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If the Liberal-NDP agreement to create a national dental care program for low-income Canadians becomes a reality in the years ahead, advocates and health-care workers say it could help prevent dental health issues from spiraling into life-threatening conditions — and keep more people from resorting to hospital emergency rooms.
Millions of families with annual incomes of less than $90,000 and no dental insurance could be eligible for coverage under the proposed, phased-in program, which is just one element of the new two-party “supply-and-confidence” agreement that could see the Liberals stay in power until 2025 in exchange for action on several NDP priorities.
The NDP previously promised the program would cover a slate of services, including exams, cleanings, X-rays, fillings, root canals and crowns.
“I think that this will be the beginning of a lot of change to ensure that we now see oral health as part of our health, which it clearly is,” said Joan Rush, a Vancouver-based advocate for people with disabilities.
Statistics Canada data shows roughly two-thirds of Canadians have dental insurance to cover all or part of their expenses — but that leaves a third of the country paying out of pocket for pricey dental work and preventative care, including many seniors, people with disabilities and those experiencing homelessness.
Infections can lead to heart attacks, strokes
That’s been Colette Langdon’s experience. The Barrie, Ont. resident — who uses they/them pronouns — is on disability support through the province, which doesn’t cover the full range of dental care they require.
A root canal, for instance, came with a bill of a couple thousand dollars that Langdon thought would be covered, but wasn’t. Their dentist wound up footing the bill, but that’s usually not the case.
“That root canal tooth? I still don’t have a crown on it,” Langdon said. “Because I can’t pay for it.”
Advocates and medical experts agree prevention is the best approach for Canadians’ health, and to avoid straining the medical system.
“The bacteria that infect gums can travel all the way through the body, and actually cause heart attacks and stroke, for instance,” said Jo Connelly, the executive director of Toronto’s Inner City Family Health Team, who has spent more than four decades working with marginalized populations.
“When you think about the cost of health care of people who’ve had strokes at an earlier age, you can imagine that alone can cause all kinds of ripple effects for the health-care system,” she said.
‘All this, just from an infection in the tooth’
Ottawa resident Shane Mckenzie knows too well how a simple dental issue can turn serious, requiring life-saving medical care and a lengthy hospital stay.
In the spring of 2016, while working in construction in northern Ontario, the then-31-year-old began experiencing a pain in one of his molars. Although he has dental coverage, Mckenzie wasn’t near a dentist at the time, so he waited until he came back to Ottawa a month later to have the tooth pulled.
“But I guess it was too late,” he recalled, “because it was infected and it went into my bloodstream.”
Mckenzie developed a fever and other flu-like symptoms. In July 2016, while staying at his mother’s house, he collapsed in the bathroom and his mother called 911 — marking the start of what was to become a years-long medical ordeal.
When Mckenzie arrived at a local hospital, he was put into a medically induced coma and woke up about a week and a half later.
That’s when he learned the grim reality: he had sepsis, an often life-threatening condition that occurs when an unusual, overwhelming bodily response to an infection begins damaging the person’s own tissues.
Mckenzie’s feet turned black, and half of his arms, too. He wound up being in an intensive care unit for a month, required dialysis to get his kidneys working and faced multiple surgeries to remove his damaged appendages. He then spent an entire year of his early 30s in a long-term care home that usually cares for seniors and veterans.
“And all this just from an infection in the tooth, and I didn’t take it out quick enough,” he said.
Speaking to CBC News from his home, Mckenzie explained he no longer has any fingers on his left hand, and is now missing much of his right. He also required a below-knee amputation on his right leg, and is missing the toes on his left.
“When I woke up from a coma, they said if you were older, you may have not survived,” he recalled.
“So for older people to not have dental care, that’s really scary to think of.”
Program could cost $1.5B annually
The price tag for the Liberal-NDP dental care program could be revealed in the federal budget expected in early April, but previous NDP proposals already have been examined and costed.
An analysis by the Parliamentary Budget Officer in 2020 estimated the cost of a similar program at $1.3 billion over the year following the plan’s announcement, and $4.3 billion during the first year of the plan’s operation. The program would then cost about $1.5 billion annually until 2025.
Advocates stress those investments would prevent some of the financial burden on emergency room teams — which often can’t even resolve dental issues.
In Canada, an estimated one per cent of all emergency room visits in a given year are made by patients with non-urgent dental conditions, such as toothaches or tooth decay.
A B.C.-based analysis of dental-related emergency visits published in the Canadian Journal of Public Health in 2017 suggested that one per cent figure translated to nearly $155 million being paid by taxpayers in that province alone.
“But the vast majority of these dental visits are discharged while the oral problem likely persists, hence taxpayer dollars are wasted,” wrote dentists Dr. Mario Brondani and Dr. Syed H. Ahmad.
Dr. Gaibrie Stephen, an emergency physician in the Toronto area, echoed the idea that hospital medical teams aren’t typically equipped to tackle many instances of dental pain, even though those issues often get worse and lead to people coming back for help or falling seriously ill — potentially resulting in longer, pricier hospital stays.
In Ontario, the total cost of an average hospital stay for sepsis for adults aged 18 to 59 — similar to what Mckenzie experienced — can range from roughly $12,000 to more than $25,000, according to figures provided to CBC News by the Canadian Institute for Health Information.
At the emergency room level, when patients come in with initial tooth pain, “all I really can do in those situations is prescribe people antibiotics or painkillers,” Stephen said.
‘Best’ approach is enhancing provincial programs: dental association
In a statement, the Canadian Dental Association (CDA) questioned if the Liberal-NDP approach is the ideal way to improve access to dental care. The CDA stressed that it will be “important to ensure that any new initiatives do not disrupt access to dental care for the large majority of Canadians who already have dental coverage through employer-provided health benefits.”
“The single best way to quickly improve oral health and increase access to dental care is to invest in, and enhance, existing provincial and territorial dental programs,” the CDA statement continued.
“These programs are significantly underfunded and are almost exclusively financed by provincial and territorial governments.”
There’s indeed a patchwork approach across the country, and not all procedures are covered equally among the provinces.
Full coverage for preventative care in particular would be helpful, according to Langdon, the Barrie resident, since avoiding the dentist can lead to further health complications.
“It would actually be a big savings in my mind for our health-care system to have full dental, to have full preventative care,” they said.