Allison Hanes: Dental program for Montreal’s vulnerable is expanding

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Pierre Serge Grenon long had a habit of grinding his teeth.

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Whenever the stress in his life increased, the tension got worse — until the 70-year-old said he was in constant pain and his teeth were badly damaged.

“When your teeth hurt, it affects everything,” Grenon said. “I had trouble sleeping. My jaw hurt. My head hurt. It was torture.”

But adding to his agony, he couldn’t afford to visit a dentist. Quebec only covers emergency dental care, limited service for social assistance recipients and some basic procedures for children under 10. Everyone else must pay out of pocket unless they have private insurance. That leaves about 27 per cent of Quebecers without access.

“If you don’t have money, you have no choice but to suffer,” Grenon said.

While the minority Liberal federal government is promising to roll out a national dental plan in exchange for support from the opposition New Democratic Party, it could still be a long wait for people in Grenon’s position.

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Fortunately, he was finally able to get relief this spring through the Welcome Hall Mission, which in partnership with the McGill University’s dentistry program treats some of the most vulnerable Montrealers. Since 2011, the Mission has operated the Jim Lund Dental Clinic at its main facility in St-Henri, while McGill has provided the dentists from among its faculty and students.

Now the program is doubling in size with $800,000 raised from Welcome Hall donors. It will soon be able to offer up to 8,000 procedures a year, add new equipment, increase operating hours and offer more specialized services, said Dr. Elham Emami, dean of the McGill University Faculty of Dental Medicine and Oral Health Sciences.

The clinic is also opening on Saturdays to make it easier for people to get seen. And there is also a specialist in prosthodontics available, to treat complex cases like the restoration and replacement of damaged or missing teeth.

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“Our dentists are doing many extractions. When you extract the teeth, that means that the person hasn’t had the opportunity to restore their teeth at an earlier stage. Like all diseases, it starts small, with maybe cavities and then progresses to extraction when we can’t do anything,” Emami said. “Poverty is a determinant of poor oral health. The socioeconomic determinants are there. This is why you see this.”

Once teeth are removed, a full or partial denture or a prosthetic is required. The clinic has been referring patients elsewhere for those services and helping fund the cost.

“Now, having this new clinic with the new equipment, we can provide more specialized care as well. So one of the new pieces of equipment, for example, we are bringing there is a panoramic (X-ray) that we didn’t have before, which will allow us to do more diagnosis of disease,” Emami said. “I hope that in the future we can do more rehabilitation, so dentures, partial dentures, that would be some of the services we are actually thinking of doing there.”

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Sam Watts, CEO of the Welcome Hall Mission, said many Montrealers from a variety of backgrounds simply can’t afford basic dental care, among them: new arrivals, unhoused people and those living below the poverty line who don’t qualify for social assistance. Although there is increasing recognition that oral health is an important component of overall health, too many people are left to fall through the cracks in the system.

“Up until now it’s just been something our donors have funded,” he said. “I always have questions from donors saying ‘Why are we funding this when it should be part of basic health care?’ And I say, ‘Well, because right now it isn’t.’ ”

But the tide may be turning. Quebec policymakers are realizing that the province has fallen way behind on dental care, with long-term repercussions on the entire health system. And federal political leaders are discussing a national program, which would hopefully come with requisite funding.

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If these initiatives advance, the pioneering work of the Welcome Hall Mission and McGill could serve as a template.

“The model of community dentistry is an important way to deliver the service,” Watts said. “One of the ways to make that improvement happen is to provide people who are disadvantaged or vulnerable with the opportunity to access something that’s right in their community and experience dental care with dignity. For us, the whole dignity piece is a big deal at the Mission.”

The importance of dental health is given short shrift, said Emami, even though studies have found associations between oral disease and colorectal and cardiac problems.

“Besides the impact of physical health, there is also an impact on psychosocial well-being, self-esteem, quality of life,” she said. “There are several articles and a good body of evidence that tooth loss and oral diseases really have an impact on the sociological aspects of health and mental health also.”

Basic dental care can make a big difference. Once Grenon secured his appointment with the dentist at Welcome Hall Mission, he was offered help on the spot.

“I didn’t even have to come back. Now there’s no pain,” he said. “This clinic saves lives. They’re angels … angels on Earth.”