When Justin Merritt has a toothache, he knows it is time to book a flight.

Merritt lives in Rankin Inlet, Nunavut, but he has to travel to Manitoba to see a dentist. So far this winter, he has taken three separate flights to Winnipeg for dental work.

"There is a dentist in town sometimes," said Merritt, "eight or nine months out of the year."

But for more complex procedures, he prefers paying out-of-pocket for a flight down south than braving "40-year-old equipment" in the local clinic.

Merritt is not alone in making the trek to Manitoba for dental care. Dr. Rakhi Palta, who owns the Thompson Dental Centre in Thompson, Man., says about half of her patients are from remote northern communities, including an estimated three to five per cent from Nunavut.

"I would say the majority of time they come in because there was no dentist, and coming to Thompson, they get in sooner," Palta said.

Patients see a can dentist quicker, and according to Merritt, they also get superior care.

"I needed a root canal and they don't have the ability to do that [in Rankin Inlet]," he explained.

"Well, I'm sure they could do it the old fashioned way … four hours in a chair and someone digging at your mouth. But you go down to Winnipeg and you spend 45 minutes in the chair; no pain."

'Robot teeth' for many northern children

Palta worries that the same "song and dance" she experiences "over and over" with adult patients who have poor dental health is transferring to younger generations.

Mitali Ruths' daughter Sonya shows off her "robot teeth"

Montrealer Mitali Ruths's daughter shows off "robot teeth," which are steel caps placed over back teeth to prevent decay until adult teeth grow in. (Courtesy of Mitali Ruths)

One routine procedure at her clinic, but less common in southern clinics, is placing steel crowns on children's baby teeth to protect them from further decay. It's often called "robot teeth."

Palta estimates about 40 to 50 per cent of children who come to her clinic from the North have tooth decay so advanced, they need at least one tooth capped, sometimes more.

She said that number is vastly greater than the amount of steel caps she places on children's teeth in Mississauga, Ont., where she also treats patients.

Numbers from Health Canada seem to support Palta's observation. A 2011 survey found that among Inuit, only 49.8 per cent had visited a dental care provider, compared to 74.5 per cent for southern Canadians.

"For the last eight years that I've worked in Thompson, many patients coming from northern communities are seeking treatment [but] they don't maintain their teeth," said Palta.

Misconceptions about the cause of tooth decay are common, according to Palta  partly due to the fact that many adults from remote communities had all their teeth removed while they were still children.

Dentures more common in adults in North, says dentist

Palta said it is typical to see parents with dentures who had all their teeth pulled at 15 or 16 years of age.

The challenge, she said, is convincing those parents that the outcomes can be different for their kids if they brush and floss regularly.

"It's normal to have a tooth pain and have the tooth extracted," she said. "A lot of people don't know about the options of saving the teeth … the education is lacking there."

Palta said she would like to see Health Canada devote resources to providing seminars "to kids and parents" about oral hygiene. She said the current system of relying on dental nurses in schools and part-time dentists does not go far enough.

Justin Merritt said northerners would have healthier teeth if remote places had one regular dentist with time for check-ups and cleaning, not just emergency care.

"When the dentist comes up here, he's dealing with pulling teeth, probably doing some fillings. There isn't a lot of time for preventative maintenance," he said.