MACLEAN’S REPORTS

Why Canadian kids get a rotten deal in dental care

JANICE TYRWHITT,DOUGLAS MARSHALL January 1 1967
MACLEAN’S REPORTS

Why Canadian kids get a rotten deal in dental care

JANICE TYRWHITT,DOUGLAS MARSHALL January 1 1967

Why Canadian kids get a rotten deal in dental care

MACLEAN’S REPORTS

THERES A 13-year-old girl in a downtown Toronto school who’ll be wearing a complete set of false teeth for the rest of her life. All her natural teeth were too rotten to save. They were pulled out after an exasperated teacher finally took the girl to a free dental clinic run by the local board of health. It was her first visit to a dentist and she was not unusual. Seventeen percent of Toronto children aged five to 19 have never been to a dentist either.

In terms of free dental care, Toronto is better off than the rest of Ontario. And Ontario, along with British Columbia, Manitoba and Alberta, is one of the best-served provinces. An average 15year-old in Nova Scotia has 10 decayed teeth of which only 2.5 have been filled; five haven’t been treated and 2.5 have been pulled. But Nova Scotia, with one dentist for every 3,859 people, is luckier than Newfoundland which has one for every 11,167. In normal practice one dentist can serve 850 people.

Canada is one of the few remaining developed countries without organized dental care for children. Throughout the country free care—even the simple early examination that might have saved the Toronto girl’s teeth—depends on the efficiency and generosity of local boards of health and education. At best it’s haphazard; frequently it’s non-existent. Too often the hardpressed free clinics that do exist find themselves performing major rescue operations that could easily have been prevented by a comprehensive dental program.

Generally speaking the provinces have steered clear of dental programs involving the actual treatment of children—except to provide mobile units in some rural areas. Most big cities maintain free clinics — usually for poorer children in lower grades. But even so the percentage of city children who have never seen a dentist is remarkably high (7.1 percent in Edmonton; 11 percent in Regina and Saskatoon) and much higher for the provinces as a whole.

In Quebec Dr. Louis J. Bonneau, director of the provincial government’s dental-health division, estimates that about 30 percent of the children in the province have never sat in a dentist’s chair. Like most other provinces, Quebec’s immediate plans to deal with this

situation mainly involve increased fluoridation. Although Montreal still lacks fluoridated drinking water, the province expects all first-graders will have their teeth painted with fluoride starting next September.

Alberta and Manitoba offer dental care through their provincial versions of medicare—in both cases after means tests. The only fully comprehensive free dental program in Canada is in the Swift Current, Sask., public-health region. It provides total care for children 12 years and under—regardless of parents’ income—with the aid of government grants. A similar program planned by three other health regions in the province had to be cancelled because of a shortage of dentists.

This shortage is critical across the country. Although Health and Welfare Minister Allan MacEachen has forecast a comprehensive dental program by the 1980s, he hasn’t suggested how to raise funds or train dentists for it. The Scandinavian countries consider their dentist-to-population ratio of 1:1,370 just adequate for their program of free dental care for school children. The ratio in the United States is 1:2,100. Canada, with a ratio of 1:3,100, is hoping to achieve a ratio of 1:2,500 by 1990.

Right now we have only seven dental colleges. Dalhousie has the only fac-

ulty of dentistry in the Maritimes (in Nova Scotia one dentist has come out of retirement to give free treatment to children) and Saskatchewan is building its first school.

Assuming the dentists could be found, politicians are frankly frightened by the high costs of dental care. Some U. S. studies based on private schemes have estimated costs as high as $70 per child for initial care (diagnosis and treatment of neglected teeth) and $45 a year for maintenance. Medicare, by comparison, is estimated at only $40 per person. But other dentists point out that fluoridation can cut dental costs for children in half by reducing decay 60 percent in those who drink fluoridated water from birth. In Brantford, Ont., where the water has been fluoridated since 1945, the average five-year-old now has 2.6 decayed teeth contrasted with 5.6 in 1944.

There are no signs that denticare will stir up the militant professional opposition aroused by medicare. Dr. W. G. Campbell, registrar of the Manitoba Dental Association, says: “There’s no question the profession will agree. How happy dentists will be will depend on what kind of financial arrangements are made.” Dr. Campbell thinks most dentists accept denticare as inevitable but will try to gain a hand in controlling the plan.

The Canadian Dental Association is already mellowing. Two years ago the CDA was severely critical of the Hall Royal Commission’s report on health services, which recommended a dental program for children and suggested the use of “auxiliaries,” nurses trained to fill children’s teeth. (This system has been used in New Zealand since 1922 and Saskatchewan recently proposed a crash program that includes two-year training of dental auxiliaries.) The CDA has now modified its views and has directed its dental services committee to draft a dental-program plan which it hopes to present at its national conference next May.

Dr. A. M. Hunt, professor of dental public health in the University of Toronto, recently published an article in the Journal of the Canadian Dental

Association urging a responsible plan for children’s care. Hunt says a realistic plan would start with a full program for five-year-olds and extend year by year until all school-age children are included. Hunt notes that New Zealand's dental program covers nine out of 10 children; in Canada right now two out of three children receive little or no dental care.

“Canadian kids are getting a bad break,” says Hunt. “It takes three years to plan a dental school and five years to turn out your first dentist. If we’re going to have a children’s dental program within 10 years, we’ve got to start planning right now.”

JANICE TYRWHITT and DOUGLAS MARSHALL