Canadians spend almost $12-billion annually on dental services, but glaring inequalities in access to oral health care remain, especially for the poor.
In fact, six million people a year avoid visiting the dentist because of the cost and those with the worst dental problems are most likely to go without care, according to the findings of a blue-ribbon panel.
"The system is really not working and it's only going to get worse unless we act," Dr. Paul Allison, dean of the faculty of dentistry at McGill University in Montreal, said in an interview.
He noted that almost all dental care is funded privately, through employer-based insurance or out of pocket, and the number of people with insurance is shrinking as the population ages and the economy morphs, with workers increasingly toiling part-time, self-employed, or retired.
Dr. Allison chaired a panel, struck by the Canadian Academy of Health Sciences, that has just published its findings and recommendations in a document titled Improving Access To Oral Health Care for Vulnerable People Living in Canada. The report does not call for dental care to be included in the "free" medical services provided under medicare, saying that is unrealistic in the current economic and political environment.
But it says that publicly funded dental care programs need to be broader and more coherent and provide essential care to those most in need, including children in low-income families, seniors living in institutional care, people with disabilities, the homeless, refugees and immigrants, aboriginal peoples, and those on social assistance.
About $700-million a year is spent on publicly funded dental care. First Nations and Inuit have state-funded dental insurance, but often have trouble accessing care because they live in remote communities.
All provinces and territories pay for in-hospital dental surgery, and some have prevention programs for children. For example, dental care is free for children under 10 in Quebec and for those under 14 in Nova Scotia.
A number of ad hoc and charitable programs also provide dental care to the poor, many of them run out of Canada's 10 schools of dentistry.
"But these programs are a drop in the bucket compared to what's needed," Dr. Allison said.
The report notes that Canada has one of the lowest rates of publicly funded dental care in the world – only 6 per cent of total spending. Even the U.S. has a higher public share, 7.9 per cent. Many European countries include dental care in their universal health programs. In Finland, for example, 79 per cent of dental care is publicly funded.
Dr. Stephen Hwang, a research scientist at the Centre for Research on Inner City Health and a physician at St. Michael's Hospital in Toronto, said lack of dental care is a "gaping hole" in Canadian medicare and causes significant health problems for many of his patients.
"Their teeth are atrocious," he said, and the result is that they live in pain, and it affects their nutrition, mental health and cardiovascular health.
"These patients have abscesses in their mouths that, if they were in any other part of the body, we would treat," Dr. Hwang said, and that's illogical and a false economy because it exacerbates other conditions.
"I'm not talking about cosmetics but necessary medical care," Dr. Hwang said. "A lot of people aren't getting that necessary care because they can't afford it."