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The Current Transcript for August 7, 2018

Host: Laura Lynch

STORIES FROM THIS EPISODE

Prologue

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VOICE: We are always going to speak up for human rights. We're always going to speak up for women's rights. That is not going to change.

LAURA LYNCH: That is Canada's Foreign Affairs Minister Chrystia Freeland signalling the government's refusal to back away from criticism of Saudi Arabia. It comes after the Kingdom moved swiftly to hit Canada with diplomatic, economic and other consequences. It accused Canada of meddling. We'll look into what sparked the fury and what impact it will have coming up. Also today, we'll repeat our special broadcast, Filling the Gaps: Dental Care in Canada.

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VOICE: Not asking for root canals and the Hollywood teeth here. I'm just, please God, can I get these teeth out of my mouth.

LL: Brandi Jasmine learned to live with excruciating pain. On an artist's salary she couldn't even afford to get teeth pulled and she's not alone. An estimated 11 million Canadians have no dental insurance or even if they do, it doesn't cover everything. Take Dave Stock for example. His coverage ran short after cancer treatment left him with a mouth full of problems.

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VOICE: It started with one tooth breaking and then a few days later, another one chipped and a few days later another cracked. Like when your smile has more gaps than teeth, it's not very nice to look at.

LL: We'll hear stories of Canadians struggling to care for their teeth and find out why dental care isn't part of our universal health care in Canada. That's all coming up in the last hour of the show today. I'm Laura Lynch and this is the summer edition of The Current.

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Was Canada's criticism of Saudi Arabia a diplomatic faux-pas?

Guests: Aya Batrawy, Bessma Momani

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VOICE: I thought the Kingdom's response was really as self-defeating as it is and just. The crown prince has been making a point that he is seeking a more moderate Saudi Arabia, a more open society. That he is seeking a trade and investment and then goes ahead and arrests Samar Badawi, who had been advocating for the very thing that the crown prince has implemented, mainly the right women to drive.

LL: That was lawyer, Irwin Cotler, former Liberal Justice Minister under former Prime Minister Paul Martin, speaking yesterday with CBC News. Cotler is International Council for Raif Badawi, the dissident blogger jailed in Saudi Arabia. Badawi's sister Samar Badawi was also arrested last week in the country's latest crackdown on human rights activists. Her arrest set off an unusually heated diplomatic dispute between Canada and Saudi Arabia that's making headlines around the world. It started last Friday when Global Affairs Canada sent out a tweet that criticized the move and called for the activist's release. On Sunday, Saudi Arabia responded by ordering Canada's ambassador out of the country, recalling its own ambassador from Ottawa and freezing new trade and investment deals. It also plans to move Saudi students on government-funded scholarships out of Canadian universities and all flights operated by Saudi Arabian Airlines to and from Toronto will be suspended as of next Monday. Despite all that, Chrystia Freeland says Canada isn't backing down from its position. In a few moments we'll speak with a political science professor about what it all means for diplomatic and trade ties between the two countries. But first, journalists and experts in the region say the dispute is just the latest example of a growing pattern that sees Saudi Arabia hit back when confronted with criticism over its human rights record. Aya Batrawy is an Associated Press reporter covering the Arabian Peninsula. She's normally based in Dubai, but we have reached her in Atlanta this morning. Hello.

AYA BATRAWY: Hi.

LL: This move by the Saudi government came as a shock to a lot of people in Canada, but as someone who covers the Arabian Peninsula, was it surprising to you?

AB: Not really because if you look at the pattern of how Saudi Arabia has responded to critics, it's been very forceful and extremely aggressive and many would say it's an overreaction. So in 2015, a very similar situation happened with Sweden. The Swedish foreign minister stood in parliament and criticized Saudi Arabia as a dictatorship and as an absolute monarchy. Shortly after, Raif Badawi, the Saudi blogger who you mentioned in your opening statement, was publicly flogged in Saudi Arabia as punishment for some of his blog posts that were seen as critical of the clerics in Saudi Arabia and the religious establishment. And so there was international outcry towards that, even by close Saudi allies, but Swedish foreign minister at the time, she took it a step further and sort of used that language that Saudi found derogatory. They responded similarly by threatening to cut off business ties, by issuing really aggressive statements against the Swedish foreign minister. It's almost seemed like it was an attack on her personally. It's very similar to what you're seeing now, the criticisms directed at Canada's foreign ministry, Canada's foreign minister. Maybe hoping to put pressure on her domestically and see Canadian businesses pressure her to pull back or ring back those statements or backpedal because that is what happened in Sweden's case. Swedish companies you know lobbied and said this is not okay for our business in Saudi Arabia and we need you guys to fix this situation. And it was essentially fixed with some backpedalling on behalf of the Swedish foreign minister at the time. We've also seen that happen with Germany, which is a very important trading and very important country with regards to Saudi Arabia. And last year it was a quieter kind of dispute, but you did see Saudi Arabia also respond forcefully with Germany when they criticized Saudi Arabia for its interference in what they saw as Lebanon's domestic politics. So it is a pattern and it's a pattern that is increasing under the crown prince, Mohammad Bin Salman. He's 32-years-old, his father King Salman has given him free reign almost to really rule over the country as he sees fit and he is not open to criticism and you can see it domestically and internationally.

LL: But one of the things it seems like a contradiction is the crown prince is also given credit for lifting the ban on women driving and trying to shake up the kingdom a bit. How do these two sides of him, how are they resolved, if at all?

AB: Well I think he's given himself the credit for that. And I think people who aren't you know in tune with what's happening in Saudi Arabia, may see him as the person to give credit to. But you know these changes happen after decades of social reforms and pushing, they don't just happen because a 32-year-old person in power decides now is the time. I mean it it was very much a decision that only he could make at this time, but it was something that you know was good for his public image and it was something that is good for the Saudi economy. To have women, if you want women working, you two income households and you want people less reliant on the government, it's good to have women be able to move around and get themselves to work and drop their kids off and go shopping and not have to rely on drivers and brothers and fathers. So there were a lot of reasons, not just social, that he made that decision, but it's interesting like you said because you have this situation where he's making these massive social reforms and it is not a small thing to see women driving in Saudi Arabia. It's not a small thing to hear music in the open in Saudi Arabia. Women showing their faces, not covered in a full.

LL: So again, how do you reconcile that with the crackdown on dissidence?

AB: I think the message he's sending is that I will decide the time and the pace and the type of change and that activism does not pay off. This is not a result of activism. This is not a result of people pushing me or pressuring the government. This is not a result of the international media's attention on these issues. This is not a result of human rights groups. This is another result of foreign statements. This is a domestic decision carried out for domestic interests. And I think you know the fact that he has used these womens rights activist, who are very prominent, very well respected in the country. They're professors, they're grandmothers, these are well-spoken, well educated icons in Saudi Arabia. The fact that he's arrested them, I'll just say this, I think it also shows that no one is untouchable. No one is beyond his reach.

LL: How then are Saudi citizens responding to these actions against Canada?

AB: Well you know, you're living in a climate of fear if you speak out anything critical. So people do speak out critically, but quietly and not even on the phone, not even in messages. It's always in person. You know in people's houses or at a cafe or something. So people don't speak openly, critically anymore as much. And not that, I mean it's always been an absolute monarchy and it's always been a country where free speech hasn't been you know that free. You can't you know have a political party or even an NGO. You can't even establish a non-government organization.

LL: So we can't really get a sense of how people are receiving it in the country then.

AB: It's difficult, but I can say that the arrest of these women did shock a lot of people because they're very well known and it did surprise people, but at the same time there's such a strong government message to people in Saudi Arabia. This is for domestic security, that there's reasons behind this that have to do with national security. They haven't gone into details or really brought to light what they've done wrong, but you know there is this strong messaging that I think a lot of people do accept at face value. They do want to have trust in their government and a lot of young Saudis are really happy with the changes that are taking place. And with the movie theaters that have opened up and the concerts that have come through and feel like Saudi Arabia's on the cusp of change. And you know a few women being arrested doesn't seem to concern.

