Building a sustainable and effective federally funded program
CDA supports the FDI World Dental Federation definition of oral health and has worked with provincial and territorial dental associations to adapt a Canadian version of this definition. This holistic approach to oral health includes preventing and managing oral health diseases, as well as consideration for the whole person and how their oral health intersects with their general health and well-being. It is essential that any federally funded dental care program or oral health initiative be designed to be compatible with a holistic approach to oral health.
CDA’s definition of oral health:
Oral health is part of your overall health. With a healthy mouth you can eat, speak and smile in comfort, which helps you feel physically, socially and mentally well. A healthy mouth helps you enjoy life.
Policy design should promote the concept of patient-centered care. Patients should be active participants in their own oral health care, and have timely and local access to preventative care, any necessary treatment and education. The patient-provider relationship should be built on mutual respect and decisions should ultimately be agreed upon by both parties. Putting patients at the centre of the oral health journey allows individual needs, preferences and experiences to be met. CDA respects that the interim Canada Dental Benefit allows treatment decisions to be agreed upon by patients and providers.
Federally funded initiatives should focus on the management of a patient’s oral health throughout their life, in the same way other parts of health care manage chronic conditions and disease on an ongoing, long-term basis. Oral health needs are unique and vary from patient to patient and need to be addressed using more than just a pre-defined list of services. Ensuring that there is flexibility to allow patients and providers to agree on a customized oral care routine and treatment plan is a must.
The federally funded dental care program should be designed to prioritize and promote preventative care. Preventative care, which helps prevent dental problems such as decay and gum disease, is often less expensive and more beneficial for long-term oral health than treating oral disease. An oral health care system that focuses on preventing disease and maintaining oral health by ensuring access to care such as regular exams and preventative services is not only more sustainable but also leads to the best oral health outcomes for Canadians.
Oral health conditions and needs vary greatly from patient to patient, so it can be difficult to estimate the annual cost of dental care. While someone with good oral health may only need routine examinations, radiographs, and preventative services, others may require more significant dental care. Patients covered by any federally funded dental care program should not face arbitrary limits on type or cost of necessary dental treatment. While it may be prudent to set a soft annual cap for budgeting and accountability purposes, this should not be a barrier to patients receiving the treatment they need.
For patients living in rural, remote and northern areas that must travel greater distances to receive dental care, there is a significant advantage to being able to proceed with necessary treatment at a single appointment, rather than forcing a patient to make a return visit. This can also be beneficial for other demographics where there are barriers to accessing care—for example seniors, children, persons with disabilities, medically compromised patients, shift-workers with irregular hours, and even those with dental fear and anxiety. For this reason, the elimination of pre-determination requirements would be beneficial for patients. Being able to diagnose and provide treatment in a single appointment helps break down barriers to care. While understandable in the case of complex treatment plans, pre-determination requirements should not be used as a cost-control mechanism, especially when it impedes the provision of routine dental care.
Canadian dental offices are complex facilities; in effect, they are miniature outpatient hospitals. They provide services often including oral surgery, anaesthesia, and treatment of medically compromised patients. The provision of safe, quality treatment comes at a cost, however. These costs include the facility and associated infrastructure, clinical materials and equipment, dental personnel, and administration. Given the current inflationary environment and the tight labour market, most, if not all, of these overhead costs are rising. Dentists must also account for long-term costs such as infrastructure and technological maintenance and upgrades as well as continuing education that are directly linked to better oral health outcomes for their patients. It is essential that any federal dental care formula ensures the cost of treatment provided to patients is fully covered.
Provincial and territorial dental associations consult with experts and use calculations driven by key economic indicators and financial data to provide their member dentists with a set of suggested fees each year to objectively calculate the cost of providing each dental service. Any federally funded dental care program should use the most up-to-date version of provincial and territorial fee guides as the basis to determine funding of treatment. Depending on the design of the program, balanced billing might be a useful mechanism to make up the difference between any amount covered and the recommended level in the current fee guide. Appropriate funding to dental practices will ensure that dentists can provide high-quality oral health care to all patients and that the federally funded dental care program is sustainable.
The quality of Canada’s dental offices was demonstrated by dentistry’s successful response to the COVID-19 pandemic. Dentistry already had stringent infection protection and control procedures, and, during the pandemic, heightened protocols were introduced. The result: there were no known cases of COVID-19 transmission between oral health professionals and patients in Canada.