PSPC POR number: POR-014-23

CANADA DENTAL BENEFIT – EXPANDED BASELINE SURVEY

Final Report

HC POR – 23-01

Prepared for Health Canada

Supplier Name: The Strategic Counsel
Contract number: CW2271909
Contract Value: $182,147.53
Award Date: 2023-06-06
Delivery Date: 2023-09-13

Registration number: POR 014-23
For more information on this report, please contact Health Canada at:
hc.cpab.por-rop.dgcap.sc@canada.ca
Ce rapport est aussi disponible en français.

Canada Dental Benefit – Expanded Baseline Survey

Final Report

Prepared for: Health Canada
Supplier: The Strategic Counsel
September 2023

This public opinion research report presents the results of an online and telephone survey conducted by The Strategic Counsel on behalf of Health Canada. The research study was conducted with 2,250 Canadians with a household income of less than $90,000 between July 26 and August 23, 2023.

Cette publication est aussi disponible en français sous le titre: Prestation Dentaire Canadienne – Enquête De Référence Élargie

This publication may be reproduced for non-commercial purposes only. Prior written permission must be obtained from Health Canada. For more information on this report, please contact Health Canada at hc.cpab.por-rop.dgcap.sc@canada.ca or at:

Health Canada, CPAB
200 Eglantine Driveway, Tunney's Pasture
Jeanne Mance Building, AL 1915C
Ottawa, Ontario K1A 0K9
Catalogue Number:
H14-442/2024E-PDF
International Standard Book Number (ISBN):
978-0-660-69526-6
Related Publication (Registration Number: POR-014-23)
Catalogue Number: H14-442/2024F-PDF (Final Report, French)
International Standard Book Number (ISBN): 978-0-660-69527-3

^©His Majesty the King in Right of Canada, as represented by the Minister of Health, 2023.

Table of Contents

• I. Executive Summary
  • A. Background
  • B. Research Objectives
    • 1. Purpose
    • 2. How the Research Will Be Used
    • 3. Objectives and Key Research Questions
  • C. Methodology in Brief
  • D. Total Contract Value
  • E. Key Findings
  • F. Conclusions and Recommendations
• II. Detailed Findings
  • A. Attitudes Towards Dental Care
    • 1. Perspectives on Dental Care Relative to Other Issues of Concern
    • 2. Perceived Linkages Between Oral Health and Overall Wellness
    • 3. Views on Regular Dental Care
  • B. Oral Health Habits
    • 1. General Oral Habits
    • 2. Oral Health Conditions / Diagnoses
  • C. Access to and Use of Dental services
    • 1. Access to Dental Services and Frequency of Visiting
    • 2. Use of Dental Services
  • D. Barriers to Accessing Dental Care
    • 1. Barriers to Regular Dental Visits for Adults and Children Under Age 18
  • E. Views on the Canadian Dental Care Plan
    • 1. Awareness of a New Government of Canada Program on Dental Care
    • 2. Uptake of the Canada Dental Benefit
    • 3. Attitudes towards the Canadian Dental Care Plan
    • 4. Motivators to Applying for the Canadian Dental Care Plan
  • F. Profile of Respondents
    • Demographic Profile in Brief
    • Access to Dental Insurance
• III. Detailed Methodology
  • A. Sample Design
  • B. Questionnaire Design
  • C. Pre-test
  • D. Fieldwork and Length of Survey
  • E. Final Dispositions
  • F. Study Limitations
• IV. Appendix
  • A. Online Panel Questionnaire (English and French)
  • B. Telephone Questionnaire (English and French)

List of Tables

• TABLE 1. LEVEL OF CONCERN ABOUT ISSUES. 12
• TABLE 2. PERCEIVED CONNECTION – CAVITIES AND GUM DISEASE and SERIOUS HEALTH CONDITIONS SUCH AS DIABETES, HEART DISEASE, AND PNEUMONIA.. 14
• TABLE 3. PERCEIVED CONNECTION – GOOD ORAL HEALTH and OVERALL PHYSICAL WELL-BEING..15
• TABLE 4. IMPORTANCE OF REGULAR DENTAL VISITS – FOR YOU.. 16
• TABLE 5. IMPORTANCE OF REGULAR DENTAL VISITS – FOR YOUR CHILD/CHILDREN UNDER 12 YEARS OF AGE. 17
• TABLE 6. IMPORTANCE OF REGULAR DENTAL VISITS – FOR YOUR CHILD/CHILDREN 12-17 YEARS OF AGE. 18
• TABLE 7. LEVEL OF AGREEMENT WITH STATEMENTS ABOUT DENTAL CARE. 19
• TABLE 8. HEALTH OF TEETH AND GUMS. 22
• TABLE 9. FREQUENCY OF BRUSHING – YOU.. 24
• TABLE 10. FREQUENCY OF BRUSHING – YOUR CHILDREN UNDER 12 YEARS OF AGE. 25
• TABLE 11. USE OF FLOURIDE TOOTHPASTE – YOU.. 26
• TABLE 12. USE OF FLOURIDE TOOTHPASTE – YOUR CHILD/CHILDREN UNDER 12 YEARS OF AGE. 27
• TABLE 13. FREQUENCY OF USING AN ORAL RINSE – RESPONDENT. 27
• TABLE 14. FREQUENCY OF USING AN ORAL RINSE – YOUR CHILD/CHILDREN UNDER 12 YEARS OF AGE. 29
• TABLE 15. FREQUENCY OF FLOSSING – YOU.. 30
• TABLE 16. FREQUENCY OF FLOSSING – YOUR CHILD/CHILDREN UNDER 12 YEARS OF AGE. 32
• TABLE 17. INCIDENCE OF ORAL HEALTH CONDITIONS. 33
• TABLE 18. INCIDENCE OF DENTAL PROCEDURES – YOU.. 34
• TABLE 19. INCIDENCE OF DENTAL PROCEDURES – YOUR CHILD/CHILDREN UNDER 12 YEARS OF AGE. 35
• TABLE 20. INCIDENCE OF ORAL HEALTH CONDITIONS. 36
• TABLE 21. ACCESS TO DENTIST/DENTAL SERVICES. 37
• TABLE 22. AGE FIRST VISITED A DENTIST – CHILDREN UNDER 12 YEARS OF AGE. 39
• TABLE 23. LAST TIME VISITED A DENTIST – YOURSELF. 40
• TABLE 24. LAST TIME VISITED A DENTIST – YOUR CHILD/CHILDREN UNDER 12 YEARS OF AGE. 41
• TABLE 25. LAST TIME VISITED A DENTIST – YOUR CHILD/CHILDREN 12-17 YEARS OF AGE. 41
• TABLE 26. FREQUENCY OF VISITING A DENTAL OFFICE – YOURSELF. 42
• TABLE 27. FREQUENCY OF VISITING A DENTAL OFFICE – YOUR CHILD/CHILDREN UNDER 12 YEARS OF AGE. 43
• TABLE 28. FREQUENCY OF VISITING A DENTAL OFFICE – YOUR CHILD/CHILDREN 12-17 YEARS OF AGE. 44
• TABLE 29. PERSON IN HOUSEHOLD WHO SCHEDULES DENTAL APPOINTMENTS FOR CHILDREN.. 44
• TABLE 30. REASONS FOR VISITING A DENTIST – YOURSELF. 45
• TABLE 31. REASONS FOR TAKING YOUR CHILD/CHILDREN UNDER 12 YEARS OF AGE TO DENTIST. 47
• TABLE 32. REASONS FOR TAKING YOUR CHILD/CHILDREN 12-17 YEARS OF AGE TO DENTIST. 47
• TABLE 33. METHOD OF PAYMENT FOR DENTAL SERVICES – YOURSELF. 48
• TABLE 35. BARRIERS TO REGULAR VISITS WITH DENTIST – YOURSELF. 50
• TABLE 36. BARRIERS TO REGULAR VISITS TO DENTIST – YOUR CHILD/CHILDREN UNDER 12 YEARS OF AGE. 52
• TABLE 37. BARRIERS TO REGULAR VISITS TO DENTIST – YOUR CHILD/CHILDREN 12-17 YEARS OF AGE. 53
• TABLE 38. AWARENESS OF THE CANADIAN DENTAL CARE PLAN.. 54
• TABLE 39. SOURCES OF AWARENESS OF THE NEW DENTAL PROGRAM... 56
• TABLE 40. LOOKED FOR INFORMATION ON THE PROGRAM WITHIN LAST 3 MONTHJS. 57
• TABLE 41. WHAT THOSE WHO HAVE HEARD ABOUT THE PROGRAM KNOW ABOUT IT (OPEN-END). 58
• TABLE 42. INTENT ON APPLYING FOR CANADA DENTAL BENEFIT. 60
• TABLE 43. LEVEL OF SUPPORT FOR CDCP. 61
• TABLE 44. ENCOURAGEMENT TO APPLY FOR CDCP. 62
• TABLE 45. AGE. 64
• TABLE 46. HOUSEHOLD INCOME. 65
• TABLE 47. AGES OF CHILDREN.. 65
• TABLE 48. IDENTIFY AS PERSON WITH DISABILITY. 65
• TABLE 49. TYPE OF DISABILITY. 66
• TABLE 50. DISABILITY TAX CREDIT CERTIFICATE WITH CRA.. 66
• TABLE 51. ETHNICITY. 67
• TABLE 52. REGION.. 68
• TABLE 53. GENDER. 68
• TABLE 54. MARITAL STATUS. 69
• TABLE 55. AGES OF CHILDREN UNDER 12 YEARS. 69
• TABLE 56. AGES OF CHILDREN 12-17 YEARS. 70
• TABLE 57. NUMBER OF PEOPLE IN HOUSEHOLD.. 70
• TABLE 58. EDUCATION.. 71
• TABLE 59. EMPLOYMENT STATUS. 72
• TABLE 60. LANGUAGE MOST OFTEN SPOKEN AT HOME. 72
• TABLE 61. ACCESS TO DENTIST OR ORAL HEALTH PROFESSIONAL. 73
• TABLE 62. DISTANCE OF NEAREST DENTAL CLINIC TO HOME. 73
• TABLE 63. ACCESS TO INSURANCE. 74