LL: Or a dispute with Canada doesn't seem like a big deal to them either I guess.

AB: If anything, the dispute with Canada may strengthen his position domestically by showing him to be a strong man who doesn't allow Saudia Arabia to be bullied. And I think also when you look at the Canadian government's position, it may strengthen them domestically too. To show that they're standing up for human rights in an era where Washington has absolved itself of that kind of position they may have had in the past.

LL: Well it's interesting you say that because last night the United State's state department came out squarely in the middle on this. It didn't seem to throw the support one way or the other and I'm wondering if you think Saudi Arabia is becoming more bold in how it responds to foreign criticism because Trump and his administration seem to be in lockstep with Saudi Arabia much of the time.

AB: I mean certainly you have an administration in Washington that calls its own media establishments and its own media institutions fake news and enemy of the people. So it's not a stretch to imagine that Saudi can go after some human rights activists and not really be transparent about what they're being charged with and you know blame their interactions with foreign entities, which could include the press. It could include rights groups. It could include embassies you know and just say that this is a national security problem. So definitely you know Saudi Arabia, under this administration, working with this administration, Trump administration, does not feel any pressure to change course and if anything feels very emboldened, especially because they have a lot of you know common issues that they need to work together on. Whether it's countering Iran or whether it's you know the response of the move of the embassy to Jerusalem. And there's so many regional issues, the war in Syria, where Washington really feels like it needs to work with Saudi Arabia.

LL: We'll have to leave it there. Thank you very much.

AB: Thank you. I'll just say this though, if you allow me. I want to say that it's really incredible that you know, one thing I would say that's come out of this is that we're talking about the arrest of women's rights activists in Saudi Arabia, which had kind of not been in the news. So if anything I think Canada so far has come out one step ahead because now it's something being discussed.

LL: Thank you.

AB: Thanks so much.

LL: Aya Batrawy is an Associated Press reporter covering the Arabian Peninsula. She's normally based in Dubai, but spoke to us today from Atlanta. Well as we mentioned earlier, Foreign Affairs Minister Chrystia Freeland says Canada stands by its position and it's not yet clear for what this will mean for Canada's relationship with Saudi Arabia going forward. Bessma Momani is a professor of political science at the University of Waterloo and the Balsillie School of International Affairs and she is with us from Waterloo, Ontario. Hello.

BESSMA MOMANI: Hello.

LL: You just heard Aya Batrawy saying that Saudi Arabia's actions against Canada aren't that surprising. So should Foreign Affairs Minister Chrystia Freeland have seen this coming?

BM: Well first of all, I agree completely with Aya's analysis. No I don't think it's something that one could have predicted. I mean part of the boldness if you will, is the unpredictability of the crown prince Mohammad Bin Salman's moves. So I don't think anybody could have predicted this and let's keep in mind, frankly similar statements have been made by many other Western governments increasingly the international heat on Saudi Arabia, not just for its domestic policies, which I think are obviously very critical, but also even its foreign policies have been very, very high. So I don't think this was out of place and frankly it just was not out of character for a Western government to point out. They continue to arrest these civil society actors.

LL: Now trade between Canada and Saudia Arabia accounts for about four billion dollars back and forth annually. How do you think Saudi Arabia's decision to freeze new trade deals will affect the Canadian economy.

BM: I mean in the big scheme of things, it's a drop in the bucket. I mean you know Saudi Arabia is not the most important destination for our investment or our goods and trade. But there are going to be some companies that are going to be hurt, particularly in the engineering sector and overall construction. Some health care companies do very well all in the Gulf and Saudi Arabia and Saudi Arabia is undergoing a boom, if you will, a building boom, particularly in creating these large new economic cities from scratch. So there are going to be some you know perhaps opportunity costs here, but I think in the big scheme of things, they're quite small.

LL: Now a lot of attention was focused a few years ago on this one deal with Saudi Arabia to supply light armoured vehicles. It was signed under the Harper government, but put into effect under under the Trudeau government. Could that be in jeopardy?

BM: It might. It really depends on how far in the process they are. Are they about to be shipped? Have they been paid for? I think there's a minutiae detail that frankly I don't have any knowledge of, but there may indeed be some ramifications on that particular deal.

LL: Well, I guess that gets to the heart of the question is, can you criticize a country's human rights record and still do business with it?

BM: That's a really important and I think larger and you know normative question and certainly there's plenty of people who would suggest that you know in many ways if we're going to have in particular a feminist foreign policy, if we're going to be calling out countries on their human rights records, we should also back that up with our economic relations with them. And others would suggest that perhaps one needs to have engagement to change things in a country and that perhaps if one encourages economic development in that country it'll better the masses living standards and that might in fact create more domestic political pressure on governments to actually liberalize politically. So again, there are two sides to that particular debate and I would say though that our particular viewpoint on Saudi Arabia has been consistent and I don't think there is anything out of the ordinary in Minister Freeland's statement and I don't think that the reaction is something that we could have anticipated. Really as I think a more reaction problem with the Saudis and how they tend to take things to the extreme.

LL: So it's not just about business. Saudi Arabia also said approximately 12,000 Saudi students enrolled in Canadian universities aren't going to be able to attend class in the fall. What kind of impact does that have on Canadian universities? And is this an unusual step by the Saudi government?

BM: Well they did the same with Qatar you know a few years back with their diplomatic spat there, but they didn't have those kinds of numbers. And you know as a professor, I am heartbroken by this. I have met many of these Saudi students, I interviewed them for a book that I did a few years ago and you know these are promising young individuals who are going back to their country, frankly with the kinds of liberal values of meritocracy, you know productivity, even democracy to Saudi Arabia. So it's a loss to Saudi Arabia in the long run. In terms of the economic you know impact here, certainly Canadian universities really you know appreciate obviously having international fees paid. It will have some negative local economic impact on certain communities. Not all of these students obviously go to the big city centres, but sometimes they're in smaller towns, which are going to feel the brunt. But overall in the big scheme of things, only two per cent of our international students come from Saudi Arabia. So in the big scheme of things it's not a lot. It's not insignificant economic dollars that we're talking about here, but it's certainly not a lot. I would just point out though, it's really devastating for the students. We are weeks away from starting term and so that's really I think the tragedy out of all of this.

LL: I want to play you some tape. We spoke with Omar Alam, founder and CEO of Alam Advisory Group, that's an Ottawa-based global trade advisory consulting firm. Here's what he had to say about this diplomatic row.

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VOICE: In the case of Saudi Arabia, what has gone backwards is that we didn't keep all channels for trade and political dialogue open, especially when the Canadian government was critical of the Saudi government. These complexities aren't a new challenge for the Canadian government. We've navigated them before with success with other countries, namely China. Prime Minister Pierre Elliott Trudeau, you know once said, our relationship with China doesn't mute our voice on the inevitable disagreements, it lets us speak candidly as wee need to and to be heard and you don't get that from yelling through an ideological bull horn.

LL: Bessma Momani what do you think of Alam's view that Canada mishandled this issue?

BM: Again, I don't think that you know of course hindsight is 20/20, but even there I don't think that there was anything that minister Freeland said that hasn't been said before. That hasn't been in previous tweets from the foreign ministry. I mean they are been consistent, which is we are concerned about the human rights track record in Saudi Arabia. I certainly understand the view that you know engagement is important to change and that argument has often been said, particularly with China. But I would also point out that I think there are some fundamental values that sometimes the Canadian public feel are really you know important and dear. And I can understand why many believe that human rights is a cause worth fighting for and a cause worth continually repeating and I would also point out that you know for the civil society actors that are jailed today in Saudi Arabia, for the journalists, the poets, the intellectuals, I mean there are hundreds that are being arrested for political purposes or reasons, but I think they really appreciate Canada's voice on this.

LL: Then what is the path forward? Is there room for compromise? Can they reset the relationship? What happens next?

