Jason Jones is 25 years old, and nearly all his teeth are missing.
Decayed to the bone, his nerves exposed, the years of endless pain led Jones to seek the removal of his teeth, using his wife's entire savings to pay the oral surgeon's $600 fee.
The reason Jones lost his teeth is simple: he is poor. There is no public dental insurance for the working poor in Ontario, and only partial coverage for those on social assistance, meaning the government will pay for a few emergencies, such as tooth extraction, but not to prevent them from rotting in the first place.
Two months after the surgery, Jones's appearance is startling – he has the wide eyes of youth and the gaunt jaw of an elderly man. And worse, he is still in pain. The surgeon left in his two bottom front teeth, saying they would be anchors for his false teeth, but they are rotten and feel like shards of broken glass poking into his gums.
A dentist at a low-cost clinic quoted him $2,150 for the final two extractions, tooth posts and dentures, far out of his price range, but he is hoping to find a new job and save enough money.
For now, he is learning to eat only soft foods. "I maybe eat one meal a day. I can eat chicken, if I cook it just right. I chew it with my fingers in a way. Sandwiches, I can eat. Peanut butter and jam sandwiches. I can chew them with my tongue," he says.
The lack of dental coverage means those with little money have been shut out of the preventive care that leads to healthy teeth. No one knows how many go without dental benefits but nearly 900,000 Ontarians survive on low incomes, meaning they are either on social assistance or working in low-paying jobs.
Medically, dental disease is associated with diabetes, heart conditions, infections and diminished health. Economically, it lessens the odds of finding a job, or job advancement.
Medical practitioners who work with the poor say the impact is extreme. Minor tooth problems turn into decay, which can develop into abscesses and require extraction. One doctor described a beautiful woman with a low income with gaping holes in her teeth. A nurse said patients with minor dental problems will watch their teeth blacken in a decade if they do not receive treatment.
Toronto Public Health operates 13 free dental clinics for low-income children and seniors, and there are several other clinics that offer lower fee services to residents of all ages. But, the city's chief dentist, Dr. Hazel Stewart, says waiting lists are months long and for most working poor adults, affordable dental care is unattainable.
"I get calls from people who are trying to go for a job interview. They say, `Can you help me? Because my front teeth need to be fixed and I know I am not going to get the job looking like this.' Really, there is no place for me to send people like that," Stewart said.
Dr. Stephen Abrams, a Toronto dentist and spokesperson for the Ontario Dental Association, says low-income adults in Ontario have very few options. "You are really in a very difficult situation."
"Tooth decay is an infectious disease and it needs to be treated just as one would treat other diseases," he said.
Dental care was not included in the Canada Health Act, the legislation that determines which medical treatments provincial insurance like OHIP must cover. The federal Act only requires that provinces pay for dental care that requires treatment in hospital.
In Ontario, social assistance programs like Ontario Works and the Ontario Disability Support Program provide limited dental care. Children whose families are on social assistance receive basic preventative dental care until they are 18 as long as they remain in school. Adults on Ontario Works, formerly called welfare, are only entitled to emergency care. In Toronto, that includes extractions and root canals of the front teeth. There is no preventative care.
For children whose parents are on low incomes, but not receiving social assistance, there are 13 clinics across the city that provide basic dental care.
Low-income seniors also receive treatment at these clinics. Every year, there are 20,000 visits from children and youth, and 7,000 from seniors. Additionally, there are six community or university clinics that offer either free services to street youth, or lower cost services to adults.
Dr. Michael Cusato has a private dental practice but volunteers at the Urban Dental Clinic at Scarborough Hospital on Lawrence Ave., a clinic for low-income residents who need mostly emergency care. Demand for the volunteer dentists who staff the clinic is so high that there is a waiting time of several months.
"A lot of time is spent putting out fires," Cusato said. "There is a need for the preventative aspect, where they can come in and get their teeth cleaned, because a lot of gum diseases and things like that need regular care."
Some clinics, like the one offered by George Brown College, provide low-cost cleanings, but few offer more than emergency care that Dr. Cusato provides. Outside of Toronto, the need is even higher. Advocates say that without a provincially mandated dental plan, the services will continue to be hit and miss.
