Public preferences for seeking publicly financed dental care and professional preferences for structuring it

A perspective: Challenges and opportunities of a novel national dental benefit

In Canada, the federal government launched the interim Canada Dental Benefit (CDB) on December 1, 2022, to support access to dental care for children <12 years. The interim benefit shows government's assurance to develop a long-term national dental care program. The benefit will be a cash transfer through Canada's revenue services agency, ranging from $260 to $650 annually. This perspective examines the federal initiative and reflects on its strengths and challenges to learn lessons, which can support the long-term solution that is being currently planned. This article outlines a number of positive aspects as well as challenges from the perspectives of varied stakeholders; the feasibility of the application process; remaining potential gaps due to restricted eligibility criteria; possible effects of unrestricted oral health care services and reimbursement rates; valuing of patient autonomy; guidelines for the expansion of the program to other populations; and remaining barriers to oral health care access are analyzed. The CDB is cause for excitement for the Canadian population because it is an opportunity to reduce affordability barriers to accessing dental care. That said, it is important to discuss anticipated challenges and indirect consequences, particularly through the lens of equity, to support the new CDB and the proposed national dental care program in achieving the much-awaited goal of putting the mouth back into the body.

Socioeconomic Disparities in Iranians’ Preferences toward Dental Care Services: A Population-Based Survey

Background and Aims

Patients' perspectives and preferences are considered an essential influencing factor for healthcare utilization. This study is one of the first to investigate patient preference for dental services across socioeconomic and demographic indicators in Iran.

Materials and Methods

This cross-sectional study was conducted through telephone interviews with adult residents in Mashhad and Kerman cities. A representative sample was selected by stratified random sampling. A valid structured questionnaire was used for data collection, including people's preference toward dental care services in terms of dental settings, choosing a general or specialist dentist, prevention or treatment, and the preferable gender of the dentist. Factors potentially associated with preferences included gender, age, educational level, job, monthly income, house size, family number, insurance coverage, dental insurance, type of insurance, and social class in the city were investigated.

Results

1475 individuals participated in the study [response rate 63%]. Our findings showed higher preferences for private offices (50.6%), specialist dentists (76.2%), treatment services (40.8%), and no specific gender preference for the dentist (60.6%). Their preferences were significantly influenced by age range, social class, insurance status, dental insurance, and type of insurance. Income, household size, level of education, and job were not statistically significant with none of the preferences.

Conclusions

Socioeconomic and demographic factors' correlation with people's preferences was observed. Efforts are needed to promote preventive care demand in deprived regions. Moreover, increasing financial resources allocated to preventive care and covering preventive dental services in insurance plans are recommended.

Children's Oral Health and Barriers to Seeking Care: Perspectives of Caregivers Seeking Pediatric Hospital Dental Treatment

Objectives:

To investigate the demographics of children (and their caregivers) requiring hospital-based tertiary dental care, oral health services use and perceptions of and barriers to oral healthcare in Nova Scotia.

Method:

A questionnaire was administered to caregivers (N = 62) on behalf of their child (N = 62).

Results:

Nearly half (45.8%, N = 27) of the caregivers experienced difficulty seeking oral healthcare for both themselves and their children. Less than a quarter (23.2%, N = 13) of the caregivers sought care for their child by the recommended age of one (mean age of first visit = 2.69 years). Alternate delivery in a school, community or primary healthcare setting was preferred by 53.3% (n = 32) of the caregivers for children's oral healthcare. Low-income families (53.8%, n = 28), rural areas (47.4%, n = 27) and Indigenous children (9.7%, n = 6) were over-represented in the study's sample.

Conclusion:

Socio-economically disadvantaged populations are more vulnerable to oral diseases. Oral health of priority populations in Nova Scotia appears to be inadequately addressed.

Narrative review of affinities and differences between the social determinants of oral and general health in Canada: establishing a common agenda

BACKGROUND

This article overviews Canadian work on the social determinants of oral and general health noting their affinities and differences.

