The percentage of children with cavities has been steadily increasing since the termination of the provincial dental health plan more than 15 years ago, a new report shows.
Every five years since 1993, when the dental health plan ceased, Grade 1 students have been screened for signs of tooth decay. The percentage of students with cavities has increased in each screening, to 27.5 per cent in 2008-09 from 20 per cent in 1993-94.
It’s a warning sign that oral health is a “neglected epidemic,” said Dr. Gerry Uswak, dean of the college of dentistry at the University of Saskatchewan.
“People think we’ve conquered it,” he said. “We think we’re doing a wonderful job with people brushing and flossing and (receiving) fluoride, but we’re starting to see that it’s almost like despite our best efforts, certain segments of the population are going up.”
It’s alarming because cavities are “100 per cent preventable,” said Uswak.
“People don’t have to suffer from dental disease if they eat healthy, brush regularly with fluoridated toothpaste, if they have access to fluoridated water, if they seek care in a preventative way, not just when it hurts.”
The Saskatchewan Dental Health Screening Program 2008-09 Report identifies a number of disparities among children in the province. Children from rural, low-income neighbourhood schools, Hutterite schools and schools with no access to community water fluoridation were more likely to have cavities.
For example, 58.1 per cent of children attending schools with community water fluoridation were cavity-free compared to 43.9 per cent of those without fluoridation. That number includes both Grade 1 students and Grade 7 students, after Grade 7 students were included in the screening for the first time in 2008-09.
The report also shows the province isn’t meeting federal goals set out in the Canadian Oral Health Strategy Guidelines. One of the guidelines is that 50 per cent of six-year-olds won’t have a history of dental decay. Saskatchewan was well below that goal, at 41.5 per cent.
The Saskatoon Health Region was the only health region to meet the guidelines, with 50.8 per cent of Grade 1 students with no history of dental decay.
Saskatoon sees payoff
A big part of that success is the high level of access to fluoridated water, said Dr. Cory Neudorf, chief medical health officer for the Saskatoon Health Region.
“I think we’re seeing the payoff,” he said. “And the literature will suggest that communities with fluoridated water will see more kids that aren’t experiencing tooth decay and have higher rates of oral health.”
The Saskatoon Health Region had the highest percentage of students attending schools with access to fluoridated water, at 87.2 per cent. The Regina Qu’Appelle Health Region had the lowest, at 2.8 per cent.
Saskatoon had the lowest rate of students with current cavities, at 12.6 per cent. With the exception of northern Saskatchewan, Regina had the worst, at 24.6 per cent — nearly double Saskatoon’s rate.
Neudorf said he was happy to see comments from Mayor Don Atchison in a recent article in The StarPhoenix that the city has no intention to stop fluoridating its water. A $200,000 renovation to Saskatoon’s fluoridation system began this week.
“When you take fluoridated water away, it’s not the well-to-do kids that tend to suffer. It’s those who are the more vulnerable parts of the population,” Neudorf said.
Targeting those at higher risk in Saskatoon is another strategy the health region has employed. Since 2003-04, additional fluoride varnish clinics with dental screening and referral for treatment have been implemented in core neighbourhoods on an ongoing basis.
Resources are directed based on the results of each screening. It was initially a pilot project, but has continued, said Neudorf.
“We found it was, in fact, having a positive impact, by screening in this way and then directing resources where they’re most needed,” he said, “so we continued funding it because of those positive results.”
Screening is periodically done in different grades in different schools, with locations for the next set of screening based on the previous results.
There is still much work to do, however. The cavity-free rate for children attending schools in low-income neighbourhoods in Saskatoon is 34.1 per cent, compared to 59.8 per cent of children attending schools not located in a low-income neighbourhood.
The provincial report contains a number of recommendations, including calling for public policy in support of community water fluoridation. It also calls on the provincial government to create the position of a dental health officer to be the guiding voice for oral health in the province.
The Ministry of Health received the report earlier this month and is in the process of formulating a response, said a ministry spokesperson.
There’s a need for more focus on oral health, said the college of dentistry’s Uswak.
“I think what has to happen is oral health has to be recognized as as important as any other health condition,” Uswak said. “We need to at least be understanding its importance and working together on it.”
Percentage of Grade 1 students with cavities
Percentage of grades 1 and 7 students with current cavities
Health Region Percentage
Five Hills 19.5
Kelsey Trail 22.0
P.A. Parkland n/a
Prairie North 23.5
Regina Qu’Appelle 24.6
Sun Country 21.6
(Northern includes Mamawetan Churchill River and Keewatin Yatthe)
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Note: The article doesn’t comment on the impact of poverty on dental health in Saskatchewan where significant differences were found in the report.
Page 13: “Children from rural, low income neighbourhood schools, Hutterite schools and schools having no access to community water fluoridation were more likely to be experiencing caries, pain or infection, show no evidence of care (NEC) and at the same time are less likely to be cavity-free.”
Page 50: “Overall it appears that children attending schools that are not located in low income neighbourhoods in the cities of Regina and Saskatoon, have better oral health when compared with children attending schools that are located in low income neighbourhoods. This is evident from the lower average ‘deft/DMFT’ value which is statistically significant. In addition, schools that are located in low income neighbourhoods had higher proportions with current caries, ECC, pain/infection and showing absence of dental care which is statistically significant. Furthermore, schools that are not located in low income neighbourhoods had higher proportion being cavity-free, which is statistically significant. (See Table 22 and Figure 10)
Tables 30 and 31 illustrate regional statistics based on income status of a neighbourhood, respectively.
Table 34: Calculation of Odds Ratio for being Cavity-free between Low Income (LICO) Cut-off Neighbourhood School and Non-Low Income Cut-off (LICO) Neighbourhood School in Saskatchewan (City of Regina and Saskatoon), 2008-2009