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Quebec’s dentists are charging the first set of patient fees in the country aimed at recouping the extra costs related to the COVID-19 pandemic, and their counterparts in other provinces are studying whether to follow suit.

Earlier this month, dentists resumed regular appointments and began charging up to $30 per visit extra for personal protective equipment (PPE) like respirator masks, and infection control measures needed to meet new provincial standards. The Association des chirurgiens dentistes du Quebec, the provincial professional organization that suggests fees each year, is also recommending dentists charge another $84 for the “time and liability” needed to deliver extra care such as screening for the novel coronavirus.

“It may be less or more, depending on the specific situation of the clinic,” association spokesperson Annie Massicotte said in an e-mail of these new fees.

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Dentistry is a self-regulated profession across the country, and the provincial colleges that protect the public by disciplining bad dentists do not oversee the fees for treatments.

The federal lobby group that represents Canada’s provincial dental associations (PDAs) includes a member organization from every province but Quebec. The Canadian Dental Association says its members have not yet had the chance to review and suggest new fees related to the pandemic, but that will happen soon.

“The COVID-19 pandemic has impacted the cost of delivering care across the country, including increased costs for PPE in high demand,” spokesperson Zelda Burt said in an e-mail. “Over the next few weeks, PDAs across the country will be reviewing how to strike a reasonable balance between increased costs and access to oral health care.”

Each year, these PDAs produce a guide suggesting a uniform fee for each service for the dentists in their province, but the 2020 guides did not foresee the challenges of the global pandemic, Ms. Burt said.

Paul Allison, an expert in public dental health who teaches at McGill University, said these costs will “have a significant effect” on the ability of Canadians to get dental care in the time of COVID-19. Dentists also will see fewer patients each day because of the extra precautions and, he added, the public may be reluctant to rush back for care that can require someone else to put their hands into their open mouths for long periods of time. In the end, Dr. Allison said, the fees will cost more for even those with health plans, because insurers will inevitably pass these costs to employers, who will require higher premiums from employees.

Two weeks ago, the B.C. Dental Association issued a statement saying dentists in the province may charge whatever they want to cover extra personal protective equipment and the cost of sanitizing their workplaces more thoroughly. However, they must inform patients of these fees before any procedure, and it is the patient’s responsibility to know what their insurance covers, the association’s May 26 statement said.

The College of Dental Surgeons of B.C. says “a few people” have contacted the agency about dentists charging extra for PPE, but the regulatory body has not received any formal complaints.

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​Just over a third of Canadians don’t have dental insurance and pay out of pocket, according to the latest survey data from Statistics Canada. Those without insurance are three times more likely than those with coverage to avoid going to the dentist because it is too expensive, the survey found.

The Canadian Life and Health Insurance Association (CLHIA), a lobby group that represents companies that insure dental work, said it is up to each insurer or employer with a plan for their staff whether to cover coronavirus-related fees as benefits under their policies.

“We understand that COVID-19 has meant that dental regulatory colleges have imposed new requirements on dental practitioners as they look to reopen,” CLHIA spokesperson Kevin Dorse said in an e-mailed statement.

The Association des chirurgiens dentistes du Quebec has asked the provincial government for $25-million to help defray pandemic-related costs. The provincial health ministry declined to say whether it would provide this money, but added in an e-mailed statement that it is concerned the extra fees could be a new barrier.

Prof. Allison said a clear solution is to create public coverage for specific areas of dental care that are linked to wider health and preventing other diseases.

“In the current crisis, lots of people have lost their jobs, so they won’t have insurance any more and, on top of that, they won’t have any money anyway,” Dr. Allison said. “Unless they’re in a lot of pain, dental care will not be at the top of their list of priorities. It will be all sorts of other things, like paying the rent and paying for food.”

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With a report from Kate Taylor

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