[00:00:00] Jordan Heath-Rawlings: This month, I went to a new dentist, my old dentist retired. I sat down in the chair and the new guy took one look in my mouth and he saw dozens of fillings. Most of them, about 15 years old. And I swear there were dollar signs in his eyes. He seems like a really nice dentist, I don’t blame him for his reaction.
My mouth has made dentists a lot of money over the past couple of decades. And it’s all because of about three years, in the early 2000s, when I was too old for my parents’ dental plan, but didn’t have a job that gave me one. So I didn’t go to the dentist and my teeth got bad. And there are hundreds of thousands of Canadians in that same situation right now. Even for Canadians who are lucky enough to have a job with some kind of dental plan, the amount those plans cover is often not enough to take care of [00:01:00] any really complex procedures.
And I just want to ask, why is that? It’s not like Canada generally has private health care. It’s just our provincial healthcare doesn’t often include any dental coverage. And why is that? Other countries do it, it is certainly possible. Is dental care an afterthought in Canada? Is it just too expensive? Is it cheaper to have people with really bad mouth problems show up in emergency rooms and deal with them there? Why is dental care in Canada like this? How did it get this way? Was there ever a plan and to fix it? Does anyone have one now?
I’m Jordan Heath-Rawlings, this is The Big Story. Anne Thériault Is a freelance journalist based in Toronto, who looked into the lack of dental care in Canada for The Walrus. Hey, Anne.
Anne Thériault: Hey! [00:02:00] Thanks so much for having me.
Jordan Heath-Rawlings: You’re welcome. Um, as somebody who also spent a good five years without dental insurance, um, and has bad teeth as a result, this is a cause near and dear to my heart.
Anne Thériault: Yeah, it’s definitely something that impacts a lot of Canadians. The statistic is like one in five Canadians avoid or delay going to the dentist because of the cost.
Jordan Heath-Rawlings: Maybe you could chronicle, um, and you don’t have to go into, you know, super personal detail if you don’t want to, but just chronicle, uh, your dental nightmares that you wrote about in The Walrus, because I think, um, it’s pretty relatable and even Canadians that are lucky enough to have dental insurance face this kind of stuff.
Anne Thériault: Yeah. So I’ve kind of had escalating dental problems, um, ever since my son was born, uh, which was, uh, just over 10 years ago. In late 2017, I had a dental abscess that was misdiagnosed at the [00:03:00] emergency room. And so I waited a couple months to get it treated because I thought it wasn’t really a big deal. And then by the time I saw my dentist, it was quite bad. And so I had to have an emergency root canal, even that didn’t fully resolve the pain. And after that, I found out that there had been an abscess and kind of on top of that, there was what’s called a vertical root fracture. So kind of, of a fracture in the root of the tooth.
Jordan Heath-Rawlings: Eurgh.
Anne Thériault: Which can lead to infections in the surrounding bone. Um, and they kind of said, you know, the only option is to pull the tooth and either you will just be missing a tooth or you can get a dental implant, but that’s going to cost thousands of dollars. So I just kind of said, well, I’ll think about that later.
Jordan Heath-Rawlings: Yes!
Anne Thériault: And, um, I didn’t do anything about it for about two years and then it got quite bad and there really was quite a [00:04:00] bad infection in the jawbone there. And, um, and it sort of hit a crisis point and I had to make a decision about it. And it turned out the, the surgery was going to cost, uh, just under $4,000. So I ended up crowdfunding it, um, because I, I did like a lot of Canadians. I didn’t have thousands of dollars kind of at the ready to, to spend on that.
Jordan Heath-Rawlings: And to reiterate, you have insurance, right? It’s just, this is, this is stuff that happens out of pocket in this country.
Anne Thériault: Yes, I have insurance. Um, I have $2,000 of coverage every year. Because dental procedures are so expensive, um, you know, I have years where I blow through all of that insurance. Um, or even, I mean, something like this surgery, which like I said, was nearly $4,000, that’s even if the insurance covered it, they would obviously wouldn’t cover the full [00:05:00] amount. But also the insurance decided they weren’t going to cover it because they felt that, you know, it was kind of above and beyond the most minimal treatment I could have had.
Jordan Heath-Rawlings: Can you explain, um, what kinds of results can occur from neglecting stuff like, uh, you know, the abscess you mentioned or an infection that can spread to the bone. Like these are some pretty serious health concerns.
Anne Thériault: Right, yeah, and there are all kinds of adverse outcomes that can happen. The most serious would be, um, you know, the abscess spreading to the brain, which is obviously quite close to the roof of your mouth. Um, it can lead to sepsis, so like a body-wide bacterial infection. It can lead to, if there’s quite a lot of swelling, it can lead to a blocked airway. Um, I mean, those are the most kind of extreme cases, but, you know, even on the lower end of things, it can just mean living with extreme pain.
