A child opens wide in the dentist's chair, her parents' insurance covering the cleaning and check-up that will keep her teeth healthy. Across town, another child has never seen a dentist, her family unable to afford the cost, her tooth pain treated with over-the-counter medication until the infection spreads. An elderly man in a nursing home has not had dental care in years, his teeth rotting, his ability to eat diminishing, his pain untreated because dental care is not part of long-term care. A working adult without dental benefits delays necessary treatment until a filling becomes a root canal becomes an extraction. A family chooses between dental care and groceries, knowing that both are essential but only one is covered. Emergency departments see patients with dental pain they cannot treat, directing them to dentists they cannot afford. Dental care, essential for health yet excluded from Canada's universal healthcare system, creates two-tiered access where ability to pay determines whether teeth are treated or left to decay. How dental care is organized, funded, and accessed shapes oral health and overall wellbeing.
The Case for Universal Dental Care
Advocates argue that dental care should be part of universal healthcare. From this view, the mouth is part of the body and dental care is healthcare.
Oral health affects overall health. Dental disease connects to heart disease, diabetes, and other systemic conditions. Dental pain affects nutrition, sleep, and quality of life. Oral health is health.
Current access is inequitable. Those with employer benefits or personal resources access dental care. Low-income Canadians, the uninsured, and seniors often cannot. This creates health inequity based on economic status.
Prevention is cost-effective. Regular dental care prevents expensive emergency treatment. Untreated dental problems become complex and costly. Investment in dental access saves money overall.
From this perspective, dental care should be publicly covered, accessible to all regardless of ability to pay.
The Case for Targeted Approach
Others argue that universal dental care is costly and may not be best use of resources. From this view, targeting those with greatest need may be more appropriate.
Most Canadians have dental coverage. Employer benefits cover many working Canadians. Universal programs would cover those already insured. Targeting the uninsured is more efficient.
Costs are significant. Universal dental care would cost billions annually. These resources might address other healthcare priorities. Cost-benefit analysis is needed.
Dental care is different from medical care. Private delivery works for most dental care. Public insurance need not mean public delivery. Various models can address access gaps.
From this perspective, targeted programs for uninsured populations may be more appropriate than universal coverage.
The Federal Dental Benefit
Canada has introduced federal dental coverage phased in over time.
From one view, the Canadian Dental Care Plan is historic step toward dental equity. Covering those without insurance addresses the gap. Phased implementation is practical approach. The program should be fully implemented and sustained.
From another view, implementation has been challenging. Provider participation is uncertain. Program design has limitations. Whether the program achieves its goals remains to be seen.
How the federal program develops shapes dental access.
The Provider Capacity
Expanding dental coverage requires provider capacity.
From one perspective, dentists are available but not where most needed. Inner cities and rural areas face shortages. Expanding public coverage must address geographic access.
From another perspective, dentists may not participate in public programs if fees are inadequate. Provider buy-in is essential. Program design must work for providers as well as patients.
How provider participation is ensured shapes access.
The Preventive Focus
Preventing dental disease is more effective than treating it.
From one view, public dental programs should emphasize prevention. Community water fluoridation, school-based prevention programs, and accessible preventive care reduce disease burden.
From another view, those with existing disease need treatment. Prevention cannot help those already suffering dental problems. Both prevention and treatment are needed.
How prevention is prioritized shapes oral health outcomes.
The Seniors' Dental Crisis
Seniors face particular dental challenges.
From one perspective, seniors' dental care is crisis. Many seniors lose employer coverage at retirement. Seniors in long-term care have especially poor oral health. Targeted seniors' dental programs are urgently needed.
From another perspective, seniors' dental needs are part of broader dental access problem. Comprehensive approach serves seniors along with others.
How seniors' dental care is addressed shapes a vulnerable population's oral health.
The Canadian Context
Canada historically excluded dental care from medicare. Most dental care is privately financed through employer benefits or out-of-pocket payment. Public programs existed for some populations - children in some provinces, social assistance recipients, some Indigenous programs. The federal Canadian Dental Care Plan represents significant expansion of public coverage, targeting those without insurance and with lower incomes. Implementation is ongoing with phased eligibility. Provider participation has been a concern. Provincial programs vary. Oral health disparities are well-documented. Emergency department visits for dental problems are common. The policy landscape is shifting toward greater public coverage.
From one perspective, Canada should fully implement and expand public dental coverage.
From another perspective, targeted approaches may be more practical than universal coverage.
How Canada approaches dental care shapes oral health equity.
The Question
If oral health is health, if dental disease causes suffering and systemic harm, if access is inequitable, if prevention works - why was dental care excluded from universal healthcare? When a child's tooth rots because their family cannot afford a dentist, what message does that send about their worth? When working adults choose between dental care and other necessities, what should a wealthy country provide? When seniors in care homes have teeth that cause pain and prevent eating, whose responsibility is their mouth? When emergency rooms see dental problems they cannot treat, what system gap does that represent? And when the Canadian Dental Care Plan is implemented, will it achieve the access its proponents promise?