METHODS

A literature search identified Canadian journal articles addressing the social determinants of oral health and/or oral health inequalities. Analysis identified affinities and differences with six themes in the general social determinants of health literature.

RESULTS

While most Canadian social determinants activity focuses on physical and mental health there is a growing literature on oral health-literature reviews, empirical studies and policy analyses-with many affinities to the broader literature. In addition, since Canada provides physical and mental health services on a universal basis, but does not do so for dental care, there is a special concern with the reasons behind, and the health effects-oral, physical and mental-of the absence of publicly financed dental care.

CONCLUSIONS

The affinities between the social determinants of oral health and the broader social determinants of health literature suggests the value of establishing a common research and action agenda. This would involve collaborative research into common social determinants of oral and general health and combined policy advocacy efforts to improve Canadians' living and working conditions as means of achieving health for all.

CAEP Dental Care Statement

Oral health is an important part of an individual's overall health; however, dental care is not included in the Canadian public healthcare system. Many Canadians struggle to access dental care, and six million Canadians avoid visiting the dentist each year due to cost.1 The most vulnerable groups include children from low-income families, low-income adults, seniors, indigenous communities, and those with disabilities.1–5 The lack of affordable, equitable, and accessible dental care puts undue strain on emergency departments across the country, as patients desperately seek the care of a physician when they actually need the care of a dental professional.6 Emergency physicians do not have the same expertise or equipment as dentists and, in most cases, are only able to provide temporary symptom relief. This results in an increased reliance on prescription opioids that would otherwise be unnecessary if patients could access the dental care they required.

Governmental Illegitimacy and Incompetency in Canada and Other Liberal Nations: Implications for Health

The welfare state literature on developing nations is concerned with how governmental illegitimacy and incompetency are the sources of inequality, exploitation, exclusion, and domination of significant proportions of their citizenry. These dimensions clearly contribute to the problematic health outcomes in these nations. In contrast, developed nations are assumed to grapple with less contentious issues of stratification, decommodification, and the relative role of the state, market, and family in providing economic and social security, also important pathways to health. There is an explicit assumption that governing authorities in developed nations are legitimate and competent such that their citizens are not systematically subjected to inequality, exploitation, exclusion, and domination by elites. In this article, we argue that these concepts should also be the focus of welfare state analysis in developed liberal welfare states such as Canada. Such an analysis would expose how public policy is increasingly being made in the service of powerful economic elites rather than the majority, thereby threatening health. It would also serve to identify means of responding to these developments.

Self-reported oral health among a community sample of people experiencing social and health inequities: cross-sectional findings from a study to enhance equity in primary healthcare settings

OBJECTIVE

To describe the self-reported oral health issues among a community sample of primary care clients experiencing socioeconomic disadvantages.

METHODS

As part of a larger mixed-methods, multiple case study evaluating an equity-oriented primary healthcare intervention, we examined the oral health of a sample of 567 people receiving care at four clinics that serve marginalised populations in two Canadian provinces. Data collected included self-rated oral health and experiences accessing and receiving healthcare, standard self-report measures of health and quality of life, and sociodemographic information.

RESULTS

The prevalence of self-rated poor oral health was high, with almost half (46.3%) of the participants reporting poor or fair oral health. Significant relationships were observed between poor oral health and vulnerabilities related to mental health, trauma and housing instability. Our findings suggest that the oral health of some Canadian populations may be dramatically worse than what is reported in existing population health surveys.

CONCLUSIONS

Our findings reinforce the importance of addressing oral health as part of health equity strategies. The health and oral health issues experienced by this client cohort highlight the need for interdisciplinary, team-based care that can address the intersections among people's health status, oral health and social issues.

