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Auditor general blasts Indigenous dental-services initiative

Health Canada doesn't track whether the $200 million it spends is helping

Michael Conroy / The Associated Press files</p><p>Dr. Robert Diamond says First Nations children with dental pain are waiting nine to 12 months for care.</p>

Michael Conroy / The Associated Press files

Dr. Robert Diamond says First Nations children with dental pain are waiting nine to 12 months for care.

OTTAWA — The federal and provincial governments say they’re trying to boost dental care for First Nations kids after Manitoba dentists said children’s teeth are getting worse, and a federal watchdog revealed that Ottawa isn’t keeping track of the issue.

The federal government pays for dental care for most Inuit and status Indians through a program called non-insured health benefits, with Health Canada picking up the tab for services provinces don’t, such as mental health and prescriptions, in exchange for various land treaties.

The program aims to bridge gaps in Indigenous health compared with the overall population.

Research shows dental disease and decay are twice as prevalent among Indigenous Canadians compared with the rest of the population.

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OTTAWA — The federal and provincial governments say they’re trying to boost dental care for First Nations kids after Manitoba dentists said children’s teeth are getting worse, and a federal watchdog revealed that Ottawa isn’t keeping track of the issue.

The federal government pays for dental care for most Inuit and status Indians through a program called non-insured health benefits, with Health Canada picking up the tab for services provinces don’t, such as mental health and prescriptions, in exchange for various land treaties.

The program aims to bridge gaps in Indigenous health compared with the overall population.

Research shows dental disease and decay are twice as prevalent among Indigenous Canadians compared with the rest of the population.

But on Tuesday, Auditor General Michael Ferguson revealed that Health Canada simply doesn’t track whether the $200 million it spends on dental services is helping the 298,000 people who receive the service.

"The department doesn't know if what they're doing is going to reduce that gap," Ferguson said after releasing a scathing report.

He also found that Ottawa moves slowly to fill upcoming shortages in dental staff, and doesn’t adequately track the medical histories of patients.

50,000 people use service at cost of $37 million

Almost 12 per cent of Manitobans quality for federal dental care, but only a third of them — roughly 50,000 people — use the service each year, costing Ottawa $37 million.

"It's a whole vicious circle. There are too many people with their fingers on the start button; it's a big, bureaucratic mess." -Robert Diamond

Many of them who are children end up at Robert Diamond's Portage Avenue clinic. The pediatric dentist says First Nations kids are facing a patchwork of services.

"I've been at this for 40 years, and I think things have gotten worse," Diamond said. "The money being spent on this isn’t doing any good."

In 2004, Ottawa rolled out the Children’s Oral Health Initiative, which aimed to prevent dental issues among Indigenous children by providing them annual checkups, temporary fillings and applying fluoride varnish to their teeth.

It’s around then that Diamond started seeing the same children with dental issues more frequently because the federal effort had focused on prevention, but wasn’t reaching all the kids; in fact, Tuesday’s audit found the COHI was only available on half of First Nations reserves, and has been treating a declining number of children over the past three years, despite a baby boom.

Children in pain waiting 9 to 12 months

Parents told Diamond their children were no longer getting checkups because fluoride and educational campaigns had overtaken their reserve’s dental programming, he said.

"It's a whole vicious circle. There are too many people with their fingers on the start button; it's a big, bureaucratic mess."

PHIL HOSSACK / WINNIPEG FREE PRESS files</p><p>Dr. Robert Diamond</p>

PHIL HOSSACK / WINNIPEG FREE PRESS files

Dr. Robert Diamond

Indigenous Services Minister Jane Philpott said the auditor’s report was helpful, so Ottawa can better track its progress.

"There's a whole lot of catch-up to do," she admitted.

"It's been perceived to be highly effective, but was unfortunately never funded enough that it could be available to everyone."

Philpott said COHI's "flat-lined" funding didn't increase for inflation or population since 2004, which she said the Liberals have nearly doubled.

Regardless, Diamond said First Nations children with dental pain are waiting nine to 12 months for care.

Change funding mandate: dentists

As the Free Press reported last week, Diamond and a handful of other dentists asked Manitoba's Health Minister Kelvin Goertzen a year ago to change the province’s funding mandate so private clinics could cut down wait times.

Other provinces have de-listed some anesthesiology and private-facility fees from provincial health insurance. Doing so would put those expenses onto the federal non-insured plan, which Diamond claims would give children cheaper, faster care paid by Ottawa.

As part of the Manitoba hospital pediatric dentists group, Diamond proposed a 12-month pilot to see whether it improves First Nations’ kids waiting times without hurting others. He claimed Goertzen’s staff eventually referred him to the Winnipeg Regional Health Authority, and the agency never responded.

Goertzen’s spokeswoman Amy McGuinness wouldn’t confirm that account. She instead said the government is developing the province’s first preventive-services plan through the new Shared Health organization.

"Children who lack access to preventive care are at risk for severe tooth decay. We know that this includes a disproportionate number of Indigenous children in our province," she wrote, adding that close to 2,100 pediatric dental surgeries a year are offered in Manitoba.

For now, the WRHA is monitoring dental-surgery rates to identify communities in need of additional preventative supports, she said.

Meanwhile, a 2012 peer-reviewed University of Manitoba study found Indigenous people in the province have much worse dental health than Caucasian people, but that difference largely disappeared among white Manitobans who smoke, live rurally and lack access to dentists.

Philpott referenced similar studies.

"It's not just a matter of these services that drive that [gap]." McGuinness agreed.

"Severe early childhood tooth decay is often influenced by the social determinants of health."

Diamond said environmental factors impact dental health, but said that doesn’t distract from the severe need among Manitoba children.

dylan.robertson@freepress.mb.ca

Read more by Dylan Robertson.

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