Executive Summary

Executive Summary

A. Background

In the 2022 federal budget, the Government of Canada committed $5.3 billion over five years to provide dental care for Canadians who are unable to access proper dental care because of the cost. In December of 2022, an interim measure (the Canada Dental Benefit) was launched, providing tax-free payments for eligible Canadians with children under the age of 12 and household incomes of less than $90,000 annually.

In Budget 2023, the Government of Canada proposed to provide $13 billion over five years and $4.4 billion ongoing to Health Canada to implement the Canadian Dental Care Plan (CDCP). The CDCP will provide dental coverage for uninsured Canadians with an annual family income of less than $90,000, with no co-pays for those with family incomes under $70,000. The plan is set to launch by the end of 2023 and will be administered by Health Canada, with support from a third-party benefits administrator.

B. Research Objectives

1. Purpose

While the Canada Dental Benefit targeted eligible Canadians based on their household income with children under 12 years of age, the new CDCP is being introduced to a wider spectrum of eligible Canadians whose household incomes are less than $90,000 annually and who do not have access to an insurance plan that includes dental coverage. In replacing the interim CDB, the new Plan will continue to encompass dental care for children under age 12 but will be rolled out initially for seniors aged 65 and older, children and youth aged 12 to 17, and people with disabilities who meet the other eligibility criteria. People living in rural and remote communities as well as racialized communities will also be a key focus for the new plan.

Conducting a baseline survey is an important component in the lead-up to the launch of the plan. Based on a more complete understanding of the concerns, attitudes and behaviours of target audiences for the CDCP as they pertain to dental care coverage and oral health in general, the results will inform the development of related communication and marketing activities.

2. How the Research Will Be Used

The research findings from this study will be used as input in the development of messaging for the eventual long-term national dental care program, known as the Canadian Dental Care Plan. They will also be used to evaluate communications initiatives which have been deployed to date in order to improve future efforts. Additionally, the research findings will assist in identifying opportunities to raise awareness of the Plan as well as identify barriers and gaps in accessing and awareness of the Plan. With the research findings from this study, communications, advertising, and marketing materials will better reach and resonate with key target audiences, resulting in a higher uptake of the Plan.

3. Objectives and Key Research Questions

The primary objective of this research is to establish a baseline level of awareness and barriers to access among those eligible for the CDCP. More specifically, the research will be used to:

• Determine the level of awareness of the existing CDB, and the upcoming CDCP, among Canadians with a household income of less than $90,000;
• Identify the barriers to accessing the existing CDB, the future CDCP and dental care in general; and
• Identify opportunities to maximize uptake of the CDCP.

C. Methodology in Brief

A dual-methodology approach was undertaken to complete this research study, utilizing an online panel as well as telephone specifically targeting respondents in remote areas.

A 15-minute online survey was administered to 2,150 adult Canadians, aged 18 and older. Eligible respondents included those with a household income under $90,000 per year.

The total sample consisted of Canadians, aged 18+ with quotas set for six priority groups – families with children under the age of 12, families with children aged 12 to 17, seniors aged 65 and over, people with disabilities, people from racialized communities and those living remotely. A strict quota was also set on the sample (excluding the remote component) to ensure that approximately 70% of respondents did not have access to private dental insurance (another requirement to be eligible for the new Plan). The remainder (30%) comprised those who did have dental insurance. The sample was structured in this manner to allow for comparisons in the attitudes and behaviours between those with and without access to insurance coverage.

Regional quotas were also applied (again with the exception of remote completions), and monitoring was undertaken while the survey was in field in order to obtain broad representation from all regions of Canada. A disproportionate sampling plan was employed, including oversampling in Atlantic Canada and the Prairies to ensure sufficiently robust samples in these areas to be able to analyze the results within and between regions. A weighting scheme was applied in order to bring the final sample back into line with the distribution of the population in Canada, by region^[1]. Given the highly targeted audiences for this survey, only soft quotas were set for gender and age.

As noted above, a telephone methodology was employed to reach remote respondents (n=100). This approach was taken based on the assumption that a nationwide online panel would not yield sufficient completes to provide useful insights for this group. The length of telephone interviews varied between 20 and 30 minutes.

Given the reliance on a commercial online panel as the primary methodology, the study utilized a non-probability approach to sampling. As such, a margin of error cannot be applied to the final sample of n=2,250 and no inferences can be made to the broader target population. The fieldwork was conducted between July 26^th and August 23^rd, 2023.

D. Total Contract Value

The contract value was $182,147.53 including HST.

E. Key Findings

Affordable dental care is a significant concern for many Canadians, particularly for those without access to dental coverage, but also for those with children under 18 years of age, those in larger households and people from racialized communities.