BM: Well I think we have to ride this out. I mean understanding Saudi foreign policy and as Aya pointed out quite eloquently, you know they tend to just continue to stick by their positions and there's really just no room for compromise. We saw that for example with the Qataris, we see it with Yemen. You know they tend to start a move and frankly you know take it right to the end. And so there really is no other way out other than you know if we were to change foreign ministers. That would satisfy them, which is absolutely not, a non-negotiable for a sovereign country. And so I think that's just the reality of the nature of how they do foreign policy, under particularly this crown prince. So I think we frankly have to ride it out and it's not going to be easy of course. But the fact that we haven't engaged in further Twitter war is really important. I want to point out that some of the comments that are coming out of Saudi Arabia are very, very hurtful about Canada and some of these are even semi-official news outlets. I think we need to be careful not to sort of stoop to that low level.

LL: Alright we will leave it there, Bessma Momani. Thank you.

BM: Thank you.

LL: Bessma Momani is a professor of political science at the University of Waterloo and Balsillie School of International Affairs and we've reached her in Waterloo. The CBC News is next. Then a repeat broadcast of Filling the Gaps, our special program all about dentistry in Canada. We'll talk to some of the 11 million Canadians without dental coverage and ask whether it's time to treat our teeth the same way as we treat the rest of our bodies. I'm Laura Lynch. You are listening to the summer edition of The Current.

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Dave Stock beat cancer twice but faces a $10,000 dental bill

Guest: Dave Stock

LL: Hello. I'm Laura Lynch and you're listening to the summer edition of The Current.

[Music: Theme]

LL: Still to come, a debate over whether it's time to include teeth in our universal health care plan. That's in the last half hour today. But first, what happens when dental insurance leaves gaps in coverage for millions of Canadians.

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LL: An estimated one third of Canadians do not have dental insurance. Even those who do aren't covered for everything and the costs of dental care mean many are simply going without getting their teeth fixed or even cleaned. The Current devoted a whole show to the issue back in November of last year. It was called, Filling the Gaps: Dental Care in Canada. Over the next hour, we'll repeat that program, looking at why dental care is different from health care in Canada and whether that should change. We'll also hear about how dental work has changed and how our smiles have adapted to new techniques. But first, the stories of some Canadians struggling to get the help they need. We start with Ana Maria Tremonti's visit to a parking lot in Hamilton, Ontario.

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[Sound: Dentist drill]

AMT: You know that sound the sound of a dentist's office. But those sounds are coming from inside of a bus parked outside the community health center on a little street in Hamilton Ontario.

DR. KASH ZAKI: I am Dr. Zaki Nice to meet you. How are you.

VOICE 1: Nice to meet you too. I a fine thank you.

AMT: Dr. Kash Zaki has his own private practice in Toronto. But two days a week he's here with Hamilton Public Health in a rolling full service dental office willing to tackle any dental emergencies.

DR. KASH ZAKI: We see teenagers and we see seniors people who can't access dental care anywhere else for whatever reason. We see some people are homeless. Some people have recently lost their jobs and lost their coverage. Some people haven't seen a dentist in years. We're talking 25-30-40 years and some people have gone to the dentist last year and now they can't go because of cost concerns. [To patient] What brings you here today? What's going on?

CAMELA ROSS: I have a lower jaw tooth that is...you might see it is on the right hand side.

DR. KASH ZAKI: Can you just open for me?

CAMELA ROSS: When the cool wind hit my face. I feel like I'm going to pass out. It's like a freeze. I feel like I can't talk to nobody anymore and my friends would say "you getting red Camela."

AMT: For about the last month Camela Ross has lived with that pain hoping it would just go away. She knows she needs some kind of dental work but she can't afford it she doesn't have insurance. She's raising her nine year old daughter alone and she never gets more than a four hour shift as a personal care assistant. This visit is her last resort.

DR. KASH ZAKI: So you have a big cavity on the side of your tooth. Okay. You aslso have a big cavity on the back of her too. You could try putting a filling in there. Okay. I don't know if it's going to work. OK. Because the cavity looks very big.

CAMELA ROSS: Okay.

DR. KASH ZAKI: If we do that feeling it doesn't work you'll need to have a root canal. Okay. We don't do root canals here. That's something you'd have to do in a private office.

CAMELA ROSS: Just try the filling and see what happens. And if that doesn't work maybe try and figure out how do I get to the root canal.

DR. KASH ZAKI: Well I'm doing the filling. And if it ends up into the nerve right at that point you're going to have to have a recount right away or have the tube taken out. So that's the risk. Yes. I don't want to put you in a position where you know I've started this filling. Right. And then I'm going to send you home and then you're going to be in pain. Right. That's the last thing I want to do.

CAMELA ROSS: Okay let's give it a shot. See what happens. Maybe you can call a family members all over the place and see if they can pitch in.

DR. KASH ZAKI: Any pain there?

AMT: There was a time when the man now sitting in the dental chair would have never believed he need to come to this bus. His name is Bill.

BILL: I had a career in a corporation in Hamilton till 2008 when the economy went up. I had 20 years and I lost all my benefits. I have two teams that were filled before and they're getting older so they both have chipped. One chip about a year ago and one chipped about eight months ago and they're starting to bother me a bit now and because I don't have benefits. This is the only place I can go.

DR. KASH ZAKI: Okay. Well your X-rays look okay. I don't see any impact. On. You. I see where your tooth is broken.

BILL: I know pretty soon it's going to start getting into the nerve. I want to get it before it gets too bad. And I got two chips so because they're chipped the edge the tooth is sharp and it irritates my tongue.

DR. KASH ZAKI: You have a very big filling in that tooth. Yes. We're going to have a closer look. [To interviewer] Bill came to me and his chief complaint or his chief concern was a broken tooth. [To Bill] With the freezing you are going to feel a.

DR. KASH ZAKI: Just turn towards me. And so we were able to fix that for him today. [To patient] Deep breath. [To interviewer] But when people come and I don't just look at that one tooth they have an overall what's going on with their health. And you know he had a gum problem he had to have a good cleaning. He had other broken teeth. He had other cavities. So you know if he doesn't deal with those situations they're going to become an urgent problem and then he'll be back.

[Sound: Dentist's drill]

AMT: People will come and go all day. Some mornings them line up outside even before the bus is ready for them.

DENISE: I'm a retired caretaker.

AMT: With her twenty something grandson in the chair. Denise explains how they came across the bus.

DENISE: He's got a really really bad tooth and we came to the bus thing because kids Google everything nowadays. He googled and found out where the bus was going to be and I brought him up because we don't have the money for a dentist. I don't know what's going on but it's driving him crazy and he's driving me crazy like with pain. He might want to erase that [laughs].

AMT: And even as she jokes Denise gets serious moved in how caring this dental team is.

DR. KASH ZAKI: So you let me know if you have any problems.

[Sounds: Drilling and chatter]

DENISE: I really like to that they treated us equal here you know they didn't look down on us because we're here for the bus which is free. My grandson can't afford a dentist and I can't afford one for him and they didn't look down on us at all. You know we're equal I mean I'm wearing jogging pants and an old coat - clean but old coal.

AMT: This bus hums with the kind of openness and concern Denise has identified. As a dental assistant with Hamilton Public Health. Danielle Di-Angelo has seen some pretty desperate cases.

DANIELLE DI-ANGELO: Some of the worst case scenarios we've seen is people not being able to get the help that's needed. So they've tried to take it in their own hands and take teeth out on their own. Literally going in the garage and grabbing some pliers and trying to remove it to themselves and it doesn't go well at all.

AMT: By this time Dr. Zacky has spent the better part of an hour with Comela.

CAMELA ROSS: So we have changed our treatment plan a little bit.

AMT: They were both hoping they could save her.

DR. KASH ZAKI: The original plan was to try and put a filling in there, but after I gave her the freezing and started to take up the decay. We found the decay was too deep and it was into the nerves. So that at this point, it's either you go get root canal right away or you have to take the tooth out. So we've decided to take that to go.

CAMELA ROSS: I cannot afford the root canal right now. And it is very painful. And I don't think I have much of a choice at this moment.

AMT: Someone with money or insurance would likely consider an implant. She's just going to have a hole there.

CAMELA ROSS: Will I be able to chew and eat properly still?

