Re: Poor Economy Negatively Impacts Dental Health

A SURVEY CONDUCTED IN AMERICA REGARDING COSTS IN DENTAL CARE
Objective: Dental disease is concentrated among those with low socioeconomic status. Dental care is not publicly funded, and many Canadians must therefore make difficult financial choices when accessing dental care. Families who live in poverty have difficulty meeting even their most basic household needs, so dental treatment may not be affordable. The objective of this study was to understand how the cost of dental treatment affects the monthly budgets of families with low incomes.

Materials and Methods: A chart review was conducted for a sample of 213 new patients examined at the Dalhousie University dental clinic over a 1-year period. Costs for proposed treatment plans were averaged. The patients’ ability to pay for proposed treatment was examined in the context of various income scenarios.

Results: Two hundred and one patients were included in the final analysis. Dental treatment costs per patient averaged approximately $1600 for the year, with 42% of the planned treatment completed within the first year. The estimated monthly cost of completed treatment was $55. When the cost of a healthy diet was included in the monthly budget, it was determined that families in Nova Scotia with parents working for minimum wage and those receiving income assistance would experience a 100% shortfall for dental expenses.

Conclusions: Low-income families in Nova Scotia were unable to afford both a nutritious diet and dental care. This is disturbing, given the links between a healthy diet and both overall health and dental health. An understanding of the significance of income shortfalls for those with low incomes, especially as they affect even basic nutritional needs, will help dental professionals to appreciate the seriousness of this issue and the difficulties that many Canadians face when trying to access basic dental care.

Introduction

It is well established that dental disease is concentrated among those with low socioeconomic status.1,2 Even in Canada, which ranks among the most developed countries, those who bear the greatest burden of morbidity have the most difficulty affording dental care.3 In most jurisdictions, those who do not have access to private dental insurance and do not qualify for government assistance programs are required to pay for dental care out of their own pockets.4 This is a difficult situation for many Canadians, especially the “working poor” and those receiving government assistance.4

According to the National Council on Welfare, 11% of Canadians live in poverty.5 Families who live in poverty are known to have difficulty meeting even their most basic household needs.6 Among the most troubling reality is “food insecurity,” a situation characterized by a lack of sufficient resources to meet the requirements for a healthy diet.7 Of particular relevance to dentistry is the impact that dental disease and the costs of dental treatment may have on the household budgets of low-income families and, by extension, their food security. Research has demonstrated that dental disease is linked to food insecurity when food purchases must be compromised to pay for dental care.8 In the face of these difficult choices about how income is to be spent, it is not difficult to understand why many Canadians are unable to place a high priority on dental care.

The purpose of this study was to better understand the economic implications of the real costs of dental treatment as they relate to budgeting for low-income families. University dental clinics provide ideal sites for such research. A large proportion of patients who attend such clinics have very low incomes and seek care in this setting to take advantage of fees that are typically lower than those in private practice.9 Using various income scenarios, we set out to examine dental treatment costs in relation to other household expenses, particularly food costs.
Materials and Methods

In this study undertaken at Dalhousie University, Halifax, Nova Scotia, the average treatment costs for new patients attending the dental teaching clinic were calculated. Ethics approval was obtained from the Dalhousie University Health Sciences Human Research Ethics Board. Retrospective data were collected from the clinic’s computerized patient database (axiUm, Exan Enterprise Inc., Las Vegas, NV). From the list of patients who had received a treatment plan during the academic year 2006–2007, every fifth patient chart was selected to generate a sample of 213 patients. Edentulous patients and children under the age of 16 were excluded using specific identifier codes. The sample represented 14.8% of the 1439 new patients seen that year. Twelve patients had total fees that were greater than 2 standard deviations above the mean, and these outliers were removed, for a final sample size of 201. Income data were not available for the patients in the sample.

The costs of planned and completed treatments were determined for each patient for the 1-year period after approval of the treatment plan. Treatments analyzed included diagnostic and preventive procedures, periodontics, restorative procedures, removable prosthodontics, minor surgery, interceptive orthodontics and endodontics. Prosthodontic procedures related to fixed and implant-retained prostheses were excluded from the analysis because of the complexity of these treatments and the lengthy time frames for their completion. Fees at the dental clinic were based on approximately 50% of the fees in the 2006 fee guide of the Nova Scotia Dental Association (for general dentists). Therefore, an estimation of the costs of similar treatments in private practice can be determined by doubling the fees reported here. Projected household costs for families with various incomes were obtained from food-costing data for 2004/056 and included the cost of the National Nutritious Food Basket (NNFB) for a family of 4. To understand the financial burden of treatment needs for families living at or below the median income range, the average cost of treatment was examined in the context of 5 income scenarios for a family of 4 with 2 children: income assistance without benefits for dental services; income assistance with Nova Scotia Department of Community Services employment support and income assistance dental benefits; employment with minimum wage, with 1 parent working full-time and the other working part-time; employment with average call centre wage, with 1 parent working full-time and the other working part-time; and median income for Nova Scotia families. No adjustments were made to account for the 1-year difference between the income and food-costing data (2004/05) and the dental costs in the fee guide (2006), as the increase in dental fees from 2005 to 2006 was negligible (less than 3%).