• Among a select list of issues, the cost of living, affordability of dental care and housing affordability garnered the highest levels of concern (96%, 86%; 85%, respectively are 'somewhat/very concerned' about each of these three issues). By comparison, access to dental services is less of an issue, but is still concerning for 70% of respondents and more so for those without insurance (73%) compared to those with dental coverage (62%).
• Many believe there is a clear connection between oral health and overall well-being and see dental care as vitally important for themselves and their children. Nine in ten respondents (or more in the case of their children) view regular dental care as important. And, while just over half (56%) rate regular care for themselves as 'very important,' this increases to 66% when it comes to care for their children under age 12, and to 71% for those with children aged 12 to 17.
• Care for children tends to be prioritized over adult care – while 65% of respondents say they make appointments for themselves only when they feel it is necessary (higher among those without insurance (70%)), this drops to 51% who take the same approach with their children (although this is the case for a higher percentage of those without insurance (57%)).
• Over two thirds of those without insurance (69%) say they would schedule more regular dental appointments for themselves if they had a bit of extra money. This compares with 59% among those with dental coverage.
• Notably, those living in larger households of five or more members would be more inclined to schedule more regular visits to the dentist (79%), compared to those in smaller households of 2 to 4 people (68%) or just one person (61%).

Although many respondents rate their general oral health positively, a significant proportion do not follow generally recommended oral hygiene instructions or practices and have experienced issues such as bleeding gums and tooth pain. There is a clear correlation between insurance coverage, regular dental visits and overall good oral health/oral health habits.

• While most respondents rate the health of their teeth and gums as good to excellent (65%), the proportion who offer the highest rating of 'very good/excellent' varies considerably between those with dental insurance (39%) and those without (28%).
• Almost half of respondents (49%) say they brush their teeth twice a day – morning and evening. The balance of respondents tends to brush less often – either once a day (33%) or less frequently (8%). Relatively few (9%) brush their teeth three times daily or more often.
• Similar patterns are evident for children under age 12 with very few brushing their teeth more than twice a day. Again, access to dental insurance appears to positively affect brushing habits – a higher proportion of those with coverage report brushing twice daily – although there is no difference based on insurance coverage with respect to those brushing their teeth more frequently than this.
• Irrespective of one's insurance status most respondents rarely or never use an oral rinse (52%). While a modest proportion of respondents use a mouthwash or mouth rinse on a daily basis (19%), this habit is somewhat more common among those who frequent the dentist on a yearly basis or more often.
• Flossing is also undertaken infrequently, with just one third (34%) of all respondents (and just 15% of children under age 12) reporting they floss daily or more often. And, while there is some correlation between flossing and access to dental insurance, the practice of daily flossing is not the norm regardless of insurance status. There is, however, a slight uptick in daily flossing among those who visit a dental office more frequently – at least once every 12 months.
• About one third of all respondents have experienced bleeding gums (35%) and tooth pain (31%), while one quarter or slightly more have reported dry mouth (28%) or tooth decay (25%) in the last 12 months. With the exception of bleeding gums, these issues are more commonly reported by those without access to dental insurance.
• With respect to dental care, while one in four (24%) have had a filling within the last 12 months, those with dental coverage are more likely to report having had a filling compared to those without (31% vs. 20%). Of note, while the percentage of respondents reporting that their child under 12 years of age has had a filling is about the same (29%) as for adults, there is no difference based on insurance status. This finding provides further evidence that parents tend to prioritize their children's dental care needs over their own.

There is a stark difference based on access to insurance in the proportion of those saying they have a dentist or oral health professional who provides services to them/their family. Nine in ten of those with insurance have access to dental care. This drops by 26 points to just six in ten of those without insurance coverage. It is also lower among racialized communities and for persons with a disability.

• Those with insurance coverage are not only more likely to have visited the dentist within the last year, compared to those who do not have coverage (77% vs. 48%), but are also more likely to visit the dentist on a yearly basis or more often (80% vs. 49%).
• By contrast, about one in three of those without insurance visit the dentist only when required or when there is an emergency, compared to just one in ten of those with insurance.
• A higher proportion of respondents with insurance visit the dentist for preventive care and services (e.g., regular check-ups and cleaning, fillings, and dental sealants and fluoride treatments). By contrast, insurance status has little bearing on the reasons for parents taking their children under the age of 18 to the dentist, with about equal numbers citing regular check-ups and fillings. This finding, along with others, underpins a key insight from this research (and previous research on the Canada Dental Benefit^[2]) that parents do their best to obtain dental care for their children.
• Payment for dental services also varies based on one's insurance status – those without coverage are more likely to pay by credit card or in cash, while those with insurance are more likely to say their costs are partially or fully covered.

Cost is the primary barrier to accessing regular dental care both for adult respondents and for those with children. For those without dental insurance, cost becomes quite a significant barrier with almost two thirds (64%) citing this as an issue preventing them from obtaining dental services, a 22-point difference relative to those with insurance coverage (42%).

• Another two in five (38%) mention a lack of insurance coverage, an issue which is cited with much greater frequency among those without insurance (47%) relative to those with coverage (15%). Other impediments include the cost of getting to and from the dentist (22%) and anxiety or fear (17%).
• The degree to which various barriers are cited varies – for example, parents of children under 18 years of age are more inclined to face additional barriers related to the cost of travel, anxiety and fear, lengthy waitlists, a lack of time, and trouble finding care for their children.

Awareness of the CDCP is reasonably high (43%)^[3], with impressions being mainly driven by coverage in the news media. Strong levels of awareness are also accompanied by a general familiarity with key aspects and features of the Plan, particularly its focus on dental care for lower income families with children as well for seniors. Moreover, among those who have not already applied for the Canada Dental Benefit there is overwhelming support for the new program across all target audiences.

• Of those who had heard about the new program, nearly three in four (72%) recall hearing about the new program via the news and/or in the media, while information shared on social media appears to have had some penetration (18%), more so among racialized communities and those in the younger age cohort (18-34 years of age).
• Of those who had heard about the new program about one third (32%) were prompted to look for information. While modest proportions of respondents with dental coverage sought information about the program, results indicate that respondents without access to insurance were more likely to do so. This was also the case for other priority groups and key target audiences, including parents with children under 18 years of age and those with a disability.
• Notably, respondents 65 and older were generally less inclined to seek out information about the program, relative to the average. However, those who did were somewhat more likely to learn about the program's focus on dental coverage for their demographic – seniors. At the same time, respondents aged 65+ were also slightly more likely to say they hadn't learned much about the program after looking for information about it, suggesting that there may be some value in targeting this audience with additional focused communications.
• There is significant support for the program across the board (82% overall, and 58% who 'strongly support' the program) and it is particularly high among those who do not have access to dental insurance (84%), compared to those who do (76%). While lower levels of support were registered by respondents who identified as Indigenous, it is important to note that almost three quarters (72%) are supportive.
• The main motivators for applying to the program center on opportunities for eligible respondents to have their dental costs covered and for improved dental health for the entire family (themselves and their children). Other motivators are a factor of the ease of enrolment as well as reliable information about the Plan and what it offers. Additionally, the need for urgent dental care would incentivize many to apply.
• Among parents of children under 12 who do not have dental insurance, over one in ten (14%) indicate having already applied for the Canada Dental Benefit, and another 47% say they are planning to apply.

F. Conclusions and Recommendations

Results from this study underscore a clear need and desire for the CDCP. As noted above, affordable dental care is a major concern for many. Additionally, the new program is widely supported by those who would be eligible to apply based on a household income of less than $90,000 a year, and it would meet an evident gap in obtaining regular dental care for those who are currently uninsured. The program addresses a key impediment to regular dental care related to the cost of dental services and a lack of dental coverage.

