MONTREAL – An unaffordable price tag kept Melanie Laxson out of the dentist’s chair until the pain became unbearable.With no access to insurance, the 38-year-old says there’s no way she could afford the full cost of a dentist.Canadians spend about $12 billion per year on dental services, but six million people annually avoid dentists because of costs, said a 2014 report by the Canadian Academy of Health Sciences.According to the Canadian Life and Health Insurance Association, some 25 million Canadians, representing 80 per cent of working families, have coverage under extended health insurance which covers dental and prescription drugs, hospital and medical expenses not covered by provincial government plans.Yet insurance typically doesn’t cover the entire dental bill, often leaving patients with large out-of-pocket expenses.Experts say some patients make dental visits a little more affordable by spreading out the frequency of visits, contacting dentists in lower-cost neighbourhoods, discussing alternative treatment plans with the dentist and negotiating lower prices.Laxson turned to a teaching clinic operated by McGill University’s Faculty of Dentistry in Montreal.As she waited for the first of several procedures to extract teeth and get fitted with dentures, Laxson said the clinic gives people with limited means the ability to get the care they need to relieve persistent pain.“When your teeth hurt, it really hurts,” she said.Dr. John Drummond, a Montreal dentist who also teaches at the university, says patients can save about 30 per cent depending on the procedure.However, the tradeoff for lower fees is more time in the dentist’s chair, as dentist-supervised students take longer to perform procedures than trained professionals.He said access to care is an increasing challenge as the cost of dentistry rises while wages remain stable.“There is definitely a section in the middle that doesn’t get to the dentist,” he said in a clinic room with the latest dental equipment.Drummond believes most dentists charge a little above or below the provincial fee guide that lists recommended prices for thousands of procedures.Patients can check by contacting a dentist and comparing the fee associated with a procedure’s specific code with the suggested provincial fee guide.Provinces make fee guides available at public libraries, while some have abbreviated lists on the dental board’s website. Patients can also call the provincial board itself.Pricing differentials are often dictated by the dentists costs to run an office, including rent.But dental groups warn that it’s difficult to shop for a dentist based on fees because most people have difficulty making sense of costs among the thousands of codes in provincial fee guides.The Ontario Dental Association says dentistry isn’t a commodity so treatments should be patient-specific and the result of an exam and diagnosis.“Because dental health varies between people, there really is no average treatment that applies to everyone across the board,” said association president Dr. LouAnn Visconti.The incoming president of the Canadian Dental Association says dentists have no obligation to respect provincial fee guides.Dr. Mitch Taillon of Saskatchewan says cost is a factor for some patients but feeling comfortable with the dentist, technology, convenient hours and location are usually more important.“In my experience cost is one of the factors, it’s not the biggest one,” he said in an interview.Dr. Barry Dolman, president of the Quebec Order of Dentists, said most dentists are willing to help patients with limited means and no insurance to find affordable treatment options.“I think most professionals on a one-by-one basis do have a heart to be able to moderate fees,” he said.But many dentists are reluctant to negotiate.Dr. Drummond says he sometimes works out deals with a patient in need, but he won’t haggle.“I don’t like offering discounted dentistry because then the patients who are paying the normal price are getting short-changed, so I have my fees very up front as being the same for everybody.”Follow @RossMarowits on Twitter.