Why hasn’t medical care in Canada included teeth?

Posted on November 12, 2022 in Health History

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TVO.org – Health/History
Nov 9, 2022.   Written by Karen Black

Experts say that dental care has long been viewed as a personal and family responsibility — but that could be about to change.

Readers encountered a concerning headline in the December 30, 1910, edition of the Globe and Mail: “School children’s teeth in a deplorable state.” The accompanying article detailed the findings of the Dental Education Committee, which had conducted tests at Toronto’s Elizabeth Street and Church Street schools: A “very large percentage” of students “could not make full use of their power of mastication, because of decayed or defective teeth”; 87 per cent had mouths “not considered clean”; 42 per cent of students at Elizabeth Street School and 22 per cent at Church Street School were suffering from toothache; and 99 per cent “were found to have pus exuding into the mouth, same being swallowed with their food.”

Since then, the oral health of Canadians has improved dramatically. But experts say the way dental care has developed in this country has created enduring inequities — and they’re hoping new legislation will start to bridge the gaps.

Roughly a decade after the Dental Education Committee report, advertising of toothbrushes and toothpaste started to boom. In the 1920s and 1930s, readers were often treated to full-page colour ads, says Catherine Carstairs, a history professor at the University of Guelph whose recent book, The Smile Gap, documents the history of oral health in Canada. “Advertising stressed the importance of keeping your smile bright for work and for romantic success and made a very compelling case for the importance of brushing your teeth,” she says.

“New beauty comes with glistening teeth and every woman owes that to herself,” proclaimed a full-page ad for Pepsodent in the Toronto Star in 1921. This type of advertising reflected the idea, “pervasive in Canadian and North American culture, that oral health is an individual responsibility,” says Carlos Quiñonez, director of dentistry at Western University’s Schulich School of Medicine & Dentistry and author of The Politics of Dental Care in Canada.

Some collective action was ultimately taken: the introduction of fluoride into municipal water supplies and government-funded education programs exhorting people to brush and to eat right caused the oral health of Canadians to improve dramatically in the 1950s and 1960s. Nevertheless, Maclean’s magazine sounded the alarm in 1961, stating that “four out of five Canadian school children lack treatment for open cavities, and their general health is suffering.”

But when Canada’s Medical Care Act was passed in 1966, only physician services were covered — even though the 1964 Royal Commission on Health Services report (considered the blueprint for Canada’s universal health insurance program) had recommended free dentistry for all children and eventually for all adults.

Quiñonez says that dental care was excluded for a number of reasons. Dental associations lobbied hard against being included. “There was the political reality that dentists, just like physicians at the time, rejected the idea of being conscripted into a national health-insurance system,” Quiñonez says. “They didn’t want governments involved in their business. But dentists, because of a variety of other contributing factors, ended up getting what they wanted, while physicians didn’t.”

Policy makers, he adds, prioritized physician and hospital services and were aware that oral-disease rates were in decline and that there wouldn’t be enough dentists to meet the projected demand.

But, in his view, the fundamental reason dental care is not part of the national insurance plan is that “as a culture, we made the decision that brushing and flossing your teeth and going to the dentist regularly for preventative care was your responsibility and your family’s responsibility — and not the state’s responsibility.”

Once the Medical Care Act was in place, medical benefits provided by employers were no longer needed, and unions began demanding dental insurance instead. Employers responded, and today about 60 per cent of Canadians are covered by private dental insurance.

Many working families, though, don’t qualify for the few public dental programs that the  government provides, says Jacquie Maund, policy and government relations lead for the Ontario Oral Health Alliance, an association of dental professionals: “It’s a major concern, particularly for low-income people who are in the workforce but are not eligible for any of the limited public dental program.”

And while there are public dental care programs for people on social assistance and for other marginalized groups, “the vast majority, an overwhelming 94 per cent, of all dental expenditures in Canada” are either paid for by patients themselves or through their private insurance or their employer-sponsored insurance, says Quiñonez, and “that puts Canada near the bottom among OECD countries in terms of public expenditures on dental care.”

In Ontario, one in five people do not visit a dentist because of cost, Maund adds. As a result, they suffer much higher rates of tooth loss. That has knock-on effects, says Quiñonez: “We know that you’re more likely to be discriminated against if you have broken teeth. We know that kids don’t do as well academically if they’re constantly dealing with the pain of dental cavities.”

See Video:  The Politics of Dental Care in Canada with Dr Carlos Quiñonez – https://youtu.be/yBJ8ANYipiA

Some of this is about to change. Almost 75 years after Canada’s Medical Care Act provided universal health insurance to cover physician care, the federal government is now set to launch the first phase of a national dental-care program in December.  The Canada Dental Benefit, which received parliamentary approval on October 27, will provide free dental care for uninsured Canadians with an annual family income of less than $90,000, starting with children under 12 in December 2022. Full implementation for all ages is expected by 2025.

Maund says there is now hope for the millions of Canadians who do not have access to dental care — if the new federal dental program is properly designed. “We don’t want to have even more of a patchwork with people getting different baskets of services, different kinds of hoops to jump through in order to get access to care,” she says. But she’s nevertheless optimistic: “I would say we’re in a watershed moment in Canada.”

Karen Black is a journalism fellow with the University of Toronto’s Dalla Lana School of Public Health.


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One Response to “Why hasn’t medical care in Canada included teeth?”

  1. kat says:

    I was born with bad teeth. My enamel is very weak. No matter how much care I give, I have bad teeth. I live in constant pain. I don’t have insurance from work, I make “too much” for the federal program but I can’t afford care. I am sick. I can’t get relief without going into debt. Now the “poor” will have better teeth than “middle class”.


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