A small cohort of pediatric dentists says not enough has been done over the last decade to curtail the wait-list for children’s dental surgery, and those professionals are tired of waiting for provincial health officials to take action.
For years, Dr. Robert Diamond — one of maybe two dozen dedicated pediatric dentists in Manitoba — has led the charge, criticizing the Winnipeg Regional Health Authority’s (WRHA) handling of the wait-list and pushing for more operating-room time.
"The decay process spreads rapidly," Diamond said. "Kids go quickly from something that’s restorable to something that is abscessed."
Abscessed teeth can cause many issues, including pain, trouble eating or sleeping and speech problems. In an attempt to get more children into surgery faster, Diamond and the Manitoba hospital pediatric dentists group have spent the past year attempting to get approval for a pilot project that would result in hundreds of surgical cases diverted to the Maples Surgical Centre in Winnipeg.
More than 100 cases already are done each year at the private facility, which supplies its own surgical support staff and anesthesiologists. By more than quadrupling that number, Diamond argues, the WRHA could free up operating-room time, cut down on delays relating to anesthesiologist shortages and put a significant dent in the wait-list.
The Winnipeg wait-list currently tops 1,000, with nearly 600 children awaiting their surgery slot at Misericordia Health Centre. Those children, who tend to be the less serious cases, wait an average of three months, in keeping with the Pediatric Canadian Access Targets for Surgery. However, the remaining 400 or so children wait around 27 weeks for dental surgery at the Health Sciences Centre Children’s Hospital.
While a half-year is substantially lower than the 15- to 18-month wait times the hospital was recording in 1999, when Diamond first started publicly arguing for change, the WRHA’s head of pediatric dentistry said he wouldn’t exactly call it "outstanding."
"It’s not perfect," Dr. Bob Schroth said, "but I think other surgery disciplines would covet getting in within that time frame."
Schroth and the WRHA want to reframe the conversation. The focus, they say, needs to be on prevention: brushing teeth, getting enough vitamin D, eating fewer sugary foods. They also want to encourage parents to take children to see a dentist before their first birthday.
It’s a large part of why the health authority has been less than receptive to Diamond’s pitch, said Dr. Brock Wright, president of the newly formed Shared Health Services Manitoba.
"A key message from our perspective is that the real emphasis going forward needs to be on prevention," he said.
That’s a fine goal, said Dr. Ross Anderson, executive director of the Canadian Academy of Pediatric Dentistry, but it’s a trickier reality.
Most day surgeries for children between the ages of one and five are for decaying primary teeth. The risk goes up if the children live in a rural community, if they’re poor and if they’re Indigenous, according to the Canadian Institute for Health Information.
People do their best, Anderson said, but "the reality is that if a can of apple juice costs less than a quart of milk, or if you can’t get any fresh vegetables… it’s very, very difficult."
Still, Wright said prevention isn’t the only reason the WRHA hasn’t approved the pilot. Shared Health Services is looking at the idea of centralizing the pediatric dental surgery wait-list, he said, an idea that requires waiting until a full audit of the WRHA’s program is finalized this spring.
After all, the bulk of the province’s pediatric dentists operate out of Winnipeg. The only other regional health authority with designated pediatric dentists is Northern Health, which has eight doctors responsible for performing roughly 670 surgeries annually.
"With a centralized wait-list, you can be confident that everybody who’s on the wait-list needs surgery," Wright said. "Then you can prioritize children to ensure that those who are most in need are getting the care the quickest."
There isn’t enough information yet to make that call, he said, although he isn’t ruling out mixed-model public-private partnerships in the future like Diamond is suggesting.
"We’ll keep an open mind," Wright said. "That will be part of what we will be looking at when we do the provincial planning, but we can do that on our own."
Except they haven’t, Diamond said in frustration, and it seems as if "they’ve been auditing this program for 10 years and still haven’t got it right."
On that, Dr. Charles Lekic, the former head of pediatric dentistry at the WRHA, would agree.
"Of course, we want to prevent, and yes, there are programs," he said, "but it’s not enough to say we have programs. Where are the results? Did we change anything?"
Lekic is one of eight Manitoba pediatric dentists who work at Children’s Dental World in Winnipeg. While the doctors offer a number of teeth-related services, they have had their own private surgical centre for eight years now, which they subsidize with their own salaries.
"The wait for healthy kids has been so long that we thought the only way to help them was to start our own surgical centre," he said.
Still, his colleague, Dr. Fadi Kass, said it’s not a financially realistic solution for the entire province.
"The subset of the population that has these needs a lot of the time can’t afford paying out of their pocket," he said. "They rely on federal or provincial and, in some cases, private insurance."
The financial constraints in conjunction with changes made in the last year to surgical time slots at Misericordia make the doctors even more resolved to see the pilot project come to fruition. Whereas pediatric dentistry used to have five days of surgical time at the health centre, now they only have four.
The WRHA characterizes it as a consolidation, saying the change hasn’t affected annual surgery numbers. But, Wright said, some of their slots weren’t being filled for various reasons and pediatric anesthesiology services are too precious a resource to sit idle. Diamond doesn’t agree, calling it "double-talk."
"How can they reject the idea of lost surgical slots while acknowledging, technically, that they have gone down?"
At the end of the day, Lekic said, nobody is more qualified than pediatric dentists to address long-running wait-list issues. The WRHA’s head of pediatric dentistry — Schroth — is not actually a pediatric dentist.
"We’re the experts, we know the problem," Lekic said. "We say that something has to be done."
Read more by Jane Gerster.