DR. KASH ZAKI: Well you're just going to be missing one tooth I don't know. I mean you will learn it, you will learn to chew, yes.

AMT: Camela sits in the dental chair a wad of tissues in her hand. The gauze still in her mouth where her back lower tooth used to be. [To Camela] You were hoping to keep that tooth today.

CAMELA ROSS: Yes I am very sad to lose my tooth. I was hoping they can fill and just try and see what happen. But then he talks about the pain. If the pain come back bad and he's not around. Like what do I do? We have to pay the rent. We have to pay for food, clothes, a lot of things, you know. And every month a lot of us were cut off. We don't have enough people need teeth. You know it is aesthetics, it adds to your confidence. It makes you feel good about yourself. It's health because you've got to eat.

AMT: You know there are people who say we should have dental care coverage he way we have health care coverage what do you think?

CAMELA ROSS: Yes we should. I think. That's 100 percent. Everybody should have. A teeth is very important.

[Background clinic noise]

AMT: What stays with you when you're when you're through a usual day on this bus?

DR. KASH ZAKI: Yeah. What stays with me is - People come here we're dealing with you know their toothaches. But that's just a symptom of the overlying problem, like this is not just dental or a tooth problem. This is like a socio-economic problem. And that's what sticks with me. Like why are these people coming to the dental bus? Like Why can't they access dental care anywhere else? Like how did you end up in this situation? That's what sticks with me.

[Music]

AMT: A dentist's office on a bus like the one in Hamilton doesn't roll around often so most people who can't afford dental care often find themselves in pain and without options. The Current producer Willow Smith went to Welland Ontario to meet Brandi Jasmine, a self-employed artist. She needs thousands of dollars’ worth of dental work and can't pay for any of it. So she's taken matters into her own hands.

BRANDI JASMINE: Going from left to right on the top there's only three molars left and one of them is broken in the middle. And I told you that I had created this plastic thing because I can't afford to even get the broken tooth fixed. So what I'm doing I'm just getting a little bit of tooth paste here and then I have to kind of pop out the.. just brush it, just like you know most people do with their dentures. And then you just pop it back in and away I go. I'm an artist and I am - it just sounds so arrogant to say - but I'm very clever at finding my own solution so there's a product called Friendly Plastic and it's heat sensitive so you boil it and it it goes gooey and then when it it cools down it it hardens. So I created sort of a temporary cap that I've had in there for at this point almost a year . I have had to have it because otherwise the tooth would be cutting the side of my mouth. So this is one of my art pieces it's a guitar. It's beaded. I call it Starburst Zodiak. [Sound: Guitar] It really wasn't intended to be played. If you see it it's completely covered with beads all the way up the neck of the guitar. I've been doing this kind of artwork for about 10-12 years now and had some success at it. It's just not enough to pay all the bills. These are all different kinds of beeds I have gotten from different places. I get them from dollar stores. The last time I'd had it assessed that I could afford to see a dentist at all, he did this list all the things that need to be fixed and there are 12 teeth. I think there's five of them that need to be pulled and the rest could be recovered at that time but at this point in time I don't even know if those teeth can be recovered, because it's been over a year and I'm sure there's more damage. In total it was somewhere between five and six thousand dollars including getting dentures made. Just having your teeth done was around 2500. I can't even afford to have one tooth pulled at this point. I'm struggling just to make ends meet and you know pay the grocery bills and pay the you know like there's two bills that are coming due tomorrow and I don't know if there's going to be money for them. Even $150 is too much for me to spend on this. And so I just- you know the pain comes and goes it's not there all the time. Only most of the time or if you bite into something the wrong way or if there's a cold breeze hits the wrong way or you know laughing. And it the pain in the front of my mouth goes all the way from the tooth area all the way up my nose and sometimes even up to as far as my eye. It'll go away for a week or two and then it'll flare up for two or three days and I won't even be able to think. You know the pain will be just so bad that I can't get anything done. [To her cat] Hey honey, come on say hello. [Sound: Cat mews]Oh baby you love your momma? She's shy so there she goes. It affects me emotionally in a variety of ways. I have challenges with anxiety and depression. You know at times in my life I've been on medications for them, and staying what I would call it balance or equilibrium is extremely hard not just because of the pain - which is bad enough - but also the feeling of being abandoned by my people by my government is I mean [sobbs] you feel like you're being tortured every time it happens and it's happening over and over and over again. And you just feel like you can't - there's no way out of it, there's nothing you can do about it. All you have to do is take it. And like I don't take it personally or anything like that. And I know there's a lot of other people in that same situation. And I wonder when I'm having that moment what their lives are like and how many other people are out there having the same experience. And that really gets to me too. So it's - I just don't understand why people are suffering like this for the want of something so simple as a tooth extraction. I'm not asking for root canals and the Hollywood teeth here. I'm just "please God. Can I get these out of my mouth.

[Music]

AMT: Like Brandi Jasmine, Dave's Stock has lived with excruciating dental pain although after going through two bouts of cancer he never imagined his teeth would be the thing to cause him so much misery. Our producer Suzanne Dufresne visited Dave and his family in Winnipeg.

DAVE STOCK: Should we call Zoe for dinner?

AMANDA STOCK: I think we are good to go.

DAVE STOCK: Zoe, dinner. Come on kid.

ZOE: Coming.

DAVE STOCK: Garlic ribs and some rice and probably broccoli.

AMT: The bustle of dinnertime as Dave and Amanda Stock get ready to eat with their six year old daughter, Zoe. It wasn't too long ago that sitting down for a regular meal like this would have been unimaginable for Dave. Massive doses of chemotherapy and a bad reaction to a bone marrow transplant ravaged his teeth and left his family with a crushing dental bill they can't afford. Like many other Canadians in that position, they had to turn to friends, family, even strangers to raise money. Here are Dave and Amanda stock.

DAVE STOCK: So in 2011 I was diagnosed with large lymphoma non-Hodgkin's, started chemotherapy, actually the day my daughter was born I'm also a very large person. And so it was a lot of medication that I had to go through to take in. But luckily I went through it all and I beat it and was deemed cured, for the most part. A year and a half later I started to get really ill. And we thought it was just a cold. It turns out that I had contracted, as a result of the chemotherapy, leukemia.

AMANDA STOCK: So we've spent about six months in the hospital on and off. He needed a bone marrow transplant. So the first thing we saw was he lost all of his skin. He lost all of his hair. But that's - you know with chemo that happens. Then he started to show signs of graft versus host disease. It's when the new bone marrow starts overriding the old bone marrow what's left and there's a war going on inside your body. So with Dave his saliva glands stopped working. So not only were his teeth brittle from the chemo but he had dry mouth because his saliva wasn't working, and it caused his teeth to just completely decay. He would eat a sandwich and his teeth would break.

DAVE STOCK: It started with one tooth breaking and then, a few days later another one chipped, a few days later another one cracked part of it came off. [unintelligible] would be a good way to describe it if you didn't know my situation. Like when your smile has more gaps and teeth and cracks. Tt's not very nice to look at.

AMANDA STOCK: It's heartbreaking to have to watch someone you love go through this and all you want to do is find ways to help. You know he probably lost a good 25 pounds just in those months from only being able to eat liquids.

DAVE STOCK: So after examining my mouth my dentist determined that we I needed implants the dentures would not work. So far the total expenditure on my teeth has been around $10,000. Half of that from a charity and the rest from our insurance and the kindness of my dentist and also my Go Fund Me helped a lot.

AMANDA STOCK: I created the Go Fund Me page without Dave's knowledge because he probably wouldn't let me do it if I told him about it, but he needed to eat. I didn't know what else to do.

AMANDA STOCK: When I found out Amanda had put the Go Fund Me up I was I was mad. But then I started to see even the numbers rising on the page and ended up bringing in around three and a half thousand dollars, something like that, I can swallow my pride didn't get much fixed [laughs]. So that's what I did. And very thankful for everybody who donated and I don't know what to happen for the bottom part. Bottom teeth should cost about the same as the top. So around nine to $10,000.

