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Dental Care for People in Poverty
the Early Edition, CBC Radio, September 26, 2001
Freelance journalist Sarah Efron talked to people in Victoria about the problem.
It’s three o’clock outside the Open Door drop in centre. This house is where low income people in Victoria come to chat, sleep on the porch and munch on day old donuts. Many people here are eager to talk about one of their greatest frustrations--their lack of access to dental care.
“At the front I have six teeth, I have two that are missing. The roots are still there….”
Phyllis Khan’s dental problems are never very far from her mind. She says she lost all her back teeth because welfare wouldn’t pay for her root canals. Khan doesn’t want to have her remaining teeth pulled, but the Ministry of Human Resources won’t pay to have them fixed.
“To me I think it’s reasonable to want to take care of your teeth and want to save them and fix them, so I was immediately shocked when I was told the Ministry recommended my teeth be extracted rather than repaired and restored.”
Khan has been going through welfare’s appeal process to try to get her dental work covered. She says the process has been humiliating and frustrating.
“I had to fill out an appeal form, and that took two weeks, which I did. I got back a denial. What they said was the work that I wanted was extraordinary! And I found their reaction to what I wanted extraordinary. In my not so humble opinion I think that everyone is entitled to dental care. You shouldn’t just have to have all your teeth pulled out because you’re on welfare.”
Khan’s story isn’t unusual. The Province funds dental care for children, but there is no comprehensive program for adults. Most of the coverage is for emergency work only-not for cleanings or restorative work. People either have their teeth pulled, or they live with ongoing dental pain.
“Dental pain effects what you eat, increases the use of pain killers, and makes you more suspect to other diseases….”
Bruce Wallace is from the Vancouver Island Public Interest Research Group. He wrote a report earlier this year on dental care for the poor called Brushed Aside. He says he doesn’t understand why universal health care stops at the gum line.
“We surveyed over 150 people in Victoria who live in poverty to find out what their dental needs were and how would best respond to dental needs. Our findings were that people who live in poverty have same needs as more comfortable people, but they have no way for those needs to be met. Cost is the reason. What’s happening is as these needs go unmet for a great amount of time, they become larger and larger problems.”
Wallace says one of the problems is that welfare pays dentists less than their normal rates. This means some dentists refuse to provide treatment to welfare recipients. Wallace says the most disturbing finding in the survey was the amount of people in poverty who get their teeth pulled.
“We heard that one in four people who live in poverty, when they go to the dentist, they come out with less teeth than when they came in. So when somebody with a dental plan could have restorative work, the same person if they lived in poverty would lose their teeth.”
Back at the Open Door, Tom Adams has brought a stack of paper work documenting his battle with welfare. Adams teeth had rotted from lack of dental care over the years, so welfare bought him a set of dentures. Two years ago, his backpack containing his false teeth was stolen. Now he doesn’t have any teeth at all, and he can’t eat any solid food.
“I’d like to see anybody eat tomato soup for a long time and smile. I get upset with people when I see them eating in restaurants and stuff like that. It’s jealously maybe. I just want to chew into something. You don’t miss it until you don’t have it.”
Welfare rejected Adams request for $1200 to replace his dentures. Under welfare regulations, a person is only entitled to one set of dentures every five years. Adams suffers from Hepatitis C and tuberculosis, illnesses which can grow more serious with poor nutrition. He lost a third of his body weight because of his inability to eat solid foods.
“Welfare did buy me a blender for $40. (laughs) I guess they expect me to just blend everything up. A nutritionist tried to say the blenders for fruits and stuff. It’s not for high protein diet for my Hepatitis C and to stop from getting active TB again.”
Adams says having no teeth contributes to his feelings of depression.
“I grow a goatee to hide the fact that I don’t have teeth. That’s how self-conscious I am about it. It doesn’t do much for a person’s self esteem. You know, I like smiling at women sometimes. You give them a buggy smile with no teeth and very seldom you get a smile back.”
In Vancouver, poverty advocates are trying to find solutions for people like Adams.
Dentist: “This is the X-Ray area. It’s all digital. We don’t have films anymore…”
A dentist at shows off the brand new Portland Community Clinic. An old run down pub has been transformed into this state of the art dental office. This pilot project offers free dental work for low income patients. Mark Townsend is from the Portland Hotel Society. He’s been working to establish the clinic for over four years.
“It’s almost like a disaster, the oral health of people in this community. When you have no money, teeth are not something you’re going to spend money on. By neglecting it, there’s no free lunch. It just gets worse and those things that should be dealt with by dentists end up being dealt with in the emergency wards at St. Paul’s or VGH and people have terrible chronic pain that they accept and live in this state.”
When the clinic opened its doors for the first time last week, there were already 400 people on the waiting list.
“You just have to walk around and people will smile and you’ll see there are lots of problems.”
Townsend hopes the clinic will prove that it’s cheaper for the government to fund dental clinics than to have dental problems end up in hospital emergency wards. Subsidized clinics would also get rid of the high bureaucratic costs of the welfare appeal system. He says if he can’t convince politicians of the need for affordable dental care on humanitarian grounds, maybe they’ll be convinced when they look at the bottom line.
In Vancouver, I'm Sarah Efron.