Keira Johnson lived with unrelenting pain in her teeth during high school in Langley, a tumultuous time when she made her “home” inside a friend’s car or stayed with a boyfriend’s family.
“I’d wake up and there would be blood on the side of my face, blood on my pillowcase,” recalls the resilient teen, who graduated on time despite enormous obstacles.
“At that point I hadn’t talked to my family in years and years. I had no (insurance) coverage. I was just on my own.”
Johnson, who hadn’t had a dental appointment in years, finally saw a dentist who told her it would cost $2,000 to have her problematic wisdom teeth removed. She worked full-time at White Spot, while going to high school, to try to save the money.
Then the Langley Youth Hub, which helps vulnerable teens with basic needs, told Johnson about two dental hygienists who drive around in a Fraser Health Authority van to provide services to at-risk youth. Johnson was hesitant, but she met hygienist Helga Thordarson in the mobile health unit in the fall of 2021, when she was 17 and starting Grade 12.
“She was in a lot of pain. And she was kind of quiet and she really needed our help,” Thordarson said. “She was in a low spot in her life.”
Within weeks, Thordarson and a youth worker found dental coverage for Johnson through the Ministry of Children and Families, even though the teen was not connected to foster care. Through her network of dental contacts, Thordarson also found a kind dentist who made the anxious teen feel less nervous.
Having her teeth fixed was life-changing.
“It was awesome and huge for me,” said Johnson, 18, sitting with her American pocket bully dog Koda, her constant companion during her difficult teen years.
“That area of your face and your head, and everything being in pain 24-7, it’s not fun. You just feel crappy all the time, and sleep deprived because you’re not getting any sleep because your head’s always hurting.”
Since Fraser Health launched its mobile dental service three years ago, it has helped more than 800 youth under age 19 who may be homeless, in conflict with their parents, or struggling with other challenges. It operates one or two afternoons a week, staffed by either Thordarson or fellow hygienist Sandra Wheeler, with a program coordinator who doubles as the driver.
Johnson “was a very, very nice person and very, very thankful for anything we did for her,” Thordarson said. “I am so happy that we got her out of one of her rough spots.”
Thordarson has been a hygienist for four decades, but her job in this van is part social worker, as she meets at-risk teens at drop-ins or resource centres in Surrey and neighbouring cities. She brings them into the large vehicle — equipped with swivel chairs, a flashlight to peer inside mouths, and an impressive wall of free toothbrushes and toothpaste — to chat about their teeth and, often, other challenges they are facing.
“We see some very sore mouths and broken teeth, bleeding gums, pain, infection, swelling. A lot of dental fear, a lot of anxiety, a lot of fear of being judged,” she said.
Some teens will let Thordarson look in their mouths, and may leave with a dentist appointment. Others might only want the free toothbrush, although she encourages them to come back. A handful are scared to come inside the van, double-checking that she doesn’t have any pain-inducing tools inside. (She doesn’t.)
Besides building trust with youth often reticent to trust anyone, Thordarson routinely has to employ detective work to find ways to pay for dental procedures. She checks with B.C. Healthy Kids to see if their families have registered for basic dental coverage for low-income families; the federal government’s Jordan’s Principle program for Indigenous children with unmet needs; the B.C. Dental Association’s Save A Smile financial assistance for underprivileged kids; the B.C. Children’s Ministry, if the youth have received any government services; and the teens’ former dentists, if she can find them, or the teens’ parents, if they give her permission to contact them.
Questions about federal dental plan
A new arrow in her quiver will be the federally administered dental insurance program, announced in last month’s budget, to subsidize care for eligible Canadians without coverage. Teenagers are one of the first three priority groups when the insurance becomes available, along with seniors and people with disabilities.
The plan will apply to households making up to $90,000 a year that have no dental insurance through a group plan — a “missing middle” income bracket that was too high for most other low-income assistance plans, but typically too low to finance pricey dental work.
“It’s a piece of good news. It’s another avenue for people who don’t have dental coverage,” Thordarson said. “There’s been this middle income bracket (struggling) for so long. I think it’s really great that it’s going to get them in to see their dentist.”
Approximately one million British Columbians who don’t have dental insurance could eventually benefit from the federal government’s plan, but there are few details so far about exactly how it will work, said Mario Brondani, an associate professor of dentistry at UBC.
“I think the plan is a start,” said Brondani, who has witnessed the dire circumstances of many patients at a non-profit clinic. “I can tell you that families need this plan.”
The recent promises in the federal budget actually expand a program that Ottawa started late last year, which allowed uninsured parents to apply for up to $650 a year to cover dental expenses for children under 12. That plan, which will be discontinued in the coming year when the new insurance program kicks in, was applied to households making less than $90,000 who had filed a tax return.
“The new (insurance) program then expands to youth under 18, seniors and folks with disabilities. But that’s where the unknowns start,” said Brondani, chair of UBC’s division of dental public health.
For example, he said it’s not clear yet which dental services, such as braces or replacing a crown, will be covered by the new program. Details have also not been released on whether there will be a limit on how many services will be covered per person.
“If there is a cap, then they will not get all the treatment they need,” Brondani said. Some low-income people, who perhaps haven’t been able to afford to see a dentist for years, may need an extensive list of treatments, he warned.
Also unknown is whether the plan, which will be run with the help of a third-party insurance administrator, will require people to pay up front for their procedures and then be reimbursed by the government, a route that won’t be realistic for many families that need this type of program, he said.
Unclear, as well, is the sliding scale of payments that patients will be required to make if their household income is between $70,000 and $90,000. Those making less than $70,000 are not expected to make any copayments.
‘It will not solve all the problems’
Another question is how helpful the program will be for the type of youth seen in the Fraser Health mobile van, Brondani, said.
