Introduction
In Canada, while citizens benefit from universal healthcare (Medicare) for medical needs, dental care has largely remained outside this publicly funded system. The landscape of Canadian dental care is primarily driven by private insurance and out-of-pocket payments. Approximately 60% of Canadians rely on employer-sponsored dental insurance, and about 35% directly fund their dental care. Public programs cover dental services for a small fraction of the population, around 4%–6%, mainly through third-party financed initiatives targeting specific groups like low-income children and social assistance recipients. This reliance on private and financed dental care distinguishes Canada’s approach, where publicly funded dental options are limited.
The Canadian Dental Care Plan (CDCP) emerges as a landmark federal program designed to bridge this gap and extend oral health care to eligible Canadian residents. This initiative aligns with the 2019 United Nations General Assembly’s call to strengthen global efforts towards universal health coverage, including oral health (1). The CDCP represents a significant stride in recognizing and addressing oral health as a fundamental component of overall well-being within Canada’s healthcare framework.
This program holds particular importance for Canadian seniors, a demographic disproportionately affected by inadequate dental care. Historically, seniors have faced significant barriers to accessing dental services due to lack of insurance or insufficient coverage (2), compounded by challenges related to mobility and independence as they age (3). The financial strain of escalating living costs—including prescription medications, heating, food, and gas—combined with limited returns on savings, further exacerbates the affordability of dental care for seniors.
Research in Canada and globally underscores that financial constraints can prevent individuals from obtaining necessary prescriptions, lead to medication misuse, and result in adverse health outcomes (4, 5). Alarmingly, nearly one million Canadians, many of whom are seniors, have had to compromise on basic necessities to afford their prescriptions (6). This stark reality highlights the precarious balance seniors on fixed incomes must maintain between essential needs and healthcare expenses. Given that seniors aged 65 and over now constitute a larger segment of Canada’s population than children, approximately 7.5 million individuals (7, 8), the CDCP is a timely and crucial intervention.
CDCP Eligibility and Coverage
The Canadian Dental Care Plan, backed by a CAD $13-billion investment, is specifically designed to alleviate the financial burden of basic dental care for uninsured Canadians, including seniors, who meet certain household income criteria (Table 1) (9). This makes the CDCP an essential resource, enabling access to necessary dental care without the burden of prohibitive costs or enduring dental pain. Seniors were prioritized in the initial rollout of the program, with plans to extend eligibility to other age groups subsequently (9, 10, 11).
Despite an income threshold of CAD $90,000 or less for eligibility, disparities in dental insurance coverage and access to care remain significant challenges for working-poor Canadians. This underscores the critical role of the CDCP in addressing these persistent gaps in healthcare accessibility.
Table 1. Application Timeline and Coverage for Seniors Under the CDCP.
| Adjusted Family Net Income | CDCP Coverage for General Population | CDCP Coverage for Seniors |
|---|---|---|
| Below $70,000 | 100% | 100% |
| Between $70,000–$79,999 | 70% | 70% |
| Between $80,000–$89,999 | 50% | 50% |
CDCP Challenges and Opportunities for Improvement
While the Canadian Dental Care Program is a progressive initiative, its effective implementation faces several hurdles. These include ensuring public awareness, addressing potential misinterpretations due to program naming, and accommodating the diverse needs of Canada’s senior population.
A key factor in the CDCP’s success is public awareness. The extent to which Canadians are informed about the program’s benefits and specifics directly influences its uptake and impact. Currently, many dental offices report being underinformed about the CDCP, even following updates from Health Canada regarding the application process (1, 9). There’s also a need to enhance recognition within the broader medical system about the importance of routine oral health care. Efforts to educate healthcare providers, associations, health authorities, and community organizations about the CDCP are crucial. Such outreach will empower these entities to better inform and enroll seniors and their caregivers in the program.
The program’s title itself presents a potential limitation. Using the term “dental” instead of the more encompassing “oral” may lead to confusion, particularly among seniors who are edentulous (toothless). This demographic might not realize that their denture-related needs fall under “dental” care. Anecdotal evidence suggests that some seniors with dentures believe they no longer require dental care, including the CDCP, due to their use of dentures. It is vital to educate seniors that regular oral exams remain necessary to monitor changes in oral tissues and denture fit, regardless of whether they have natural teeth or dentures.
