Across Ontario, going to the dentist is financially out of reach for many people. This dilemma is well-known to physicians — many of us regularly care for patients who have terrible dental problems that we are powerless to address. We see people who have delayed seeking dental care that they can’t afford until they are in serious pain or their health is at risk. We see people who have trouble finding employment, miss school, or avoid social situations because of the condition of their teeth. We see people who avoid eating because their mouths constantly hurt.
Lack of access to oral health care is a pressing issue for a large segment of Ontario’s population. Most often, this lack of access is due to economic barriers. In Toronto, a new study from the Centre for Research on Inner City Health found that low incomes are a very strong predictor of poor oral health, and mouth pain. In Hamilton, a new report from the City of Hamilton’s Public Health Services found that there are. ‘…clear differences in oral health status across income levels.’ According to a report from Ontario’s Chief Medical Offer of Health, 20% of Ontarians who stayed away from the dentist for a long time cited cost as a barrier. Nationally, cost has kept a full 16.5% of people from seeking recommended oral health care.
For people who are homeless, the situation is particularly acute. Recently, researchers from the Centre for Research on Inner City Health and the Faculty of Dentistry at the University of Toronto worked together to assess the oral health of about 200 people staying at 18 homeless shelters in Toronto. We found that 97% of the people we examined needed some kind of dental care, and 40% needed emergency treatment. Thirty-five per cent of the people we surveyed had avoided eating due to mouth pain. Many had experienced pain over the last month, and most of them didn’t seek treatment.
Dental care remains a gaping hole in our health care system for people with limited means. There are currently no coordinated, city-wide dental care programs for women and men experiencing homelessness in Toronto. More generally, children, youth, and elders are covered by a patchwork of public programs that leave many falling through the cracks. Adults earning wages that add up to low and middle incomes have no access to public dental care programs at all. The recent discontinuation of very basic dental care for people who are refugees has made the situation even worse.
As a physician, I can tell you how much it’s needed. The overall health of people living on low incomes is deeply impacted by their lack of access to dental care. The current situation in which we provide health insurance to cover the treatment of every part of a person except his or her teeth makes little sense, and leaves thousands of people to suffer from chronic pain and tooth loss. Would we tolerate a system in which we didn’t cover the treatment of eye diseases, and allowed people who didn’t have the means to pay for their own care to go blind?
It’s time to address the very real pain, distress, and long-term health consequences caused by the fact that many in Ontario are simply not able to go to the dentist. The data on the oral health of people living in homeless shelters in Toronto simply adds to the already compelling body of evidence suggesting that oral health care for all should be part of Ontario’s Poverty Reduction Strategy, and a permanent component of our universal health care system.
A version of this commentary was originally published in the Huffington Post.
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Feels hard to see people especially children and women deprived from basic health care and oral care, not even get a yearly checkup. We all know that lack of proper oral care leads to more health issues like hearing problem and heart diseases etc., but still many people are not able to get a proper oral treatment. Few dentist in Ontario region, like Phelan Dental, few months back conducted a oral health champ and it gave chance for many to get a free dental checkup. More and more dentist should join and conduct regular champs every year and this will be a great relief for the ones who can’t afford that.
read my povertyfreeontarioblogspot blogs. I am researching this very issue this summer as a masters student.
I’m trying to find the numbers for how much dental care is covered by the public sector in Canada and USA vs France/Sweden/Germany/etc… The point being is that many of the European OECD countries are funding >70% of dental care with similar total health expenditures as ours. I definitely agree this is an issue many of the lower socieconomic hospital patients seem to face, and can lead to serious bacterial infections if not treated appropriately – namely endocarditis, septic arthritis and even meningitis.
Hopefully in the “second stage” of Tommy Douglas’ vision of medicare we are able to somehow bring dentistry into the fold.
My current understanding is that any dental care provided inside the hospital setting is funded… maybe it is time for hospitals to have their own ” mall” services that extend beyond simply gifts, snacks and coffee, .. on into “special” services for underserved clients.