That’s because the federal government typically sets eligibility requirements for these types based on income tax returns; and if vulnerable youth are estranged from their parents or are from marginalized families, there may not be tax returns on file.
He noted, though, that this possible hiccup could be addressed by another announcement made in the budget: $250 million over three years, starting in 2025, to establish an oral health access fund to address gaps for vulnerable populations and reduce barriers to accessing care.
The federal dental insurance program is to be fully rolled out by 2025, and presumably by then will include all low-income adults that don’t fit into the first priority groups.
“It will not solve all the problems, definitely not. It will not please everybody, definitely not. But we have to start somewhere,” Brondani said.
According to the Canadian Health Measures Survey, he said, one in five people avoid going to the dentist because they can’t afford it. In B.C., that translates to one million people.
Federal Health Minister Jean-Yves Duclos said last month that the dental insurance program, for which the government has budgeted $13 billion over five years, will be much more expensive than originally thought, as he anticipates far more Canadians will sign up because of long-overdue dental needs.
“This is appearing to be in high demand,” Duclos said in March, citing the fact that demand for the dental benefit for children under 12 grew faster than expected since December.
Dr. David Lim, president of the B.C. Dental Association, has said there may not be enough dental hygienists and dental assistants in the province to meet the anticipated demand of new patients once they gain access to this federal insurance. He estimated 300,000 to 450,000 B.C. children alone will be eligible to access the plan by 2024.
Federal New Democrats, who are propping up the minority Liberal government, have said they want the insurance program for youth, seniors and those with disabilities launched by the end of this year. The full implementation by 2025 will be based on people’s income, although workers who have group benefits through their employer will not quality.
Brondani is worried the people who will need this help the most may be unable to take advantage of it because they are consumed with more pressing needs, such as how to feed or house their children.
“Oral health for them, it is important, but it gets low priority because they are in survival mode,” he said. “The program is a start but I don’t think we will be successful without a larger consideration of food security and housing.”
Non-judgmental care key for vulnerable teens
Thordarson has also witnessed the dire need among her youthful patients, many of whom come from low-income situations.
“Our clients are often people that haven’t been to a dentist for a while,” she said.
“Many of them are in difficult spots, for whatever reason. Sometimes it’s just going through a rough patch as a teenager, sometimes there’s some conflict with the parents, sometimes they’re not living at home.”
The teens may have toothaches or are worried about stained teeth or, like Johnson, have major issues such as impacted wisdom teeth.
Some, especially those who have faced trauma, will visit the van two or three times before they’ll consent to letting Thordarson help. She takes it slowly, building up rapport until they are comfortable. And she would never give them unrealistic advice, such as flossing every day, as that would be too big a leap given their circumstances.
“As a hygienist, I do a little bit of nudging, talking a little bit about hygiene and what they can do. And I have a little look at their mouth, but I try to make a point of being very non-judgmental,” she said. “I completely stay away from the lectures.”
She gave one client with bleeding gums the achievable goal of brushing once a week, as a small first step toward improving oral health. Eventually the objective is for them to see a dentist, and to gain the ability to look after their teeth long-term.
“It’s not just about providing services for them on the van. It’s also setting up the opportunities for them to get treatment in the future, giving them connections,” said Hanshil Jhuboo, a coordinator of Fraser Health’s mobile public health units, who works with Thordarson on the van.
“Maybe some youth don’t want treatment, which is completely OK. Even if we’re just talking to them about dental hygiene, stuff like that, that’s still good.”
Jhuboo estimates there are a dozen youth resource centres that ask the van to come by to help their clients, mainly in Surrey, but also in other Fraser Health cities such as Langley and New Westminster.
The van has also repeatedly visited students at an alternative school in Coquitlam, where a grateful teacher has asked Thordarson — who has a warm, friendly personality — to speak with teens about issues that go beyond dental, if they are willing.
“Sometimes, for example, that teacher will tell us, ‘Hey, could you talk to her about vaping? Or they’re wanting to try to quit smoking? Do you have any ideas for them?’ So, that’s kind of within our realm, too. And, again, it’s small steps: talking a bit about it, what they think they can do,” she said.
She and Jhuboo can refer students to other experts they can see for additional life challenges.
Telus provided the financial backing for the van, and has sponsored similar vehicles in other Canadian cities, including Victoria, Calgary, Ottawa and Montreal. The mobile units are used to deliver a variety of health services, such as one launched in Vancouver in 2021 to provide primary health care in the Downtown Eastside with participation from Indigenous elders.
The Fraser Health van is used on different days as a mobile immunization clinic, or as a sexual health clinic. Its role as roving dental office is less common, said Thordarson, who loves her job.
“It feels pretty good. I feel like we make a big difference in almost everybody that we see in some way. And even if it’s just that someone looked in their mouth, even if they were able to come on the van, it’s one more step to improved health care, improved oral health.”
Johnson doesn’t hesitate when asked about the care she received in the van: “It helped so much.”
Johnson, who graduated from Langley’s R.E. Mountain Secondary last June, works at a dog daycare, and plans to take courses to become a certified dog trainer. During Grade 12, after meeting Thordarson, she was connected with the Children’s Ministry, which paid for an apartment for her.
As a teenager on the street, she was scared of dentists and didn’t trust many people. But she wants other young people in a similar situation to know walking into the van didn’t come with the same anxiety many underprivileged youth feel in a busy medical waiting room.
“Honestly, when it comes to the van, it’s so different than a doctor’s appointment or going into the dentist. It was so comfortable,” she said, adding other teens shouldn’t wait as long as she did for treatment.
“That was my big thing: I never wanted help. It took a lot for me to realize that if I ever wanted to get anywhere, sometimes I need some help.”
With files from The Canadian Press
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