Mario Brondani (MB), director of the dental public health program in the faculty of dentistry and the school of population and public health, and Leeann Donnelly (LD), assistant professor in the faculty of dentistry, recently examined the barriers British Columbians face in accessing dental care.
In a study published this week in the Canadian Journal of Public Health, they examined the cost of ER visits for preventable dental problems like tooth decay. Additionally, for a study published recently in PLOS ONE, they conducted interviews with 25 people with mental illness and addiction issues who reported feeling stigmatized when trying to access dental services.
What barriers do people face in accessing dental care in B.C.?
MB: The main barrier is primarily affordability as almost one third of Canadians do not have dental insurance.
LD: We found that those who are marginalized due to their mental health status and substance use face additional barriers related to how they are treated at the dentist office. Feeling stigmatized in this setting as well as in other health-care settings was a strong deterrent to seeking care, even when finances were not an issue.
Why are people ending up in ER for tooth problems?
LD: If people don’t get access to preventative or timely dental care for problems like gum disease and tooth decay, it often results in minor and treatable dental issues becoming a much larger problem. These problems are often accompanied by excruciating pain and lead people to seek care in an ER.
MB: Once people go into the ER, they are often treated for pain and infection, i.e., they are prescribed painkillers and antibiotics, and told to go see a dentist as hospitals do not have the expertise or proper equipment. Although these visits are infrequent and covered by the medical care system, they do not address the issue that caused the problem in the first place: common toothaches and abscesses caused by dental cavities. The ER visits do little to stop the problem, they just put a Band-Aid on it.
What is the cost of emergency dental care and how could we better address this problem?
MB: ERs are an important part of the health-care system but they should not be a place for dental care. In our study, we found that people were visiting the ER with dental problems throughout the day, not just at night or on weekends when dental offices may be closed. This indicates that people may be relying on ERs for the consequences of preventable diseases and these visits cost unnecessary health-care dollars. We found that ER visits for preventable dental conditions cost B.C. about $1.5 to $3 million annually. The operational costs of maintaining an ER do not justify their use for non-traumatic dental problems. Going to a dentist should not hinge upon your ability to afford the care. The mouth is part of the body and oral health should be part of our overall health care.
LD: Approaching the problem through a health equity lens might be a place to start. Patients need to feel welcome and should not feel shunned or stigmatized for their current situation because this might compel them to avoid care and ultimately end up with an emergency.
One of our projects that we have been running between UBC Dental Hygiene and a community-based mental health organization in Burnaby for seven years sets up a mobile dentistry clinic weekly all year long so that residents can get free preventive care from fourth-year hygiene students and referrals for needed dental treatment. Due to their mental health conditions, this population tends to be suspicious, anxious and apathetic towards dental professionals. We’ve found that with this program, patients are more willing to access dental care and some patients are now seeking care from the students and dentists in private practice. Much of this has to do with being ‘comfortable’ with dental professionals.