One of our main recommendations is that, in conjunction with federal investment in access to dental care, the federal government develop an oral health strategy to address non-financial barriers to care. This approach will have strong, measurable impact on oral health of the most vulnerable Canadians. While the full scope of such a strategy should be designed in concert with a diverse group of stakeholders and partners, it should include action on the following issues.
The oral health care needs of all Canadians must be considered when developing an oral health strategy, specifically those of vulnerable populations with specialized needs. Some of the specialized groups that need to be considered include Indigenous Peoples, seniors and persons with disabilities, among others.
Although the Non-Insured Health Benefits program for eligible First Nations and Inuit provides dental coverage for about one million people, Indigenous oral health outcomes lag significantly behind those of the general population. This discrepancy shows that other barriers to dental care and optimal oral health for Indigenous People’s need to be addressed in an effective oral health strategy.
Many seniors in Canada face financial, physical and geographical barriers within the health care system, including access to dental care. Canadians have progressively lower incomes as they age and older people are less likely to have private dental insurance through employment. Federal investment in coverage for dental care for seniors will help, but the complex physical, geographical and socioeconomic needs of seniors must also be considered when developing an oral health strategy.
Some persons with physical and developmental disabilities have special dental care needs that intersect with general health and well-being in complex and interrelated ways. In some cases, providing dental care for people with disabilities requires specialized equipment, use of surgical suites or training to accommodate their treatment. It is important to ensure that any federally funded dental care initiative considers the unique oral health care needs of persons with disabilities and the multifaceted barriers to care they face.
Better Oral Health Data and Research
While oral health is an essential component of overall health, it is rarely included in any large-scale health-related surveys conducted by the federal government. An oral health component has not been part of the Canada Health Measures Survey since 2010, nor has oral health been regularly included in the Canadian Community Health Survey. It is impossible to monitor and track progress on Canadians’ oral health outcomes without regular, reliable data. The ability to collect oral health data in future Canada Health Measures Survey and Canadian Community Health Survey cycles will be critical to evaluating the impact of publicly funded oral health initiatives, and identifying any adaptations needed to ensure they are contributing to a long-term improvement in Canadians’ oral health. The federal government should commit to long-term, ongoing funding to ensure that oral health components are routinely included as part of both the Canada Health Measures Survey and the Canadian Community Health Survey.
The oral health indicators to be included, as well as the roles of both household questionnaires and physical examinations, should be determined in consultation with oral health experts, specifically dentists. CDA has also encouraged the new House of Commons Standing Committee on Science and Research to undertake a dedicated study of oral health research and data collection in Canada and provide further recommendations to the government.
Funding for Oral Health Organizations
Federally funded dental coverage will potentially lead to an influx of up to 7 to 9 million new patients into dental offices over the next several years. This increase will require oral health organizations across Canada to significantly boost their activities relating to oral health promotion and professional support for their members. In the coming months and years, they will need to pivot and adapt their activities to support both patients and providers alike. These actions could include promoting awareness of new federal dental care initiatives, public education campaigns on the importance of oral health with respect to overall health, responding to questions from individual oral health professionals, and continuing to provide expert advice and feedback to the federal government on developing and delivering future oral health proposals. To address this, and as part of a broader oral health strategy, the federal government should make financial support available to oral health organizations who choose to participate in these activities, to offset the costs. Support could begin as early as Budget 2023.
Addressing Dental Workforce Challenges
Canada’s health care system is experiencing a human resources crisis, and the oral health sector is no exception. Long before the pandemic, dentists were raising concerns about their ability to recruit and retain dental office staff, particularly certified dental assistants. In the decade preceding the pandemic, the ratio of new dental assistants to new dentists fell by half. By 2019, one third of dental offices had vacant dental assistant positions. Since then, the situation has further deteriorated as a result of the broader labour market challenges resulting from the COVID-19 pandemic.
With an expected increase in demand for dental appointments because of federally funded dental coverage, ensuring the dental workforce has the capacity to respond is critical. This workforce is already stretched thin, especially in rural areas, where there is a shortage of all oral health care workers, including dentists. Recent public opinion research conducted for CDA has also indicated that there is an increasing rate of dental appointment cancelations and increased patient wait times due to dental office staffing issues. CDA recommends that the federal government specifically address these human resource challenges and staffing shortages in the oral health sector. This will help to ensure that patients do not face increased wait times to see dental care providers. These challenges are more complex than simply recruiting and retaining more dental assistants and other staff. It can include, for example:
While there is a sufficient and growing number of dentists in Canada, efforts must be made to ensure that dentist-led teams can meet the needs of patients from all demographics in all parts of Canada. The federal government has already made good progress by committing to expand eligibility for the Canada Student Loan Forgiveness program. Given that the cost of attending dental school exceeds the cost to complete the education for all other comparable health professionals in Canada, providing federal loan forgiveness as an incentive for newly graduated dentists to serve in rural, remote, and northern areas could help address geographic challenges to the provision of dental care in Canada. Efforts are also required to ensure that the dental workforce across Canada has the knowledge and expertise needed to provide all patients with the care they need–particularly those from high-needs demographics (i.e., children, seniors, persons with disabilities, etc.). In this, the federal government could look to collaborate with the Association of Canadian Faculties of Dentistry as well as their member dental schools on activities such as curriculum development or continuing education modules on treating these populations.