Cultural and linguistic diversity among seniors also presents access challenges. Cultural barriers, varying life circumstances, health literacy levels, and recent immigration status—especially among senior immigrants who are parents of recent immigrants—can impede enrollment and access to CDCP information and services. These individuals often face language barriers, have limited familiarity with the Canadian healthcare system, and may lack awareness of available oral health programs (7, 12, 13). Research indicates that immigrants often report poorer oral health and lower utilization of dental services due to these obstacles (2). Targeted outreach, multilingual resources, and culturally sensitive communication strategies are essential to ensure these diverse groups are well-informed and can benefit from the CDCP.
While dental insurance, including that provided by the CDCP, significantly reduces financial barriers, it’s important to acknowledge that varying levels of coverage may still leave some financial gaps for seniors. Research confirms that universal dental insurance increases dental care utilization (14), but the extent of this increase depends on the specifics of the coverage (14). Furthermore, the introduction of the CDCP could lead to unintended consequences, such as employers potentially discontinuing existing dental benefits. With a growing number of seniors working past the age of 60—approximately 2.7 million individuals aged 60 and over in Canada, nearly a third of this population, are working or wanting to work (15)—and nearly half of them citing financial necessity as the reason (15), a shift away from employer-provided benefits could substantially increase reliance on the CDCP, potentially escalating program costs and posing challenges to its long-term management and sustainability.
The Vital Role of Dental Professionals in CDCP Success
The willingness of dental professionals—including dentists, independent dental hygienists, and denturists—to treat senior patients under the CDCP’s new remuneration framework is crucial for the program’s success. Their acceptance and active participation are paramount. Therefore, ongoing dialogue between the government and dental associations and oral health professionals is essential to ensure the compensation model is perceived as fair and provides sufficient incentive for participation from the oral health community. Currently, there appears to be some resistance from dentists and their associations in Canada (16, 17. Given that provider participation in the CDCP is voluntary, the question of patient access arises if their existing dental care providers opt out. Patients may be forced to seek new providers, potentially compromising the fairness and accessibility goals of the plan. Another concern is the variability in compensation across provinces and territories, based on differing dental services fee guides. This could create disparities in care and coverage, affecting both patients and providers depending on their location.
Clear guidance is also needed for providers and dental offices on how the CDCP will integrate with existing public insurance programs, such as the Non-Insured Health Benefits program and provincial Employment and Income Assistance. This harmonization is vital for streamlining provider enrollment, influencing their practice operations and financial planning, and determining how they manage patients covered under different insurance schemes.
Enhancing Senior Oral Health Beyond Ambulatory Clinic Care
To maximize the Canadian Dental Care Program’s impact on senior oral health, preventive care and tailored recall intervals must be prioritized. A risk-based approach, adjusting the frequency of dental and hygiene visits based on individual needs, is essential, especially for seniors at higher risk of developing severe dental conditions. Incorporating preventive measures such as fluoride varnish and silver diamine fluoride (SDF) treatments can significantly contribute to maintaining oral health in the senior population, thereby reducing the incidence and severity of dental problems (18). Tailoring recall intervals based on risk assessments aligns with current best practices in dental public health and could substantially improve the overall effectiveness of the CDCP.
The current CDCP framework primarily addresses the needs of mobile seniors who can visit dental clinics. However, it overlooks a significant segment of the senior population residing in personal care homes. These individuals often have limited mobility, varying degrees of cognitive impairment, and require on-site oral health care (19), often alongside multiple comorbidities. Providing dental care in personal care homes presents considerable logistical and financial challenges, including the need for mobile dental equipment, adaptation to confined spaces, and the additional time required for each patient visit (19).
Furthermore, providing on-site care in personal care homes involves navigating additional regulatory requirements (20), which can significantly increase the effort and cost of care delivery. The current CDCP pay structure may not adequately account for these added complexities, potentially disincentivizing dental professionals from offering these essential services to non-mobile seniors in residential care or their own homes, leading to delays in necessary treatment for this high-needs population.
