When Dr. Brandon Doucet is not helping clients in Maritime jails with their teeth, he is advocating for public access for dental care across Canada.
Now, the dentist has become a full-fledged author with the release of his debut book About Canada: Dental Care.
Early in his studies at dental school, Doucet realized Canada needed to change the way it offers dental care. That’s why he started the Coalition for Dental Care, a group of medical professionals and public stakeholders determined to highlight the shortcomings of Canada’s dental care system while also advocating for humane alternatives.
But it wasn’t until the spring of 2020, when the COVID-19 pandemic forced widespread closures that included dentistries, that Doucet had the time to pen a comprehensive understanding of the state of dental care in Canada.
Through his work, Doucet quickly realized it’s not just the odd person falling through the cracks, but a large portion of Canada’s population who face barriers to accessing dental care.
The cost of inaction
One of the key elements of Doucet’s book focuses on the prohibitive costs of seeing a dentist, and the extreme cases of dental disease that come as a result of a lack of care.
While it can be hard to gauge how many taxpayer dollars are wasted by inadequate access to dental care, Doucet offered some pretty grim statistics.
He explained that many people who cannot afford to see a dentist often end up in doctor’s offices and emergency rooms to seek relief from dental pain, which makes up for about one per cent of ER visits and costs over $150 million per year.
And after all that, patients still need to see a dentist as physicians aren’t trained to treat the root cause of oral pain.
“They don’t know how to do root canals or take out teeth and stuff like that,” Doucet said. “The person is given an antibiotic or pain medication and told to go see a dentist afterwards. So it’s really a waste of money.”
In his book, Doucet also explores the effects poor oral health can have on overall human health — from diabetes complications and worsening heart disease to increased rates of aspiration pneumonia and, in rare cases, sepsis.
What’s incredible to Doucet is not the variety of issues caused by poor oral health, but the reactive treatment offered by medical professionals who, with proper funding, could prevent the problems from happening at all.
“We have the technology to solve these problems, we have the solutions, we just don’t have the distribution,” Doucet said.
The need to shift to public spending and delivery of dental care
With nearly 95 per cent of dental spending in Canada coming from private sources, the country has a long way to go to address inequalities in access to oral care. Doucet noted that Canada spends less on public dental coverage than the U.S., Germany and Japan.
How can Canada catch up to its G7 counterparts? Doucet says it starts with the funding of dental care coupled with its delivery.
The country is beginning to see a shift in oral care access as Prime Minister Justin Trudeau’s Liberal government continues to slowly roll out a dental care plan to preserve their supply and confidence agreement with the NDP.
LISTEN: Dental care in Canada – How did we get here, where are we going?
Looking at polling numbers for the next federal election, Doucet is hardly surprised the Liberals are following through on their commitment to reform dental care in Canada.
Last month, Finance Minister Chrystia Freeland announced $13 billion over five years for the country’s dental plan, with $4.4 billion in ongoing, permanent funding moving forward.
Calling the funding “a massive step in the right direction,” Doucet added that there is a lot of work that still needs to be done. After all, the additions to Canada’s dental care spending would only bring the country to about 25 per cent of public funding, still below the Organisation for Economic Co-operation and Development (OECD) average.
“Fundamentally, we need to shift towards providing care based on need, rather than how profitable someone will be in your chair for a chunk of time,” he said, pointing to issues with the pay-per-service model which favours those with private insurance plans.
Doucet suggests introducing more dental therapists to help bridge the gap by offering procedures like fillings, simple extractions and cleanings at “a fraction of the cost of a dentist.”
“Why does a filling have to cost $250?” Doucet asks. “Well, it’s because dentists have a monopoly on care and they are the ones that have been dictating the terms of these things, which is why the cost of dental care has been rising faster than inflation for many decades.”
The need to increase the public delivery of dental care is urgent, according to Doucet, as the rise of dental corporations continues turning clinics into money-making machines. What happens as a result, he added, is the risk of overtreatment — prescribing clients more things just to help the corporation’s bottom line.
“There’s just no oversight of it in Canada, it’s very scary,” Doucet said.
Oral health and employability: Breaking the cycle of poverty
Aside from the health issues associated with poor oral health, dental care also affects people psychologically and socially.
“Our smile has such an impact on our self-esteem, how we interact with the world,” he said, noting that having missing front teeth or visible dental decay can play a significant factor on employability. “This is a big problem for many issues, but basically, it’s one of the reasons people get trapped in the cycle of poverty.”
Ultimately, Doucet believes ensuring access to dental care is a way of helping people live dignified quality of life, while also breaking the cycle of poverty at the same time.
Look no further than federal prisons for a cold, hard look at the inequalities of dental care. Doucet says many adults have admitted he was the first dentist they have seen in their entire lives, while others opened up about deferring their release date to have their teeth extracted and dentures made, because otherwise, they would not be able to find a job.
“They actually choose to stay in prison longer,” Doucet said. “It’s so hard to wrap your mind around what their living conditions actually are to actually come to that conclusion.”
While society has tended to blame people on an individual scale for their oral health issues, he is hopeful that by broadening public access and delivery of dental care, that there will be more acknowledgements of the societal structures that contribute to those health problems.
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