September 2013 – Dentistry bites

Normally this column is an opportunity for me to rant about big ticket items: the Harper government’s war on science, the idiocy of fracking, why incineration is stupid. In the last column I pointed out that often important issues can be undermined by asking the wrong question (e.g. “pipelines versus trains”).

A very expensive bowl of popcorn got me thinking about another set of questions.

We know that bad teeth and gum disease can contribute to all manner of other health problems, including heart troubles. According to the Mayo Clinic, poor oral health may affect, contribute to or exacerbate other diseases or conditions, including diabetes, osteoporosis, Alzheimer’s, and immune system and eating disorders.

Which leaves me wondering, if good oral health plays such an important role in good overall health, why on earth isn’t it covered by public healthcare in Canada?

When my friend’s daughter Jasmine was pregnant, her doctor stressed the importance of regular dental check-ups, as strong links had been established between gum disease and premature birth and low birth weight. Jasmine’s first question was: What if I don’t have private extended health care? Her doctor simply shrugged. (As it happens, Jasmine did have extended health care, but she couldn’t help wondering about pregnant women who didn’t.)

In the late 1940s, when the National Health Service was being established in the UK, it covered all health care costs, including dental. Over time it was agreed that a portion of dental costs should be borne by patients.

NHS dental charges come in three “Bands” and are flat fees for services, even if multiple appointments are required. As of 2013, Band 1 gets you a check-up and cleaning for £18. Band 2 covers everything in Band 1, plus treatments such as fillings and root canals. The cost is £49. Band 3 includes everything in Bands 1 and 2, plus treatments such as crowns, dentures and bridges. The cost is £214 ($351 at the current rate of exchange). If you are unemployed, a pensioner or otherwise living on a low, fixed income there is no charge.

The system isn’t perfect, not least because many dentists during the Thatcher and post-Thatcher eras opted for a private practice that allowed them to charge whatever they wanted for these services. As a result, in some areas of the country it can be very difficult indeed to find an NHS dentist able and willing to take on new patients. But the recognition remains – on a national level – that oral health is an overall health issue and should be covered by the NHS.

Which brings me to that bowl of popcorn. As you’ve probably already guessed, chomping on a hard kernel broke a molar.

I haven’t been to a dentist since the last time I saw my lovely NHS dentist in 2010. I freely confess I hate going to the dentist. Part of the reason is that I have a small mouth. (Those who know how loud that mouth can be may smirk, but it’s true.) This makes many dental procedures more difficult and painful than they might otherwise be. The other reason, of course, is that I have no extended medical plan and I simply cannot afford it.

But needs must. The next morning I phoned the dentist’s office on the island where I live. Luckily for me, there’d been a cancellation that day. In I went.

After an examination I was informed that I needed a crown on the molar. How much? I asked. My small jaw dropped when I was told $1300. Well, I said, that’s not going to happen. What are my other options? A filling might last a year, possibly two. Okay, how much? Came the reply:$269. And my no doubt highly original response? “God, why didn’t I go into dentistry?” Of course, that didn’t include the x-rays and examination. Total hit on my credit card: $335.50.

Is this highway robbery? By Canadian dental standards, I’m sure it’s not. (An island friend who’d had a similar run-in with a bowl of popcorn told me her off-island dentist quoted her $1800 for a crown – which she couldn’t afford.)

In recent months there’s been a seemingly never-ending saga in my local paper about the impact one of the doctor’s offices relocating and expanding may (or may not) be having on the island’s other medical practice. Two dental questions have been repeatedly posed as part of this story. The first was about whether or not the new clinic had wired an empty office for dentistry. (Eventually the answer was an irrevocable no.) The second was whether the population of island could support two dental practices. (The consensus, although not necessarily unanimous, seems to be no.)

Given that not everyone is blessed with a dental plan, are these really the most important questions we should be asking about dentistry on the island – or across Canada?

How about this question: Should low income parents have to decide what – of the little they have – to give up in order to take their kids to the dentist? Or should pensioners (and, yes, okay, struggling writers like me) have to incur credit card debt to get their teeth fixed?

Who decided this was acceptable? And how did they get away with it?