Indigenous people in remote communities may not see much benefit from national dental care plan

The co-founder of the Indigenous Dental Association of Canada says along with expanding coverage, the federal government needs to be improving access to dental care for those who live in remote communities to keep oral health gaps from widening. 

"Unless we're dealing with the issues that Indigenous people are facing ... they're actually leaving us behind," said Sheri McKinstry, a pediatric dentist who is a member of Sagkeeng First Nation, about 100 kilometres north of Winnipeg. 

First Nations and Inuit populations in Canada had nearly twice as much dental disease and more unmet oral health needs compared to non-Indigenous people, according to a 2017 report from the Office of the Auditor General of Canada. 

McKinstry said it doesn't matter how much money is available for dental care if there is no one in your community offering services, or if you're facing barriers such as racism in the health-care system. 

"In my opinion, we're just not moving fast enough unfortunately and I would like to see that improve," said McKinstry. 

The new national dental-care plan is rolling out in a phased approach starting with seniors and children under 18 and expanding to all eligible low- and middle-income Canadians in 2025. 

To be eligible for the program a person must have a household income under $90,000 and not have access to a private insurance plan. The person must also have their taxes filed up to date so the government can verify their income. 

The existing Non-Insured Health Benefits program covers certain health care costs, such as most routine dental work, for First Nations people with status and Inuit. 

"Even though the Canadian Dental Association refers to NIHB benefits as a robust access to dental care, it still falls deficient and it's very limiting," said McKinstry. 

The NIHB program has been criticized for being inconsistent in its coverage and made changes to its dental policy in 2018 after the federal government spent $110,000 in court fighting an Alberta family over an $8,000 bill for braces. 

The Canadian Dental Care Plan can help cover some of the out-of-pocket costs not covered by NIHB, said McKinstry. 

She added that Métis and non-status First Nations people may have the most to benefit from the plan because these groups are unable to access NIHB. 

"There's always been that inequality that was happening between Indigenous groups in the first place," said McKinstry.

Health Canada and Indigenous Services Canada did not respond to a request for comment by time of publishing.  

Legacy of substandard oral care 

Systemic barriers to dental services are not new, said Catherine Carstairs, a professor of history at the University of Guelph. 

Carstairs was the co-author of an article in Canadian Historical Review that looked at oral health care of Indigenous people from 1945-79.

"The Department of Indian Affairs, as it was called then, really denied that it had any obligation to provide oral health care to Indigenous people," said Carstairs. 

Overall the care provided at the time was austere and focused on cost savings, she said. 

Carstairs said there were clear disparities between the care settler children received, who got services like fillings, while Indigenous children would more often have teeth extracted. 

"Lots of people lost teeth that could have been saved," said Carstairs.

Carstairs said the archival material she reviewed had accounts of people trying to receive dentures but having to save up to $25 to help pay for the service, or being denied funds from government health services. 

"Even if there was a dentist in the community, they often didn't want to take Indigenous patients because they were aware that they were being reimbursed at rates way below their general fee schedule," said Carstairs.