopt this approach.
Dental care should be moved into the medicare system. On top of the cost savings to individuals and the population as a whole, it would help reduce the substantial inequalities in oral disease and access to care, as well as promote the integration of medical and dental care so as to help people with gum disease and diabetes, the screening of young kids for dental decay and countless other situations in which our mouth is an integral part of our body.
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Written by Paul Allison, Professor of Dental Public Health, McGill University