[00:06:00] Jordan Heath-Rawlings: What kind of care is available in Canada, um, through our universal healthcare for issues like that, when it’s quite clear that, that you might be courting a serious health problem?
Anne Thériault: Yeah, that’s something that I really struggled to figure out, uh, kind of during the two years, between, I guess, three years, between when I first had the abscess and when I had the surgery. And it’s mostly bandaid solutions or treatments that can, uh, impact other parts of the body that might be affected. So like for me, one thing that I got because of where the abscess and then later the infection was, it was next to my sinuses and I was getting kind of all these chronic sinus infections because of the inflammation.
So I could treat the sinus infections through my doctor, but she couldn’t do much else. And then kind of basically all the healthcare system can do is antibiotics and [00:07:00] painkillers.
Jordan Heath-Rawlings: How did it come to be this way? And I mean, when we set out, uh, what universal health care would look like in this country, were people talking about dental care, uh, being included? Was there ever a time that that was on the table? Because this makes us fairly unique, right?
Anne Thériault: Yeah. Most countries that have a universal healthcare system have some kind of coverage for dental. Um, I’m not an expert, but from what I’ve read, most countries at least partially cover it. We don’t cover any of it. When the whole commission was looking into, uh, or create, they, they did a report basically on what it would look like for Canada to have universal health care. And when they were doing those investigations, they did look into dental care. And they advised against including dental care in our healthcare system, uh, partially because there weren’t enough dentists in Canada to [00:08:00] offer it to everybody, I guess, for free. And also the, they felt that the added cost would be too much.
There were some weird, when you read, you can read some of the comments that the dentists who were interviewed for this made, and their comments are stuff like, “Free services will lead to moral disintegration and people need to care for themselves. And if families are just making sure that their children have a good foundation and learn good preventative care, then dental coverage won’t be needed because hardly anybody will have any tooth problems.” that kind of thing.
Jordan Heath-Rawlings: I wonder if you can give me some idea in terms of what the actual costs of approaching it are, uh, that way. You know, you mentioned that you made repeated visits to your doctor to have a sinus infection treated, and like that’s a tax on the healthcare system too, [00:09:00] that you wouldn’t be doing if you could take care of your teeth.
Anne Thériault: Right. So, We don’t have a national figure for how much it costs for the healthcare system. There are a few estimates. We have some pretty decent figures, provincially. Uh, so in Ontario, it’s, uh, in 2014, 61,000 people visited the emergency room for dental care reasons that weren’t what they call like traumatic. So not to do with like falling and knocking your teeth out, but just like kind of standard dental stuff. So 61,000 people, and that’s estimated that cost the province $31 million just in one year. In 2012, 218 ,000 patients, visited their family doctors for dental care reasons. And that cost the province an estimated $7.3 million.
So it’s, it’s [00:10:00] costing provinces tens of millions of dollars a year. And it’s probably not a stretch to say that it costs, nationwide, you know, over a hundred million dollars a year. And again, that’s money that’s going nowhere. That’s money, that’s antibiotics and painkillers, which are just band-aid solutions. They’re not fixing these problems. So it’s, it’s like pouring money into a hole.
Jordan Heath-Rawlings: Has any province tried, um, to run some sort of dental care program, uh, with their provincial health coverage?
Anne Thériault: Yeah. So, um, a couple provinces do have programs or have had programs. Quebec has a program for free dental care for people under the age of 18. Ontario has the Healthy Smiles program, which serves children of low-income families under the age of 18. Um, those are both still existing. And also, um, both Saskatchewan and Manitoba had kind of large province-wide programs [00:11:00] in the seventies and eighties, uh, where all children, regardless of income were, given free dental care. And those programs were done through schools.
Jordan Heath-Rawlings: Have we ever looked at what it would actually cost to just expand those programs naturally or put them in every province? Um, if, you know, we’re already paying doctors to do stuff on the side, we’ve already got some provincial problems. Um, it seems to me like this is kind of like PharmaCare, which has just got kicked around for a long, long time until finally the government said, okay, it’s time.
Anne Thériault:: Yeah. So the NDP did propose a program, um, and Parliamentary Budget Officer did draft up a cost for what the proposal would entail. And the estimated cost is $1.7 billion, which is a lot of money and it is definitely more money than is being spent at doctors and ERs, but it is also really a [00:12:00] tiny fraction of what our healthcare budget is right now.
