Pulling out teeth of developmentally delayed unfair solution
By Joan Rush, Special to the Vancouver Sun
If dentists acknowledge their role as health-care professionals providing critically needed treatment, they will never allow vulnerable adults with developmental disabilities to suffer in pain while they whiten teeth for wealthy clients.
Photograph by: GREG WAHL-STEPHENS
Imagine you have a serious toothache. Now imagine you have a serious toothache and a developmental disability. You’re in terrible pain but you can’t tell anyone about it because you can’t speak. No one seems to care.
Limited access to dental care for disabled adults is highlighted in the B.C. auditor general’s recently issued report Disability Assistance: An Audit of Program Access, Integrity and Results. B.C. adults who have developmental disabilities — such as Down syndrome, cerebral palsy and autism — frequently live with painful dental infections, wait months and often years for necessary dental treatment in hospital, or struggle to find dentists who will treat them.
Sadly, it seems neither the provincial government, which is mandated to care, nor the dental profession, which is supposedly trained to care, particularly care. No one seems to care that people with complex developmental disabilities can’t access dental treatment necessary for their health and well-being.
The audit explains that the government dental plan for adults with disabilities pays only 60 per cent of the suggested dental fees listed on the Dental Association fee guide. However, the B.C. Dental Association website states the fee guide is “just a guide” and dentists can charge any fee they choose. So, when considering whether to treat a client with a developmental disability, a dentist can accept the government rate (about 60 per cent of the fee guide), or charge typical fees and bill the disabled client for the outstanding 40 per cent (or more), or the dentist can refuse to provide treatment. Since B.C. adults with developmental disabilities receive only $906 per month to cover all living expenses, including food and housing, they have little left to pay for dental care. Therefore, apart from a few principled dentists, many dentists won’t treat adults covered under the government plan since these people can’t afford to pay the remaining percentage of the dentist’s usual fees.
The auditor also states, “In some situations, clients may receive a less costly procedure rather than what they really need.” Translation: their teeth are pulled out instead of being restored. Many disabled adults have had so many teeth extracted that their caregivers must mince their food, causing other health complications.
An additional barrier is lack of dentist education in treating adults with developmental disabilities, which leaves many dentists feeling unqualified to treat the complex needs of these patients. The Canadian Dental Association has published a statement about lack of access to dental care for Canadian adults with disabilities. However, the CDA-administered Commission on Dental Accreditation, which establishes dental school curriculum requirements, does not compel mandatory training in special needs dentistry.
Do the regulators or dental educators care?
“Not our mandate,” says the Registrar of the College of Dental Surgeons of B.C. He advises the college is not the “lead agency” on this problem, although it is required under B.C. law to serve all members of society. The UBC Dean of Dentistry does not “foresee” any change to the dental curriculum to teach special-needs dentistry although there is no requirement for UBC students to acquire competency to treat patients who have developmental disabilities.
However, the Faculty of Dentistry teaches students about dental implants, an impossibly expensive option for anyone but the rich. Dentists, like financial managers, chase the wealthy, offering Botox treatments and teeth whitening and other expensive cosmetic dentistry.
Access to dental treatment is not a luxury; it is essential for good health and quality of life. We can’t allow people with developmental disabilities to live in misery or lose their teeth because no one cares enough to ensure they can access dental treatment. There are three things we can do:
First, B.C. must establish hospital-based special needs dental clinics with access to general anesthesia suites, so people who require hospitalization for dental treatment can receive care promptly. The regulators, educators and dental professionals agree the province must increase hospital access for adults with developmental disabilities.
Secondly, dental students must be trained in special-needs dentistry.
Finally, government and B.C. dentists must establish a workable fee arrangement.
The first two solutions require commitment from the government, particularly health and advanced education, but the third requires the dental profession to negotiate. A huge part of dental tuition is taxpayer-funded, so dentists have social obligations. If dentists acknowledge their role as health-care professionals providing critically needed treatment, they will never allow vulnerable adults with developmental disabilities to suffer in pain while they whiten teeth for wealthy clients.
Joan Rush, LLB, LLM (Health Law and Ethics), is a retired lawyer in Vancouver who advocates for adults with developmental disabilities.