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Dental hygienists in the Northwest Territories can now treat patients without being supervised by a dentist.
Registered dental hygienists can provide a variety of preventative dental care, from cleanings to treatments like fluoride rinses, and sometimes preventative treatments for small cavities.
The change came into effect on Monday. It was originally proposed by Caitlin Cleveland in a private member’s bill during the N.W.T.’s 43rd assembly in March 2023. At the time, it was proposed as part of the solution to addressing the lack of access to dental care in the Northwest Territories.
Hygienists are already allowed to set up independent practices in all provinces, according to the Canadian Dental Hygienists Association’s website.
Stacey Ridgely oversaw the creation of the new Dental Hygiene Profession Regulations for the N.W.T. government. She said the new regulations make the Northwest Territories more aligned with other jurisdictions in Canada.
“Very much our work is to ensure that, you know, there’s mobility for dental hygienists who are trained and registered in other areas. That they are able to come practise their full scope here,” she said.
“Separating dental providers to allow for the option of dental hygienists to work independent of a dentist is key to empowering dental hygienists to secure their own contracts; and, in turn, provide prevention oral health care in small remote communities,” Cleveland told legislators during the bill’s second reading.
But Ridgely said there’s no guarantee that the bill will make preventative dental care more accessible in the Northwest Territories.
“It potentially could, but not necessarily,” she told CBC. “It would really depend on if dental hygienists are interested in expanding their own work, their own practice.”
A challenging business
Registered dental hygienist Collette Murray has operated an independent practice in Calgary for 13 years. She runs a mobile practice, carrying her equipment in her SUV and treating patients in private homes, long-term care homes or assisted living facilities.
She said a similar model could potentially work for dental hygienists serving small remote communities in the N.W.T. — especially if providers can work with someone on the ground who can help co-ordinate the care to ensure there will be patients to treat when the hygienist arrives.
“The biggest struggle in a practice is not setting up practice, it’s having clients to work on,” she said. “I would think you would be able to travel with [your equipment] by plane, you would just have to be very strategic with it.”
Registered dental hygienist Meg Kreutziger was less optimistic that this model could work in remote N.W.T. communities. She’s owned her own practice in Grande Prairie, Alta. for six years, and now serves patients through a storefront and a mobile practice.
She said any dental hygienist thinking of operating a mobile practice in the N.W.T. would need to factor in the time and cost of transportation in how they set their fees — which may mean charging above the amount that would be covered by a government-run dental program like NIHB.
“I have been asked to drive five hours to go to a community, and I had told them how much it would cost just for me to agree to go,” she said. “Nobody has ever paid that fee.”
She also has to factor in the risks of travel delays, power outages, and people not attending their appointments in the fees she charges for mobile care — which can also drive up fees.
“I can’t take the risk to be at a loss … even though I understand that service is needed and I truly from the bottom of my heart want to provide that service.”
No government support available
Both Murray and Kreutziger said that if the territorial or federal government was able to provide contracts for dental hygienists to visit communities, it would likely make it easier and less financially risky for independent dental hygienists to visit small communities.
Murray said support from local health centres or community organizations could also be valuable for independent dental hygienists.
“We have to remember that oral care is health care. So when those silos don’t exist and health care is just one thing, the mouth included, that’s when we get the best outcomes for patients and our community,” Murray said.
A Department of Health and Social Services spokesperson told CBC via email that there is no financial support for independent dental hygienists in the territory, or to offer them contracts to provide dental care at all in the territory.
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