AMANDA STOCK: People don't think cancer will lead to dental issues. Once you're done with the cancer there's nothing really to cover what happens next. And when you're on disability we're getting about a third of what Dave used to make which is hard enough, but then to have his mouth fall apart and this extraordinary bill to fix it. You know it's like what people in the states have to deal with. I don't know how they deal with that. Dave's medical bills would have cost about over ten million dollars, if we were in America. We're lucky that you know we're only having to fight about a you know $15000 dental bill. But it's a $15,000 dental bill at least.

DAVE STOCK: To me, if it was one thing - if I needed to have my teeth fixed because I was ignorant and silly and I didn't brush them I ate candy and pop and didn't brush my teeth and they rotted, and I need help, or I was doing illegal drugs or whatever. Yes, I should have to pay for it. But when your teeth are snapping and breaking as a side effect from a medical treatment I think that should be covered as the medical treatment was because it's the same thing.

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Ontario artist all smiles after anonymous donors pay for her desperately needed dental care

Guest: Brandi Jasmine

LL: We'll pick up on that idea of what dental care should be covered and why it's considered different from other health care in our next half hour. You're listening to the repeat broadcast of a special edition of The Current called, Filling the Gaps: Dental care in Canada. It originally aired in November of last year. Since then, Dave Stock says he's doing great. His dental expenses were covered by a charity and his dentist. Brandi Jasmine is also doing better. She's the woman in Welland, Ontario we heard from earlier, who was crafting her own homemade dental devices.

SOUNDCLIP

VOICE: I'm doing a lot better. All of my teeth have been fixed. Dr. Zina Alwash is the dentist that stepped forward to help me out and I had two anonymous donors pay some of the non-emergency work. So I was also able to get an upper set of dentures. So now I actually have a smile and can go out in public and feel good about myself and my emotional state is much better. I'm not in any pain now. I feel just like I can't even tell you the difference, it's like night and day. It's like coming out of you know a huge black hole and you know seeing light at the end of the tunnel. I would like to see fully covered dead care for, at the very least, I'd like to see everything covered. The preventative care is equally important as emergency care, but at the very least, emergency care, having teeth pulled, having intervention for infections. If you've never been through chronic pain, you have no idea how many other areas of your life that can affect. I have a lot more energy. I'm a lot happier. I'm a lot more confident and I don't live with you know that obsessive thought that this is going to be this way for the rest of my life. Now I have some hope. I kept that bridge I made myself. I keep it in a little jar. It's here somewhere. I did keep it sort of as a reminder of those times. I don't look at it much, but I couldn't bring myself to throw it out.

[Music]

LL: To see before and after pictures of Dave Stock's teeth or Brandi Jasmine and her homemade cap or Anna Maria Tremonti's visit to the dental bus in Hamilton, visit cbc.ca/thecurrent. And if you have your own stories to tell, find us on Twitter @TheCurrentCBC or me @LauraLynchCBC or search us on Facebook. Send us an e-mail through the website at cbc.ca/thecurrent. Well coming up in our next half hour, with so many Canadians not getting the dental work they need. We look at solutions.

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VOICE: There is no dentist who doesn't feel very sad to hear these stories, but in many cases, as a society, government hasn't gotten the message that these plans are important and that they need attention and they need to be funded so that the people who need the help are the ones who are getting the help.

LL: Is it time to include the mouth in universal healthcare coverage? Two different views on that debate, after the break. I'm Laura Lynch and you're listening to the summer edition of The Current.

[Music: Theme]

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Overall health includes oral health: Should dental be part of universal healthcare

Guests: Larry Levin, Paul Allison

LL: Hello. I'm Laura Lynch and you're listening to the summer edition of The Current. This morning, we're repeating a special edition of the show called, Filling the Gaps: Dental Care in Canada. It first aired in November of last year. This half hour, we'll look at how dental care has evolved. But first, the debate over calls for universal dental care, starting with a visit to a dentist with a private practice in Toronto.

[Sound: Dental drills and dental tools]

JOHN GLENNY: We're lucky with Catherine because she opens wide. You see how that tooth is broken? I'm John Glenny I'm the dentist. Today we're doing a crown preparation on tooth number one six. Hopefully Catherine has the tooth the rest of her life.

[Sound: Dental drill]

JOHN GLENNY: If I go to the dentist as a layperson and I'm told a procedure is going to cost, let's say for the crown, let's say it's a thousand dollars I think "Why on earth does this cost so much?" But in general I find people are very understanding when they ask and then they see for example today "okay how long this procedure is taking? What are the materials involved?" The background support for these procedures think of the staff. You know how many people support this crown? The laboratory is making the crown so there's staff at the lab. There's a driver that picks up the case and takes it to the lab. I think when people understand you know what goes on behind they think "gee whiz, actually it's high but more or less it might make sense."

[Sound: Dental drill]

AMT: Those costs set up for the dentists running a practice, for insurers and for patients but dentists are not the only health care professionals seeing patients with tooth pain. Costs spill over into the rest of the health care system. Hasan Sheikh is an emergency room physician at the University Health Network in Toronto. He says that pain often builds up for those Canadians who can't afford to get regular dental care and that's when they end up in the E.R.

HASAN SHEIKH: I see patients come into the emergency room with dental complaints probably once or twice a week and people are miserable. You can barely have a conversation with the person because of how much pain they're in. They want anything that they can in that moment to take away the pain. When patients come in they know that they actually do need to see a dentist but they come into the emergency room because they have nowhere else to go. And we do our best to diagnose the issue but unfortunately I'm not a dentist. I don't have the skill set to make a lot of the diagnoses or or even if I can to know how to do the treatments that patients need. So what we end up doing is sometimes we have to treat patients with antibiotics and then the rest of it is really just about pain control. Plain acetaminophen and ibuprofen often aren't enough. And so we're left with this discussion of do we prescribe a stronger opiate painkiller. There are dangerous medications that we really want to keep off the streets. I don't want to suggest that the lack of publicly funded dental care is a major driver of the opiate crisis but it certainly is not helping.

AMT: Dr. Shiekh would like to see big changes changes that could make dental care as accessible as the emergency room.

HASAN SHEIKH: In the emergency room we have a window into the healthcare system and our social safety net systems overall and people invariably end up in the emergency room when they fall through the cracks. And dental care is one of these frustrating issues that keep coming up where we see the same thing over and over again. And we don't have really anything to offer these patients and we feel like we're not doing right by them. What I'd like to see happen is an understanding that oral health care and overall health care are one ofthe same. And if we're going to start with that assumption, it just makes sense that we bring dental care under the umbrella of our publicly funded health care system.

AMT: Some dentists have built a practice of trying to reach patients who would otherwise have trouble getting dental care. Dr. Yu Kwong Li is the director of the Service Dentaire Mobile MDC in Montreal. Pulling along a cart full of tooth care tools Dr. Li visits patients with mobility issues or dementia in their long term care homes. But Dr. Lee's practice is not a publicly funded program. It's a business.

SOUNDCLIP

DR. YU KWONG LI: Bonjour.

VOICE 5: Bonjour.

DR. YU KWONG LI: Je m'appelle Dr. Li, je suis le dentiste. [To interviewer] How are the teeth in the patients that I treat? Not very good, unfortunately. One of the first things to go is his daily oral hygiene. So if the patient is not able to take care of their teeth like they used to. And there's nobody around who’s able to do that for them. And you can imagine these will decay fairly quickly.

[Grunting Patient]

DR. YU KWONG LI: And a lot of the patients that I treat can suffer from some form of dementia. They do have issues with cooperation. [To patient] Fermez les dents ensemble. [To interviewer] Dentistry is interesting in which it is a health care profession but it's also business. In office, I could see maybe 20 30 patients, when I'm doing mobile dentistry I'm going to nursing home because the procedures take longer. I see between six to eight patients. Very small percentage have dental insurance. Generally they will have enough savings to pay for that care. The basic dental care that we provide is not expensive. I'd say in the past two years I've had cases where two social workers have approached me and said "look the the patient really has no money and he is in pain. Is there anything you can do?" I said "No problem. I'll take care of them at no fee." Do I think if dentistry should be part of the public health system it would be a great idea. But is it feasible? I don't think it is. It's too expensive. If it was feasible then why aren't the government doing it now? [To patient] Merci Monsieur.

