Dental Care a Gaping Hole in Our Health System

Across Ontario, going to the dentist is financially out of reach for many people. This dilemma is well-known to physicians — many of us regularly care for patients who have terrible dental problems that we are powerless to address. We see people who have delayed seeking dental care that they can’t afford until they are in serious pain or their health is at risk. We see people who have trouble finding employment, miss school or avoid social situations because of the condition of their teeth. We see people who avoid eating because their mouths constantly hurt.

Lack of access to oral health care is a pressing issue for a large segment of Ontario’s population. Most often, this lack of access is due to economic barriers. In Toronto, a new study from the Centre for Research on Inner City Health found that low incomes are a very strong predictor of poor oral health and mouth pain. In Hamilton, a new report from the City of Hamilton’s Public Health Services found that there is a clear link between poor oral health and lower income levels.

According to a report from Ontario’s Chief Medical Offer of Health, 20% of Ontarians who stayed away from the dentist for a long time cited cost as a barrier. Nationally, cost has kept a full 16.5% of Canadians from seeking recommended oral health care.

For people who are homeless, the situation is particularly acute. Recently, researchers from the Centre for Research on Inner City Health and the Faculty of Dentistry at the University of Toronto worked together to assess the oral health of about 200 people staying at 18 homeless shelters in Toronto. We found that 97% of the people we examined needed some kind of dental care and 40% needed emergency treatment.

Thirty-five per cent of the people we surveyed had avoided eating due to mouth pain. Many had experienced pain over the last month, and most didn’t seek treatment.

Dental care remains a gaping hole in our health care system for people with limited means. There are currently no coordinated, city-wide dental care programs for men and women experiencing homelessness in Toronto, for example. More generally, children, youth and elders are covered by a patchwork of public programs that leave many falling through the cracks.

Adults earning wages that add up to low and middle incomes have no access to public dental care programs at all. The recent discontinuation of very basic dental care for people who are refugees has made the situation even worse.

As a physician, I can tell you how much it’s needed. The overall health of people living on low incomes is deeply impacted by their lack of access to dental care. The current situation in which we provide health insurance to cover the treatment of every part of a person except his or her teeth makes little sense, and leaves thousands of people to suffer from chronic pain and tooth loss.

Would we tolerate a system in which we didn’t cover the treatment of eye diseases, and allowed people who didn’t have the means to pay for their own care to go blind?

It’s time to address the very real pain, distress, and long-term health consequences caused by the fact that many in Ontario are simply not able to go to the dentist. The data on the oral health of people living in homeless shelters in Toronto simply adds to the already compelling body of evidence suggesting that oral health care for all should be part of Ontario’s Poverty Reduction Strategy, and a permanent component of our universal health care system.

Hwang_Stephen_high resBy Stephen Hwang

Stephen Hwang is an expert advisor with and a contributor to He is a practicing physician in general internal medicine at St. Michael’s Hospital and a research scientist at the Centre for Research on Inner City Health in Toronto.