Submission ID 130492
| Issue/Objective | Oral health is a fundamental determinant of health, yet access to dental care in Canada remains inequitable. Despite the introduction of the Canadian Dental Care Plan (CDCP), insurance alone does not guarantee access. Consistent with the Inverse Care Law, those with the greatest oral health needs consistently receive the least care, driven by socioeconomic barriers that financial coverage cannot resolve. Geography, discrimination, language, immigration status and psychosocial deterrents continue to suppress use among Canada's most vulnerable populations. These non-financial barriers have not been systematically synthesized in the Canadian adult context, representing a gap at a pivotal moment in health policy. This rapid review identifies non-financial barriers to dental care use among Canadian adults to inform equitable interventions. |
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| Methodology/Approach | A rapid review was conducted following PRISMA guidelines with pre-specified streamlined modifications. PubMed and Embase were searched for peer-reviewed quantitative observational studies published between 2011-2026 examining non-financial barriers among Canadian adults aged 18-64. Outcomes included dental service use, unmet dental need, delayed care, and patient-reported experiences of access. Screening and extraction were completed by a single reviewer with 25% duplicate verification. Findings were synthesized narratively. |
| Results | Of 183 records identified, 15 studies met eligibility criteria. Five barrier categories emerged: geographic accessibility and provider distribution; dental anxiety, stigma, discrimination, and mistrust; immigration and refugee status; social marginalization and structural vulnerability; and language and cultural barriers. Barriers were consistently associated with reduced dental service use, unmet need, foregone care, and avoidable emergency department visits. Disparities were most pronounced among rural residents, immigrants and refugees, people who use drugs, and individuals with limited English proficiency. |
| Discussion/Conclusion | Findings reveal that oral health inequity in Canada is rooted in upstream determinants that insurance coverage cannot address alone. Geography, marginalization, and systemic discrimination function as barriers before a patient ever reaches a dental chair. Dental education must shift to train graduates for the communities that need them most. CDCP implementation must be paired with workforce distribution policy, outreach infrastructure, and primary care integration to reach populations currently excluded from realized access. Expanding coverage without addressing structural barriers is necessary, but not sufficient to achieve equitable access for all Canadians. |
| Presenters and Affiliations | Lauren Bal Western University, Schulich School of Medicine & Dentistry, Interfaculty Program in Public Health Lauren Bal Western University, Schulich School of Medicine & Dentistry, Interfaculty Program in Public Health |