AMT: Well we have two people with us today to talk about what gaps need to be filled in dental care in Canada and how best to fill them. Dr. Paul Allison is the dean of the faculty of Dentistry at McGill University. He was the chair of a panel for the Canadian Academy of Health Sciences that produced a report in 2014. And that report was called improving access to oral health care for vulnerable people living in Canada. Dr. Paul Allison joins us from Montreal. Dr. Larry Levin is the president of the Canadian dental association. He is a practicing dentist in Hamilton, Ontario. He joins me in our studio in Toronto. Hello gentlemen welcome.

PAUL ALLISON: Good morning.

LARRY LEVIN: Thank you.

AMT: Paul Alison let's start with you. We've been hearing stories from people who have had trouble getting their teeth fixed. How easy is it for Canadians to get the dental care they need?

PAUL ALLISON: Well for many people for the majority it is relatively easy. They have good dental insurance. They have good dentists. They can get access to good quality dental care in a conventional dental office. But there's a very significant minority 20 to 30 percent of the population that have great difficulty accessing dental care across the country. There's about six million people who have avoided visiting the dentist in the last year because of the cost of the care and the problem is, the really big problem in this area, is that it's the same people who have the greatest levels of disease that have the greatest barriers getting into care. So many of us who can go to our dentist really actually have very low levels of disease. But the people who can't get to the dentist are actually the people with the highest risk of disease. So the highest levels of disease and at the same time they've got the greatest barriers. So that's where really the problem is lying with access to care.

AMT: Larry Levin we heard from Dave Stock earlier. He has private dental insurance. He still couldn't get all the work done. He couldn't afford to do all the work that he needs to fix his teeth. His dental problems were the result of cancer treatment. What needs to happen to address the needs of people such as him?

LARRY LEVIN: People need to have targeted specific plans that will help them at different stages of their life. And so for that specific area people that have cancer treatment, people and people that have medical treatment and need help if they fall into the category that needs it the help should be there to help them. We strongly support the formation of plans that will help people who have those specific areas; people who have lower incomes; people with disabilities; children in those categories; seniors and of course some medical compromised people as well. The focus has to be on identifying who needs the help. And then; as a supportive Canadian society; providing the help that those people need. No one should have to go to bed at night worried about a dental issue causing them trouble that they can't meet or having pain to interfere with with their life.

AMT: There is a bit of a disconnect here though. Why is it that our teeth the one part of our body that doesn't fall under our health care plan? It's like if you took another piece of our body and said 'no if you do that to your hand we're not going to fix it.' Why do we have that separation of teeth and body?

LARRY LEVIN: I think this historically dentistry has evolved from a different stream and it hasn't fully merged into health care today the way I understand it, and I think that more and more it is coming into the same realm and understanding the dental issues can impact your health and you should be seen as a whole person no matter what the issue is. So having a focus on your dental health is important for all Canadians. But the real thing that we're concerned about is the support for people that need it the most. And these are the disadvantaged groups that we've talked about earlier that you've highlighted in the the preamble to this show. There's no dentist who doesn't feel very sad to hear these stories. And we partner with governments to provide the services that these people need. But in many cases, as a society, government hasn't gotten the message that these plans are important and that they need attention and they need to be funded and they need to be well constructed, so that the people who need the help are the ones who are getting the help. As Dr. Allison said the majority of Canadians are well served with the model we have for providing dentistry but that targeted group is not. And we must do better for.

AMT: Dr. Paul Allison is it solely that now lower income people or people with catastrophic health issues or what do you see in the middle class?

PAUL ALLISON: Well that's the increasingly we're seeing that the middle classes are having problem accessing care. The nature of jobs and the nature of dental insurance is changing so that more and more people have part time jobs. They have several jobs and when you have those sorts of jobs the benefits that come with those jobs are less. And then that includes the health and dental insurance. And so we're seeing that the health and dental insurance that comes with those jobs is covering less care. So more and more we're seeing this problem of accessing care due to cost is coming into the middle class groups. So it's just going to keep increasing.

AMT: So Paul Allison should Canada bring in some kind of dental care coverage for everyone similar to our medical care?

PAUL ALLISON: Yes I believe we should have dental care with part of that universal health care system. We should be able to define at least a minimal level of care to get people out of pain, to get people get rid of disease and to give them some preventive care so that they can be out of pain. Dental problems are not going to kill people but they're very common. So we've just been hearing a few examples in the preamble to this show but there are very common problems. Amongst young children, dental dental operations were the most common operation for children going into hospital to be put to sleep. Thirty percent of all general anaesthesia for kids under five across Canada, in a recent study, was for dental operations. So this is a really common condition and it should be part of the universal system.

AMT: Larry Levin would would Canadian dentists support moving to a universal system?

LARRY LEVIN: I think Canadian dentists would support looking at the areas that need help and focusing on those to give them the help they need. I think that so much of the dental plan is working that we don't need to try and deal with that part. We need to focus on the area that isn't working. We know that for example prevention can make an enormous difference in the child's life. If you see a child from the very start from when their first tooth comes in their mouth and you're working with the mothers and the children to help improve their oral health, they can have a mouth that's healthy their whole life and that's going to save millions of dollars for Canadian health care. If we only focus on treatment then we'll never be able to catch up. So focusing on people who have the problem now is something that's extremely important, with the dental plans that we need to focus with governments to put in place. But a focus on prevention to make sure our future is much brighter than it is today. And those dental plans vary so much across Canada. You can have a child in one province that has much better chance of getting care than in another province.

AMT: Well that's why I'm asking should you have a system where everybody gets it? You mean you're saying that it works but it only works for people with a plan and then the plans don't always work. In the same way that not everything is covered in health care, cosmetic surgery, other things, should there be should there be something that is covered across the board for everyone?

LARRY LEVIN: I think we would and we would encourage a pan Canadian model that has targeted support for people who need it so that the is a specific basket of care that they could all access, so that no one should have to say. No one should have something that interferes with their going to sleep at night. There's a basket of procedures and treatments that everyone should have access to who finds himself in that difficult scenario of not being able to achieve it. Most Canadians can and we don't need to worry about those at this point. We're talking about the specific group that have trouble accessing the care, whether it's because of financial reasons or emotional reasons or medical reasons. Whatever it is they should be able to feel that they can get the care they need at that level and there shouldn't be barriers to being able to access that care. Dentists across Canada have offices ready and willing to see all of these people. We just need the plans in place that will allow them to go into the offices and receive the care they need.

AMT: Paul Allison what do you think?

PAUL ALLISON: Well I think part of the problem as well is, as Larry just referred to you, people need to get to the offices and that's actually part of the problem. Again many of these people we're talking about have no money to get even a bus to to an office. They don't know where the office is as well. And so we need to be thinking about where are we setting up the dental care. Not only in private offices. We need we need to think about having dental offices with community health centres , with the physicians, with the general healthcare team. We all agree that oral health and general health is part of one and the same they shouldn't be separated. So we should be working in the. Dentistry at the moment is basically outside the system. So we had the example of Dr. Yu Kwong Li who goes round from centre to centre, that's another example. We should be training more dentists that can provide mobile dental care, going into sensors for the elderly, going into people's homes, going into other community settings. So a lot of it is also about the actual geographic and physical location of dental services being better available to those people who most need it because many of these people cannot or have great difficulty getting into office.

AMT: Well I have another clip here that I'd like to hear. Dr. John Glenny the Toronto dentist we heard from earlier treat some people who are covered by public dental care programs listen to what he says.

SOUNDCLIP

JOHN GLENNY: Some of the most vulnerable in the community, children and youth from low income families are covered by Healthy Smile's Ontario. But the reimbursement rates are so low, as low as 27 percent for the feeds. So when we treat these patients that are covered by these government programs it's actually costing us for every single procedure. We still have to pay for the supplies and the overhead and so on. They're not even paying you know what's needed to cover the cost.