Discussion: Towards a More Inclusive CDCP
To ensure equitable access to dental care for all seniors, including those in personal care homes, the Canadian Dental Care Program needs to thoughtfully expand its coverage. As the federal government finalizes the services to be included under the CDCP, it is crucial to consider specific provisions for on-site dental care in personal care homes and solicit feedback from dental providers regarding the unique considerations for caring for this population. Revisions should include an enhanced compensation structure for dental professionals who provide these services, adequately recognizing the additional challenges they face. This could be achieved through a distinct fee guide with higher reimbursement rates or by allowing providers to bill a house call fee per visit (Table 2). Another potential solution is integrating mid-level dental providers, such as advanced dental hygiene practitioners, to deliver basic restorative and preventive care, thereby extending services to underserved areas.
Table 2. Enhancing Oral Health Services for Seniors Through CDCP Improvements.
| Clinical Oral Health Services | Supplemental Preventive Products | Incentives for Oral Health Professions | Grants and Subsidies | Additional Considerations |
|---|---|---|---|---|
| – Fluoride varnish (ensure frequency of applications is not restricted) – Silver Diamine Fluoride (SDF) (ensure frequency of applications is not restricted) – Frequent recalls based on risk – Frequent hygiene care (up to 4 units without predetermination, more with predetermination) | – 5,000 ppm fluoridated toothpaste or gel – Electric toothbrushes or adaptive devices for dexterity issues | – Increased fees for care in personal care homes – House call fee code for care in personal care homes (covered, but predetermination required) | – Grants for expanded services – Subsidies for preventive products – Incentives for remote area care – Funding for educational programs – Training for providers in geriatric dentistry | – Annual oral cancer screenings – Radiographs as needed (risk-based) – Specialized treatments for dry mouth – Prescription-strength mouthwashes for gum disease – Interdental brushes or floss for improved cleaning – Denture care and cleaning products – Subsidies for geriatric dentistry continuing education – Grants for geriatric oral health research – Denture labelling for identification |
Furthermore, expanding coverage to include high-concentration fluoride toothpaste and treatments like fluoride varnish and silver diamine fluoride (SDF) (Table 2) (18) is essential, particularly for seniors in personal care homes. This demographic is at heightened risk of dental caries and other oral health problems due to age-related factors such as reduced saliva production (often medication-induced) and dexterity limitations that affect oral hygiene practices (21, 22). The American Dental Association’s clinical guidelines advocate for non-restorative management of carious lesions, highlighting the effectiveness of preventive therapies like SDF and fluoride varnishes (23). These treatments are crucial for managing and arresting tooth decay, reducing the need for more invasive and costly procedures, especially for seniors with limited access to dental care and who rely on caregivers for daily oral hygiene. Implementing a fee structure for non-dental healthcare providers who use oral health screening tools to assess vulnerable populations is also a best practice that aligns with preventive oral health strategies and should be integrated into the CDCP.
Beyond the CDCP, the oral health community and educational institutions must collaborate to ensure an adequate supply of current and future dental professionals across Canada to meet the increased demand for senior dental care. The CDCP is reinforced by the Oral Health Access Fund, announced in the 2023 Budget. This fund allocates a substantial investment of $250 million over three years, starting in 2025–26, followed by an ongoing annual allocation of $75 million (24). The fund aims to reduce oral health disparities in underserved areas, including remote and rural communities, by improving access to dental care. Community-based organizations and educational institutions can contribute through initiatives such as developing educational programs and scholarships for dental professionals, creating community outreach and awareness campaigns, training non-dental health workers in basic oral healthcare and preventive strategies, and leveraging teledentistry solutions.
The Canadian Dental Care Program is poised to transform dental care accessibility in Canada, moving towards a future where dental care is recognized as a fundamental right, irrespective of age or socioeconomic status. While the CDCP represents a significant advancement, addressing the identified gaps is crucial to ensure the program is truly inclusive and effective in improving the oral health of all Canadian seniors. Collaboration among all stakeholders is essential to ensure the CDCP fulfills its objective of providing equitable access to oral health care for all eligible residents. Timely and accurate public information for seniors regarding CDCP coverage, covered services, and fee structures is also paramount. The lessons learned from the CDCP’s implementation will offer invaluable insights for other nations considering universal oral health care models for their citizens.
Funding Statement
The author(s) declared that no financial support was received for the research, authorship, and/or publication of this article.
Author Contributions
AM: Conceptualization, Writing – original draft, Writing – review & editing. RS: Writing – review & editing. KH-S: Writing – review & editing. KY: Writing – review & editing. MB: Writing – review & editing.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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