When Aquilina Sioson moved to Vancouver from the Philippines 18 years ago, high up on her list of things to do was see a dentist. She admits she was puzzled the first time she sat in the chair at the REACH Community Health Centre’s dental clinic and heard so many numbers flying back and forth between the dentist and his assistant.

“I had never had my gums measured for recession before or had those numbers explained to me,” she says on the line from her Port Coquitlam home. “I never understood the value of that before.”

She’s also learned the immense value of regular cleanings, a practice that seemed more like a luxury than a commonsense preventive-health strategy for those like Sioson, who doesn’t have dental benefits through her employer.

Located on Commercial Drive, REACH has been providing dental care to those who can’t afford it for more than 40 years. With three dentists on staff, it operates on a fee-for-service basis but offers procedures at a reasonable cost and, where possible, provides subsidies for those who are unable to pay.

However, it’s getting increasingly difficult to help those who can’t afford dental care, according to REACH executive director Madeline Boscoe.

“We work with people, regardless of the money they’ve got, to give them excellent care,” Boscoe says from her office. “That’s our mission, and we want to make sure everybody’s included in that.

“There are more poor people, more people without dental benefits. Talk to anybody under 35; they’re all in jobs without dental benefits. That’s a disappearing sector. As that occurs, there are more charities and more competition for funding. As families have to pay for these bills themselves, they tend to avoid care.”

REACH dental patients come from all walks of life: seniors, low-income families, refugees, victims of torture, people with anxiety disorders, those on long-term disability, actors whose benefits fluctuate with hours worked, contract workers, and artists and others without dental coverage. The list goes on.

The centre receives no government funding. Funding cuts by Vancouver Coastal Health and the B.C. Gaming fund, along with increasing costs without an increase in funding or fees over the past five years, have left the clinic with unsustainable deficits, Boscoe says. Although the centre raises funds and seeks donations to help subsidize treatments, all of those factors combined have meant a decrease in services to those who need them most.

“We’re trying to help solve a social problem, but we have questions for the rest of society,” Boscoe says. “It needs to be easier for people to access care so that parents and families don’t have to choose between dental care and food. That’s what’s going on.”

The fact that the care of people’s teeth and gums isn’t publicly covered only ends up costing the public system even more money in the long run. According to the Canadian Centre for Policy Alternatives’ 2011 paper Putting Our Money Where Our Mouth Is: The Future of Dental Care in Canada, a growing body of evidence shows a link between poor oral health and higher rates of diabetes, cardiovascular disease, pneumonia, and Alzheimer’s.

Of an estimated $12.6 billion spent on dental services in Canada in 2009, the paper states, only five percent was publicly funded. One in six Canadians who need dental treatment avoid going to the dentist because of cost.

By contrast, in countries such as Japan and Norway, approximately 75 percent of dental care is covered by public funding. Plus, those nations emphasize basic prevention for everyone because serious dental problems can be avoided with early treatment and because poor oral health is linked to so many costly chronic conditions.

The 2010 Canadian Health Measures Survey found that 62 percent of Canadians had private dental insurance, while another six percent were covered by publicly funded programs. That leaves almost a third of Canadians without public or private insurance. Although all provinces and territories provide some form of public support for dental care, not one of them has a comprehensive oral-health strategy.

Victoria-based researcher Bruce Wallace examined such issues in his 2008 study, Improving Access to Dental Services for Low-Income Adults in B.C.

Wallace found that in every region of the province, dentists had refused to treat patients because of inadequate funds. As a result, many low-income adults and those considered the “working poor” wound up in hospitals with severe dental pain and other oral-health emergencies.

“These adults often struggle just to pay the rent and feed the kids—in this context, regular teeth-cleaning or other preventive dental care is an unaffordable luxury item, and so is dental insurance,” Wallace wrote.

REACH has been upping its fundraising efforts to help fill the gap. At the same time, its dental clinic was recently renovated, complete with new state-of-the-art equipment, electronic medical records, new chairs, air conditioning, and the purchase of a VELscope, which screens for oral cancer. Its multicultural staff speak several languages, including Farsi, Korean, French, German, Cantonese, Italian, Khmer, Spanish, Tagalog, Russian, Czech, and English.

The clinic also serves as a training ground for dental-hygiene and dental-assisting students from Vancouver Community College as well as for students from UBC’s dentistry faculty.

According to REACH’s 2010-11 annual report, the clinic has entered into a joint agreement with the B.C. Dental Association and MOSAIC (a nonprofit organization that addresses issues affecting immigrants and refugees) to assess to what degree improving the oral health of Mosaic clients may increase their chances of becoming gainfully employed. The dental association is providing the funding for this pilot program.

Another development of importance to the clinic, the annual report states, is the interest that the B.C. Dental Association is taking in not-for-profit dental clinics. This association has convened two workshops to identify the common problems, obstacles, and solutions associated with starting and sustaining such clinics.

REACH dental hygienist Diana Lyon says that the clinic’s open-door policy reflects the philosophy of the centre as a whole. “When REACH first started out, it provided care for every strata of society,” Lyon says. “Everybody is treated the same. Everybody gets good care.” Still, a lot of patients don’t show up until they’re in pain, she says: “By the time it hurts, it’s part of a much bigger problem.”

Jim Severs, a dentist who has worked at REACH since 1992, notes that much of his work consists of basic dental care and emergency aid. “Problems with your teeth is a motivational thing,” he says. “It will get your attention….We’re here to help out people who need the help most.”