Nunatsiaq News
NEWS: Around the Arctic August 23, 2018 - 8:17 am

Nunavut dental health needs action: dentist

"What is happening in Nunavut is not sustainable"

JANE GEORGE
When dentists see crooked and rotten teeth like these in Nunavut, there is not much they can do except try to repair them or pull them. Orthodontists often refuse to put on braces to correct the teeth due to their poor condition. (PHOTO COURTESY OF MARTA DEMUTH)
When dentists see crooked and rotten teeth like these in Nunavut, there is not much they can do except try to repair them or pull them. Orthodontists often refuse to put on braces to correct the teeth due to their poor condition. (PHOTO COURTESY OF MARTA DEMUTH)

(UPDATED 11 a.m.)

COPENHAGEN—When Márta Demoth worked as a dentist in Nunavut, she says she felt more like a firefighter than a dentist.

The teeth of many of the roughly 3,000 Nunavut patients she saw between 2014 and 2016 were so bad that often she had no choice but to extract their teeth instead of repair them. Children would often be directed south for major dental surgery.

“No one shows them how to brush teeth,” Demoth told the recent International Congress on Circumpolar Heath in Copenhagen, speaking about Nunavut children who see no dentists or other oral health professionals for many years.

Painful and pulled teeth also means patients are less likely to be able to chew meat, which for these communities is a traditional source of protein, she said.

So, poor dental health can also be an important contributing factor to poor nutrition.

But given the poverty and overcrowded housing that she saw, “tooth-brushing will be the last thing on their minds.”

Among the disturbing cases she encountered: a teenager who said she was fine with having a rotten tooth pulled.

“It’s socially acceptable to have your teeth pulled,” she said.

But that’s something you would never see among teens in the south, who don’t want to have an empty space in their mouth, said Demuth, who now works in the U.K.

She also spoke about a man with a dripping wound on the outside of his cheek.

That, she learned, was the resulted of his being tasered. After this, his teeth became infected and a big abscess formed deep in his gums. After she cleaned out the abscess, the man had no more infection, but he also had no teeth on one side, which didn’t seem like a good solution to her.

At the same time, sometimes people would be in a huge amount of pain due to their teeth, when no dentist was in town, but nurses were unlikely to offer painkillers like codeine, due to the risk of addictions.

Demuth said she worked closely with health workers in every community she visited.

But she said it would be good to work with children aged 12 and younger, because they are part of the solution. If they could learn about proper dental hygiene, this would improve things a lot.

A children’s oral health program, aimed at promoting good oral health and preventing dental illness, which also offers food coupon incentives for participants, is now underway.

But encouraging Nunavummiut to see dentists is just one of the big challenges facing oral health in Nunavut.

“It seems very difficult,” Demoth said about the current situation. “It will take a long time (to improve) because it is such a complex matter.”

It’s been five years since Inuit Tapiriit Kanatami called for efforts to bridge the oral health disparity between Inuit and other Canadians with its new Inuit Oral Health Action Plan, “Healthy Teeth, Healthy Lives: Inuit Oral Health Action Plan 2013, which followed the Inuit Oral Health Survey 2008-2009.

That survey found tooth decay, a chronic but preventable disease, is two to three times worse among Inuit than among other Canadians.

At the same session on dental heath in Copenhagen—one that appeared very useful given the exchange of information among dental care providers, a Greenlandic participant spoke about how Greenland has made a big effort to improve people’s teeth.

There are perhaps fewer dentists in some of the smaller communities in Greenland than in Canada, she said, but Greenland has well-trained local dental therapists. As well, there was a big public health campaign to change the attitude among people, so everyone wants a “brilliant smile.”

The change to better dental care, she said, has been fast, although there is still a way to go.

Similarly, a school in Saskatchewan, with a poor, Indigenous population, has a tooth-brushing program, said Marcella Ogenchuk of the College of Nursing at the University of Saskatchewan.

The school has, among other moves, handed out water bottles to all children: this allows them to drink more and also to rinse out their mouths after they eat—the next best thing to brushing their teeth.

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(18) Comments:

#1. Posted by Bill on August 23, 2018

That’s what I’ve never understood. Two major problems facing Nunacvut children: food security and oral health which the schools could easily mitigate. Breakfast and lunch programs and then have the kids brush their teeth. Would it be expensive? Of course. But if bellies are full, if teeth don’t hurt kids can focus at school. It would save big bucks down the road.
But for whatever reason, the department of education and NTA are adamantly against any such programs. Why people in charge of kids seem so apathetic to their pain is beyond me.
Where did all the dental therapists go? They’ve been shown to be highly successful in making preventative dental accessible in rural regions and reducing burden on more costly dentistry services.
GN always so slow to come around to what is already well established practice elsewhere. Hope our new minister of health will finally get this through.

#2. Posted by Reality World on August 23, 2018

“It’s socially acceptable to have your teeth pulled.”

It all comes down to our distorted modern culture here in Nunavut.

Gross.

#3. Posted by homework on August 23, 2018

There are programs in place in schools and daycares across the territory for children to brush their teeth and have oral health education. Like she mentioned, tooth brushing is going to be everyone’s last priority when they have to worry about where they are going to sleep or eat. Like the TB crisis, poor oral health is absolutely attributed to socioeconomic status. Maslow’s Hierarchy of Human Needs describes this perfectly. Fix the housing crisis and you will fix many of the health crisis’ we face as Nunavummiut.

#4. Posted by Editor in Chief on August 23, 2018

“Nunavut is not sustainable”

There, fixed your sub-title for you.

#5. Posted by Nunavummiu on August 23, 2018

What really are Orthodontist? My teen aged daughters have good teeth but they have been refused by Orthodontist to get braces, even though I work for GN.

