“The cases of self-abuse because of dental pain are heartbreaking.” – Help! Teeth Hurt, A Legal Analysis
It took more than four years for Graeme, an autistic man who cannot speak, to be properly assessed and treated by a dentist in British Columbia.
In the meantime, Graeme beat his ear so severely because of a dental infection that it is permanently deformed. During the years of wait, Graeme suffered severe pain and developed a seizure disorder. He now needs to take medication for the rest of his life, a family member said during a phone interview in March.
In Ontario, which has dental anesthesiologists and access to dental surgery, Graeme may have been treated sooner. Yet, that is not often the case. One in five people in Canada have a disability and one in five Canadians avoid dental visits because of cost. Incidents of self-abuse caused by oral pain are not uncommon in people with developmental disabilities. People who are non-verbal may self-harm as a form of communication to display pain. Adults with developmental disabilities can wait up to several years to get dental surgery in some provinces.
There are four reasons for the extensive wait times.
First, in some cases, dentists are not willing to spend the extra time needed to treat those with disabilities because that extra time is unpaid. Second, many dentists don’t feel they are competent to treat people with disabilities and instead send them to hospital. Yet, only a quarter of people with disabilities may need general anaesthesia and, for them, wait times for operating rooms can be lengthy. Third, Ontario is the only province in Canada to recognize dental anaesthesia as a specialty. Ultimately, people with developmental disabilities who require hospital dental care are more likely to face year-long waits for treatment. The fourth – and most important – reason is the absence of universal dental care coverage.
Health care is considered a “free” universal right in Canada but dental care is not included in the Canada Health Act. Our health care is governed by provincial legislation that follows the terms of the act. So, why not universal care for the teeth of Canadians?
The history of oral health in Canada dates back to Ontario in the 1800s, where the first dental school was established. In 1911, the first city-funded dental clinic was founded and showed that children with better oral hygiene habits do better in school. In 1964, the Royal Commission on Health Services recommended universal dental care be included in Medicare but there were not, at that time, enough dentists to ensure universality. Instead, the commission recommended that new dental schools be built to train the needed dentists in addition to the two schools that already existed. The government of the time adopted the recommendations and began building eight new schools. Sadly, although Canadians paid to have the new schools built, later governments did not pursue the recommendation for universal dental care further.
While Canada made commitments by signing the United Nations Convention on Rights of Persons with Disabilities, we are lagging in dental care for the disabled. In 2017, the Canadian Dental Association acknowledged that people with disabilities “have special dental care needs.” While it indicated that a strategy would have to be designed through a collaboration between the profession and federal and provincial health departments, no clear implementation strategy has yet been put in place.
Canadians need better coverage, and dentists and hygienists across Canada need better training. Teledentistry may be a solution for isolated regions, as seen in the United States, where a trained dentist looks into the mouth of a person with a disability from miles away. But this is not enough to meet the needs faced by adults with disabilities and other vulnerable populations who are underserved by dentists in all geographic regions in Canada.
There is some promise on the horizon. Recently, there have been calls in Ottawa for universal dental care. There is hope that dental care will be part of the coming National Autism Strategy. As well, the World Health Organization (WHO) plans on discussing dental health, for the first time in 14 years, at its assembly in Geneva this week.
However, Canada is represented at the assembly by the Canadian Dental Association (CDA) and the Canadian Chief Dental Officer (CDO), neither of whom support universal dental care in Canada.
So, what next?
All dentists should learn to work with people with disabilities rather than passing them off, deepening and prolonging their pain. Overall, Canada and the provinces are not meeting their obligation to ensure equal access to health services, including dental care to those with disabilities. Patchwork availability and coverage of dental-care programs across the country close doors to people with developmental disabilities. A failure by a governmental program to meet the needs of a disabled person for medically necessary dental care constitutes a human rights violation.
Rather than allow those without a voice to remain invisible and be underserved, take action! Contact the Coalition for Universal Dentalcare and advocate or be part of the National Autism Strategy consultation process.
Be part of the solution.