Broken teeth and infected gums: 46K claims filed so far with Canadian Dental Care Plan

Massive cavities, mouthfuls of broken teeth, bleeding gums and abscesses — they’re just some of the serious dental issues Dr. Melvin Lee has treated in less than two weeks of providing care under Canada’s new public dental insurance plan.

“I’ve seen a lot of patients that have infections. Not just dental emergencies, but borderline medical emergencies,” the Ottawa dentist said.

“I haven’t seen patients in this condition since I did overseas mission dentistry work in Haiti and Peru.”

Lee is one of nearly 9,000 oral health care providers who have signed up so far to provide care under the Canadian Dental Care Plan (CDCP).

That number has grown significantly since last month, when Ottawa said 5,000 had registered. There are approximately 30,500 oral health care providers across the country that could sign up.

The public plan eventually will provide dental coverage for one in four low- and middle-income Canadian residents who don’t have private dental coverage.

As of May 1, eligible seniors 70 and older are covered and registration has opened for seniors 65 and older. To date, 1.9 million seniors have been approved for the plan.

Lee began treating patients on May 1 and has seen about 20 seniors through the CDCP.

Seventy-nine year old Morton Brisard was one of his first patients. He booked an appointment the first day he was covered.

“We are so happy,” Brisard said, adding he hadn’t seen a dentist in five years because of the cost.

“The dentist is expensive, so that is why I wait, I wait, I wait, till the problem was very bad,” he said. “Every morning when I wake up I have blood come from my mouth.”

Dr. Lee said most of the seniors he’s seen under the CDCP have been in a similar state, having avoided visiting an oral health care provider for years because they didn’t have private insurance and couldn’t afford to pay out of pocket.

“I’ve been reminded time and time again of the moral and ethical duty to serve, with every one of these patients that comes through,” he said.

The federal government said that 46,000 claims have been processed under the CDCP to date.

Lee said his clinic has been reimbursed for the procedures within 48 hours by Sunlife, the insurance company that Ottawa contracted to administer the plan.

“It’s been seamless,” Lee said. “It’s been no different than regular insurance.”

For most of the procedures he’s done, Lee said, the federal government is reimbursing him at about 80 to 90 per cent of what the Ontario Dental Association recommends. That’s similar to private plans, he said, where dentists charge their patients the difference.

But provincial dental associations across Canada have raised concerns about the CDCP, arguing the national program requires dentists to agree to unnecessary terms and conditions.

Ottawa has attempted to deal with those complaints. It announced recently that oral health care providers can begin accepting patients and billing directly to the plan starting July 8, without registering as a provider.

“We want this program to work,” said Dr. Brock Nicolucci, president of the Ontario Dental Association.

The auditing process also allows Sunlife to request individual patient records, which isn’t something other insurance programs require and could lead to privacy issues, Nicolucci said.

“We are committed to working with the Health Canada to get this right. And we hope it doesn’t take much longer,” he said.

Dr. Carlos Quiñonez, director of dentistry at Western University in London, Ont. and an expert in dental public health, said he’s optimistic about the program’s prospects for success, especially as dentists and their patients get used to the new system in the weeks and months ahead.

“Based on my discussions with leaders in dentistry and dentists alike, there seems to be a sense that we are moving in the right direction with respect to discussions with the federal government,” Quiñonez said.

“That gives me hope that in the end, this will just be another public dental care plan within the country that is remunerating fairly, that covers the services that patients need, and that is just part and parcel of delivering dental care in our country.”

At a cost of $13 billion over the next five years, the CDCP is being rolled out gradually through 2025, starting with seniors first.

In June, the program will expand to people with disabilities and teenagers. An interim dental plan has been covering kids under the age of 12 since December 2022.