24 November 2007

Am I my bicuspid's keeper? Canadian opinions on publicly financed dental care

In the spirit of the National Medicare Week that wasn't, it seems fitting that an article should appear discussing the results of a survey of Canadians' opinions on publicly financed dental care (1). Not only do they overwhelmingly support universal health care coverage, the vast majority of Canadians also believe dental care should be a social right, are generous as to who should have this right, and expect the government to find the necessary funds to pay for it. In fact, according to this study, which has just been published in the Canadian Journal of Public Health, 83% of Canadians think dental care should be part of Medicare, and two thirds of those think "everyone" should be included.

Contrary to this energetic expression of the people's will, the stingily funded dental care that the less fortunate are able to get in hospitals has been declining steadily in Canada from roughly 20% in the early 1980s to the current 6% of total dental expenditures. As the authors state, these cuts are a mistake, especially with mounting evidence linking oral disease to diabetes, pneumonia, cardiovascular disease and adverse pregnancy outcomes.

Oral ill health is a significant burden to the impoverished, who suffer most of the disease and experience most of the barriers to access (2,3). And the Street Health Report 2007 has found that forty per cent of the homeless are driven to extraction with dental problems. Lack of access to dental care services is an important detriment to the oral and general health of many Canadians. Not that we are an isolated case. A Surgeon General's report, Oral Health in America, called the situation in the United States a "silent epidemic" (4). It seems a simple logical step to an acknowledgement that dental care should be fully integrated into a rational health care system.

The Atlas-Shrugged types will argue vociferously that it is wrong to use taxpayers' money to provide a safety net for gingivitic ne'er-do-wells who think floss is pink and consumed in great quantities at county fairs. Pundits from corporate-funded think tanks like the Fraser Institute and Manitoba’s Frontier Centre for Public Policy will gnash their teeth in horror at such a flagrant concession to human weakness. Obviously they've never had a twanging bicuspid or a suppurating abscess they couldn't spend their way out of. One need only consider the annual expenditure by the public purse on spavined hearts and riddled livers to see that this kind of supercilious cost-accounting is all that's left of decency after the nerve has been extracted.

I pray thee, peace. I will be flesh and blood;
For there was never yet philosopher
That could endure the toothache patiently,
However they have writ the style of gods
And made a push at chance and sufferance.

Shakespeare, Much Ado About Nothing 5.1


1. QuiƱonez CR, Locker D. Canadian opinions on publicly financed dental care. Can J Public Health. 2007 Nov-Dec;98(6):495-9.

2. Leake JL. Access and care: reports from Canadian dental education and care agencies. J Can Dent Assoc. 2005 Jul-Aug;71(7):469-71.

3. Main P, Leake J, Burman D. Oral health care in Canada--a view from the trenches. J Can Dent Assoc. 2006 May;72(4):319.

4. United States Surgeon General. Oral health in America: a report of the Surgeon General. Washington, DC: U.S. Department of Health & Human Services; 2000.