Jordan Heath-Rawlings: Do we have a look, um, from any other, uh, peer countries of, of ways they do it, that maybe aren’t, uh, 100% cover everything top dollar, but that can prevent people from having to end up crowdfunding, uh, their dental care?
Anne Thériault: Yeah. So the two countries that I looked at in my piece, which, uh, have kind of comparable healthcare systems to Canada were, the UK and Denmark. And like Canada, both of them spend about 10% of their GDP on healthcare, and they both have universal healthcare systems. And they both offer partial coverage for dental care.
And in both cases with good outcomes, better outcomes than Canada when we look at things like children who have broken, discoloured, or missing teeth at the, by the age [00:13:00] of 12 or, um, how much people are spending, that kind of thing. They tend to have better outcomes than that than us.
I’m really fascinated by the NHS system in the UK, which it’s wonky from a Canadian perspective because of course the UK is one country, but it has four countries in it. And so this system is a little bit different per country, but looking at the one for England. So what they do is, uh, there are three bands of treatment and a different cost for each. And so the lowest band includes things like x-rays, examinations, diagnosis, cleaning, um, and that one out of pocket is £23 and you would get all of that and you would pay £23 out of pocket and the NHS would cover the rest.
And then the next band up would include things like fillings, root canals and whatever. And that one is £65 out of pocket. And then the highest band includes kind of more, uh, intensive [00:14:00] treatments like crowns, dentures, bridges, uh, implants, that kind of thing. And that one is £282, uh, for any of those treatments.
And then, so that is like a lot of money, but it’s nothing compared to what we pay in Canada. Like, you know, I paid almost $4,000 for an implant and comparatively in the UK or in England, it would be £282.
Jordan Heath-Rawlings: Can you tell me what it was like, um, if you don’t mind, to, to crowdfund for your teeth? Uh, as you mentioned in your piece, I think a lot of Canadians assume that, you know, that’s an American thing, right?
Anne Thériault: Yeah, definitely. I don’t think we associate crowdfunding for dental costs with healthcare in Canada and, you know, and I think sometimes we tend to get so hyped about the parts of our healthcare system that do work well that we willingly don’t [00:15:00] want to think about the parts that are really broken.
You know, I had a lot of internalized shame about doing it. Um, you know, I’m a grown-up, I’m a mom. I felt like I should have my life together enough to be able to cover something as basic as going to the dentist, which, you know, doesn’t feel like it should be a really above-and-beyond life expense. I was very fortunate that, uh, people were very generous and, um, I’m fortunate that I have pretty sizeable social media following, and I have a lot of friends on there and that made it easy for me. Um, I know that not everyone would be so lucky, even if they were to try to crowdfund.
Jordan Heath-Rawlings: When you were talking to people for this story, or even just doing your research, do you see momentum towards this building? It feels like it’s been like this my entire life, basically.
Anne Thériault: Yes and no. Um, [00:16:00] I definitely, I have talked to a lot of people who are very passionate about it and, you know, I have talked to a lot of politicians who feel passionate about it. And I, I think in, I hope in a post COVID world, we are going to be looking more at healthcare and, um, kind of expanding universal services. You know, I know we’ve already had some pledges to improve childcare. And, you know, we talk a lot about PharmaCare and I really hope dental care is next. And you know, there is this proposal by the NDP.
I do also think that it’s a pretty fragile momentum because like you said, we’re all kind of used to that, this is just the way it is.
Jordan Heath-Rawlings: Anne, thank you for opening up about your own teeth and also explaining to us, uh, this long history of doing nothing.
Anne Thériault: Thank you so much for having me.
[00:17:00] Jordan Heath-Rawlings: Anne Thériault, a freelance writer based in Toronto. That was The Big Story, for more from us, head to thebigstorypodcast.ca, you can find all of our previous episodes on that website. You can also talk to us anytime at @TheBigStoryFPN, you can talk to me on Twitter too, by the way, I’m @TheGameSheet. You can also email us, thebigstorypodcast, that is all one word, all lowercase or all uppercase, you choose, @rci.rogers.com [click here!]. If you want to subscribe or follow or favourite us or share us with your friends. We are in every podcast player you could possibly imagine, from Apple, to Google, to Stitcher, to Spotify, and dozens more. And you can ask your smart speaker, whichever one you have to play The Big Story podcast to get our latest episode.
Stefanie Phillips, Claire Brassard, and Ryan Clarke produce The Big Story, Joseph Fish joins us this week as an associate producer. I’m your host, Jordan Heath-Rawlings, thank you so much for listening. Stay safe. Have a great [00:18:00] weekend. We’ll talk Monday.
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