AMT: Larry Levin, should the government be paying full price to cover dental care for those cases?

LARRY LEVIN: I don't think dentists have ever asked for full fee. When these plans were initially set up for example in Ontario, the government came to dentists and said "would you accept 90 percent of your regular fee to look after these people?" And the dentists said "yes we would be happy to do our socially responsible part." And so the fees were established at that level and then a few years later they came back and said "well would you take 85 percent?" And then a few years later 80 percent. And Anna Maria What do you think it's at this point?

AMT: What is it.

LARRY LEVIN: It's about 40 percent, overall. And so when the cost of delivering the care is 65 or 70 percent, every time you do a procedure the dentist is having to reimburse the system, if you will, themselves. And dentists don't want to be in that position. There are still a lot of dentists doing it but increasingly dentists are saying that that's not a fair way for society to arrange its affairs. Canadians are a caring group. We want to look after each other and we want to have a dental plan that will support someone in need at that time in need in their life. We want to as a society say "we have your back and if you have a dental problem you can go to the dentist of your choice and we're going to reimburse a portion of that enough for the dentist to be satisfied to render the care," that's the model we want. We want that across Canada and we're ready and willing to sit down tomorrow morning, with any level of government that wants to focus in on how to provide better care for our Canadian citizens.

AMT: I have another clip I want you to hear before we continue on that wider issue. Inuit and First Nations people have some dental coverage from the federal government. The health of their teeth is still worse than the Canadian average. We have a clip here of Chief Leo Friday of the Kashechewan first nation in Ontario.

SOUNDCLIP

VOICE: Dental care is really really hard in our community and it's just basically our kids and our elders that cannot move around. Like in the past I guess dentists use to come regularity in our community and all of a sudden it started to decline for some reason. I can't even recall. I don't know when it's the last time that I saw or hear a dentist in my community. It's really frustrating sometimes we have to wait months and months before we can get out of the community to get their teeth fixed.

AMT: Okay, so that is Chiefly Leo Friday of the Kashechewan First Nation in Ontario. Paul Allison the federal government spends more than 200 million dollars a year on dental programs for First Nations and Inuit people. How do these programs need to change in order to get the right care to the people they're meant to help?

PAUL ALLISON: Well I think we really need to think about other ways of reimbursing dentists to do their work and we need to think about what sort of health care professionals should be doing the work. So you know we focus very much on paying people in the health system by the act. There are other ways. You can salary people, you can pay them through capitation system. There are different ways you can pay them and you can incentivize different sorts of behavior by paying people in a different way. So I think we have to be open to that as well.

AMT: Well I'll just pick up on this with Larry Levin. You know there are as you mentioned, there are provinces that cover dental care for children for other things that they cover for children across the board others offer coverage for low income children. Should all provinces and territories cover dental care for all children?

LARRY LEVIN: Unquestionably for children who are in need, who can't access care in the stream that we've talked about earlier, they need targeted help. So all children should have dental care that will keep them pain free and comfortable regardless of income or accessibility.

AMT: Should it be for all kids without a dental plan, like without their parents having to go and buy a dental insurance plan just like across the board?

LARRY LEVIN: I think it should be for kids who need that kind of help and government and society has to decide at what point where that line is, where the social assistance ends and your own personal responsibility begins. Because we know that governments of funds aren't bottomless so targeted funds will help the people that need it is the most expedient way to get there. Now I was at an Inuit clinic in Ottawa last week and I saw firsthand the dental treatment and care being provided. This is a national program to support our indigenous First Nations Inuit people. And it's a wonderful service that's provided but we can't drill and fill our way out of this problem of the number of kids who are having these kinds of decays and problems. Prevention is the only way to stop this tide of problems so that we can get it corrected for the future. Community water fluoridation that lowers the decay rate for people.

AMT: And we see a real fight against that in a lot of municipalities.

LARRY LEVIN: You do see that and yet we're asking municipalities to cover the costs for these low income children. And yet we don't want to give them the tools, something as simple and safe and effective as community water fluoridation to lower that burden.

PAUL ALLISON: Paul Allison, and we're almost out of time I'll just get you to weigh in on that briefly.

PAUL ALLISON: Well I agree that prevention needs to be part of it but I think we need to remember that a public system, one of the fantastic things about a public system, is it reduces inequalities in the status of health and access to healthcare. There are far fewer inequalities access to general health care in the medical system compared to the dental system in Canada. So I do think we really need to think about bringing in dental care into the public system.

AMT: We have to leave this conversation there. Gentlemen thank you very much. We'll continue as we keep going and we're looking for feedback as well.

PAUL ALLISON: Thank you.

LARRY LEVIN: Thank you.

AMT: Dr. Paul Allison dean of the faculty of Dentistry at McGill University. He is in Montreal Dr. Larry Levin is the president of the Canadian Dental Association as well as practicing dentist in Hamilton, Ontario. He joined me in our Toronto studio. We did request interviews with the Federal Health Minister, as well as Canada's chief dental officer, neither was available to us today.

[Music]

From tooth pullers to dentists: Dental care's 'really painful'

Guests: Peter Ungar, Colin Jones

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JIM POLUNS: So this is our dental museum to the left. It’s basically three rooms full of dental memorabilia.

KARIN MARLEY: What are those jars full of teeth?

JIM POLUNS: Those are like lot of extract mainly wisdom teeth and things. Dentists always collect for educational purposes. So they'll use those, they'll send them off to dental schools and new dentists and students can practice doing the cavity preparation.

AMT: That’s Dr. Jim Posluns, assistant dean of clinics at the University of Toronto's faculty of dentistry. He's taking our producer Karin Marley on a tour of their dental museum. Really an old office, overcrowded with dental knickknacks from the past. And judging by some of the tools on display, it's pretty clear why many people throughout history have been terrorized by the very thought of being in a dental chair.

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DR. JIM POSLUNS: These are known as keys. They're used for taking teeth. And so you need to know which way the tooth kind of wants to roll out of the job. And so you take this little hook and put it on the inside of the tooth and then roll that to the side and pull it our.

KARIN MARLEY: I am cringing here.

DR. JIM POSLUNS: But in the odd case it would take the tooth in part of a jawbone with it. It was pretty nasty stuff. And then there's other instruments that we can use to go and get the roots. So they look almost like corkscrews and you just twist this. This is the old way of doing that. The way you do now, you essentially twist down the length of the root and then just pull up.

KARIN MARLEY: So kind of like opening a wine bottle.

KARIN MARLEY: Not nearly as much fun.

KARIN MARLEY: What do we use instead of this now?

DR. JIM POSLUNS: Well an excellent anesthetic which goes a long way. This is your [unintelligible.

KARIN MARLEY: So we're looking at a drill here?

DR. JIM POSLUNS: Yes, back in the day they were run essentially with a foot pedal was like a big sewing machine trying to get the revs up high enough. So something like this turns very slowly. There's no water. So it's essentially like taking on of those old school like auguries where you want to drill a hole in a piece of wood, and you just kind of turn it around. It's a little bit better than that. So I can imagine just sitting in a chair waiting for the next discomfort.

KARIN MARLEY: And so the dentist would be simultaneously drilling and pumping this thingy with his foot.

DR. JIM POSLUNS: The earliest ones. That's right. It would be something foot driven. And then the later ones were electric.

KARIN MARLEY: So what do we have here?

DR. JIM POSLUNS: So this is a pelican. This is a very old and very barbarous instrument and some of these go back as early as the 14th century. And essentially they do the same thing with that the turnkeys gave you, a lot of leverage to go in and roll the teeth out of the jaw and you can imagine something this size and this way it could do some serious damage.

KARIN MARLEY: I can see why people were scared of dentists?

DR. JIM POSLUNS: I'm scared of dentists.

KARIN MARLEY: [Laughs] Still?

DR. JIM POSLUNS: Always [laughs].

