When Vancouver's Happy Planet Foods first offered employee dental benefits in 2001, it was kind of like a grisly Christmas. Within that first year, every single employee opened wide, said "Ahhh," and maxed-out his or her plan. Even the juice company's orally conscientious cofounder, Gregor Robertson, spent time in the chair thanks to the benefits.
"For some of our employees, it was more than five years since they'd seen a dentist," Robertson told the Georgia Straight by phone. "All of them had problems which [had] developed because they hadn't been getting care. A lot of young people just can't afford to look after their teeth."
It wasn't just the young and the poor with crumbling choppers. The middle-aged and middle-class on staff had their pearly whites drilled and filled too. The businessman and, now, politician learned that dental-care coverage is a deep cavity that needs filling in Canada's public health-care system.
According to a 2003 Statistics Canada report, almost half of employed Canadians do not have dental benefits through work. For the self-employed-the fastest-growing sector in the country-two out of three people go without.
At least as worrisome is this: StatsCan also reports that one in three British Columbians hasn't seen a dentist in at least a year. And one in six of us hasn't seen a dentist in more than three years.
This sounds like a crisis, but few folks are making any noise about it. Robertson did, in his new role as NDP candidate for Vancouver Fairview in the upcoming B.C. election, and he was slaughtered for it. After Robertson admitted to the Vancouver Sun that he is in favour of universal dental benefits for British Columbians, CanWest columnist Mark Milke scolded him in the March 21 Victoria Times Colonist for promoting a "Cuban-style" health system.
Robertson said Milke's comments are "absurd". He just thinks universal dental care is a pretty good idea-especially based on his Happy Planet experience.
"The NDP has always been the party which has brought in innovative health care," he said. "I'm personally committed to including dental coverage in our MSP…It's something we'll get at after we deal with the health-care crisis."
It makes sense to UBC assistant dental professor Dr. Shafik Dharamsi, who teaches dental ethics. After spending three years in East Africa, Dharamsi returned to Canada to find "Third World" oral health. Canada has a two-tiered dental-care system, the ethicist told the Straight in an interview at UBC. He pointed out that even massage therapy is covered by Medicare for some people but dentistry is not.
"Oral health is seen as marginal," Dharamsi said. "We pull together to address world calamities such as the [Southeast Asian] tsunami, but with systemic issues such as this, we keep [at] arms' length….Why can't we think outside the box to address it?"
Outside-the-box thinking is needed for government and dentists, he said. After all, oral health and general health are closely linked. Medicine has confirmed the connection between pulmonary [heart] infections-and even coronary heart disease-and oral health. But the road from private care to public care is full of potholes, he said.
"Dentistry has grown within the private fee-for-service setting, which acculturates dentists to look through the lens of economics before population health," Dharamsi said. "But part of the privilege of the profession is meeting the needs of society before meeting our own."
Dharamsi, along with other British Columbia dentists, is promoting a strategy called "Just One Day", which encourages dentists to spend one day per year offering free dental care to those who can't afford it.
The president of the British Columbia Dental Association, Ed O'Brien, said dentists already volunteer free care far more than many would like to admit. After all, he told the Straight on the line from Vancouver, they are out to run businesses. Although the charity approach is nothing new to the dental profession in Canada, he said the association is not in favour of universal dental benefits.
First, he explained, most people already have access to some kind of dental benefits. Similarly, those who don't but still want care can usually find it. "If it ain't broke, don't fix it," O'Brien said.
Second, in countries such as Britain that offer universal dental care, he said teeth are not healthier than in countries that don't. In fact, Britain's reputation for rotten snaggleteeth is global. "Where dentistry is socialized, people will say, 'Wow! A free thing!' They'll take advantage of it for a while; then they're back to their old habits," O'Brien said.
Third, he added, if government was to take over dental care, the small one-on-one structure of dental offices might be lost for the sake of efficiency.
Fourth, O'Brien said that oral health is available to all, although he knows that some Canadians fall through the dental-care cracks. He listed new immigrants, the working poor, and the underemployed as examples. However, he said, everybody can brush, floss, and get checkups and cleanings for the low, low price of $150 each six months.
"One of the big inhibitors is not financial," he said. "It's psychological. Even the working poor can find a way of doing it….I'm interested in how many who have not gone in for preventative work have extreme TVs at home? It's a matter of priorities."
O'Brien also estimated a universal dental-care program for British Columbians would cost taxpayers at least $2 billion per year.
To the NDP's Robertson, though, it's not individuals who should adjust their priorities-it's the government. As a small-business owner, it was seven years before his fledgling company could afford employee benefits. That's a long time to wait for dental care.
"For small business, it's difficult from the get-go to do this," he said. "Providing benefits was a significant jump in cost for the company."
But aside from Robertson, neither the provincial NDP nor the Liberals have sunk their teeth into a universal dental-care strategy. With as many as 40 percent of Canadians paying for dental care out of pocket, according to the federal 2004 Canadian Oral Health Strategy paper, you'd think the issue would take a bigger bite out of this election.