Debilitating toothaches. Tens of thousands of dollars in out-of-pocket dental bills. Trips to the emergency room — and even stays in intensive care to treat life-threatening infections.
Those are among the impacts Canadian seniors face when they lack access to dental care, say patients, advocates and health-care workers across both the dental industry and hospital sector.
Canada’s new dental plan is now being hailed as a step in the right direction that could help to keep more Canadians healthier as they age and out of crowded hospitals — although experts are watching closely to see if it lives up to those early hopes.
Unveiled on Monday, the $13-billion insurance program called the Canadian Dental Care Plan will start covering most basic dentistry costs next year for uninsured Canadians with a household income under $90,000, totalling about nine million people.
Applications are opening first to eligible seniors aged 87 and older, with a staggered approach for other age groups. The process will open to all eligible applicants aged 18 and over sometime in 2025.
“I think this is going to be a game-changer,” said Dr. Samir Sinha, director of geriatrics at Sinai Health in Toronto. “And I think it’s long overdue.”
Sinha said older patients without coverage to pay for dental care often end up avoiding treatment and can wind up in hospital emergency departments with “much more significant” health issues.
But just how much will this new program prevent serious dental issues and hospital use?
Sinha said it’s not yet clear how easy it will be to enrol in the plan, how many Canadians will sign on and whether enough dental clinics will opt in to make it function smoothly.
“The devil is always in the details.”
Links between oral health, cardiovascular issues
Right now in Canada, evidence suggests individuals seeking emergency care for worsening oral health issues can end up putting strain on the health-care system.
That’s because there’s a clear connection between gum disease and broader infections, worsened diabetes and cardiovascular issues such as stroke, said Dr. Aviv Ouanounou, a dentist and associate professor of pharmacology and preventative dentistry at the University of Toronto.
Many patients ignore tooth and gum issues until they have pain, “but they don’t know that it’s going to get worse and worse,” he said.
Emergency department visits for dental problems in Alberta from 2011 to 2016 were more common than visits for asthma and diabetes, notes a paper published earlier this year in the Canadian Journal of Public Health, while in British Columbia, 70 per cent of such visits were deemed “non-urgent.”
In Ontario, meanwhile, more than 60,000 emergency visits were made for oral health problems in 2014 alone, with an estimated cost of more than $30 million.
In those situations, both patients and physicians are frustrated, because emergency teams don’t have the training or tools to actually help with most oral health issues, said Dr. Hasan Sheikh, an emergency physician in Toronto and a board member of the organization Canadian Doctors for Medicare.
The federal government’s new $13-billion dental care plan will roll out to different age groups over the next year. Applications for people aged 87 and older will open next week.
The “worst-case scenario” is that some patients arrive with severe facial infections, which can lead to aggressive treatments, antibiotics or ICU stays, Sheikh said. But what’s more common is people arriving with basic toothaches, clutching their jaw in excruciating pain.
“It’s extremely common, extremely painful and people aren’t getting the care they need,” he said.
Canada’s new dental plan will cover a wide range of basic treatments and preventative services, including cleanings, dental exams, X-rays, fillings and crowns, root canals and tooth extractions, among others.
“It’s exciting that this is a step in the right direction,” Sheikh said. “I think the most important thing is that we actually figure out if this is helping people access care. That’ll be the years-long conversation now.”
Cut-offs and co-pays based on income
In terms of access, higher-income Canadians won’t hit the cut-off to be eligible, while others will still pay a portion of the tab as a co-pay with the insurance plan. (The more money you earn, the more of a co-pay your household would have to cover, as CBC Explains reports here.)
However, that’s still a big difference from the massive dental expenses many seniors now face, and it could open up care to millions more people.
Doctors say Canada’s new national dental care plan will help millions of Canadians who often avoid going to the dentist until it’s an emergency, but there are questions about capacity and the program’s complexity.
In Waterloo, Ont., 81-year-old Angelo Graham told CBC News that for retired Canadians like him, dental issues — and costs — can balloon once someone doesn’t have coverage through their job.
His teeth have shallow roots, dentists told him, and he ended up losing several teeth despite taking care of his oral health over the decades. After retirement, the problem got worse. “It became sort of unworkable,” he said. “I ended up losing most of my bottom teeth.”
Graham said he wanted a permanent solution — not for vanity reasons but because removable dentures seemed risky. He opted for tooth extractions and implants, which cost him more than $30,000 out of pocket.
“We’re fortunate in that we’re reasonably comfortably off. We have a generous pension. But we still had trouble affording it. I put it on our line of credit.”
Implants are one of the few dental treatments the new federal plan does not cover, along with services such as teeth whitening and mouth guards, while tooth extractions and dentures are covered.
“I perhaps wouldn’t have benefited from it,” Graham said, “but I’m still in favour of a plan like that.”
Questions over access
The big concern for Hamilton dental hygienist Carmela Marisa Mannarino is that interested seniors might have trouble navigating what could be a complex system.
As the operator of Dental Care in Motion, a mobile dental clinic, Mannarino works with high-risk groups, providing preventative dental care to homebound seniors and people living in long-term care facilities. Her team sees a whole range of issues — from broken teeth and busted dentures to people not eating properly, or at all, because of painful or missing teeth.
She questioned how easily vulnerable people will be able to access the new plan, which requires preparing your income tax return in order to enrol.
“There are a lot of people who may not get that done,” she said. “And are we going to find the right providers for the care — oral surgeons, dentists, hygienists? … Is there going to be a clear understanding of what’s covered?”
Mannarino and others are also concerned about barriers for those living in remote and rural areas, where dental teams are already in short supply.
That includes Indigenous communities, Dr. Sheri McKinstry, co-founder of the Indigenous Dental Association of Canada, told CBC Indigenous, adding the government needs to improve the access to oral health care for those who live in remote areas to keep the gap in health disparity from widening.
And if enough members of the dental industry don’t opt in or accept the plan as payment, that could leave many Canadians without many options, said Sylvie Martel, the Victoria-based director of dental hygiene practice at the Canadian Dental Hygienists Association.
“We need the dental professionals to be part of this, essentially,” she said. “They have to be a player.”
Meanwhile, others are raising concerns that an influx of patients could impact an understaffed industry.
“Some Nova Scotia dentists are currently not accepting any new patients, and so opening this up to a significant portion of the population might further complicate patients’ … ability to access care in a timely manner,” Dr. Juli Waterbury, president of the Nova Scotia Dental Association, said during an interview with CBC Nova Scotia News At Six on Tuesday.
Toronto geriatrician Dr. Samir Sinha said while there are major questions about how the plan will roll out, it’s still going to benefit many of Canada’s most vulnerable.
“How does health care cover everything but what happens in your mouth?” he said. “We’ve been waiting for this forever.”