October 29, 2013 - Let's face it dental services have always been expensive. If you have dental insurance your children are probably visiting the dentist regularly but if you don't have any form of coverage and assume full costs – your children are more than likely visiting the dentist only when your budget will allow. So, it begs the question, what do parents without dental coverage do if they learn their children require braces or dental surgery? What are their options, if any?
Children's Health and Safety Association (CHASA) received inquiries from concerned parents regarding the costs for dental services. "What is a 'fair price' for dental services from a periodontist?" "How much do braces cost?" "Money is tight. How do I know that I am not being overcharged?"
The practice of dentistry in Canada is under provincial and territorial jurisdiction – not national jurisdiction. Federal competition laws prohibit price fixing so definitive fees for services cannot be regulated. Dental care is not considered integral to healthcare and therefore not subject to the tenets of the 'Canada Health Act'. Canadian citizens are largely responsible for financing their own dental care.
Dentists are private, small business owners and not publicly funded like medical care, however, provincial programs such as the Government of Ontario's 'Healthy Smiles Ontario' provides preventive and early treatment dental care for low-income children and youth under 17 years of age.
The costs for dental services can vary from practice to practice and from province to province. Each provincial and territorial dental association provides 'suggested fee guides' to their dentists as a resource tool and they also provide reference documents for outside groups such as the dental insurance industry – however, the 'suggested fees' are only guidelines. Dentists determine the cost for their services based on a number of factors such as the competitive market, their staff, office space and the cost of their practice including dental equipment and supplies.
According to the Canadian Paediatric Society, 'Oral Healthcare for Children - a Call for Action' published in January 2013 states that:
- 62% of Canadians have private dental insurance - personal or employment granted,
- 6% have public insurance, and
- 32% have no dental insurance.
50% of Canadians in the lower income bracket do not have dental insurance and yet this population has the least access to dental care and consequently bears the greatest burden of untreated disease.
The United States Center for Disease Control and Prevention reports that tooth decay is the most common chronic childhood disease - 5 times more common than asthma in children aged five to seventeen years.
The 2010 Canadian Health Measures Survey reported that 57% of Canadian children from six to eleven years of age have had a cavity, with an average of 2.5 teeth affected by decay and the rates of caries are increasing among children two to four years of age.
The Canadian Paediatric Society states, "Currently, most publicly delivered paediatric dental programs in Canada include only emergency or basic treatment, and cover only limited care for recipients of financial assistance or for children in low-income families. The comprehensiveness of these programs differs significantly among provinces and territories in terms of the types of services covered, age restrictions and limits on the frequency of dental visits."
"In Canada, publicly funded dental services tend to have a lower reimbursement scale than private coverage, i.e., 50% to 60% of Ontario Dental Association fee guide rates. One American study showed that discrepancies between public and private reimbursement rates can lead to public patients not being accepted as readily by all dentists."
For more indepth information including a comprehensive overview of the Provincial and territorial publicly funded, dental programs for children, please click on Oral Health Care for Children provided by the Canadian Paediatric Society.
- Nearly 25% of preschoolers in the United States have baby-teeth cavities before they enter kindergarten states the Centers for Disease Control and Prevention.
- The U.S. National Children’s Oral Health Foundation estimates that 17 million children don’t have dental care every year.
- The U.S. Surgeon General reported that children lose more than 51 million school hours overall because of dental-related problems.
Poor oral health contributes to absenteeism in school, diminished learning ability, decreased nutrition, impaired speech development and self-esteem.
“Thousands of families are uninsured but do not qualify for Medicaid, causing children to lack access to regular and affordable dental care,” said Nicholas Kavouklis, DMD, founder and president of Argus Dental Plan, which provides quality-based Prepaid Dental Plans, Dental Discount Plans, Dental Saving Accounts, Dental PPO, and HMO.
Children with untreated tooth decay can experience oral pain that they might not be able to communicate to their parents. Poor oral health contributes to absenteeism in school, diminished learning ability, decreased nutrition, impaired speech development and self-esteem.
According to Kavouklis, paediatric dental care is one of the best investments for keeping children healthy. Seeing a dentist regularly can contribute to a child’s ability to succeed in school, and provides a foundation for lifelong oral health.
Tips on Selecting a Dentist for your Children
- Choose a dental office that welcomes children and provides them with a positive experience.
- Paediatric dentists are specifically trained to treat the needs of infants, children and teens.
- Each paediatric dental office is different, so look for a clean, kid-friendly environment.
- Make a list of your child's needs. Is the dentist's office close to your home? Does your child have dental anxiety? Does the dentist provide modern dental treatments? Address all your important issues by matching your child's needs to the appropriate dentist.
- Select a paediatric dentist from a reputable source. Speak with other parents in your neighbourhood or community centre and inquire as to whom they use for dental services and how long their children have attended regularly.
- Schedule a 'meet and greet' so you can view the premises and ask questions, such as:
- Does the dental hygienist teach children how to brush and how to floss properly?
- What are the dental emergency hours, if any?