Larger households, in particular, would be positively impacted – compared to smaller or single-person households they are among the most concerned about affordable dental care and about accessing the services of a dentist or oral health professional. They are also currently more likely to schedule appointments only when it's necessary and would be more inclined to schedule regular appointments for themselves if they had extra money to do so. This group is more likely to have looked for information about the program, suggesting that they are receptive to hearing more about it. More so than others in smaller households the health of their family is among the primary motivators for applying to the program. Moreover, for all families with children under 18 years of age, having more than one child requiring dental care is a motivator for about one in five.

With respect to increasing awareness of the CDCP and maximizing uptake, additional efforts may be required to enhance awareness of the program among younger eligible Canadians (including those without children), people from racialized communities, and those with a lower socio-economic status (especially those with an annual household income under $20,000). For lower income households, it will be important to understand and explain how the CDCP is or is not integrated with other dental coverage offered by provincial/territorial governments which also targets this demographic. Although those aged 65+ exhibit higher levels of awareness of the Plan and its focus on seniors, they are less likely to have looked for information about it and, among those who have are more likely to say they didn't learn much. Some in this group may also be covered by provincial/territorial programs that offer dental services to lower income seniors (e.g., the Ontario Seniors Dental Care Program (OSDCP)). Outreach to all these groups should consider multi-channel strategies which leverage earned, paid and owned media in addition to social media and word-of-mouth. Oral health professionals also play a key role in communications as their interactions with their patients on a regular basis permit reinforcement of key messaging around good oral health practices (see below).

From a communications perspective, there are opportunities to share important information about the program and reinforce a number of key messages with the various target audiences. These recommendations are based on what respondents appear to have focused on when looking for information about the program as well as what they said would encourage them to apply for the program, including:

• The eligibility or qualifying criteria for the CDCP;
• How the CDCP is integrated with other dental programs;
• Key features of the program relating to coverage (e.g., no co-pays for those with household incomes of less than $70,000); and
• The importance of regular dental care at all stages of life and, for families, the value of early preventive care for children.

At the same time, efforts should be made to ensure the application process is simple and straightforward and that information about the Plan is readily available in formats and on platforms which enhance perceptions of trust and reliability. For some, additional information which would direct them to dental clinics/offices or oral health professionals in their community who are taking part in the program would also be helpful, especially for those who currently do not have access to dental care – an issue more so for households with lower levels of income and education, racialized communities, persons with a disability, and those in rural communities. Strategies may need to be developed to address the specific challenges of those living in remote communities who have limited access to year-round dental care or must travel long distances to access dental services.

The launch of the CDCP also presents an opportunity to educate the broader population and specific target audiences on better oral health practices. The research underscores the correlation between more regular visits to the dentist and good oral health habits so one might expect to see improvements over time with uptake of the CDCP. Key messages include the following:

• The importance of brushing your teeth at least two times a day using a soft-bristle toothbrush and fluoride toothpaste – Men, persons with a disability, lower SES households, and those who have not visited a dentist or oral health professional are more likely to brush once a day or less often and they are key audiences for this message.
• Regular flossing plays a crucial role in overall dental hygiene, reduces the risk of tooth decay and gum disease and benefits your heart health – Key groups for this message are similar to those noted above and include men, persons with a disability, racialized communities, those between the ages of 18 and 44, lower SES households, and those who visit the dentist infrequently.
• Regular use of an oral rinse is recommended – While most rarely or never use mouthwash, this behaviour is more pronounced among those who see a dentist or oral health professional on an infrequent basis, and among people living in rural areas.
• The connection between cavities and gum disease and other serious health conditions – Although many appear to be aware of and/or appreciate this connection, it could be further emphasized among younger people (aged 18-34).

Communications plans and strategies supporting the launch of the CDCP and any related educational campaigns on good oral hygiene should keep in mind that it is mothers who generally tend to schedule dental appointments for children. The research also suggests that children's oral health practices closely emulate those of their parents. As such, there may also be opportunities to speak more directly to mothers about dental care for children given that women tend to follow recommended oral hygiene habits more closely than men.

Following the launch of the CDCP it is recommended that tracking be undertaken at semi-regular intervals to gauge awareness of the program and assess the target audience's experience (from enrollment through accessing dental services). Tracking over time should also assess the extent to which the program has had an impact on dental practices, including more frequent visits for preventive dental care purposes as well as improved oral hygiene habits.

Note to the Reader

Unless otherwise noted, results shown in this report are expressed as percentages and may not add up to 100% due to rounding and/or multiple responses to a given question.

Throughout the report, the findings presented are reflective of the regionally weighted sample (n=2,150) and the unweighted remote sample (n=100) for a total sample size of n=2,250. The results from each priority group (i.e., families with children under 18, seniors, people with disabilities and people from racialized communities) include initial quota completes and any additional completes from respondents within the main target audience (Canadians, aged 18+ with a household income under $90,000) that met the defined criteria for each group.

Only statistically significant differences between sub-groups, according to the Z-test at a 95% confidence interval, are presented throughout the report.

Statement of Political Neutrality

I hereby certify as Senior Officer of The Strategic Counsel that the deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Government of Canada's Policy on Communications and Federal Identity and Directive on the Management of Communications. Specifically, the deliverables do not include information on electoral voting intentions, political party preferences, party standings with the electorate, or ratings of the performance of a political party or its leaders.

Signed:

Donna Nixon, Partner

Detailed Findings

Detailed Findings

A. Attitudes Towards Dental Care

Affordable dental care is a significant concern for many Canadians who are eligible for the new Canadian Dental Care Plan (CDCP) based on their annual household income. And, while affordability is situated well ahead of concerns about access to dental services, large proportions of the target audience are concerned about both issues. They are a particular concern for parents of children under 18 years of age, those in larger households and people from racialized communities, while seniors (aged 65+) are less concerned relative to the average.

Virtually all respondents view regular dental care for themselves and their children as important. Many also feel there is a clear connection between oral health and physical well-being, although these connections are not quite as strong among the younger cohort (aged 18-34) compared to others.

Consistent with their concerns about the affordability of dental care in Canada, many respondents (two thirds or more) say they would make more regular dental appointments for their family if they had a little extra money. Larger households (5+ members) would be particularly inclined to do so, along with parents of children under age 18 and those who identify as a member of a racialized community.

The findings also suggest that parents, regardless of insurance status, are prioritizing dental care for their children. This is based on the fact that a much lower proportion say they only schedule dental appointments for their children when absolutely necessary compared to the number who do the same for themselves. There is, however, a significant gap based on one's insurance status – a 16 and 17-point difference – with a much higher proportion of those who do not have dental coverage indicating that dental visits for themselves and their children are scheduled only when necessary.

1. Perspectives on Dental Care Relative to Other Issues of Concern

Prior to posing more direct questions regarding dental and oral health care, all respondents were asked about their level of concern on a range of issues including health care, dental care, childcare, housing and the cost of living. The findings (Table 1) clearly show the cost of living as a primary concern for virtually all respondents (96%), with almost three quarters saying they are 'very concerned' (73%) about this issue. Over four in five respondents also express concern about the affordability of dental care in (86%) and housing affordability (85%), although the proportion of those saying they are 'very concerned' about each of these issues is much lower as compared to the cost of living (55% and 61%, respectively).

Expressed levels of concern continue to be high for issues such as the affordability of prescription medications (78% - 41% 'very concerned'), accessing a family doctor (74% - 42% 'very concerned'), and accessing the services of a dentist or oral health professional (70% - 36% 'very concerned'). Concern drops off slightly when it comes to accessing mental health services (66% - 33% 'very concerned'). It falls off more significantly on other issues, including the affordability of childcare in Canada (46% - 20% 'very concerned') and accessing childcare services (38% - 16% 'very concerned').

