A new study published in the Canadian Journal of Public Health is calling on the federal government to expand a program to prevent tooth decay in remote Inuit and First Nations communities.
The Children's Oral Health Initiative (COHI) is a Health Canada program aimed at increasing access to preventive oral health services for Inuit and First Nations children up to eight years of age.
It's currently offered in five communities across the Northwest Territories and Nunavut — where rates of tooth decay are more than double the national average.
"The program has been under constant pressure to get funding, so the first step was to see if it was effective," said Kavita Mathu-Muju, a professor at the University of British Columbia's School of Dentistry, and one of the authors of the study.
Building community capacity
"COHI is an example of something the federal government initiated that is actually doing well, and working well," explained Mathu-Muju.
COHI helps young children, parents and pregnant women access things like fluoride, sealants and temporary fillings.
But it also trains people in the community to help promote oral health.
According to Mathu-Muju those "COHI aides" are key to the success of the program.
"Communities that had more days not of an externally contracted oral health professional, but a community member that was trained to be an oral health knowledge keeper, it seems like the dental disease levels in those communities are less."
The aides teach children and parents about things like good nutrition and tooth brushing, but they're also trained to deliver fluoride treatments and assist the dental professionals when they're in the community.
"The aide is meant to help build community capacity, so there is someone in the community with this knowledge and can help sustain the program, versus the externally contracted professionals who are not there all the time," said Mathu-Muju.
An important program
Helen DePeuter — the principal of Rachel Arngnamaktiq Elemtary in Baker Lake, Nunavut — knows first-hand how effective the COHI program can be.
"They would do things like bring the toothpaste and toothbrushes around," recalled DePeuter.
"It was very effective in teaching not only the children to be more consciousness, but in making the parents more aware because the people who worked as part of the program were from the community, so it was a lot easier for them to get the message across."
Baker Lake lost its dental therapist about a year ago, and without one, it couldn't run the program.
"I think it's a huge problem. I would say the majority of our children have had their baby teeth extracted," said DePeuter.
Baker Lake's program was replaced with a similar program run by the Nunavut government's Oral Health Project, but DePeuter says she's not sure it can produce the same results — especially without a dental therapist or hygienist working in the community alongside it.
"I would like to see [the COHI] program continue, I think it's important," DePeuter explained.
More dental professionals needed
Mathu-Muju said she feels for communities like Baker Lake.
"The dental therapist is a critical part of the program, and if you don't have enough dental therapists or dental hygienists, it's unsustainable."
That's why she's calling on the federal government to do more than just "expand the program to communities across Canada, as well as the age range."
She also wants the government to work to employ more dental therapists or hygienists in Northern communities.
"We had a federal school of dental therapy to educate dental therapists to go and work in First Nations communities.
"It actually closed in 2011, so I think...it's important to look at why the school closed, and whether it should be re-opened."
According to Mathu-Muju, "the biggest obstacle facing remote communities when it come to good oral health is the lack of dental professionals recruited to work in them," and until that's addressed, the high rates of dental disease will be almost impossible to bring down.