Part 2:  Children and MSP

You’re Going To See A Lot Of Children

Children.  You are going to see a lot of children.  Just get good at it, or have an excellent CDA who helps you make it look like you are good with children.  There are a few reasons you are going to see tons of kids. One, most owners are going to give you the kids to see.  Why? It is generally thought to be this way because pediatric dentistry is tough, and takes up a lot of time. Two, in Canada there isn’t generally community water fluoridation, and in some areas poor knowledge of dental hygiene for children. You are going to see a lot of early childhood caries.  Three, there are just a lot of kids in some communities. There is a big push at the moment in certain regions to have education for expecting mothers or mothers of new born children about prevention methods and also placement of topical fluoride routinely.

“In Canada there isn’t generally community water fluoridation….  You are going to see a lot of early childhood caries”

Paediatric patients can test us. There isn’t public dentistry in Canada, so if the child is uncooperative or too young what do you do?  The options are really: send them to a pediatric dental specialist, have them seen by a general dentist with hospital rights to have them seen under general anesthetic, or struggle through it yourself. Where I am, the nearest pediatric dentist is a four hour drive away, and the two dentists locally who have hospital rights sometimes have a year waiting list. It’s tempting to just go in and do the work with the child in the chair to avoid the wait, but always think: are you going to be able to do an effective restoration on a screaming child who is wiggling around and wants nothing more than to bite down on your finger or worse bite down on the drill? Are you going to give them a positive experience, or are they never going to come back to the dentist because they are traumatized.  

How To Care For the Unwilling Child

You have to ultimately make the decision on if you feel you can work on the child. Sometimes it is worth having a couple of tries at it, it depends on the temperament of the child, and also the parent. It also depends if you have Nitrous oxide available, or other methods of sedation. You can see a four year old and be able to do a filling on them, but you may see a six year old you can’t even get to open their mouth. There isn’t a hard a fast rule about it, I wish there was. Some dentists just say no, anything under six gets an automatic referral, some are willing to try. Sometimes it’s better to have the parents in the treatment room, sometimes it’s better to have one parent or no parents, just consider it on a case-by-case basis. You just have to decide what you are comfortable with and start to become your own dentist.  

You did read that right; there are dentists in Canadian hospitals. There isn’t public dentistry in Canada like what exists in Australia. We do have public medical services but dental services are not included. So how come there are dentists in some hospitals? Dentists in Canada can seek to have accreditation to work on patients under general anesthetic administered by an anesthesiologist in a public hospital. The government doesn’t pay for it (usually) and the dentists have to be scheduled operating room time when the operating rooms aren’t in use by the hospital.

Medical Services Plan (MSP)

In British Columbia there is some coverage provided by the government under the Ministry of Social Development and Poverty Reduction Dental Program, which falls under the MSP, or Medical Services Plan. It’s the government, they have to have sub programs and sub programs, but in a nutshell everyone calls these MSP patients.  This breaks down into two broad programs Healthy Kids and BCEA. Under the Healthy Kids program, children under the age of 19, if they meet certain requirements, are covered up to $2000 basic dental every two years. In addition the BC Dental Association runs a save a smile program where children under 18 can be funded on top of that or instead of that in some way, again after applying for the program.  Yes there is a ton of paperwork for both you as the dentist and for your front office staff, yes it can take some time for things to get arranged, but you can actually make a huge difference in a child’s life and wellbeing and the parents don’t have to pay a huge amount.

You can actually make a huge difference in a child’s life and well-being.

What About Adults

For adults receiving income assistance through the BC Employment and Assistance program (that’s government speak for welfare) there is some dental coverage, however this program pays only at 60% of the current BC dental fee guide.  Some offices just accept this lower fee and absorb the cost difference; others charge the patient the 40% to make up to the BC dental fee guide.

In addition to that there are some quiet ways that dentists try to bridge the gap of people who can’t afford dental care and who don’t have insurance.  Some offices take on a family or two and just don’t charge them the cost of dental work. In many communities there are low cost/no cost not for profit dental clinics, which run with paid or volunteer staff, who rely on grants or MSP patients to provide services to the community.  It is important to find a way to give back to your community, seek out a non for profit that wants some help or join in with your clinic’s method of giving back to the community.

Next in the Canada Series – A Day in the Canadian Life

Want to know the major clinical differences? Find out in the first post: The View From The Canadian Side of The Pacific 1 [Series]

Andre is a general dentist who trained at the University of Sydney. He is now working in private practice in BC, Canada.

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