On the issue of affordable dental care, respondents' level of concern is similar regardless of insurance status. However, it does vary across priority groups and other demographics and is higher among each of the following groups:

Priority Groups

• Parents of children under age 18 (93% among those with children aged 12-17 and among those with children under 12 years of age)
• People from racialized communities (90%)

Demographics

• Women (89%) as compared to men (82%) – note that women express greater concern about all the issues explored in this question
• Those aged 18-64 (87% to 89%), compared to those 65+ (81%)
• Those with a university or college-level education (87% and 88%, respectively), relative to those with high-school or less (82%)
• Larger households (those with 5+ members (90%) and those with 2-4 members (89%)), compared to one-person households (80%)

There were no variations by region or community type (i.e., urban, rural, remote).

While fewer respondents express concern about accessing the services of a dentist or oral health professional than they do about affordability of dental care, concern is more pronounced among:

Insurance Status

• Those without dental insurance (73%), compared to those who have coverage (62%)

Priority Groups

• Parents of children under age 18 (81% among those with children aged 12-17; 81% among those with children under 12 years of age)
• People from racialized communities (79%)
• Persons with disabilities (74%)

Demographics

• Women (73%) as compared to men (66%)
• Those under age 65 – concern declines as one ages, from 75% among those 18-34 years of age and 76% among those aged 35-44, to 71% for those aged 45-64, and 60% among those 65+
• Larger households (those with 5+ members (79%) and those with 2-4 members (72%)), compared to one-person households (64%)
• Those with more limited access to an oral health professional, such as a fly-in/fly-out service (90%), compared to those who have access but must travel to another community (73%) and those who have year-round access (68%)

Region and Community Type

• Respondents residing in Atlantic Canada (76%), relative to those in Alberta (68%), Manitoba/Saskatchewan (66%) and Quebec (66%)

2. Perceived Linkages Between Oral Health and Overall Wellness

Research has shown that there is a synergic relationship between oral health and overall wellness. Many respondents are also either aware of this or at least sense that this is the case. Just under two thirds (64%) believe there is a strong connection between cavities and gum disease and serious health conditions such as diabetes, heart disease and pneumonia (Table 2). The plurality (35%) describes the connection as 'very large,' while slightly fewer (29%) believe it to be 'large.' Another one in five (20%) say there is a 'moderate' link, while relatively few (7%) feel there is a 'small/very small' connection between the two. A very small proportion (6%) 'don't know' and another 2% believe there to be 'no connection.'

There are a number of variations across priority groups and other sub-groups of the population, as follows:

Insurance Status

• A higher proportion of those without dental insurance believe the connection to be 'very large' relative to those with insurance (37% vs. 29%, respectively). By contrast, those with insurance are more likely to feel there is a 'large' connection compared to their counterparts without insurance (34% vs. 28%, respectively). Overall, however, there is no significant difference based on insurance status in terms of those who believe the connection is 'large/very large.'

Priority Groups

• Parents of children aged 12-17 are more likely to say there is a 'large' connection (36%), relative to those with children under age 12 (28%) and relative to the average (29%).
• Across other priority groups, there are few significant differences to report, although seniors are more likely to feel the connection is 'very large' (41%) as compared to the total.

Demographics

• Women are more likely than men to describe the linkage as 'large/very large' (70% vs. 58%, respectively).
• The connection is stronger among those aged 35 and older, compared to those between the ages of 18 and 34 based on the proportion reporting it to be 'large/very large' (18-34 (53%), 35-44 (63%), 45-64 (69%), 65+ (67%)).
• Francophones are more likely to say the connection is 'large/very large' compared to Anglophones (72% vs. 62%, respectively).

Region and Community Type

• Those living in Quebec (71%), Atlantic Canada (67%) and Ontario (66%) are more inclined to say there is a 'large/very large' connection between cavities and gum disease and other medical conditions, relative to respondents in Alberta (58%), Manitoba/Saskatchewan (57%) and British Columbia/North (54%).

Respondents also believe there is a strong correlation, in general, between good oral health and overall physical well-being (Table 3) – 74% say there is a 'large/very large' connection between the two. In this case, respondents are about equally split between those who say the connection is 'very large' (40%) or 'large' (33%). Fewer feel the connection is 'moderate' (18%) or 'small/very small' (5%), with just 1% believing there is 'no connection' and 3% who 'don't know.'

Key variations in responses to this question are highlighted below.

Insurance Status

• There is no significant difference in 'net' responses to this question based on insurance status, although those with access to dental insurance are more likely than those without to describe the connection as 'large' (38% vs. 32%, respectively).

Demographics

• Women are more likely than men to describe the linkage as 'large/very large' (79% vs. 68%, respectively).
• The connection is stronger among those aged 45 and older, compared to younger people aged 18-34 – 78% of respondents between the ages of 45 and 64 and 76% of those aged 65+ describe it as 'large/very large,' compared to 66% for those aged 18-34.
• Respondents who have year-round access to an oral health professional are more likely to describe the connection as 'large/very large' (75%), relative to those who have more limited access to oral health professionals who intermittently visit their community (60%). In line with this, those who have access to an oral health professional are more likely than those who do not to view the connection between oral and physical well-being as 'large/very large' (75% vs. 68%, respectively).
• Francophones are more likely to say the connection is 'large/very large' compared to Anglophones (84% vs. 71%, respectively).

Region and Community Type

• Those living in Quebec (82%) are the most likely to feel there is a 'large/very large' connection between oral health and overall physical well-being, compared to respondents in Atlantic Canada (76%), Ontario (75%), British Columbia/North (71%), Alberta (66%) and Manitoba/Saskatchewan (59%).

3. Views on Regular Dental Care

Respondents feel that seeing a dentist or oral health professional on a regular basis is important, both for themselves (Table 4) and for their children (Tables 5 and 6). In all, nine in ten respondents (90%) say that it is either 'very important' (56%) or 'somewhat important' (34%) for them to visit a dental office or oral health professional regularly. While 2% responded that they were 'not sure,' just 8% felt it was 'not that important/not important at all.'

The vast majority of respondents, across all priority groups and sub-groups of the target population view regular dental care as important. At the same time, there are some variations across and between groups:

Insurance Status

• A higher proportion of those with dental insurance (94%) say regular visits are important, compared to those without (88%).

Priority Groups

• People from racialized communities (93%) are more likely to view regular visits as important compared to the average (90%).
• By contrast, those with a disability (86%) are less likely to hold this view.

Demographics

• 92% of women say regular visits are important, relative to 87% of men – 60% of women attach a high level of importance to dental visits versus 51% of men (e.g., say it is 'very important').
• While at least 90% of those under age 65 say regular dental care is important, this drops off slightly for those 65+ (86%).
• The degree of importance placed on regular dental visits varies by educational attainment and is highest among those with some university education (94%), compared to those who have a college education or trades training (89%) and those with a high school education (86%).

As shown in Table 5, over nine in ten respondents with children under age 12 (95%) say it is either 'very important' (66%) or 'somewhat important' (29%) that their children in this age group visit the dentist regularly (at least once a year or more often). Very few rate this as 'not important' (4%) or say they are 'not sure' (1%).

There are no significant differences to report by insurance status, across priority groups, demographics or by region and community type.

