Baby teeth damaged by decay, infections in young gums, and children crying in pain from an untreated abscess are all challenges that Dr. Bella Panjwani faces almost every working day at her Saint John dental clinic. 

In a photo of a boy, about age six, she points to teeth she considers unrestorable. 

He was in such pain and so agitated to be in an unfamiliar dentist's chair, staff couldn't do their work. 

"So the mother was here for two hours," Panjwani said. "Very frustrated about the things we couldn't get done."

A lack of awareness around oral health, often passed down through generations, may be the biggest factor in why she doesn't see children until it's too late, Panjwani said.

But affordability is also an issue, she said, and Ottawa's promise to provide benefits for kids under 12 by the end of 2022 could make a difference. 

The federal Liberal government said its plan will target families with an annual income under $90,000. 

That's a huge leap from New Brunswick's provincial payer-of-last resort program, which covers adults on social assistance and youth under 18 from low-income families. 

The youth program, also known as the Healthy Smiles, Clear Vision program, sets its income cap below the poverty line. 

To qualify, a single parent with a child must have an annual income under $26,928 even though the Human Development Council sets the poverty line for that family unit at $30,227.

A family of four can't have an income over $38,082, when the poverty line for that household is $42,748. 

Healthy Smiles covers regular exams, X-rays and extractions as well as some preventive treatments such as sealants and flouride.

In 2014, Saint John council voted to stop adding flouride to the municipal drinking water system to save $177,000 per year.

Of the total billings by New Brunswick's 341 licensed dentists, treatments charged to the province account for about five to six per cent, says Paul Blanchard, executive director of the New Brunswick Dental Society. 

Blanchard said there are many unanswered questions about how the plan will work, a concern that was raised last week by the Ontario Dental Association. 

The promised plan came about as part of a deal the Liberals made with the New Democratic Party to stave off an election until 2025. 

Some questions being raised by the New Brunswick Dental Society:

What kind of benefits will be provided?

How will the plan be administered?

Will treatments under the plan be paid at a lower rate?

Will the plan create disincentives for employers to maintain workers' benefits?

Will New Brunswick dentists have the capacity to take on many more patients?

Will Ottawa's pledge of $5.3 billion over five years be enough?

Presumably, the government got some advice in the past four weeks, when it invited stakeholders to provide their input through a request for information portal that closed on Monday.

"They've got a lot to learn in a short period of time," said Blanchard. "But their deadline is a hard one, so my sense is that the federal government may come up with a plan that would send money directly to families, just to meet their commitment, their political promise." 

WATCH | Picture of child's decayed teeth stresses need for more dental awareness

Meanwhile, Blanchard said he's hearing from dentists whose patients are cancelling appointments because they believe if they wait, they won't have to pay. 

"I think that we need to manage the public's expectations around this," he said. "I don't think a federal plan is imminent, not even in the next year or two, so I wouldn't be cancelling that appointment for a cleaning."

Panjwani said children who suffer from poor oral health are likely struggling in other aspects of their lives. 

"This boy, he can't eat. He can't focus," she said, turning to the photo of the six-year-old boy.

"A child in pain cannot focus on education, cannot develop learning skills."

She said teaching awareness may be more important than funding, and she would like to see mothers coached in oral health as part of their prenatal care. 

"We need to increase dental IQ," she said because a dental plan can only help those who choose to use it. 

"If you just throw money and not plan all this [education and awareness] are we going to be able to help them? I have a little doubt about that."

Rachel Cave is a CBC reporter based in Saint John, New Brunswick.

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