AMT: You can see what those contraptions look like for yourself on our website if you dare, cbc.ca/thecurrent. Colin Jones is a professor of history at Queen Mary University of London. He's looked at the history of medicine and dentistry. He's the author of The Smile Revolution in 18th Century Paris. And Colin Jones joins us from London England. Hello.

COLIN JONES: Hi there. Well we just heard about some of the kind of creepy or scary tools the dentists have used in the past. How painful is the history of our teeth?

COLIN JONES: Well it's really really painful. Don't forget that aesthetic only really came in in the middle of the 19th century. So really everything before then was the bad old days in some ways. But then also in the 18th century and particularly in France actually, you see a change coming through and you can see they sort about the roots of modern dentistry effectively emerging in that period and particularly with an emphasis on preventive dentistry, rather than essentially extraction. The word dentist wasn't used until the 18th century.People before that were with tooth pullers.

AMT: Some of them did it with their fingers. Why was that?

COLIN JONES: Well you've got to remember that a lot of dentistry in the earlier period was, surprising and this may seem, a sort of form of show business. It was normally done in public by troops of people who put on a show. In fact many of them were quite good actors. They were in the commedia dell'arte tradition. From the late 17th century, particularly in Paris, you've got these very suave operators who make the sort of great trick of you know great florid gesture while they cut their fingers firmly around the tooth and pull it out, you know as a sort of miraculous thing. It must be said, a lot of teeth particularly in older people, would be very loose then. So I think that that's sort of demonstrative, performative aspect of dentistry which we find absolutely extraordinary. We would not now have our dentistry done in the open with people looking at us.

AMT: No. And like 'ta da da da' like they even had musicians didn't they?

COLIN JONES: Had musicians. They had tightrope walkers. They had just about everything going on.

AMT: Before the era of modern dentistry how much of a difference was there in the tooth care available to the rich and the poor?

COLIN JONES: Well you know King Louis the Fourteenth you know, the sun king, the greatest monarch of early modern Europe probably, but he has very bad teeth. He has a number of roots stuck in his upper jaw. He brings in essentially one of these people I'm talking about, an operator or a tooth puller, who comes and probably uses a pelican in fact like your colleague was talking about, pulls out the stumps of the tape but also takes a big chunk of the king's palette as well. And he's got this great big hole in the top of his mouth. When he's famously sort of eating soup it all sort of comes down his nose onto the soup. It was absolutely revolting sort of the fountain, Versailles fountain of rather grizzly kind. But then his surgeons realize that actually this is getting infected. He's going to get a very very serious illness and could possibly die from this. So they take what is a heroic radical surgery and essentially get a big chunk of red hot iron and cauterize the top of his mouth. Then the guy's coming towards him with this red hot iron, he says to him "treat me like a peasant." And really there is no other way. However much wealthier, you could be the wealthiest the most powerful king in Europe. You're on the same level as a peasant when it comes to tooth care. Now that starts to change it starts to change particularly in Paris in the 18th century.

AMT: So dentistry becomes a science around that point.

COLIN JONES: It definitely tries to enter into the sort of scientific field. It's a sub-branch, the tooth pulling group, if you like, almost like a guild or sub guild within the Parisian surgical college.

AMT: What state where people's teeth in the 18th century when modern dentistry was born?

COLIN JONES: InWestern Europe, teeth are probably worse than any other time in more or less the history of humanity, because it's from that period the sugar coming in from particularly the Caribbean is entering into the middle class, but also the urban working class and peasant diet as well. So in some ways I think you know because the the norm is bad teeth and falling out teeth. So preventive dentistry, white teeth becomes a mark of distinction. You can actually pay for dental care and someone can look after your teeth. They can drill them. They can fill them. There's a sort of cult of tooth transplantation as well. You take the tooth usually out of a little chimneysweep or something like that and put it in the mouth and hope it'll take. A lot of false teeth come out.

AMT: is really like let's exploit the children even more [laughs].

COLIN JONES: Absolutely. So very amusing and very sad.

AMT: Well speaking of little white teeth, that brings us to the history of the smile. How is the history of the health of our teeth tied to the history of the smile?

COLIN JONES: What I discovered was, that at the end of the 18th century in western portraiture for the first time, you can smile and show teeth without that being seen as negative. If you did that before, if the Mona Lisa had done for example rather than smile in the way that she did, if she opened her mouth to show even a little toth, people would have saidA: She's lower class. B: She was probably insane or C: She must be in the grip of some extraordinary emotion. So people didn't open their mouth to be represented. They didn't show off or flash their teeth in the way you know which obviously becomes very common now. What I argue in the book is that one of the strands leading to this and the end of the 18th century is better dentistry available for the Parisian middle and upper classes. But I also argue that there's a movement of sensibility which stress a new kind of facial expression, an expression of sympathy and pleasantness. And of course that's very familiar with us. You know you stand in front of a camera now you say "cheese" and that's smiling you somehow the you that you think you want out there in the world.

AMT: How long did it take for dental care to become the norm for the majority of people in industrialized countries?

COLIN JONES: You've got this emergence at this period and then it sort of falls away. That's sort of leading edge of the new type of preventive dentistry falls away and it's only very slowly across the nineteenth century that you professionalized dentistry and get those more systematic more scientific approach. That's actually the Americans who lead here. Of course then you also get to coming into advertisement as well and the smile can sell anything essentially and has helped effort everything under the sun really not just toothpaste.

AMT: What do you expect to see in dentistry for the future?

COLIN JONES: Now there you have asked an extremely good question and one that I'm completely puzzled about myself, because the end of my book - it came out in hardback in 2015 - I said "well smile is in" and you know it doesn't seem to have that total hegemony in Western culture. Other cultures seem to be picking it up all the time, you know smiles going from strength to strength. But then in fact, someone suggested to me that this might be a little optimistic and what the point that I which I thought was really interesting is what about the duck face? You know that smoochy sort of pouty type of thing.

AMT: But how does that translate to dental work?

COLIN JONES: Very good question. I think also there's a lot of extra stuff going on in the mouth. The Hollywood smile those classic, glacia like white teeth; all identical and all white and all perfect. A lot of people are using different types of tooth work, the inserts, the use of gold and silver and diamonds and things like that that sort of move towards piercing is also affecting the way in which the smile is seen as well. So I think it's quite complicated at the moment and it's quite difficult to say whether the smile will pull through if you like, and carry on and still have that massive significance that it had in the 20s and early 21st century, or whether something sort of quite different is going on.

AMT: Colin Jones thanks for your perspective on this.

COLIN JONES: Not at all. Nice talking to you.

AMT: Colin Jones is a professor of history at Queen Mary University of London. His book is called the Smile Revolution in 18th Century Paris.

LL: You've been listening to a repeat broadcast of Filling the Gaps: Dental Care in Canada. It first aired last November. That's our program for today. Stay tuned to Radio One for Q. Anne Clark also known as St. Vincent has built her career on a dynamic stage show, compelling and curious lyrics and boundary-pushing style. But it's her guitar work that has laid the foundation of her success. This morning she'll drop by Studio Q for a special acoustic session and perform songs from her latest record, "Masseduction." And remember, you can always take The Current with you to go on the CBC Radio app. It's free from the App Store or Google Play. Now we're going to give the kids of The Current family the last word today. Here are Isla Blamire, Vera Remerowski and Petra and Miro Goddard with their thoughts on dental care. Obviously, the tooth fairy was top of mind. I'm Laura Lynch. Thanks for listening to The Current.

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ISLA: The tooth fairy takes my teeth and she gives them to people who have damaged teeth and they needed to get them out, so then she gives to those people.

VERA: I think she gathers up all the teeth and then and then she builds a house for another tooth fairy. There might be two tooth fairies. If there are two who lose their tooth at one time, one tooth fairy can't go to two places at the same time [laughs].

PETRA:I love the dentist because at the end they give me a prize. Once I got a Hello Kitty bracelet.

RICHARD GODDARD: What's the worst part about going to the dentist?

MIRO: None.

RICHARD GODDARD: Like going to the dentist is amazing?

MIRO: Yes.

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Aug 7, 2018 episode transcript

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