"Free" dental care for children.

I n light of two fairly recent events — a crisis in pediatric dental care, precipitated by the lack of pediatric anesthe-siologists, and a study from the Quebec Health Department reporting that Quebeckers have some of the highest tooth decay rates in the industrialized world — it is interesting to look at the history of what we have called " free " dental care in Quebec. I doubt that anyone truly believes that we can get a product or service without paying for it. There is always a price tag, and in Quebec, costs for children's dental care or DentaCare, are exacted through our tax system. As the old saying goes — you get what you pay for. This may be true if we carefully monitor purchases, but how well can we do this when we are paying for something indirectly? If we examine Quebec's DentaCare program, we see that it doesn't provide " free " dental care for children, but rather " prepaid " dental care. So, are we getting our money's worth? Does the general population even fully utilize the system in place? In 1974, when the program was initiated, all children below the age of nine could receive both preventive and restorative dental care, paid for by Quebec's insurance system. This worthy grand plan also called for a system of dental education to be provided in schools and in local public health centres. The creators of DentaCare envisioned a new generation of children who would become adults with good teeth and the knowledge and motivation to maintain their oral health throughout their lives. However, the reality does not match the vision. Although dental care is available, with no direct cost to the patients, only about 50% of the population avail themselves of the program. Old family myths and traditions prevailed among the others, who continued to believe that caring for baby teeth was unnecessary, because another set would erupt, and even then, permanent teeth could be replaced by dentures. Without the proposed and necessary input from public health nurses and hygienists in the school system and in local public health centres, these myths were left to prevail, and continue to do so to this day. How did the Quebec governments of the past react? The extra money discovered in the coffers as a result of the program's under-utilization was spent by extending the age of coverage, several …