![]() ![]() ![]() The federal budget has earmarked $5.3 billion over 5 years and then $1.7 billion annually for provision of the dental program. The program will initially cover children under 12 years and expand until all family members from households with incomes under $90,000 are covered. On November 17, 2022, the bill creating a public national dental-care program for low-income Canadians became law. Moreover, no consensus on standards for oral health care provision exist among federal, provincial, territorial, and municipal governments to guide delivery of these programs and assess impact. However, only 6% of Canadian public health expenditure is on dental care. Provincial programs provide coverage for adults with disabilities, older adults, and children. Federal government programs provide coverage for Indigenous people, sponsored refugees, federal prisoners, and veterans. In Canada, oral health care is not part of the universal health care program although provincial and federal governments have implemented limited-scope public dental health programs. Due in large part to the legacy of colonization and systemic discrimination, individuals in racialized communities are generally over-represented in groups with low-incomes or no dental insurance, with high rates of oral health problems, and with low access to oral health care. Significant income-related inequities exist in oral health and access to oral health care. It is linked to higher rates of systemic diseases, such as diabetes, cardiovascular diseases, lung disease, and cancers. Additionally, poor oral health can have implications for other health issues. Without early intervention, oral problems can become severe and require otherwise preventable emergency room visits and invasive treatments, such as surgery under a general anesthetic. ![]() Low or inconsistent access to oral health care can result in high rates of oral health problems, including cavities and gum disease. Moreover, reliable and consistent data to evaluate and improve upon delivery are lacking. Despite this intent, low engagement from both oral health care providers and intended patient groups continue to challenge program impact and outcomes. Public dental programs generally aim to increase access to oral health care for individuals with financial barriers through government payments for appointment cost. However, in Canada and internationally, low-income groups are less likely to have dental insurance, visit the dentist, and experience good oral health. Routine pediatric visits typically include cleaning and a combination of fluorides and dental sealants that reduce decay and prevent nearly all cavities. Given the disparities in oral disease and access to oral health care, the results can be used most effectively to adapt programs if relevant stakeholders participate in reviewing data, investigating quality gaps, and developing improvement strategies.Įvidence and clinical guidelines suggest visiting the dentist every 6 months, starting from eruption of the first tooth or at 12 months of age. ![]() The RE-AIM framework measures performance across five domains: (1) Reach, (2) Effectiveness (patient level), (3) Adoption, (4) Implementation (provider, setting, and policy levels), and (5) Maintenance (all levels). Drawing on an example of a pediatric public dental program for children from low-income families or with severe disabilities in Ontario, Canada, this article illustrates how an implementation and evaluation framework could be applied to measure implementation and impact of the national program. As such, specifying program goals and developing a related monitoring strategy are critical as Canada begins to implement a national public dental program. This accentuates the importance of monitoring of program delivery to refine or adapt programs to better meet needs of service providers and users. Still, these programs rarely address the systemic issues that affect the experiences of intended users. Low engagement from both oral health care providers and intended patients are common challenges in delivery of public dental programs, and are impediments to program impact and outcomes. Public dental programs generally aim to increase access to oral health care for individuals with financial barriers through government payments for appointments. There are significant income-related inequities in oral health and access to oral health care. ![]()
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