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Severe tooth decay in preschoolers a leading cause of day surgery, study finds

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TORONTO - For thousands of Canadian preschoolers, going to the dentist doesn't mean a short visit to a clinic for a minor cavity, but going under general anesthesia for extensive dental surgery in hospital.

About 19,000 children aged one to five end up in hospital each year because they have multiple cavities and tooth decay so severe that it requires surgical treatment, says a report from the Canadian Institute for Health Information (CIHI), released Thursday.

In fact, about one-third of all day surgery operations for preschoolers — who still have their baby teeth — are done to perform substantial dental work.

"When you see the numbers, when you think 19,000 kids, you just really are taken aback," said Anne McFarlane, CIHI vice-president for Western Canada and developmental initiatives.

"And that's just the tip of the iceberg," McFarlane said from Victoria, noting that the figure doesn't capture children who are waiting for surgery or those who had their dental work done in a clinic.

"These children are under anesthesia for 86 minutes on average, so they have severe dental problems," she said. "What happens (during surgery) is a combination of teeth getting filled and teeth being extracted."

The CIHI study found rates for dental day surgery among young children varied by province and territory and depended on the makeup of the population and where kids live.

In neighbourhoods with a high number of aboriginal families, the rate of kids getting in-hospital dental surgery was almost nine times higher than that for children in neighbourhoods with a low First Nations or Inuit population.

Income level also appears to play a role, with dental surgery rates for kids in poorer neighbourhoods almost four times higher than for peers in more affluent areas. As well, three times more rural than urban children had day surgery for serious tooth decay.

Dental surgery rates among preschoolers were highest in Nunavut, the Northwest Territories and Saskatchewan, while Ontario, Alberta and B.C. had the lowest rates in the country.

McFarlane said a number of factors likely contribute to children who still have their baby teeth developing substantial decay: lack of fluoridation in water; ignorance of good dental hygiene practices; and having limited access to dental care if living in a rural or remote community.

Indeed, the CIHI study found that in more than one in five day surgery visits, families spent two or more hours travelling to get care. That was particularly the case in the North, where for the vast majority of dental surgeries — 92 per cent in Nunavut and 80 per cent in the Northwest Territories — families had travelled at least two hours so their child could have the operation.

“Severe dental problems can be painful and affect a child's self-esteem and quality of life," said McFarlane. "Many factors can contribute to dental health, such as fluoride levels in local water and timely access to dental care, but cavities and decay are still highly preventable."

Dr. Bob Schroth, a pediatric dentist and an assistant professor at the University of Manitoba, said tooth decay can be halted at any stage through the use of fillings or varnishes, while pulling a tooth is considered a last-resort option.

Ideally, children should be avoiding processed sweets containing lots of sugar and eating diets full of fresh fruits and vegetables, he said from Winnipeg. But for low-income Canadians and those living in remote areas, it can be too expensive or difficult to purchase such fresh food, he said.

"It is evident that there are disparities in young children's oral health in Canada," said Schroth. "These findings reinforce the need for improved access to early dental visits and effective prevention."

The report estimated that these day surgery operations cost $21.2 million each year across Canada, excluding Quebec.

McFarlane said that figure represents a fraction of the real price tag because it does not include travel costs or payments to dentists and anesthesiologists.

"Again, we think that's just the tip of the iceberg."

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