Parents of children aged 12 to 17 also underscore the importance of regular visits to the dentist. As shown in Table 6, almost all (97%) say it's important that their children/youth in this age range make regular visits – 71% say it is 'very important' and another 26% say it is 'somewhat important.' Just 1% feel it is 'not important.' Another 2% are 'not sure.'

In line with the results on the previous question, there are no variations of note across sub-groups of the target population, with well over 90% of respondents across the board indicating it is important for children aged 12-17 to visit the dentist regularly.

Respondents were asked a series of agree-disagree statements to further assess their approach to dental care and the extent to which they view regular dental care for themselves and their children as important. As shown in Table 7, almost nine in ten (or more) want their family members to receive regular dental care:

• 94% agree that they would like their children to receive regular dental care – 72% 'strongly agree' with this statement; and
• 88% would like to receive regular dental care themselves – 60% 'strongly agree.'

Two thirds to three quarters of respondents would be inclined to schedule more regular visits if they had extra money:

• 73% would schedule more regular appointments for their children – 44% 'strongly agree'; and
• 66% would schedule more regular appointments for themselves – 38% 'strongly agree.'

And, while many say they only schedule dental appointments when absolutely necessary, a smaller proportion do so when there is an issue with their child's oral health:

• 65% make appointments for themselves only when necessary – 34% 'strongly agree' with this statement; and
• 51% make appointments for their children only when necessary – 24% 'strongly agree.'

Insurance Status

• Compared to those who have access to dental insurance, those who do not are more likely to express agreement with three of the six statements:
  • I only schedule dental care appointments for myself when necessary (70% of those without insurance agree vs. 54% of those with insurance);
  • If I had extra money, I would schedule more regular dental care appointments for myself (69% vs. 59%); and
  • I only schedule dental care appointments for my children when necessary (57% vs. 40%).

Priority Groups

• Parents of children under age 18 are more likely relative to the average to say they only schedule dental appointments for themselves when absolutely necessary (80% among those with children under age 12; 73% among those with children aged 12-17). This group is also more likely to agree that they would schedule more regular appointments for themselves if they had extra money (80% among those with children under age 12; 73% among those with children aged 12-17).
• People from racialized communities as well as those with a disability (73% in each of these groups) are more likely to agree that they only schedule appointments for themselves when absolutely necessary, relative to the average (65%). Additionally, those from racialized communities are more likely to agree that they would schedule more regular appointments for themselves if they had extra money (73%) and that they only schedule dental care for their children when absolutely necessary (60%).

Demographics

• Women are more likely than men to agree with two of the statements in particular:
  • Ideally, I would like to receive more regular dental care (91% vs. 86%); and
  • If I had extra money, I would schedule more regular dental care appointments for myself (69% vs. 62%).
• By age, the youngest segment of respondents (18-34 years of age) is most likely to agree that they would schedule regular dental appointments if they had a little extra money (75%), while the level of agreement with this statement declines among those aged 45-64 (66%) or 65+ (54%). In line with this, agreement is also higher among 18–34-year-olds in regard to scheduling dental care appointments only as necessary (72%), dropping off to 64% among those 45-64, and further declining to 58% among those 65+.
• Those with a high school education or less are more likely to agree that they only schedule dental care appointments for themselves when it is absolutely necessary (70%) compared to those with a college or trades degree/diploma or training (63%) and those with a university education (62%). By contrast, those whose highest level of education is at the university level are more likely as compared to those have some high school education to agree that they would ideally like to receive regular dental care (90% vs. 85%).
• Agreement with the statements also varies by the size of the household. Respondents with larger household (5 or more members) are more likely than those with smaller households or in single-person households to agree that:
  • They only schedule dental care appointments for themselves when absolutely necessary (82% among those in households with 5+ members; 67% among households with 2-4 members; 58% among single-person households); and
  • If they had some extra money, they would schedule more regular dental appointments for themselves (79% among households with 5+ members; 68% among 2-4 person households; 61% among single-person households).

There are no other variations of note by region or by type of community.

B. Oral Health Habits

To better understand respondents' oral health behaviours and those of their children, respondents were asked a series of questions related to the frequency of brushing and flossing their teeth as well as their use of mouthwash and fluoridated toothpaste.

Although most respondents describe the health of their teeth and gums as being in good to excellent shape, significant numbers do not follow recommended oral hygiene practices. Many (42%) say they brush their teeth only once a day or less frequently than that. For parents with children under 12 years of age, the results are similar – 38% say their children brush their teeth daily or less often. Flossing is also undertaken on an occasional basis (once a week or more rarely, including never) by about just under half of respondents (45%) and more indicate this is also the practice of their children under 12 years of age (67%). The majority admit to using mouthwash or a mouth rinse rarely or never (52%) and, again this is the same for their children who are under 12 years of age (64%). By contrast, most are using a fluoride toothpaste (65% of respondents; 56% of respondents' children under age 12), although a significant number either do not or don't know if the toothpaste they are using contains fluoride.

Results do vary based on insurance status as those with dental coverage are more likely to describe the condition of their teeth and gums as either 'very good' or 'excellent' compared to those who do not have insurance coverage. The insured group also tends to brush somewhat more frequently (although regardless of insurance status relatively few brush three times daily or more) and a slightly higher percentage say they floss on a daily basis.

Between 19% and 35% of all respondents have experienced an oral health condition in the last 12 months – bleeding gums is reported by just over one third, while stomach acid is reported by one in five. Various conditions, including tooth pain, dry mouth and tooth decay or a lost tooth are reported more frequently by those without insurance, compared to those who have dental coverage. Certain of these conditions are also reported with greater frequency by those who do not visit the dentist on a yearly basis and/or whose last visit was more than 3 years ago. Age is also a factor as younger people tend to experience dental health conditions more so than those in older age groups. The same holds true among racialized communities.

The proportion of respondents who have received a filling in the last 12 months varies by insurance status with a higher proportion of insured respondents having had a filling versus those without dental coverage.

1. General Oral Habits

Respondents' rating of their oral health varies with almost equal proportions rating the health of their teeth and gums as 'good' (33%) or 'fair/poor' (34%). Just under one third of respondents rate the health of their teeth and gums as 'excellent/very good' (31%) with only a small proportion of respondents who say 'excellent' (5%).

Differences by insurance status and across priority groups and other demographics are as follows:

Insurance Status

• Respondents with dental coverage are more likely to rate the health of their teeth and gums as 'excellent' (8%), 'very good' (31%), or 'good' (36%) relative to those without insurance (5%, 23%, and 32%, respectively).
• Conversely, respondents without dental coverage are more likely to rate the health of their teeth and gums as 'fair/poor' (38%) compared to those with insurance (24%).

Priority Groups

• Those with a disability are more likely to rate their teeth and gums as 'poor' (23%) relative to the average (14%).
• People from racialized communities report the health of their teeth and gums as 'good' (39%) or 'fair' (25%) at a higher rate than the average (33% and 20%, respectively).

Demographics

Respondents more likely to rate their oral health as 'excellent/good' are:

• Those with a household income of $80,000 to just under $90,000 (41%), relative to those with a household income of less than $70,000 a year (31%);
• Those who have not experienced oral issues within the past 12 months (46%), relative to those who have (23%);
• Those who visit the dentist once a year or more (42%), compared to those who visit less often (19% for less than once a year and 14% for those who say they visit only when required or when there is an emergency);
• Those who have been to the dentist within the past year (41%), compared to those who have last visited a dental office 1 to less than 2 years ago (29%) and more than 3 years ago (14%); and
• Those aged 18-34 (37%), relative to those aged 35-44 (24%) and aged 45-64 (32%).

