How bad teeth are at the root of income inequality in Canada -

How bad teeth are at the root of income inequality in Canada

Anne Kingston: The glaring omission of dental care from Canadian health-care plans is both illogical and a public-health concern

(Spencer Platt/Getty Images)

(Spencer Platt/Getty Images)

When Bernie Sanders took his well-publicized cook’s tour of Canada’s much-vaunted universal public health care system recently, he wouldn’t have seen a cavity being filled or a root canal performed or a missing front tooth replaced. That’s because most oral health care is exempt from provincial and territorial health-care plans (some dental services are covered by government dental programs, but working-class people lacking employer coverage are on their own).

It’s a glaring omission that’s both illogical and a public-health concern. We know that periodontal disease affects heart health; that an untreated tooth infection can be fatal; that mouth pain can lead to drug addiction and force people to stay home from work; that dentists and dental hygienists can spot precancerous or cancerous lesions, as well as diabetes and gastroesophageal reflux disease; and that hospital emergency rooms are flooded with people with untreated dental problems.

Poor oral health isn’t only a physical risk, of course. It threatens education and job prospects, and thus, social mobility. It’s a problem so dire that it’s shocking a federal government elected on its promise to strengthen and expand the middle class—and one well aware of the power of a smiley selfie—hasn’t championed equal access to oral health care.

READ: Five simple ways to improve Canadian health care

The need was telegraphed in a recent University of British Columbia study that examined the daunting, important task of integrating women who’d been incarcerated back into society. The study highlighted the need for health care: specifically, access to oral health care. As authors Patricia Jansen, Mo Korchinski and Ruth Elwood Martin write: “When you haven’t seen a dentist in years and your mouth is missing teeth, it can be hard to impress at job interviews, hard to find work.”

American sociologist Susan Sered, who works with women in poverty, puts it more plainly: “More than any other marker in America, teeth indicate class status,” she writes at, adding women have told her that “being too poor to have respectable teeth is like wearing an ‘L’ for ‘loser’ on your face.”

Canadians can’t be smug. A similar class divide exists here between those with perfect, straight, bright-white teeth, able to afford a growing menu of cosmetic treatments such as teeth whitening and “gum contouring,” and those without the funds to have a cavity filled.

The fact that poor oral health has come to be framed in moral terms, rather than as a disease that needs fixing, exacerbates the problem, writes Mary Otto in her fascinating 2017 book, Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America. Otto also traces the medical politics that saw dentists deemed members of a separate profession, rather than doctors who specialize—like cardiologists or dermatologists. As a result, dental records are kept separate from “medical” records.

Such a disconnect saw Canada’s 1961-64 Royal Commission on Health Services term dental care an “individual responsibility.” The Canada Health Act of 1984 later funded coverage of all “medically necessary” health care services short of surgical-dental interventions; in other words, tending to cavities and periodontal care was up the individual.

The result, decades later, is the growing economic divide reflected in the mouths of Canadians. Long-form census data released this month revealed income inequality increasing between 2005 and 2015; poverty rose steadily, with the highest-income groups pulling away from the broad middle class. The 2017 State of Oral Health in Canada report by the Canadian Dental Association (CDA) echoes this fact. The headlines are upbeat: “Canada is among the world leaders when it comes to the overall oral health of citizens.” A closer read reveals that lower-income Canadians “have worse outcomes in terms of oral health,” and that “access to dental care may be getting more difficult for the middle-income segment” of the population due to “decreases to both the amount and availability of employment-based dental insurance.” More than half (53 per cent) of adults between 60 and 79 and 50 per cent of lower-income Canadians have no dental insurance. People living in rural and remote areas lack access to dentists, as do the “most vulnerable” (seniors, children, Indigenous peoples, new immigrants with refugee status). The CDA calls oral health care “a human right,” which it is. One hopes that a government concerned with social and economic equality would see it as such—and make access to oral health care “medically necessary” in the Canadian Health Act. The happy smiley face is built right in.



How bad teeth are at the root of income inequality in Canada

  1. I agree.

    Now what about eye exams?

    And hearing tests?

    • How about we fix Canada’s current health system before we add a tonne more to it. It already costs on average $12000 a year per Canadian.

      • Gosh yeah. A military and the Senate are much more worthwhile, right?

        • Yes our military is a worthwhile thing especially with all search and rescue, and disaster relief as well as securing our border. The Senate is a very important thing as it is our version of checks and balances on the current elected government, essentially the senate would be there to prevent somebody like Harper or Trudeau turning us from a democracy to a dictatorship.

          • LL rubbish…..none of that is needed

  2. My parents didn’t earn much, but they always took us kids (all four of us) to the dentist and paid for it out of pocket. If it meant doing without something else, and it often did, then that’s what we did. Budgeting and prioritizing are much bigger issues for most people than lack of income. The CCTB is up to over $600 per month for the lowest earners – something that didn’t exist when I was a kid. Use some of that money to take your kids to the dentist or optometrist or whatever.

    • Well if your life was like that, everyone else’s must have been as well.

      • I think I have you figured out now emilyone.


        • You have no idea what a troll even is.

        • She’s been showing up here since 2007 telling everyone else how to think. A sad way to spend one’s golden years.

          It’s Remembrance week. We will soon be treated to her theories that the Allies had no business fighting Hitler and should have negotiated a peace treaty with him instead. Yes, she’s that nutty.

          • No, you’re that ignorant. As always.

  3. In Ontario, we have the Healthy Smiles program which covers virtually any child with dental needs, including those with insurance. The fee guide is about 40% of our fee guide. Since our expenses run well above that, we lose money on those cases we accept, often as a pro bono attempt to help others. When you are a peiatric dentist, suddenly you are overwhelmed with cases and as these cases become the majority of your practice, you start to go underwater. We have tried to negotiate with the Ontario Government but they have refused to negotiate for years. Dentists know what the government has in mind. Bring in these programs and then strangle the profession with unrealistic low fees, calling these professionals tax cheats and fat cats. As a result of the Healthy Smiles program, the specialty of Pediatric Dentistry is being ruined in Ontario and attracting young people to this field is increasingly difficult. As well, it is becoming more difficult to accept and treat these kids in such desperate need and provide access to General Anaesthesia and other much needed service. So much for government funded programs.

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