Dentistry Needs to Address the Cost of Care

Dr. Peter Doig’s column titled Developing a National Oral Health Strategy¹ was certainly good news. However, unless there’s been astounding new developments in funding availability or a new attitude has emerged among the different levels of government towards accepting oral health as an integral part of general health, the whole exercise is destined to lead precisely nowhere.

Most dentists will conclude that we are merely about to embark on another one of our periodic analyses of the voids in the delivery of oral health care in Canada. It will surely be followed by a noble mission statement, after which Canadian dentistry will go about its daily business as usual.

It is unlikely that cost of treatment will be addressed at all, except perhaps in a cursory manner.

Presumably, little concern will be expressed about the fact that dentistry has become so expensive that employers have to subsidize their staff’s dental expenses with dental benefit plans. And it’s highly unlikely that reference will be made to endodontic treatments being billed at $400 per hour in general practice (while our Prime Minister earns around $167 an hour, for a 40-hour week!), or that a pensioner with no dental coverage might have to pay close to $1000 to an oral surgeon for the extraction of a molar—not a particularly complicated procedure, apparently. I wonder if the high cost of dentistry to the public will get any attention at all.

If, as Dr. Doig indicates, a 2009 survey showed that 84% of our population has satisfactory oral health, it means that as many as 16% of our citizens (or 5.6 million Canadians) might not be accessing dental treatment because of the high cost of care. Undoubtedly, everything revolves around dental economics. That being said, when the Canadian Paediatric Society expresses concerns about the inadequacy of access to care in children, it is clearly time for both the government departments responsible for health and the profession itself to wake up. Dr Doig indicated, pragmatically, that if we don’t put our own house in order someone else might just do it for us—maybe without our input and expertise.

Organized dentistry is hobbled in its efforts to find a solution by two intimately related, apparently intractable realities. First, government funding agencies don’t recognize the oral cavity as the upper limit of the human digestive system, which would put dentistry on a par with medicine in its significance to human well-being. Second, as a result of this fiscally-convenient governmental attitude, dentistry is shut out from obtaining similar public funding to that provided to medical practitioners. Governments have consistently mentioned the high cost of dentistry as a major factor in developing this resistant stance—and frankly, who can blame them? Perhaps the most effective way to resolve part of this standoff might be a serious, concerted effort within the profession to bring the cost of services down, ideally without impacting seriously on dentists’ net incomes. Without doing so, it is surely going to be assumed that we simply don’t care.

No matter how well-meaning our profession is in working to develop a new national health strategy, providing dental care for over 5.6 million uninsured Canadians will prove to be impossible unless purpose-directed funding is available on a large scale. Rather than talking among ourselves, our rhetoric needs to be directed toward the government authorities responsible for funding health care.

Response from Dr. Peter Doig

Cite this as: J Can Dent Assoc 2013;79:d125

I would like to thank Dr. Mulcahy for his interest in the development of a National Oral Health Strategy (NOHS) for Canada and I understand the concerns he has addressed. It is nice to know that my column was read carefully with a critical eye.

While there is generally an acknowledgement of the deficiencies in the delivery of oral health care to a minority of Canadians, there has never been a comprehensive knowledge-based strategy developed to address these areas of concern. Previous actions that were implemented to address issues in access to care and deficiencies in oral health care have been undertaken in an uncoordinated fashion. The programs have been established by various groups representing different levels of government, without consistent levels of consultation with the profession. They were not developed in a manner that allows proper scientific analysis of their effectiveness on either a treatment or cost basis.

Dentists, as the experts in both scientific evidence and treatment modalities, must lead the development of strategies that address the shortfalls of oral health care delivery. These strategies must be implementable and effective and offer a means to scientifically assess their effectiveness. A NOHS will provide a blueprint for programming that can deliver oral health care in a clinically acceptable, cost effective manner and allow governments to allocate resources to programs that will improve oral health care. It will not ensure that governments are willing to expend the necessary resources to achieve optimal oral health for Canadians, but will guide them so that resources they do allocate to oral health care are used in a manner that achieves an improvement in oral health.

Our profession alone cannot solve all of society’s oral health care deficiencies. But as the leaders in oral health care, dentistry can provide the best advice for the provision of oral health care to all Canadians.