Oral health care for children - a call for action

Oral health is a fundamental component of overall health. All children and youth should have access to preventive and treatment-based dental care. Canadian children continue to have a high rate of dental disease, and this burden of illness is disproportionately represented by children of lower socioeconomic status, those in Aboriginal communities and new immigrants. In Canada, the proportion of public funding for dental care has been decreasing. This financial pressure has most affected low-income families, who are also less likely to have dental insurance. Publicly funded provincial/territorial dental plans for Canadian children are limited and show significant variability in their coverage. There is sound evidence that preventive dental visits improve oral health and reduce later costs, and good evidence that fluoridation therapy decreases the rate of dental caries, particularly in high-risk populations. Paediatricians and family physicians play an important role in identifying children at high risk for dental disease and in advocating for more comprehensive and universal dental care for children.

Dental treatment needs in the Canadian population: analysis of a nationwide cross-sectional survey

BACKGROUND

Nationally representative clinical data on the oral health needs of Canadians has not been available since the 1970s. The purpose of this study was to determine the normative treatment needs of a nationally representative sample of Canadians and describe how these needs were distributed.

METHODS

A secondary analysis of data collected through the Canadian Health Measures Survey (CHMS) was undertaken. Sampling and bootstrap weights were applied to make the data nationally representative. Descriptive frequencies were used to examine the sample characteristics and to examine the treatment type(s) needed by the population. Bivariate logistic regressions were used to see if any characteristics were predictive of having an unmet dental treatment need, and of having specific treatment needs. Lastly, multivariate logistic regression was used to identify the strongest predictors of having an unmet dental treatment need.

RESULTS

Most of the population had no treatment needs and of the 34.2% who did, most needed restorative (20.4%) and preventive (13.7%) care. The strongest predictors of need were having poor oral health, reporting a self-perceived need for treatment and visiting the dentist infrequently.

CONCLUSIONS

It is estimated that roughly 12 million Canadians have at least one unmet dental treatment need. Policymakers now have information by which to assess if programs match the dental treatment needs of Canadians and of particular subgroups experiencing excess risk.

Government spending on dental care: is it a public priority?

OBJECTIVES

The majority of Canadians believe that the government should play some role in providing dental care within Canada's health care system. However, it is unclear whether Canadians consider this as a top public priority. This study determines whether dental care is a public priority among Canadian adults relative to other policy concerns and identifies factors predictive of a first priority ranking for dental care.

METHODS

Data were collected in 2008 from a national random sample of 1,005 Canadian adults through a telephone interview survey. Respondents were asked to rank five spending priorities (dental care, pharmacare, home care, vision care, and child care) in terms of preferences for new government spending. Simple descriptive analyses were undertaken based on sociodemographic characteristics. Logistic regression modeling was conducted to determine which factors are predictive of a first priority ranking for dental care.

RESULTS

Comparatively, dental care stands as the third choice among the other spending priority areas. Approximately 21 percent of adults consider dental care a first priority for spending. First priority ranking of dental care appears to be linked to socioeconomic factors: household income, educational attainment, and dental insurance coverage.

CONCLUSIONS

As a public priority, a moderate level of demand exists for more government spending on dental care in Canada, specifically among those of low income, low educational attainment, and who lack dental insurance coverage. A sustained effort should be made to push forward public dental care policies that target priority population subgroups.

Access to dental care for low-income adults: perceptions of affordability, availability and acceptability

The objective of this study was to explore access to dental care for low-income communities from the perspectives of low-income people, dentists and related health and social service-providers. The case study included 60 interviews involving, low-income adults (N = 41), dentists (N = 6) and health and social service-providers (N = 13). The analysis explores perceptions of need, evidence of unmet needs, and three dimensions of access--affordability, availability and acceptability. The study describes the sometimes poor fit between private dental practice and the public oral health needs of low-income individuals. Dentists and low-income patients alike explained how the current model of private dental practice and fee-for-service payments do not work well because of patients' concerns about the cost of dentistry, dentists' reluctance to treat this population, and the cultural incompatibility of most private practices to the needs of low-income communities. There is a poor fit between private practice dentistry, public dental benefits and the oral health needs of low-income communities, and other responses are needed to address the multiple dimensions of access to dentistry, including community dental clinics sensitive to the special needs of low-income people.