Braces for First Nation children being questioned as a "health priority"
Probe set for plan to give braces to aboriginal children - Experts question whether it is a health priority
Tom Blackwell, National Post- August 09, 2007
Health Canada has commissioned a study of its multi-million-dollar orthodontics program for Aboriginal children, as some experts question whether installing braces should be a government priority in a population afflicted by a litany of other health and dental problems.
More than 20,000 First Nations children have been approved for non-cosmetic orthodontic treatments in the past 10 years under a program that cost $5-million in 2006-07. The federal department says it is trying to find out whether the treatments, which can themselves encourage tooth decay, actually improve patients' overall oral health.
"What we want to know is are we doing more harm by keeping the braces on?" said Bonnie Tolstoy, director of benefit management for Health Canada's Aboriginal health program.
"For example ... after the braces come off, would it mean extraction of teeth due to decay and rot? Would it mean an increase in root canals?"
Independent experts say there is no question that braces can lead to "horrendous" cavity problems in some Aboriginal patients, who already are several times more likely than the general population to experience dental decay.
Public-health dentists have long debated whether the government should fund what could be considered an elective procedure when dental and gum disease is widespread, and often untreated, said Dr. Gerry Uswak, acting dean of dentistry at the University of Saskatchewan.
"If one was looking at this as public money and if one was looking at providing the best bang for the buck, personally I would like to see more money into prevention and treating the existing disease to get people out of pain and suffering."
For some Aboriginal people, who can have terrible tooth misalignments, orthodontics is an "absolutely" appropriate service for taxpayers to fund, said Dr. Doug Brothwell, head of community dentistry at the University of Manitoba.
The trouble is that many of the children who get braces do not regularly brush their teeth, and orthodontics only makes dental hygiene more difficult, he said. The result of giving them braces can be "horrendous failures," said Dr. Brothwell.
"Some are getting harmed through, I would say, poor case selection."
As with many other areas of health, Canada's Aboriginal people suffer disproportionate teeth trouble. As many as half all First Nations preschoolers develop early childhood "carries": so many cavities they have to be put under a general anesthetic while all the bad teeth are fixed or extracted. That is about 10 times the rate in the general population, said Dr. Brothwell.
Likewise, Aboriginal people generally get three to five times as many cavities as the overall population.
Poor diet in communities that have shifted in recent decades from traditional "country" foods to more processed and packaged fare is one factor, dentists say. In places where poverty, poor housing and deficient water supplies are more pressing challenges, teeth cleaning can also be overlooked, they say. And, despite federal help, many Aboriginal people have little access to professional dental care.
Dental care of First Nations members is provided under the government's non-insured health benefits program, which also covers their medical costs.
Orthodontics services are provided for young people who have facial "anomalies" such as cleft palates and to counter severe functional defects, said Bonnie Tolstoy, director of benefit management for the program. Braces are not applied for purely aesthetic reasons, she said.
Still, the department has no clear idea of the overall result of the service, which is why it has commissioned Kathy Russell, an orthodontist and professor at the Dalhousie University school of dentistry, to study the question.
Dr. Uswak said one reason that aboriginal people end up needing braces in the first place is because they had numerous cavity-ridden teeth removed earlier in life. He advocates putting more resources into prevention - teaching people about dental hygiene, providing more professional dental care and flouridating drinking water - before the problems become serious.