Trevor Hancock: Our health system should fund dental care

It might come as a surprise, but the federal and provincial governments in Canada seem to believe that your teeth are not part of your body. Dental care, with a few exceptions, is not included in our publicly funded health-care system. This is problematic for four main reasons.

First, it doesn’t make any sense. Of course your mouth and your teeth are part of your body — and a very important part, too. Why would we set up a system to care for your body and mind, but not your teeth?

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Second, dental disease is a common condition. While children’s dental health is good — only 14 per cent of kindergarten children in B.C. had visible evidence of decay in one or more teeth in the most recent provincial dental survey — this is not the case in older age groups.

Nationally, 56 per cent of six- to 11-year-olds and 58 per cent of 12- to 19-year-olds in the 2007-09 Canadian Health Measures Survey had dental caries. And among adults aged 20 to 79, almost all had visible caries.

More troubling, dental disease is much more common in low-income populations. In B.C., a 2011 evaluation of early-childhood dental programs found that while only about 30 per cent of children in high-income neighbourhoods experienced dental decay, it was about 50 per cent in low-income neighbourhoods.

Third, dental disease also makes other conditions worse. Obviously, you need your teeth — or failing that, false teeth — to chew your food and thus be adequately nourished. But our teeth play a role in our health that extends well beyond eating.

A 2014 B.C. Health Ministry evidence review noted that dental disease can have a harmful impact on “pregnancy, delivery and the health of both mothers and their children (particularly in the early years, but also into the school years and adolescence).”

The review notes there is evidence that for pregnant women, dental hygiene and treatment can reduce the bacteria that cause dental caries in their children.

Finally, dental care is a large economic cost for Canadians. In 2009, Canadians spent about $13 billion on dental care, or seven per cent of total health expenditures. This makes dental disease the second most expensive disease category after cardiovascular disease, and more expensive than either cancer or respiratory disease.

But 95 per cent of dental care in 2009 was privately funded, largely through work-related private insurance. This means that many low-income Canadians do not have adequate or even any insurance. The health-measures survey found that: “Lower-income families and those with no insurance reported not obtaining care three to four times more frequently than families with higher incomes.”

This lack of access to dental treatment and to routine dental hygiene and preventive care is important, because good preventive care is effective at preventing dental disease, or detecting it early so it can be treated more easily and cheaply. Unsurprisingly, “Canadians from lower-income families are twice as likely to have unfavourable dental-health outcomes as Canadians from higher-income families.”

But the biggest impact — and the biggest cost — is in the pain and suffering related to dental disease. We all know how nasty toothache can be, and how hard it is to attend to school or work when in that sort of pain. In fact, a 2010 Health Canada report found that “an estimated 2.26 million school days and 4.15 million working days are lost annually due to dental visits or dental sick days.” This results in a significant economic cost due to lost work days.

The 2014 B.C. evidence review identifies the best ways to prevent dental disease. The use of fluoride in drinking water, toothpaste or mouth rinses is useful for most ages (the latter two with caution under age six), while fluoride varnish is effective when applied to teeth.

Reducing sugar consumption is also important.

So we should be ensuring that dental hygiene and basic dental care are available as part of our publicly funded health-care system, at the very least for all pregnant women, for children and for those who lack private insurance. The returns in both health and economic terms would be considerable.

Surely it’s time we recognized that our teeth are part of our body.

Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

thancock@uvic.ca

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