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Remote and rural communities in B.C. are currently facing a shortage of dentists, according to WorkBC.

This is especially true in Indigenous communities, where most people have to leave the community to access dental services, according to the First Nations Health Authority.

Medium-sized communities are also feeling the squeeze. In Powell River, a community of nearly 14,000 people with four dental offices, locals told The Tyee they’ve had to head by ferry to neighbouring communities for care after a year of trying to be seen by a local dentist.

This shortage is expected to grow over the next decade as the province’s population grows and ages while working baby boomer dentists retire.

Right now there are 1,550 job openings for dentists and 3,500 dentists working in the province, according to WorkBC and the 2016 census, respectively.

WorkBC estimates that new graduates will be “insufficient to meet demand.”

Over the next decade around 58 per cent of new hires will be needed to fill vacancies left by retiring dentists. Forty-two per cent will be needed to meet new market demand, estimates WorkBC.

Unequal access

There are a few different factors snarling people’s ability to access regular dental care.

First, many remote and rural Indigenous communities don’t have dental offices, so community members have to travel long distances for care, wrote John Mah in an emailed statement. Mah is vice-president of health benefits and services for the First Nations Health Authority.

That’s not always as easy as driving to the next-closest town; many Indigenous communities aren’t connected by road, and locals have to take a plane, train, boat or icy road in and out of town. Accessibility varies by season and weather.

Second, Indigenous people aren’t starting off on the same foot as non-Indigenous people when it comes to oral health. First Nations youth have poorer oral health than their non-First Nations counterparts due to the legacy of colonialism. Indigenous adults may have previously experienced racism when accessing health care, making them mistrustful, Mah says.

Third, there’s a shortage of dental hygienists and dental assistants in the province, which limits how much work dentists are able to do, says BC Dental Association director of member support Salima Dadani.

The average dentist needs 1.5 certified dental assistants to run a practice (with the ideal ratio being two to one) and B.C. is currently short around 800 assistants, Dadani says. Once the Canadian Dental Care Plan is fully online and more people are asking for dental services, that dearth will increase to 1,200, she adds.

There’s currently a shortage because many older assistants retired during the pandemic rather than work in-person jobs that carried a high risk of infection, Dadani says. The dental assistant certification program takes a year, but many young parents take time off to raise families. If they take more than five years off, they have to go back to school to get recertified, she says.

Chantal Rodrigue, a coffee shop manager and student who moved to Powell River just over a year ago, told The Tyee she was caught off guard with the lack of dental access in her new town.

In the small Albertan community she moved from, finding a dentist had been easy. When she moved to Powell River, she spent a year calling local offices to ask if they were accepting patients before giving up and heading to Comox for care.

To leave Powell River you need to take a ferry, which is expensive, and you also lose out on a day of work, Rodrigue says. When she travelled to Vancouver for an emergency root canal, there was the added cost of staying in the city, she says.

Luckily, the Vancouver dentist told her she didn’t need a root canal — but she had to travel a long way to learn that, she says.

How to fix the shortage

The Tyee heard a number of solutions that people are using to make a trip to the dentist more accessible for everyone in B.C.

The First Nations Health Authority has a dental benefit plan to help cover the cost of dental services and an oral health program that offers preventive services for kids under seven and brings dentists to Indigenous communities.

The FNHA isn’t the only one working to bring the dentist office to you.

Helicopters Without Borders, a non-profit charity co-founded in 2020 by Owen McClung-Sitnam, flies food, medical equipment, health-care professionals and community members in and out of remote Indigenous communities in B.C. McClung-Sitnam says they regularly fly to five communities on the coast, but have flown to a total of 22 communities so far.

Over the last year they’ve developed a way to fit equipment for two mobile dental clinics into the helicopters, McClung-Sitnam told The Tyee. This means Helicopters Without Borders can fly two dental offices and all their staff into a community and set up shop, or set up two offices in two separate communities.

Around 200 patients have been seen at these mobile clinics since the program was launched last year, he adds. This costs one-quarter of what it would cost to fly those 200 patients out of town for dental care, McClung-Sitnam estimates.

The FNHA has partnered with Helicopters Without Borders, and McClung-Sitnam says he hopes his organization can keep growing.

The BC Dental Association’s Dadani also owns Silver Valet Dental Care, a company that builds mobile dental clinics in Sprinter vans. This helps connect people living in long-term care facilities, and people with limited mobility, with dental care, she says.

Schools are also working to increase the number of seats in their dental programs.

The University of British Columbia faculty of dentistry bumped its seats to 70 last year, up from 60, says Leeann Donnelly, director of community engagement and associate professor with the faculty.

Schools are also encouraging graduates to settle in smaller communities. The UBC Summer Student Practitioner Program places students heading into their fourth year in a rural dental office for the season, which Donnelly says helps them “get comfortable” in smaller communities.

Dadani says provincial grants have helped pay for the tuition and living expenses of students going through oral hygienist programs, and there’s work being done to create work-integrated learning programs that would allow students to learn and study in their hometowns and only head to urban schools for testing.

A future paved with gold fillings

Dentists have also come up with innovative ways to fundraise to help schools boost their student numbers.

Dentists pull a lot of teeth and occasionally those teeth have gold fillings, Dadani says. An office will save all of this scrap metal and cash it in once a year to help cover office expenses. In 2023 dentists across the province pooled their scrap metal, which had built up over the pandemic, and fundraised $160,000, which was donated to Okanagan College to add an extra 24 seats to its 2023 certified dental assistant certificate program.

Donnelly says UBC is starting to hold seats in its oral hygienist program for Indigenous students, with the hope that students will graduate and set up practices in their home communities.

Back in Powell River, Rodrigue says she’d like to see the provincial Travel Assistance Program be extended to cover people’s travel expenses when they have to travel out of town to see a dentist.

The TAP BC program helps cover travel costs for residents who have to travel within the province for non-emergency medical specialist services not available in their community.

In a statement the Ministry of Health said that to access TAP, a patient must be referred by a general practitioner or nurse practitioner for medical specialist services not available in their home community. This can include dental surgery if the patient is referred by a physician or orthodontist, but doesn’t cover other dental services.

— This story was originally published by The Tyee.

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