#6. Posted by Jon on August 23, 2018

if my message can go everywhere, I would say, post all sorts of pictures of rotten teeth! I brushed my teeth the second I saw the picture.  A simple picture of rotten teeth encourages us to brush! try it! it works and its a very fast and easy way to encourage others who don’t brush that often.  and maybe put a very simple message like, that’s you when you don’t brush. that simple!

#7. Posted by parent on August 23, 2018

It is the responsibility of parents to ensure that our children brush their teeth.
The schools, dentist and public health have handed out free tooth brushes and tooth paste. There is no excuse by for laziness.
Yes over crowding, hunger and other situations may be more dire, but that does not stop a child from brushing their teeth at least once a day. Start a routine with children when they are small, and they will continue when they get older.

#8. Posted by Sugar Sugar Sugar on August 23, 2018

Brushing is part of the solution, and so is diet. Too much sugary food is being fed to our kids. Way too much. Parents don’t seem to care, as long as it makes their little kid happy. So messed up man.

#9. Posted by Oopik on August 23, 2018

The only people who benefit from northern living allowances are those who are already ahead of the game in having regular income and access to housing. To everyone who judges parents in today’s Nunavut, take a good long look at the privileges that afforded you a safe place to eat food, not be raped, not be beaten, to wear clean clothes, and to meet the needs of your children and feel good about it. When you’re home life is unstable and you’re living off the social welfare programs like child tax and at the mercy of whoever took you in that day/month/year (because housing is near unattainable for many) it’s not feasible to afford healthy food for dental care and appease your child in any other way than small pleasures like sugar.

#10. Posted by noted on August 23, 2018

Thanks for your comments, #9 Oopik. Some of the points you made actually changed my opinion.

#11. Posted by iThink on August 23, 2018

#9 Isn’t that just a counsel of despair?

I know families who make great money and still feed their kids crap. What it really comes down to, in my opinion, is education. In many cases you can eat healthier foods for cheaper than what you will pay for processed junk. But you need to know how to prepare them and you need to value and understand the difference between those foods and the junk you are feeding your kids.

As for the privileges of those of us who were raised better, yes that’s true we were fortunate. But what does this imply? That people who aren’t so lucky should just be left to continue wallowing in it?

That’s a tautological and pointless ‘point’.

#12. Posted by Jiini on August 23, 2018

NWT days there was a full time dental therapist in the schools.  Now even a start of a cavaty doesn’t get caught until its so bad it has to be pulled by the time a dentist arrives into a community.  It’s s not always so simple as oral hygiene but regular availability of a dentist.  In Iqaluit easy as making an appointment, in communities dentists leave with a list still long because they can’t see everyone.

#13. Posted by Look Ma, no teeth on August 23, 2018

There needs to be a basic dental clinic in every Nunavut community. 

Dental clinic in a sea canister with 1 dentist chair and a dental x-ray machine.  Buy 24 of them, deliver one by sea-lift to each community except Iqaluit, install in each community, supply with electricity, water, sewage and telephone. Then fly in dentists on a scheduled basis.  It will take a while to work through the backlog.

But the government has become the problem.

All it can do is say “No, wait for us to take care of that, next year, or maybe the year after that.  First we have to form a committee, then hire a consultant to conduct a study and write a report.  Then we have to review the report, consult stakeholders, get Cabinet approval, put it in the budget for the following year, write a request for proposal, award a contract and hope the contractor does what we asked.”

We know what needs to be done.  Why did our Health Minister not do this?

Maybe that’s why we have a new Health Minister…

#14. Posted by Hear this. on August 24, 2018

Nunavut has to build on what already is in place. There are rooms fir dental care visits in many schools. As these rooms were not utilized thanks to no dental visits, they were repurposed for other things. Schools should not be expected to do it all with inadequate resources. Wake up world. You want dental care taught: send in dentists; sex Ed: send in CHRs who know about it; vision screening; hearing screening; nutritionists. Create mobile teams to do it: dentist, nurse, optometrist, audiologist, doctor. Visit 3, 4 times per year. Work out of the school. Start with kindergarten. Refer on for hearing aids, glasses, education. Teach the parents about it. Do it over dinner at the school prepared by the nutritionist with funds from GN/ITK/NTI. Educate, educate, educate. Don’t just dump it all on the schools.

#15. Posted by Not Normal on August 26, 2018

Kids with ugly mouths, missing teeth do not realize that it is going to affect their future chances and choices.
No one else anywhere walks around with teeth as bad as we do.
An employer may not want to look at an ugly mouth every day on the job.
Clients may wonder why someone doesn’t clean up their mouth, if they do get hired.
Yellow, poorly brushed teeth turn people right off.
Missing teeth make people look old and sloppy.
Who wants to look at that?
Keep your teeth, take care of them NOW.

#16. Posted by Kenn on August 27, 2018

#1 the schools should feed the kids and brush their teeth? Probably also house them to ensure they are sleeping in a safe environment? Does anything ring a bell here? This is exactly what residential schools were supposed to do; however, everything went wrong and did not stick to the original plan. Parents have to man up and play their roles home, or they should have their kids and funds taken away by social services! Enough of relying on the government for EVERYTHING.

#17. Posted by :) on August 28, 2018

Back in 07 when I was in elementary here in Iqaluit we had a full time dentist within our school. He had his own office and we often went as a class to learn about different oral hygiene techniques. Our school dentist even pulled out one of my loose teeth that had been distracting me from class because of the pain. We should bring that system back, no more silver toothed kids.

#18. Posted by Laura on August 29, 2018

Kenn I completely agree with your comment. Glad someone is brave enough to say that.

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