By Greg Basky for SHRF
From his 10 years working as a specialist in pediatric dentistry, Dr. Keith Da Silva can still recall at least once a month having three- and four-year-old patients whose tooth decay was so advanced that he had to pull out most or all of their teeth. “Kids only have 20 teeth until their permanent teeth come in. So a lot of these kids, they were just so far gone that we had to take everything out,” says Da Silva. “And you know they’re not getting new teeth until they’re six years old, when their adult teeth start coming in.”
While those were the extreme cases, Da Silva saw many other children with dental problems that could have been treated or prevented from worsening had the young patients been seen earlier.
A new project involving Dr. Da Silva – now an assistant professor in the USask College of Dentistry – and his colleague Dr. Amrinderbir Singh – aims to detect and treat kids’ oral health issues sooner, by teaching doctors and nurses at the Saskatoon Community Clinic to take a closer look inside the mouths of very young children while they’re already in for well-child medical visits. The project is one of two Singh and colleagues are conducting, with the support of SHRF research grants, to address barriers the city’s Indigenous population face in accessing dental care. While the kids dental project isn’t specifically targeted at Indigenous children, the Community Clinic does tend to see more patients from this community.
Dr. Amrinderbir Singh (left) and Dr. Keith Da Silva (right) are working to address oral health disparities in Saskatoon.
The pair of projects align with the Dental College’s belief in community outreach and engagement and in providing accessible dental care to underserved communities through initiatives such as Saskatoon West Dental. Through its research efforts and clinical training, the College is committed to strengthening dental care for Indigenous patients.
"This is about co-creating an oral healthcare delivery model that addresses barriers"
Growing up in northern Saskatchewan, Trish Goulet regularly heard stories of Indigenous people going in for dental treatment, not getting proper anesthetic, then simply being held down and having treatment forced on them.
“One of the racist tropes that’s really common in the dental world – that most people outside of the dental world likely are not aware of – is that Indigenous people – particularly Indigenous men – are the best patients because they don’t complain when they’re in pain,” says Goulet, a member of the Peter Ballantyne Cree Nation, who has worked as a dental hygienist and is now an assistant professor in the College of Dentistry.
Trish Goulet is working alongside colleague Dr. Singh to conceptualize Indigenous-informed oral care approaches.
This kind of traumatic experience has a significant impact on a person’s sense of safety, she says, and on their ability to go into a dental care setting where there’s such a significant power differential between provider and patient.
Now Goulet is working with her College of Dentistry colleague Dr. Singh on a project aimed at finding out directly from Indigenous people what an ideal dental care experience would look like. Through voluntary surveys and in-person interviews to be conducted at Saskatoon West Dental, the research team will dig into how the dental care system can better serve urban Indigenous people, what they need to feel safe in this care setting, what can be done to make them more comfortable – and perhaps most importantly, to start to build back trust that’s been lost.
Our failure to meet the dental care needs of Indigenous communities demands action, says Singh. The First Nations Oral Health Survey conducted in 2009-10 found prevalence and severity of oral diseases were between 1.6 and 2.9 times higher among Indigenous Canadians than in non-Indigenous Canadians.
“Like any other clinic, we deliver care in a very Western way,” says Singh. “But there’s been very little research done to understand what are some of the specific needs and aspirations of Indigenous patients. How do they want to receive dental care? What does the ideal dental clinic environment look like for them? This is about co-creating an oral healthcare delivery model that addresses barriers, and provides a welcoming, culturally safe environment where urban Indigenous individuals can come and feel safe and comfortable.”
Singh and the team are going in with a blank slate; they have no preconceived notions about what this patient population wants or needs. Through this work, they hope to gain a better understanding of whether Indigenous people have different expectations about dental care and how providers can modify their practices to deliver care more holistically. “Every individual has the right to be treated, to receive care based on their values,” says Singh.
Supported by an Align Grant from SHRF, this second project will establish a baseline against which to measure changes in perceptions of Indigenous patients after staff at Saskatoon West Dental alter their environment and processes in response to what people tell them.
For Goulet, the project is about relationships. “We don’t know where this is going to go. But we’re going on this path together with our participants and being open to where that ends up,” she says. “If we can do that and establish a baseline of where we’re at, what we can do to begin to improve, and we do that in a collaborative way, to me that’s success.”
The thread linking these projects is addressing barriers to accessing dental care, according to Singh. In the case of young children, those barriers could be due to parents not knowing when to take their child to a dentist or perhaps because of limited financial means. With Indigenous adults, it’s about creating a dental care space that feels welcoming and safe, so that they keep up with their routine care.
“My passion and my goal as a dental public health practitioner is to address oral health inequities that exist amongst all populations,” says Singh. “Some populations suffer disproportionately when it comes to health and oral health. So how can we put extra effort into bridging those disparities? This has become the purpose of my life.”
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