Canada - A mouthful of problems

Dr. Ross Anderson, chief of dentistry at the IWK Health Centre, says the waiting list for dental surgery in Nova Scotia and across the country is ‘out of control.’ (ERIC WYNNE / Staff)

A mouthful of problems
N.S. youngsters suffering with gum disease, abscessed teeth, infections
By JOHN McPHEE Health Reporter
Sat. Oct 3 - 5:21 AM
THE IMAGE on the computer screen tells the story of a little boy’s suf­fering.
The photo shows a three-year­old’s teeth — or what’s left of them.
Most of his 20 teeth are ravaged by cav­ities. Many are simply reddish-brown stumps.
Dr. Ross Anderson, chief of dentistry at the IWK Health Centre, brings up a photo of another boy who was a patient at the IWK dental clinic. One side of his face is red and swollen to the point that his eye is partially closed.
“Here’s the bad things that happen," Dr. Anderson said in a recent interview. “Pain, infection. We see two, three kids a week whose faces swell up and we have to drain the pus to make them better."

Dr. Anderson has many similar photos stored on his computer. He also has a slew of reports, statistics and other documents that tell another story: Nova Scotia faces a big problem in treating dental disease in young children.

Early childhood caries are on the rise among Nova Scotian children, he said. Gum disease is the most common chronic disease among children. The waiting list for surgery in Nova Scotia and across the country is “out of con­trol," he said. Dr. Anderson acknowledges waiting lists aren’t uncommon in our health system. And there’s a tendency to dismiss dental problems as minor, com­pared to other diseases.
But the consequences of ab­scessed teeth and infected jaws are anything but minor, he said. In the most severe cases, den­tal problems can slow a child’s growth.
“When you have a mouth that looks like that (photo), you’re probably going to have trouble eating," Dr. Anderson said.
Besides Dr. Anderson, there are four specialists in the prov­ince who can perform dental surgery on children. The prov­ince needs twice that number to deal with the need, he said.
About 350 children, ranging from toddlers to teens, are wait­ing for surgery at the IWK alone. While the hospital deals with some cases quickly, particularly if the patient is seriously ill with another disease, some children must endure eight to 11 painful months waiting for surgery.

The procedures can involve filling and capping multiple cav­ities to more complicated oper­ations such as draining an in­fected jaw. As for the children waiting to be seen, Dr. Anderson and other dental specialists must spend hours on the phone with parents talking about pain management The IWK operating committee recently gave the clinic 150 hours of additional surgery time, which will reduce the wait­ing list by about 50 children.

But these are only stopgap measures, said Dr. Anderson, who has sent the province a re­port detailing the need for more pediatric dental specialists in Nova Scotia.

The report includes data from a recent study that reveals pedi­atric surgical wait times are “out of control" across the coun­try, he said.

“While I’ve been telling people it’s bad, we never really had data to say how bad it is."
For example, children with se­verely abscessed teeth should get surgery within 42 days after they are first seen. About 67 per cent wait longer, although the IWK clinic does a little better at 65 per cent.
Nova Scotia isn’t the only province facing specialist short­ages and long waiting lists, Dr. Anderson said. The lack of in­centives for training in this area is a big part of the problem.
“In the United States, they de­clared war on early childhood caries," he said.
“They increased graduate funding so they could pay resi­dents stipends. And they dou­bled the number of people going through the special programs. There’s been no such manoeu­vre in Canada."

A spokeswoman said Wednes­day that the Health Department has received the report but it has not been reviewed. Dr. Anderson has asked for a meeting with the de par tment.

Dr. Anderson also hopes that a community outreach program could be created, which would send specialists to communities across the province where oper­ating room time was available. More awareness and education programs for parents on provid­ing good dental care for their children are also needed.

“The public doesn’t look in­side these mouths. A three-year­old whimpering all night long in their sleep doesn’t vote," he said. “We call it the silent epi­demic? It isn’t silent in these houses."

Nova Scotia is fluoridated:NYSCOF