Respondents who are more likely to rate their oral health as 'fair/poor' are:

• Those who only visit the dentist when it is required or an emergency (58%), compared to those who say they visit less often than once a year (43%) and those who visit once a year or more (21%);
• Those who last visited a dental office more than 3 years ago (57%) or 2 to 3 years ago (48%), relative to those who visited more recently (23% for within the past year and 36% for 1 to less than 2 years ago);
• Those who are unemployed and looking for work (47%), compared to those who are employed (30%) and those who are not in the workforce (35%);
• Those who have experienced some form of an oral issue within the past 12 months (43%) as compared to those who have not (17%);
• Those who must travel to another community to access an oral health professional (42%), compared to those who have access year-round (33%) and those who only have limited access, such as a fly-in/fly-out service (29%); and
• Those with a high-school education or less (41%) relative to those with a college-level (33%) or university (27%) education.

Region and Community Type

• Respondents living in the province of Quebec are more likely to rate the health of their teeth and gums as 'excellent/very good' (37%), relative to those in Atlantic provinces (26%), Ontario (29%) and British Columbia/North (28%).
• No variations were noted by community type (i.e., urban, rural, remote).

The vast majority (82%) of respondents say they brush their teeth once (33%) or twice a day (49%). Just under one-in-ten (9%) report brushing their teeth more often – three times a day (7%) or more than three times a day (2%). A smaller proportion (8%) indicate that they brush their teeth infrequently (6% who say less than once a day) or never (2%).

Some variations regarding the frequency of brushing one's teeth were noted:

Insurance Status

• Respondents with dental coverage are more likely to report brushing their teeth twice a day (53%), relative to those without coverage (47%).
• Those without dental insurance report at higher rate brushing their teeth once a day (7%) than those with insurance (5%).

Priority Groups

• People from racialized communities are more likely to report brushing their teeth twice a day (59%) than the average (49%).
• Persons with a disability are less likely to report brushing twice a day (42%) than the average (49%) and more likely to report brushing less than once a day (12% vs. 6%).

Demographics

• Respondents with a household income of $80,000 to just under $90,000 report brushing their teeth twice a day (70%), at a higher rate than those with household incomes less than $80,000 (50% for $70,000 to just under $80,000 and 48% for less than $70,000).
• Those with a university education are more likely to say they brush their teeth twice a day (54%), compared to those with a high school diploma or less (45%).
• Women, more so than men, report brushing their teeth twice a day (54% vs. 44%) or three times a day (9% vs. 5%). Conversely, men are more likely to say they brush once a day (37%) or less than once a day (8%) relative to women (30% and 4%, respectively).
• Respondents who visit the dentist more frequently, every 12 months or more (54%), report brushing their teeth twice a day which is at a higher rate than those who only visit the dentist when it is required or an emergency (41%).
• Those who have visited the dentist more recently, within the past year, are more likely to report brushing their teeth twice a day (53%), relative to those who have not (43% for those who last visited between two and three years ago, and 43% for those who last visited more than 3 years ago).
• Anglophones (51%) and those who speak a language other than English or French at home are more likely to report brushing their teeth twice a day (53%), relative to Francophones (42%).

Region and Community Type

• Respondents residing in British Columbia/North are more likely to indicate brushing their teeth twice a day (56%) relative to those in the Atlantic (46%), Quebec (43%), Manitoba and Saskatchewan (44%), and Alberta (46%).

The frequency with which children under 12 years of age brush their teeth is similar to that of respondents themselves, with the vast majority (87%) reporting that their children brush once (29%) or twice a day (58%). Just under one-in-ten (9%) say their children under the age of 12 brush their teeth less than once a day (7%) or never (2%). Fewer report brushing more often than twice a day – 4% say three times a day and 1% say more than three times a day.

Significant differences are not noted as small base sizes preclude any further analysis.

Respondents were then asked about their use of fluoride toothpaste when brushing their teeth. Just under two-thirds (65%) of respondents report that they do use fluoridated toothpaste. One in five (20%) say they do not use fluoride toothpaste when brushing their teeth and notably, over one in ten (15%) don't know if the toothpaste they are using is fluoridated.

No differences were noted by insurance status.

In terms of variations for other demographics, those more likely to report that they do not use fluoridated toothpaste when brushing their teeth are:

Demographics

• Respondents without access to a year-round oral professional within their community (30%) (i.e., must travel to another community or fly-in/fly-out service) as compared to those who have access year-round (18%).
• Francophones (25%) vs. Anglophones (19%).
• Respondents with a high school education (24%) compared to those with a college-level education or trades certification (19%) and those with a university education (17%).
• Aged 18-34 (24%) or aged 65 and older (22%), relative to those aged 45-64 (17%).

Region and Community Type

• Residing in Quebec (25%), relative to those living in the Atlantic provinces (17%), Ontario (18%), and B.C./North (19%).

Conversely, a few variations were noted among those who say they do use fluoridated toothpaste.

Demographics

• Those with a university education use fluoridated toothpaste (68%) at a higher rate than those with a high school diploma or less (61%).
• Anglophones, more so than Francophones report using fluoridated toothpaste (68% vs. 56%).
• Respondents who have access to an oral health professional year-round in their community are more likely to say 'yes' to using fluoride toothpaste (67%), relative to those who do not (55%).
• Respondents aged 45 to 64 (70%) are more likely to say they use fluoride toothpaste when brushing their teeth, when compared to those aged 18 to 34 (58%) and those 65 years of age and older (64%). Notably, those between the ages of 18 and 34 are more likely to say they 'don't know' if their toothpaste is fluoridated (18%), relative to those aged 45 to 64 (14%).

For children under 12 years of age, over half (56%) of respondents report that their child/children is using fluoride toothpaste when brushing their teeth. Just over three-in-ten (31%) say their child/children under 12 are not using fluoride toothpaste when brushing their teeth and similar to respondents themselves, over one-in-ten (13%) are unsure.

Significant differences are not noted as small base sizes preclude any further analysis.

Respondents were asked about the average frequency with which they use an oral rinse, such as mouthwash or mouth rinse, at least once daily and responses varied. The majority (52%) of respondents report 'rarely' (33%) or 'never' (19%) using an oral rinse. Just under half (48%) say they are using mouthwash or mouth rinse at least one day a week, with almost one in five (19%) reporting that they use it every day of the week.

No differences were noted by insurance coverage.

Priority Groups

• Seniors, aged 65 and older, are both more likely to report they either 'never use' (23%) mouthwash or use it 'every day of the week' (25%).
• People from racialized communities are less likely to say they 'never use' (15%) an oral rinse.

Demographics

• Those with access to a year-round oral health professional within their community are more likely to say they 'rarely use' (34%) mouthwash or mouth rinse, relative to those who do not (27%).
• A higher proportion of respondents who last visited a dental office more than three years ago say they 'never use' (25%) mouthwash compared to those who visited within the past year (18%) or one to two years ago (15%).
• Those who have not experienced an oral issue within the past 12 months are more likely to say they use an oral rinse 'every day of the week' (23%), relative to those who have experienced an oral issue (16%).
• Respondents who visit a dental office every 12 months or more, report using mouthwash 'every day of the week' (21%) at a higher rate than those who visit less often than once a year (15%) and those who only visit when it's required or for an emergency (15%).

Region and Community Type

• Rural respondents are more likely to report 'rarely' (40%) using mouthwash when compared to those in urban areas (33%).
• Those residing in Manitoba and Saskatchewan are more likely to say they 'never use' (26%) an oral rinse, relative to those in the Atlantic (17%), Ontario (18%), and Alberta (15%).

