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We All Deserve Dental Care

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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 care that they can't afford until they are in terrible pain or their health is at risk. For example, poor dental health is a risk factor for poor nutrition because of its impact on eating habits, and may also be a risk factor for cardiovascular disease. 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.

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 of them didn't seek treatment.

There's a good chance they would have had a hard time finding dental care if they had tried -- our own search turned up less than a handful of potential services. There are currently no coordinated, city-wide dental care programs for women and men experiencing homelessness in Toronto. 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 oral health care programs at all. The recent discontinuation of very basic dental care for people who are refugees has made the situation even worse.

Across the province, dentists, health care providers, and public health experts are calling for a unified oral health care program for Ontario. As a physician, I can tell you how much it's needed. The overall health of the people I work with 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?

A program that reaches people who are homeless should be community-based and simple to access. People should be able to receive easy referrals to free dental programs from homeless shelters, meal programs, health providers, community agencies, grassroots groups, peers, or by calling 311. The same should be true for everyone. Right now, there is no single route to accessing the few public dental care programs that are available.

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.

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