In this multi-part series, I share my experiences working with Northern Ontario’s First Nations Reserves as they face an oral health crisis. As one dentist, my impact is limited and slow reaching. As one voice, I hope to raise awareness of the access to care barriers facing our Canadian neighbours.
(All names have been changed to protect patient confidentiality)
“Approximately 86% of First Nations children between the ages of 3 and 5 have tooth decay.”
Catching up on clinical notes at the end of each day.
Setting: Fort Hope Nursing Station, dental clinic. Daphne is the first of many patients to have teeth extracted due to neglect and poor oral hygiene. We brought her in from the waiting list, as she wasn’t able to be seen when the last dentist was in the community three months prior. She’s brought along her 3 year old son, who is also suffering from toothaches.
“We need to brush our teeth.”
My words aren’t reaching Daphne. She’s trying to calm a fussing boy on her lap… he doesn’t want to be here. The dental office is as foreign to him as it is for his young mother. I press on,
“At this point, I’d be happy if we started with once a day - never mind twice.”
Eye contact with the toddler unbroken, she responds,
“I can’t.”
The little one grows restless. Like a slinky, he tries to unravel out of her arms and onto the sanitized floor below. Unsuccessful - she intervenes before a landing is made. Daphne continues,
“I try, doc, but my stomach hurts after brushing. Or worse,” tilting her head to the washroom across the hall, “it gives me the runs.”
Unsurprising.
A regular conversation: undrinkable water. Unfit for even personal hygiene. Of the three First Nations reserves I’ve visited, two had long-term boil water advisories*.
In fact, it’s one of the first things brought to my attention soon after landing in Fort Hope: don’t drink the water. The short corridor connecting our nursing station (where the dental clinic is) with the healthcare residence contains the industrial looking water purifying system. A tower of intertwined chrome pipes, plastic levers, and buzzing electronics. This entangled machine will be the source of hydration and washing for myself, my assistant, and the nurses.
What do the 1,300 locals of Fort Hope have? Not this.
Daphne looks at me. With a mix of impatience and slight concern, she awaits a response to conclude my mental monologue. Brain stutters on from sleep mode,
“Can you just… not swallow the toothpaste?”
Ingenious, Sherlock.
“Sure, I can try,” Daphne turns her 3 year old towards me, “but he doesn’t listen.”
As if on cue, he looks up and smiles. A full complement of black stubs glare back, occupying where two rows of baby teeth are meant to reside. He stares at me. I stare blankly back.
Once again, unsurprising.
Typical house, transportation, and roads.
Day one is full of extractions. If you live in a community where a dentist flies in only every 3-6 months, you’re essentially waiting that long before any toothaches are seen. In private practice the norm is to first try and save teeth with fillings or root canals, but there’s only so long they can hold without help before crumbling away.
The moment our spacious plane of eight lands in Fort Hope, phone calls are sent out with the news, “The dentist is here!” closely followed by, “When can the dentist see their first patient?” Bags, left unpacked, are thrown into hastily assigned nursing station bedrooms, a round of quick formalities are made with the equally hurried healthcare staff, and then the dental assistant and I start dusting off dental chairs and sterilizing tools.
Adrenaline pushes us through.
6:00pm.
My stomach has plans that don’t involve the mountain of paperwork before me. Unfortunately, the food boxes didn’t make it on the plane, so unless I buy something I’ll be without food for the unforeseeable future. Time to explore.
The sun beams high in the sky. It’s nice to finally be on a summer rotation. Last two trips, at two different reserves, were in the dead of winter - sun sets at 4pm and the mercury dropping past -45°C (-49°F). But during these long summers of Fort Hope, the sun doesn’t set until past 9pm.
Walking to the only grocer in the community, a few minutes northeast of the Nursing Station, I’m accompanied by stray dogs - each one getting a deserved head scratch for being a good boy. With every step kicking up small clouds of dust, I journey past numerous pastel houses, colours bleached by the sun. Cars going the opposite direction slow to a crawl, passengers peering at the strange man in black suddenly wandering their roads.
I’d wave. They always waved back.
Eventually arriving at the local merchant, I push past heavy double doors. With a space similar in size to a gas station, the room is divided into two. Five aisles of non-perishables, stacked floor to ceiling with canned soups, boxes of cookies, cereals, preserves, and so on. Along the back wall are two industrial freezers - the ones with the glass tops, allowing you to see the frozen meats without any precious cool air escaping into the stuffy air.
Needing only enough food to last 48 hours, I’m scanning for anything fresh, or at least not processed and stuffed into a can. And behold: a single bag of apples! A plastic bag with five, maybe 6, small apples, bruised and softened after numerous days on the shelf, and aggressive thumbs investigating their ripeness. The cost of this “fresh”, and frankly only, bag of fruit?
$5.99.
Dominating the rest of the shelf? Stacks of baked goods, flown in from the nearest bakery in Winnipeg. Immediately next to the sad sack of apples are boxes of powdered donuts. Through plastic windows you smell uniform rows of deep fried rings, each powdered in their perfect coating of saccharine cocaine. The cost of a dozen diabetic delicacies?
Also $5.99.
It’s becoming increasingly clear: In the North, tooth decay isn’t a choice. It’s an inevitability.
HERE ENDS PART 1
*A boil water advisory signals when water is unsafe to drink or to use for personal hygiene. The federal government defines “long-term” as an advisory that’s been in place for a year or more.
If you’re a dentist, hygienist, or dental assistant interested in joining the Remote Areas Program, I encourage you to contact Janice Sawyer at jsawyer@oda.ca
Applications can be found here.