- What paediatric dental techniques are available to soothe children with anxiety?
- What are the costs for paediatric dental services?
- If you don't have a dental plan and your child requires serious dental attention will they provide a plan wherein you can pay monthly over a period of time?
'Healthy Smiles Ontario' Program
Starting April 2014, Ontario will expand eligibility for the Healthy Smiles Ontario program to 70,000 more low-income children and youth aged 17 and under providing access to oral health services such as cleanings, diagnostics and basic treatment. To qualify for the program, families need to have an Adjusted Family Net Income of $21,513 or less for one child, increasing by approximately $1,500 for each additional child.
A new dental clinic at Western University will provide free dental services for individuals from London and the surrounding communities who are covered under provincially funded dental programs, such as Healthy Smiles Ontario and the Ontario Disability Support Program.
The new clinic includes a general anaesthetic suite, two operating rooms and six recovery areas, which, at full capacity, is anticipated to provide dental care to more than 60 people per week. The additional capacity provided by this suite will reduce wait times for vulnerable patients and allow these procedures to be provided outside of a hospital setting, where they have traditionally been performed.
Ontario contributed $900,000 in total to help build the facility, which is the first clinic of its kind for a North American dental school.
Starting August 2015, six publicly funded dental programs will be integrated into one to provide seamless enrolment, making it easier for eligible children and youth to receive timely dental care. This new program will streamline administration and delivery of services, reducing confusion for families looking to access care. Currently, families are required to determine:
- Which of six different programs they may be eligible
- Which services each program covers
- Where they can go to access care
- A simplified enrolment and renewal process
- Access to a full range of dental services, from preventive care such as cleanings and fluoride treatments to basic care such as fillings, extractions and X-rays
- Up to a full year of Dental coverage
Children of social assistance recipients will be automatically enrolled into this new dental program, while all other low-income families will be able to apply through a simplified and streamlined application process.
Publicly Funded Dental Programs that will be integrated include:
- Healthy Smiles Ontario is delivered through public health clinics and private dental offices to eligible low-income children and youth aged 17 and under in need of preventive and treatment dental services including check-ups, cleanings, fillings and X-rays.
- The Children In Need Of Treatment program is delivered through public health clinics and private dental offices, and provides a basic range of prevention, treatment and out-of-hospital anaesthetic coverage to eligible low-income children and youth aged 17 and under who have urgent needs.
- Oral health preventive services provided by Public Health Units to eligible children, including topical fluoride, pit and fissure sealants and scaling.
- Ontario Works is overseen by the Ministry of Community and Social Services and delivered by municipalities and First Nations, to provide financial assistance and help in securing employment to Ontarians in need of temporary financial help. Families who receive Ontario Works are automatically eligible to get coverage for basic dental services for children under the age of 18.
- The Ontario Disability Support Program Income Support is administered by the Ministry of Community and Social Services to provide financial help and other benefits for people with disabilities who are in need, including dental services for children under the age of 18.
- The Assistance for Children with Severe Disabilities Program is provided by the Ministry of Community and Social Services to help parents with some of the extra costs of caring for a child who has a severe disability including health related benefits such as dental services.
- Tooth decay is the single most common childhood disease, affecting 57% of children and 59% of adolescents.
- Cavities can contribute to children's poor nutrition, affect their ability to speak clearly, and influence the growth of adult teeth.
- In 2013, an estimated 300,000 children and youth were enrolled in or were treated by Ontario’s free dental programs.
Provincial and Territorial Government Programs
- Alberta – Alberta Health Services and Alberta Health Services – Price List
- British Columbia – Healthy Kids Program
- Manitoba – Where to Go and S.M.I.L.E. plus Program
- Newfoundland and Labrador – Children's Dental Health Program
- New Brunswick – Healthy Smiles, Clear Vision
- Northwest Territories – First Nations and Inuit Health
- Nova Scotia – Health and Wellness and Income Assistance
- Nunavut – First Nations and Inuit Health
- Ontario - Healthy Smiles Ontario Schedule of Dental Services and Fees
- Prince Edward Island – Children's Oral Health Programs
- Quebec – Régie de l'assurance maladie
- Saskatchewan – Children's Health Benefits and Supplementary Health Program
- Yukon Territories – Children's Dental Program
The Canadian Dental Association provides contact information for all of the Dental Regulatory Authorities and Associations across Canada as well as additional information on caring for your teeth, speaking with your dentist, dental procedures, oral health complications and frequently asked questions. Most of the sites have a 'find a dentist' section. Please contact the dental associations directly for information regarding the services they provide.
- Canadian Dental Association – Dental Care for Children
- Canadian Paediatric Society – Healthy Teeth for Children
- Health Canada – Caring for your Children's Teeth
- A Parent's Guide to Healthy Teeth for Children (Alberta Health and Wellness) – from birth to six years – contains templates that you can print for recording your children's teeth and dental visits.
- The American Academy of Pediatric Dentistry – Frequently Asked Questions (FAQ's)