Of all the countries in the Organization for Economic Cooperation and Development (OECD), only Spain spends less than Canada on dental health care for its citizens. Only 6% of dental health expenditures are publicly funded in Canada. Of the $12.5 billion spent each year on our teeth, the vast majority is paid through employee benefits and private insurers, or out of pocket. Most provinces have some publicly funded dental care for children and for people receiving social assistance, but income thresholds can be set so low that many low-income families don’t qualify. Even worse, as in the case of social assistance, services can be so bare bone that diseased teeth are extracted rather than restored.
In October 2010, Ontario invested $45 million on oral health initiatives as part of its poverty reduction strategy. Thanks to these, most communities have some publicly funded dental infrastructure available at Community Health Centres, Public Health clinics or Aboriginal Health Access Centres. Our public health clinic at Peterborough Square is busy seeing eligible children, and those clients on social assistance who choose to come to us. But local research has found that 43% of people in Peterborough (city and county) continue to report that the cost of dental care is a barrier. Because of the lack of access, many people end up sick and in pain, at the Emergency Department, where a dental abscess can be tempered with antibiotics and pain medications.
Currently, the province has promised to introduce dental coverage for low-income adults and vulnerable seniors by 2025. In the meantime they have focused on children and on prevention. Public health continues to screen all children in grade 2 every year – last year, Peterborough Public Health (PPH) screened over 4,500 local children. Schools with higher rates of dental decay in their grade 2 children are deemed to be “high risk” and screening gets bumped up earlier, to Senior Kindergarten. We found about 10% of Peterborough’s children needed urgent dental care. Public health follows up to make sure this happens, with funding available to families who need it. In addition, we can provide preventive treatments like fluoride varnish or dental sealants for those children at higher risk of dental decay. And families earning below a certain threshold are eligible to have their children covered by the Healthy Smiles Ontario program, which extends to the 18th birthday. Better prevention and early detection in children should help prevent loss of teeth later in life. This is all good, and provides a solid foundation that can be built upon.
And build, we must. The Canadian Medical Association called for universal “Denticare” in 2007. The Canadian Dental Association has been advocating for a “dental safety net” for all disadvantaged Canadians since 2001. There appears to be consensus that more dental care should be publicly funded – it’s a matter of finding the dollars to do it. Finding affordable ways to provide this care through existing
publicly funded clinics and settings could result in savings if we can prevent people from going to hospital as a last resort. Supporting municipalities to add a small amount of fluoride to their drinking water could end up saving up to 30% in averted dental decay across the lifespan. In fact, for every dollar spent on community water fluoridation, we save $38 in dental treatment costs. Training and deploying other kinds of salaried providers, such as Dental Therapists, might help to reduce costs as well.
This week, members of the Ontario Oral Health Coalition (OOHA) met in Peterborough to strategize on ways they can effectively advocate for more publicly funded access so that fewer people suffer from a lack of dental care. OOHA would like to see dental coverage for vulnerable adults and seniors fast-tracked rather than waiting till 2025, as currently projected. Since oral health and oral health care are as integral to good health as the mouth is to the body, this seems like a worthy cause.
By Dr. Rosana Salvaterra, Medical Officer of Health, Peterborough Public Health
