National dental plan must address major access and equity issues, disability advocates say

Group wants health minister to 'ignore the myth' that all Canadians are well served

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In the three years since Joanne Shimakawa last hada dental checkup, her multiple sclerosis had progressed to the point where she'd become increasingly prone to falling and no longer felt safe transferring to adentist's chair.

So she recently began searching for someone in her Toronto neighbourhood who could treat her in her wheelchair.

"I basically took every dentist in the west end and called them one after another," Shimakawa told CBC News. "I couldn't find anybody."

In the end, there was just one dentist whose office didn't have stairs or other obstacles and who said treatment in the wheel chair wouldn't be a problem.

"When something like that happens ...it's depressing," Shimakawa said.

As Canada prepares this year to unveil a national dental plan that will include oral health care for people with disabilities —as well as low-income earners, seniors and children — advocates are pleading with the government to pay attention to the stories of people like Shimakawa.

Not only does the high cost of dental care and limited coverage through provincial benefits make regular treatment unattainable for a disproportionate number of disabled people, but many of these patients say they also struggle to find dentists who are willing and able to care for them.

'Gaps' in access to oral health care

This spring, the Canadian Society for Disability and Oral Health (CSDH) made a submission to Health Minister Jean-Yves Duclos that urges him to "ignore the myth that Canada's current dental system serves most Canadians well."

It points out several issues, including a lack of mandatory disability-specific training for dental professionals; physical accessibility barriers in clinics; fee structures for dentists that don't take into account the extra time necessary to treat someone with complex needs; and long wait lists for people who require general anesthesia for all treatments.

Those are all points that Shimakawa's new dentist — Dr. Maria Salome Lomlomdjian in Mississauga, Ont., just west of Toronto — says deserve immediate attention.

"We all deserve quality and the same type of care, and unfortunately, this is what I don't see happening," Salome said.

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Duclos told CBC News in a written statement that he welcomes the CSDH's feedback and will review it carefully.

Dr. Heather Carr, president of the Canadian Dental Association, an advocacy group for dentists, acknowledged that there are “gaps" in access to oral health care.

"The Canadian Dental Association has been advocating for years for improved access to care for vulnerable populations, including persons with disabilities," she said.

Carr said her hope is that the federal government's promised $250million Oral Health Access Fund will help fill some of those gaps.

Dental care too often 'a piecemeal thing'

CSDH president Dr. Paul Romanson said his organization wants to see a Canadian dental program that ensures people with disabilities living anywhere in the country will have comprehensive coverage for regular treatment with a trusted professional.

"We want to get people so they can speak and smile, have good self-esteem, they can chew their food and not have stomach problems. It's all one big package," he said.

Right now, Romanson said, dental care for many disabled people only happens in case of emergency.

"A lot of times, it's a one-off. A person comes in, they will have a need for infection control or gum disease or they're going to have a tooth that needs to come out, and that's it. There's no other plan. It's sort of a piecemeal thing," he said.

Discrimination and fears of being treated poorly can also be a barrier.

Jo-Anne Gauthier, past-president of B.C. People First, a self-advocacy group for people with developmental and intellectual disabilities, said ableist attitudes have made her reluctant to seek treatment in the past.

"Where can I go? Once you get a dentist, would they treat you decent?" Gauthier said.

"I will pick up how they treat you off the bat. Did they treat you, like, 'Oh, you're one of those ones, eh?' Or are they going to treat you as normal as anybody else?"

'The waiting's been hard,' parent says

For Leslie Goddyn, the biggest obstacle is waiting for an operating room where he can receive treatment under general anesthesia.

The 40-year-old Metro Vancouver resident has a condition called pachygyria that causes physical and developmental disabilities, so treatment in a regular dental clinic is impossible.

"He has quite a bit of involuntary movement, and having any stimulation in his mouth is really challenging, “his mom, Rachel Goddyn, said.

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In February, Leslie began complaining of tooth pain. His mouth was so sore, he was having trouble sleeping and eating.

An X-ray revealed an infection under a crown, and the Goddyns learned that Leslie will need three root canals. None of that is covered by disability benefits in British Columbia, which limits dental work to$1,000 every two years.

Today, he finally has a date for the procedures, but it won't be until June — four months after the problem was identified.

"The waiting's been hard," Rachel Goddyn said. "He's had two rounds of antibiotics, and we're feeding him a soft diet."

Little specialized training in Canada

Salome, the Mississauga dentist, has built her clinic to cater to all types of disabilities.

She has tablets that allow her to communicate with non-verbal patients, portable X-rays for people who can't use a standard dentist’s chair, light and sound adjustments for patients with sensory issues, and a sling-like fabric swing that hugs anxious patients from all sides while they’re receiving care.

Salome said providing accessible care requires patience and empathy.

"So many colleagues told me, 'Why are you doing this? You should quit and dedicate your profession to doing implants or doing regular care. You can make more money,'" she said.

‍WATCH | The National reports on dental care and disability:

Disability advocates are calling for urgent improvement to accessibility of dental care across Canada because few dental offices can to treat patients in wheelchairs.

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Meanwhile, Salome said, there's little education available in Canada for dentists who want to do this kind of work.

The CSDH submission calls for mandatory training in disability care in Canadian dental schools, something that currently does not exist.

At McGill University in Montreal, the Faculty of Dental Medicine and Oral Health Sciences runs a clinic specializing in autistic adults and those with intellectual disabilities, and another for children with complex needs, and it offers home-based services for seniors.

But Dr. Elham Emami, the school's dean, said services like these are difficult to access outside major cities, and a lack of training is a major barrier.

"At this moment, we don't have a program in Canada that is designed for this specialty," she said.

"The starting point is universities. Until we have trained dentists, we can't really, totally address the needs."

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Bethany Lindsay is a Vancouver-based journalist for CBC News.

‍https://www.cbc.ca/news/health/national-dental-plan-disability-issues-1.6850029