“You cried, didn’t you?” joked one Grade 8 boy to another as he headed into a recent dental screening at Barrie’s Ferndale Woods Elementary School.
Hygienist Kelly Goldsworthy pulled out two clean instruments and scanned the next student’s teeth, keeping an eye out for any cavities requiring attention.
“Looks like you’ve had some sealant done on your six-year teeth, you could use it for your 12-year molars,” she told the 13-year-old student.
With the help of her assistants, Debbie English and Cathy Wassenaan, Goldsworthy expected to screen the teeth about 120 kids, following the 149 she saw at the same school the previous day.
Some get forms announcing a clinic in the spring in which the children with deep grooves in their molars can have a sealant put on for free. Others with large cavities that can lead to other problems are also sent home with notices pointing out the problem, offering assistance to families with no health coverage.
Through these regular in-school screenings of children in junior kindergarten, senior kindergarten, Grade 2 and Grade 8, Simcoe Muskoka District Health Unit officials determined that children in this area don’t do as well as kids in the rest of the province.
The two-year, provincewide study found more than half the seven-and nine-year-old children in Simcoe County and Muskoka have tooth decay. Overall, the study determined that the dental health of local children ranks in the bottom third in the province.
The regular screenings help to keep the problem at bay as does a program offering dental services to children in need, that’s been extended to the child’s 18th birthday.
But the study is an indication that more needs to be done, say local public health officials.
One thing that we ought to seriously consider is fluoridate the drinking water, they say.
“The best thing is to try to prevent decay in the first place,” said Dr. Dick Ito, public health dentist for the health units in Simcoe-Muskoka and Peterborough. “All the research has shown that fluoride works as a preventative measure.”
Fluoridated water is most prevalent in Alberta and Manitoba, where 74.6 and 73.2 per cent of the population respectively has access to fluoridated drinking water. Much of Ontario is covered, as well, with 70.3 per cent having access to fluoridated water, including much of the area south of Highway 9.
Apart from the Yukon, which has no fluoridated water, Newfoundland and British Columbia have the smallest of the population with fluoridated water, 3.5 and 3.9 per cent respectively.
In Simcoe County, Tottenham’s population of 5,000 is the only community with fluoridated water. That represents about one per cent.
Following the Fluoridation Act in the early 1960s, many towns and cities in Ontario had a referendum question on the ballot, including Barrie and Orillia. While some communities did introduce fluoride after that, the 1967 vote didn’t meet the grade here.
In Barrie, it didn’t attract the 50 per cent of the voting population that was necessary and the referendum was deemed ineligible.
Fluoride was likely introduced to the drinking water in Tottenham at about that time. The Town of New Tecumseth has two water systems, one for Alliston and Beeton and the other for the 5,000 people in Tottenham.
The prospect of fluoridating Barrie’s drinking water is not a simple one.
Currently, the city provides drinking water to its 130,000 or so residents through 14 wells. By 2010, a surface water treatment centre will be added to accommodate the needs of the growing population.
Introducing fluoride would mean adding the necessary equipment, infrastructure and labour to at least 15 different locations. That could well be a wieldy task, suggested Barrie’s engineering director, Wendell McArthur.
“It is a difficult thing when you have a mixture of wells and surface water” with pump houses at each site, he said.
Already chlorinating the water is a challenge, added Craig Hebert, the city’s director of operations. The system requires an injection point at each well, which “is not a trivial exercise.”
Officials were somewhat hopeful that the “halo” effects of Toronto-area municipalities adding fluoride to its tap water would be of some benefit here. Food and drinks are packaged in Toronto using the fluoridated water and are purchased here.
But Toronto reduced its fluoride content, reducing the benefits of the halo effects.
While the health unit lobbies local municipalities to examine the fluoride issue, officials are also encouraging the provincial government to introduce more preventative measures.
The provincial government announced $45 million over each of the next three years would be spent on the dental needs of low-income families. But only about $25 million of the total $135 million has been designated.
“There’s still a substantial amount of funding left that has not yet been allocated,” Ito said, adding that there’s still no indication on how it should be used.
Ito has some ideas.
More prevention, he suggested, will save money in the long run as well as the pain that children with significant cavities suffer.
Young adults, who aren’t yet in the workforce and have no coverage, could use some help, as could mothers at risk who
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could transmit decay-causing bacteria to the child. The optimal point for treatment is before having children. Another group needing help is seniors, who often have no coverage after retirement.
The health unit estimates 154,000 people in Simcoe County and Muskoka are without dental coverage.
The provincial government says it is working with health units and community health centres to build community capacity and expand the service for low-income Ontarians, especially children, rolling out services over the next two years.
The dental team checking out children’s teeth at Ferndale Woods is happy with its findings over the two days. Very few families received notices advising them or urgent situations.
That isn’t always so typical and they were not surprised to hear the results of the study showing poor oral health.
“We try to do a little bit of instruction with them with them” individually, during the brief screenings, said Goldsworthy. But it could be a bit of a challenge trying to fit that into 120 visits.
That’s also a far cry from the 1980s when the assistants recalled going into every classroom from kindergarten to Grade 8 providing dental health education.
As one astute 13-year-old girl sits in Goldsworthy’s chair and the hygienist brings her tools forward, the girl said: “It’s clean right?”
“Everything’s sterilized,” assured Goldsworthy. “It’s cleaner than a spoon you would put in your mouth.”
Within minutes, she’s done and headed into the hall, motioning the next student in with the declaration: “They’re sterile, don’t worry.”
What is fluoride?
Fluoride is found in abundance in nature, primarily in water and soil. Sea water contains 1.2 to 1.5 mg/L of fluoride in its ionic form while fresh water throughout Canada contains .01 to 11 mg/L.
Fluoridation has been the subject of 18 major reviews over the past 40 years, including four in Canada. The most recent was in Quebec. Health Canada currently has a review in draft format, expected to be released this spring.
As a result of these studies it is generally accepted that fluoridated water is the most effective way to prevent tooth decay.