Pelagie Sharp couldn’t watch her preteen son suffer any longer when she e-mailed a Government of Nunavut official to ask how soon the boy could be flown out of his home community of Rankin Inlet for dental surgery.
“It’s difficult to see him in pain, he is my first child out of four kids to have cavities,” Ms. Sharp wrote on June 14, 2021. “I have never had a cavity in my life and I don’t know what the pain is like but he is definitely in a lot of pain. He has also lost weight, there are days he will not eat because it triggers the pain in his decayed teeth.”
In the summer of 2021, Howard, then 12, was among more than 1,000 Nunavut children waiting for dental work that required sedation or general anesthesia. As of early October, that queue had grown to 1,378 children, according to the territorial government. Many of those children are waiting in pain, as Howard was.
Tooth decay is an enduring problem in Inuit communities, but the longer-than-usual line for children’s dental surgery in Nunavut is another example of the pandemic making a bad situation worse, the territory’s chief dentist said.
Travelling dentists are identifying more children who need cavities filled and teeth pulled after more than a year in which many of Nunavut’s fly-in communities received no dental visits because of COVID-19 restrictions. That backlog is on top of surgical backlogs at the out-of-territory pediatric hospitals that do some of the dental work on Nunavut children. Those hospitals, crippled by staff shortages and a wicked RSV and flu season, have extensive waiting lists of their own.
“If we send a child down to Ottawa to be treated, they just go into the line with everyone else,” said Ron Kelly, Nunavut’s chief dentist. When it comes to accessing southern health care capacity, he added, “we’re asking, not demanding.”
In Nunavut, the need for children’s dental surgery is so great that concerted efforts to meet it haven’t slain the backlog. In 2021, for example, the territory’s lone hospital opened a second operating room and more than doubled the number of weeks per year in which one of the two is reserved for nothing but dental work performed on patients under general anesthesia.
The number of weeks set aside for dental surgery at Qikiqtani General Hospital rose to 25 from 11, Dr. Kelly said. That is about a quarter of all the annual operating room time at the Iqaluit hospital. The Government of Nunavut also charters flights to a small hospital in the northern Manitoba town of Churchill for 16 to 18 weeks of dental surgery a year and taps private dental clinics in the south for children who require mild sedation rather than full-blown anesthesia in a hospital.
Since 2017, the federal government has spent more than $22.5-million on medical travel for Nunavummiut receiving dental work, according to the Nunavut Department of Health. That outlay, paid by Ottawa’s Non-Insured Health Benefits (NIHB) program for First Nations and Inuit, covers accommodations, food, ground transport and most of the airfare for clients – the vast majority of them children – and their escorts. It doesn’t include the cost of the dental work itself.
Indigenous children, many of whom experience poverty, overcrowded housing, food insecurity, frequent boil-water advisories and less access to dentists in their communities, have rates of preventable cavities requiring day surgery that far exceed the rates among non-Indigenous children.
Severe tooth decay among young children is a bigger problem in Nunavut than in any another province or territory, according to a 2013 Canadian Institute for Health Information (CIHI) report on preventable cavities that led to day surgery for preschoolers and kindergarteners. In the years 2010 to 2012, the rate of dental surgery among children ages one to five was 97.2 per 1,000 in Nunavut, nearly twice the rate in the Northwest Territories. In Ontario, the rate was 8.4 per 1,000.
There appears to have been some improvement in the past decade, according to data for 2020 to 2022 that CIHI crunched at The Globe and Mail’s request. In that period, the rate of dental day surgery among Nunavut’s youngest children dropped to 67.5 per 1,000 population, still the highest in the country.
“There is an effort to get in and deal with kids as young as possible to provide preventative interventions that we know work,” Dr. Kelly said, referencing a children’s oral health project that sends dental professionals into schools in every Nunavut hamlet.
But he acknowledged that the lower rate could reflect a drop in available surgical slots during the pandemic, rather than a reduction in the true need for dental surgery.
One method to chip away at the backlog could be to let dentists working for the Government of Nunavut offer mild sedation with nitrous oxide or medication to children who can’t tolerate having a cavity filled or a tooth pulled with freezing alone, but who don’t need hours of dental work under general anesthetic.
Dr. Kelly said his team is about to propose new standards to Nunavut’s medical advisory committee that would allow government-contracted dentists to use mild sedation on children 12 and under in some of Nunavut’s larger communities, likely Rankin Inlet and Cambridge Bay. The service is available to children in other remote parts of the country, Dr. Kelly said, but it’s not without risk in Arctic communities with no hospitals.
“There’s always an issue around safety,” Dr. Kelly said. “Every child is a bit different. You intend to provide light to medium sedation and somehow the child tips over the edge and goes into a deeply sedated state.” Such cases are rare, he said.
Howard Sharp is the kind of patient who might have benefited from mild sedation provided safely. Travelling dentists at Rankin Inlet’s health centre tried twice, in February and May of 2021, to extract two of his teeth and fill several cavities, but Howard was too anxious and in too much pain to sit through the procedures, his mother said.
After the failed second attempt, Ms. Sharp said she was told Howard would have to travel to the south where he could be put under to have the work done. She sent her e-mail after she learned the health centre had lost his referral. “It was excruciating,” Ms. Sharp said. “He was crying all night, every night and he missed a lot of school.”
Fortunately, Ms. Sharp learned of a new alternative for Howard. Hamza Jafri, a dentist originally from Pakistan, opened a private dental office in Rankin in June of 2021 – the only clinic of its kind in Nunavut outside of Iqaluit.
Dr. Jafri saw the need for better dental services in Nunavut while he worked as an oral health promotion specialist for the territorial government before securing his Canadian dental licence and opening his Rankin clinic.
He was stunned to see some of Nunavut’s smaller hamlets go months without a visit from a travelling dentist. “I could see, back home in Pakistan, this happening because we don’t have the best health care programs,” Dr. Jafri said. “But up in Canada in the 21st century, this was just shocking.”
Dr. Jafri prescribed 10 days of antibiotics for an infection in Howard’s mouth. Then, with patience and kindness as their only sedative, Dr. Jafri and his staff froze Howard’s mouth, pulled both of his decayed teeth, and filled his cavities.
“They talked him through it,” Ms. Sharp said. “They were very kind and caring … and they were able to do the extractions.”