Improving Equity in Access to Dental Care in Canada: Historical Lessons for Policy Change.

Abstract

Objectives: This paper outlines and compares the major provincial initiatives on dental care from the 1970s-with emphasis on Saskatchewan's innovative children's dental program-and their relevance to the current changes in Canadian dental policy.

Methods: Narrative review methodology. A snowball search was conducted on articles obtained through MEDLINE, Scopus, and ProQuest, followed by other databases such as Google Scholar. Primary data was collected from different sources: historical professional journals, archives, government reports, Hansard debates, and historical newspapers.

Results: Saskatchewan and Ontario were on opposite ends of a government-sponsored dental care policy continuum during the 1970s. While Ontario never implemented a large-scale public dental plan, Saskatchewan carried out an effective province-wide children's dental plan using an alternate model of delivery, despite strong opposition from the dental profession. Dental public initiatives in other provinces lie between these two poles. While several considered employing dental therapists, they faced opposition from the dental profession, which reinforced the traditional model, despite its inability to resolve issues of access to care.

Conclusions: This study argues that while the current Canadian Dental Care Plan represents a major advancement towards more equality in dental care, it is unclear whether persistent issues of physical barriers to access will be fully resolved, and suggests employing an alternate model of delivery, proven to improve access to dental care in Canada. However, given organized dentistry's continuing resistance to dental therapists working largely independently, future studies should examine whether different levels of supervision and/or program format could yield greater acceptance.