Uninsured dental patients end up in Ottawa emergency rooms, report says

An increasing number of uninsured and under-insured dental patients are resorting to Ottawa's emergency rooms for treatment, according to a new report to be presented before the Ottawa Board of Health Monday.

The research by Ottawa Public Health found a 52-per-cent increase in emergency room visits for dental care between 2004 and 2014. In total, there were 1,740 visits to the city's hospital emergency rooms for dental services in 2014 for "conditions that should have been managed in the community," the report said. 

According to the report, the emergency visits included treatment for cavities, eroded teeth and gingivitis. With an average cost of $513 per emergency visit, the estimated public bill is close to $900,000.

While 70 per cent of the city's residents have dental coverage, "those without insurance are about five times more likely to use dental services only in an emergency (34 per cent) compared to those with insurance (seven per cent)," the report said.

If they can't afford the [dental] work...it's a very sad situation.- Dr. Jonathan Mayer, Ottawa Hospital Dental Clinic

Ottawa Public Health has been trying to divert uninsured dental patients away from hospital emergency rooms, where care is expensive and physicians are generally not equipped to do more than offer pain relief or antibiotics, said Aaron Burry, OPH's dental officer of health.

The report highlights the opening of a new clinic serving aboriginal patients beginning in January.

'It's a very sad situation'

The problem is going to get worse if the province does not find a better way to fund preventative care for people who are not adequately insured, said Dr. Jonathan Mayer, director of the Ottawa Hospital's Dental Clinic.

Mayer said he's has had patients — some in their early 20s — who have had to make very difficult choices because they lack insurance.

"If they can't afford the [dental] work, and it comes down to either continually having infections and pain or having your teeth taken out and getting dentures, it's a very sad situation," he said.

There is also growing evidence about the links between poor dental health and other health problems, including cardiovascular disease and diabetes, said Mayer.

Most children under the age of 18 are covered in Ontario, if not through private insurance, then through various programs including the Healthy Smiles Ontario program.

But among adults, according to Mayer, "we're not doing so well."

Seniors, workers without benefits most vulnerable

Seniors and workers without benefits are among the most likely to put off preventative dental care, said Mayer.

Even among those with dental coverage through social assistance programs like Ontario Works or the Ontario Disability Support Program (ODSP), coverage can be inadequate, said Mayer.

Emergency care is covered under Ontario Works, but in a situation where a patient needs all of his or her teeth removed, the individual may have to then foot the bill for dentures — and many can't afford that, he said.

While ODSP covers basic care like regular cleanings, the program pays well below private dental insurance and has led many dentists to stop taking patients who are on government assistance. It's a problem that's created an added barrier to accessing dental care, said Mayer.

Costs borne by public health care system

People shouldn't have to suffer another 10 years.- Jacquie Maund, AOHC

According to research commissioned by the Association of Ontario Health Centres, the burden of cost to the public health care system is province-wide.

Approximately 60,000 dental patients found their way into Ontario emergency rooms in 2014, at a cost of $30 million, said Jacquie Maund, the AOHC's lead on policy and government relations.

An additional 230,000 people in 2014 visited their family doctors for help, at a cost of $8 million, where "they get no treatment, just painkillers," said Maund.

While the Ontario government committed last year to extend some dental benefits to low-income adults by 2025, Maund said her organization is calling on Health Minister Eric Hoskins to move that commitment up to 2018.

Given the costs associated with family doctors and emergency room physicians treating dental patients, there's a strong financial argument for fixing the system sooner, said Maund.

"People shouldn't have to suffer another 10 years," Maund said.