The Road to Health Starts Here

The 2005 updated Ontario Curriculum for Grades 1-8 on Health and Physical Education says the following:

“Topics related to healthy eating include nutrition, eating disorders, body image, and dental health. Students require knowledge to make healthy eating choices. Using this knowledge, they will examine their own food choices and eating patterns, and then make wise decisions and set appropriate goals. In later grades, students will learn more about the factors that affect healthy body weight and lead to eating disorders, and will increase their understanding of a healthy body image. Throughout the healthy living strand, the importance of healthy eating and regular physical activity is emphasized.”

Dental health is integral to physical health but what our teachers may have neglected to mention is that except for the lucky few with private insurance, the cost of maintaining the health of your teeth and gums would have to come out of your own pocket.  For people living and coping with the many stresses of HIV/AIDS, the burden and responsibility of maintaining healthy teeth and gums can prove to be onerous indeed.  The fathers (and hopefully mothers) of the Canada Health Act were silent on a number of matters when they formulated the Act.  They got the following five principles right: Public Administration, Comprehensiveness, Universality, Portability, and Accessibility) but were silent on the obligation of the health care system to cover the cost of drugs (outside of hospital) and specifically to ensure coverage of basic dental health care within the principles of “Comprehensiveness and Accessibility”.

CTAC has long believed that PHAs are particularly susceptible to problems related to the teeth and gums that arise with a compromised immune system regardless of where people are on the spectrum of treatment – watchful waiting or on ARV.
Today we know that no treatment of any oral health problem should be avoided simply because a person is HIV+. This is in contrast to assumptions years ago that some procedures such as root canals should not be performed in people with HIV, or that dental treatment should be postponed for anyone with a low CD4 cell count.

We still encounter stories of people who are refused treatment even though the Canadian Dental Association (CDA) said on WAD in 2007: "CDA has lead in development of guidelines for patient care and in the dissemination of information to the dental community in Canada since the onset of the epidemic". (Dr. Joel Epstein)

It is now recognized that all procedures and devices, including periodontal surgery, root canals, orthodontics (braces and retainers), implants, bleaching, and bridges can be safely and effectively provided regardless of immune status. Decisions about such procedures should be made by the HIV-positive individual in consultation with his or her dentist. While dentists recommend that all people seek routine care to prevent oral health problems from developing, this is particularly important for those living with HIV. One rationale for this preventive measure is that individuals with a compromised immune system need to avoid bacterial infections. The two major oral health conditions, dental caries and periodontal disease, are both caused by bacteria and may be exacerbated by other factors.

The cost of many of these procedures can be prohibitive for people who are already coping with “catastrophically” high medical expenses.

That is why CTAC has decided to create a position paper that will examine how dental costs are covered for citizens of other countries and for Canadians in different provinces and territories. The paper will make recommendations for coverage for Canadian PHAs who are low income, without private insurance or inadequately covered for adequate dental care.  It is expected the paper will take a look at how various public and private insurance plans define “basic” dental care. It will attempt to cost out the added cost to governments of assisting low income PHAs with coverage for basic dental care, and will examine possible cost-control options such as means testing or deductibles.  The Trillium Drug Program in Ontario is one example of a provincial catastrophic drug program that could be extended to offer coverage for dental or oral care.

When AIDS activists in Ontario fought for and won the creation of the Trillium Drug Program, it was extended to offer assistance to all Ontarians with low income and high drug costs – in other words, a victory for all Ontarians.  As you may know, CTAC is working currently on its “White Paper on a National Catastrophic Drug Program” and it is expected that in advocating for PHAs, we are at the same time striving to create a national program of benefit to all Canadians based on need and not on specific illness or disability.