Organizations like the ODA and the Toronto Dental Health Coalition have separately lobbied the Ontario government, asking it to provide basic dental care to low-income residents, and to improve coverage for adults on social assistance. Little has changed, although people returning to work after being on social assistance are now entitled to keep their medical and dental benefits for six months. So people like Jones, who has spent his adult life working in full-time, low-income jobs and cannot afford any dental fees, are simply out of luck.
From the time he was a child in North Bay, Jones had trouble with his teeth. He has a tiny mouth and his teeth grew in twisted and crowded. In his sleep, he ground them down, digging holes through the enamel. His mother was on social assistance, so he received basic dental care. He was given a mouth guard to stop the grinding, but wore it out in a few weeks. Over time, he had some fillings and a few teeth pulled in an attempt to make room in his crowded mouth.
There was no money for braces, so his teeth remained crooked, the cause, dentists have since told him, for the incessant grinding. Over the years, as his teeth rotted, his nerve endings became exposed. His teeth grew painful to touch and difficult to clean.
"It made me very depressed."
By the time he was 20, "I didn't even want to smile," Jones said.
When he was 23, Jones and his live-in partner, Candice, moved to Toronto. For one year, she worked in a daycare centre, and Jones had access to her company benefits. He immediately saw a dentist, who used up Jones' annual limit trying to clean his teeth and give him fillings. It was too late. The pain from the cleaning, Jones said, brought tears to his eyes and his teeth were so decayed that the fillings fell out.
In job interviews, potential employers stared at him. His personality veers towards gregarious, making him a natural for sales, but the jobs he found were out of the public eye. He worked full-time in machine shops, running the punch press.
"I was really good at what I did, I was really fast," Jones said. When the pain was most acute, it forced him to slow down, and, combined with an injured arm, it diminished his production of parts. He quit some jobs, and was fired from others.
In the summer, Jones said, he went to see a pain specialist, Dr. Peter Charlebois, who practises at a clinic at Kennedy Rd. and Eglinton Ave. in Toronto. Charlebois was appalled at the state of his teeth, and his inability to pay for proper care.
"This is Canada," Charlebois said. "I cannot believe that this is happening in a country as wealthy as this."
The doctor sent him to a nearby dentist, who said the only solution was to have his teeth pulled. Jones was referred to an oral surgeon, who operated in Scarborough Grace Hospital in December.
For most Canadians, dental coverage is accessible through work or other private benefit plans.
For those who have it, it can mean visits to an oral hygienist for cleaning and other preventative treatments every three or four months.
Advocates, from those who represent poverty health coalitions to the Ontario Dental Association, have for years lobbied the province to increase dental care for the poor.
"Governments are slow beasts to move," observes the ODA's Abrams.
A few weeks ago, Abrams said the ODA met with officials from the community and social services ministry (which oversees the dental care offered by the Ontario Works and the Ontario Disability Support Program).
The association wants the ministry, along with the ministry of health, to increase funding so dental services can be offered in private clinics, the dental schools at the University of Western Ontario and the University of Toronto, and community health clinics. Prevention of tooth decay is a cornerstone of the ODA's proposal, he said.
"It needs a will on the part of the government to recognize that these are important services," Abrams said.
Provincially, little has improved. Federally, in 2004, a Chief Dental Officer, Dr. Peter Cooney was appointed, with a mandate that will, in part, examine dental care information collected by the Canada Health Measures Survey.
Toronto's chief dentist, Dr. Stewart, who was part of the Toronto Oral Health Coalition, said the appointment of her federal counterpart is a good first step but in the interim, wants the province to provide more care in community clinics.
"It is very difficult to tell someone who is in pain, or has a swollen face, that you have to wait three months before you see the dentist," Stewart said.
"Dentistry is pretty expensive. It wasn't written into the (Canada Health) Act and looking back, that doesn't make sense because, for example, an abscess in any place in your body should be looked after.
"There is no reason why you shouldn't, at the very least, have access to the relief of pain and the condition that is causing the pain. That is very basic, in any health system," Stewart said.
For Jones, it will be months before he can afford dentures. He is on unemployment insurance, looking for a new job and awaiting the birth of his first child.
Once, people stared at him because of his teeth. Now they stare because of the emptiness in his face.
"They say, Oh my God,' what happened to you?' I tell them, `It's a very long story. Goes back to the time I was a kid.'"
http://www.thestar.com/article/180323
Reporter Moira Welsh talks about her Saturday Star special on dental benefits and the working poor -- the latest instalment in the Star's continuing series War On Poverty.
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