Dr. Pirjo Friedman hasn't travelled to see her dental clients in smaller N.W.T. communities since March when she was in Łutselk'e, N.W.T.
"We had two more patients to see but yet, we were not allowed to continue … Obviously I have worried about all of those patients," said Freidman, a dentist with Adam Dental Clinic in Yellowknife.
She said the clinic has a contract with the territorial government to provide dental services to Norman Wells, Łutselk'e, Fort Resolution, Deline, Fort Good Hope, Tulita and Colville Lake. But dental services were immediately put on hold at the start of the COVID-19 pandemic.
While they resumed this summer in places like Yellowknife, Inuvik and Hay River, N.W.T., the same hasn't happened in the territory's smaller communities, where Freidman said some patients have not seen a dentist since February.
"It's obviously not fair for those people," she said. "It's not a very encouraging situation at all."
Freidman said when dental services started up again, she got a phone call from the federal government asking why she wasn't going to the communities. She responded that under the Chief Public Health Officer's dental guidelines, she's not approved to do dental work there.
Non-urgent dental eligible for medical travel
According to Freidman, shortly after the conversation, the federal government approved patients in need of non-urgent dental treatment to be eligible for medical travel.
"That's happening but that's a drop in the bucket really. How many people can we see? And is that safer? To have everybody coming to Yellowknife?"
Representatives with Indigenous Services Canada said in a statement that the federal government has been covering medical travel for non-urgent dental care since the summer "in response to the decision from the Government of the Northwest Territories to pause dental travel into communities."
"Indigenous Services Canada is engaged in discussions with the Government of the Northwest Territories to identify solutions that will enable dental services to resume for NIHB (non-insured health benefits) clients in remote communities," wrote William Olscamp, a spokesperson for the department.
"All options are being considered including the creation of service hubs, with the goal of resuming services as soon as possible."
CBC News asked the territorial government why dentists weren't being sent to the communities, but was deferred to Indigenous Services Canada.
Territorial government spokesperson Mike Westwick said the territory's COVID-19 dental standards "do not preclude anyone traveling to small communities for dental care and provide guidance for safe dental care for workers and clients."
Dr. Roger Armstrong, the president of the Northwest Territories and Nunavut Dental Association, said there is confusion among dentists over why community travel has been on hold for so long.
Armstrong, who operates the Great Slave Dental Clinic in Yellowknife, said there's been almost no discussions between the territorial government and dentists since dentists went back to work in the summer.
Restrictions impeding rural dentistry
For about two months, Armstrong says the association has asked to join meetings between the federal and territorial governments on the issue of northern dental services.
Armstrong said the association believes some of the government's COVID-19 restrictions, such as the dental standard's provision on aerosols, may be an issue for dental clinics to resume in the communities.
Armstrong explains that after dental procedures, there needs to be a certain period of settle time for airborne contaminants to dissipate.
He said the settle time is determined by the number of "air changes" in the treatment room per hour, and that a baseline measurement is needed.
Armstrong said if dentists are doing 45 minute procedures, they have to wait 15 minutes after each procedure. This can add up to about two hours in lost time per day.
He said the current guidelines are difficult to implement in the small communities where there is only a single treatment room.
Armstrong said that the territory has some of the most stringent dental guidelines in the country, and that other jurisdictions don't adhere to the aerosol settle time, which is one of the main obstacles communities face in meeting dental standards.
"In my clinic you got multiple treatment rooms so that means while you are waiting for the aerosol settle time in one room, you can work in another room," said Armstrong. "You don't have that option in the communities."
"What they have right now, it works in a multi-treatment room facility, but it's not going to work in a single treatment room facility."
Armstrong also noted that dental equipment in some communities is in need of maintenance, but that work requires a dental maintenance technician, and it could take months before one can get to those communities. On top of all that, he said dentists are getting warnings from the Canadian Dental Association that a shortage of masks and gloves is imminent.
He said right now, the Yellowknife clinics are trying to catch up with cleanings and the wait lists are abnormally long.
"The problem is it's a snowball effect. It's like everybody's struggling to get caught up," said Armstrong. "Everyone [is] working as hard as we can to get through this situation … We have no idea when we are getting back into the communities," he said.
"Everybody is super frustrated with the government."
He said his worst fear is this current situation could lead to a dental-related death from an infection. Although residents in communities are able to get a referral to come to Yellowknife for dental appointments, this message hasn't been relayed to everybody.
"These are all surprises to me. I've never heard this in the community," said Janet MacCauley, the acting deputy mayor of Tulita, referring to residents having to travel to Yellowknife for a cleaning.
"I don't like the idea that you have to go to Yellowknife to get your dental work. That's just lots of travelling that we don't want people to travel out of the community."
She said that if essential workers are allowed to come to communities, dentists should be included.
MacCauley said typically, a dentist comes at least every six months.
She worries that if cleanings and check-ups don't happen regularly, it could lead to dental emergencies.
"In the past two months, I've seen there's been a lot of people going [to Yellowknife] for dental," said MacCauley. "Why weren't we told that this was going to happen?"
Friedman urges the government to allow dentists to treat patients in the communities soon.
"I just want them to know, the communities where I've been going for many years that this is not up to me," she said. "I'd like to be there and help them."