Three days after a visit to an Ottawa emergency department (ED) for bleeding gums and a chipped tooth from a playground accident, 5-year-old Amy’s tooth started to change colour and the swelling on her gums was still apparent.
Amy’s mother, Nicole, had tried to find a dentist after the playground incident but couldn’t locate one with immediate availability. After a long wait in the ED, Amy received first aid and was sent home.
Now, with the discoloration raising Nicole’s concerns, she once again tried to book a dentist appointment; she was told the wait time would be five days. She again tried the ED but was advised to see a private dentist for consultation and was given anti-inflammatories with a pain killer for Amy.
The medical condition was the beginning of necrosis of the tooth pulp that, if left unchecked, could also lead to abscess, fever and expanded infection of the oral cavity.
Nicole’s incident highlights the urgent need for dental units in hospital EDs. A dental emergency encompasses more than just a chipped tooth. It can also involve cellulitis in the oral cavity, causing breathing distress and fractures to the jawbone as part of a polytrauma. In such incidents, multidisciplinary involvement is often necessary at the ED, along with in-patient admissions for observation and IV medications. Failing to associate a dental unit with EDs limits treatment options. While there are a few independent dental clinics in larger cities that accept dental emergencies, they typically require private insurance or out-of-pocket payments as modes of transaction.
Oral health is a crucial component of overall health, influencing both physical and mental well-being. Children’s oral health can affect functional capacities, psychological well-being and social integration. Additionally, health behaviours established in childhood extend into adulthood and can influence oral health outcomes later in life.
While recent commitments to implement a national public dental program are a step in the right direction, they fall short in addressing the pressing need for immediate access to emergency dental care.
A large percentage of Canadian children under the age of 5 have never visited a dentist, though about 90 per cent of children between 5 and 17 have visited a dental professional in the past 12 months.
A large percentage of Canadian children under the age of 5 have never visited a dentist.
A study conducted within a population in North America estimated that 47 per cent of children suffer some form of dental trauma. The majority (64.2 per cent) happen during indoor and outdoor playtime activities, while sports fields were the second most frequent setting at 17.4 per cent. (A friendly reminder that we are in hockey season: do guard up to avoid a 10 times greater risk of dental injury).
Though 2.4 million Canadians have been approved to receive coverage under the federal government’s dental care plan since its inception earlier this year and up to 9 million by the time it is fully implemented, emergency care is still a missing component.
Data obtained from the Children’s Hospital of Eastern Ontario through a freedom of information request showed that 440 patients with dental emergencies visited the ED in 2023. Since there are no dental professionals in the ED, no treatments were applied beyond basic first aid. We were also informed that some surgeries were postponed because dental care was not provided for children who couldn’t afford it but needed it because of the high risk of bacteremia. Considering that the data is from only one of the four main hospitals in Ottawa, we can only speculate on what the total number is and how severe the problem is.
To ensure equity across our health-care systems, we urgently call upon governments to revolutionize children’s dental care and integrate dental emergency services into existing provincial health insurance plans. This reform would help in providing coverage for the provision of dental units associated with EDs along with coverage of expenses for procedures performed in private clinics, to fall under provincial insurance plans.
A comprehensive approach would be useful for centralized data collection, further providing a clearer picture of oral health needs across the country. Parents would have peace of mind knowing their children are covered for emergencies at all times, and hospitals could invest in dedicated pediatric dental units, offering much-needed trauma care and follow-ups.
We also need to advocate for strategies that effectively link children to a dental professional.
By prioritizing children’s dental health, we’re not just improving smiles – we’re building a healthier future for our nation. Let us lead this charge by placing our youngest citizens first in line for essential health-care services.
