Make Someone Smile

Mae West said that love conquers all things except poverty and toothache. There is no love in British Columbia towards adults who have to attend emergency rooms with extreme dental pain and other oral health emergencies, because they cannot pay for dental work. Reportedly, half of these visits are due to abscesses and serious infections. The cost of these visits to the taxpayers is in the millions. The estimate does not include visits to doctors’ offices and walk-in clinics.

Conquering this issue starts with realizing that teeth are important for everyone, of every age, of every socio-economic status. Not only are they aesthetically pleasing (which has its own psychological and social benefits) but they support speech and nutrition. Without them, or with them infected, abscessed and oozing, people can develop arthritis, rheumatism, malnutrition, addictions, trauma, depression, heart disease, Parkinson’s Disease, some kinds of cancers, and even death.

When we see Canadians pulling their teeth out with pliars because they cannot see a dentist, people over-medicating themselves to erase the pain, people dropping dead from heart infections, or if we wonder why the sullen closed mouthed beggar is not getting a job, the inequalities in access to oral care is the reason.

Conquering this issue starts with ethics and those skilled practitioners offering that help in a humane and compassionate way. It is not always about money, it is about service, and dentists need to team up with front line social service agencies to provide care for all members of society. While it is in their code of ethics not to exclude, as patients, members of society on the basis of discrimination which may be contrary to applicable human rights legislation, unfortunately human rights legislation only protects prospective tenants from being discriminated against based on income. It is open season in every other situation.

In every region of our province people are routinely refused treatment by dentists because they do not have the money to pay. These adults often struggle just to pay the rent and feed their families, so regular teeth cleaning, preventive dental care or dental insurance is completely out of reach.

For those who are not working and on “welfare”, and if they are lucky enough to be eligible to have Ministry coverage for dental needs, the government pays only 72% of the BC Dental Associations 2007 fee guide. That leaves poor people who are disabled to save up the other 28% of what could be a two thousand dollar bill. Many just abandon the need. In addition there are caps on coverage and all treatment plans have to be approved by the Ministry as submitted by the patient’s dentist. Often, the decision is made to deny the plan by the dentist and just extract the tooth (cheaper) than crown it (better).

Is there just cause to treat someone’s health issue differently based on whether they have the money or not? Is there just cause to destroy a tooth that could be spared in order to save a few hundred extra dollars? Is there just cause to pay for tooth extraction but not dentures? Is there just cause to refuse to accept patients who are on welfare, or any other public benefit plan due to the reduced fees received for their services? Is there just cause to make the patient pay the difference before treatment for an urgent dental condition is provided? Is there just cause to refuse to even conduct an initial exam without funds up front in order to determine if the problem is urgent or not? This is happening frequently.

According to the BC Dental Association, 80% of their members accept patients receiving social assistance disability benefits, but many set a quota so that only 4-5% of their patient load are welfare clients. In some communities there are no dentists who will accept any welfare clients as patients. In our community, there used to be two or three dentists who accepted social assistance patients, and occasionally do pro bono work, but they were so over run by demand that most stopped altogether.

Throughout the province, communities have been organizing locally to create community-based dental care programs. In recent years these community-by-community types of responses have increased dramatically. Since 2001, there has been at least one new community dental clinic established every year in British Columbia. The only one on Vancouver Island is in Victoria.

There are several solutions to this issue. The Ministry of Housing and Social Development should pay the full rate charged for dental services and low income people will receive the dignity of care. The BC Dental Association should lower its rates or create a responsive, compassionate and realistic pro bono program in every community.

Finally, there is just cause for Campbell River to form a community coalition or task force to improve adults’ access to dental care. A dental trust fund can be created through fundraising to expand the availability of dental care for vulnerable and underserved populations, to assist everyone, homeless, no income, low income, working families with no benefits, not always with the entire cost but often just paying the difference between what is available and what is charged, and ensuring this includes restorative and preventative care.

These possibilities should give us all something to chew on.