For children under the age of 12, it is not surprising that under two thirds (64%) of parents indicate their child/children 'rarely use' (18%) or 'never use' (46%) mouthwash or mouth rinse given that younger children (before the age of 12) are advised against using mouthwash. Just over one in ten report that their child/children under the age of 12 use mouthwash 'every day of the week' (12%) and a quarter (25%) say their child/children are using an oral rinse at least once a week but not every day of the week.

Significant differences are not noted as small base sizes preclude any further analysis.

As a final measure of assessing oral health habits, respondents were asked about how often they clean between their teeth with a flossing aid or dental floss. The frequency with which respondents use dental floss or other flossing aids varies. Just over one quarter indicate they floss 'only occasionally' (28%) and an equal proportion say 'daily' (28%). One in five reports flossing less frequently saying they do it 'more than once a week but not everyday' (20%). Notably, almost one in five say they 'never' (17%) floss while even fewer say they floss 'several times a day' (6%).

Insurance Status

• Those with dental insurance are more likely to report flossing 'daily' (32%), relative to those without coverage (27%).
• Conversely, respondents without dental insurance are more likely to say they 'never' (19%) floss, compared to those with coverage (13%).

Priority Groups

• People from racialized communities are more likely to report flossing 'only occasionally' (33%) and less likely to say 'never' (12%), relative to the average.
• Persons with a disability are more likely to report a frequency of 'never' (22%) and less likely to report 'daily' (24%), compared to the average.
• Seniors, aged 65 and older, are more likely to say they floss 'daily' (33%) or 'several times a day' (9%) and less likely to report a frequency of 'only occasionally' (19%), relative to the average.

Demographics

Respondents who are more likely to report they 'never' floss include:

• Those who only visit a dental office when it is required or an emergency (30%), compared to those who visit every 12 months or more (7%);
• Those who must travel to another community to access an oral health professional (27%), relative to those who have access within their community year-round (15%);
• Those with a high school diploma or less (23%), relative to those with a college degree or trades certification (14%) or a university education (14%);
• Men (21%), compared to women (13%); and
• Those not in the workforce (19%), compared to those who are employed (15%).

Those more likely to report they floss 'only occasionally' include:

• Larger households with 5 or more (38%), compared to smaller households with 2 to 4 people (28%) and single person households (27%);
• Younger respondents aged 18-34 (36%) and 35-44 (38%), relative to those who are older (25% for those aged 45 to 64 and 19% for those aged 65 plus);
• Those who only visit a dental office when it is required or an emergency (32%), compared to those who visit every 12 months or more (27%);
• Those who have experienced an oral issue within the past 12 months (32%) versus those who have not (22%); and
• Those who have access to an oral health professional in their community year-round (29%), relative to those who must travel to another community (23%).

Respondents more likely to say they floss 'more than once a week but not everyday' are:

• Younger, aged 18-34 (24%), relative to those who are aged 45 to 64 (19%) and 65 or older (18%);
• Those with a college-level education or trades certification (22%) or university education (21%), compared to those with a high school diploma or less (15%);
• Respondents who visit the dentist at least once every 12 months (23%), relative to those who only do so when it is required or an emergency (14%); and
• Those who have access to an oral health professional within their community year-round (21%), relative to those who do not (16%).

Those more likely to report a frequency of 'daily' are:

• Households with an income between $70,000 and $79,999 (37%), compared to those with an income less than $70,000 (27%);
• Respondents who last visited an oral health professional within the past year (36%), relative to those whose last visit was more than a year ago (ranging from 16% to 20%);
• Similar to the above point, those who visit a dental office at least once every 12 months (35%) compared to those who visit less frequently (ranging from 18% to 21%);
• Those who have not experienced an oral issue within the past 12 months (35%), relative to those who have (25%); and
• Aged 65 and older (33%) and aged 45 to 64 (30%), relative to those who are 35 to 44 (24%) and 18 to 34 (22%).

No variations were noted by region or community type.

The flossing habits of children under 12 years of age vary somewhat from those of respondents themselves. Almost two in five report that their child/children younger than 12 'never' (38%) floss. Under one third say their child/children are flossing infrequently, reporting that they floss 'only occasionally' (29%). Similar proportions (29%) report flossing more regularly, with 16% saying their child/children is flossing 'more than once a week but not everyday' and 13% reporting the frequency as 'daily'. Very few (2%) parents say their children under the age of 12 are flossing their teeth 'several times a day'.

Significant differences are not noted as small base sizes preclude any further analysis.

2. Oral Health Conditions / Diagnoses

At least one-in-five respondents report experiencing some form of oral discomfort within the last 12 months. With over one third, the most common condition reported by respondents is bleeding gums when eating or brushing their teeth (35%). This is followed by tooth pain (31%) and dry mouth (28%). One quarter of respondents report experiencing tooth decay or the loss of a tooth as a result of decay (25%) and just under one-in-five say they experience, on a daily or almost daily basis, stomach acid in their mouth or throat after eating or when lying down (19%).

Insurance Status

• Those without insurance, relative to those with dental coverage, are more likely to report experiencing tooth pain (33% vs. 27%), dry mouth (30% vs. 24%), and tooth decay or loss of a tooth as a result of decay (28% vs. 17%).

Priority Groups

• Seniors, aged 65+ are less likely than the average to report experiencing the forms of oral discomfort listed, with the exception of dry mouth. This could be related to the proportion of seniors who have dentures or dental implants as studies among patients 65 and older have shown that dental implants correlate to low periodontal disease index scores^[4].
• By contrast, persons with a disability are more likely than the average to report having experienced all forms of oral discomfort within the past 12 months, except for bleeding gums.
• People from racialized communities are more likely to say they have experienced bleeding gums (43%) or tooth pain (36%) when brushing their teeth or eating, relative to the average.

Demographics

• Respondents younger than 45 years of age are more likely to report having experienced bleeding gums (51% for 18-34 and 47% for 35-44) and tooth pain (41% age 18-34 and 42% age 35-44), relative to those who are older (bleeding gums – 32% for 45-64 and 18% for 65+; tooth pain – 29% for 45-64 and 19% for 65+).
• Respondents who frequent the dentist less often than once a year report at a higher rate of bleeding gums (46%) than those who visit at least once a year or more (32%).
• Those who last visited an oral health professional more than 3 years ago are more likely to say they have experienced tooth decay (33%) within the past year, relative to those who have more recently visited a dental office (25% for those who visited a year to less than 3 years ago and 22% for those who have visited within the past year).
• Respondents aged 35 to 44 are more likely to say they have experienced tooth decay (31%), when compared to those aged 18 to 34 (22%) and those 65 plus (22%).
• Those with a high school education or less report dry mouth (33%) and tooth decay (30%) at a higher rate than those with a college-level or trades certification (28% and 24%, respectively) and a university education (24% and 20%, respectively).
• Those without year-round access to an oral health professional in their community are more likely to report stomach acid (25%) as an issue they experience, relative to those with access (18%).

Region and Community Type

• Respondents living in the Atlantic provinces are more likely to say they have experienced tooth decay (31%) in the last year, compared to those living in Ontario (25%), Manitoba and Saskatchewan (22%), Alberta (24%), and B.C./North (24%).

In terms of dental procedures, just under one quarter of respondents indicate they have received fillings (24%) within the past 12 months and over one in ten reports having received a tooth extraction (13%). Other dental procedures are reported less frequently – 6% for root canals, 5% each for crowns or dentures, and 2% for gum grafts.

Insurance Status

• Respondents with access to dental insurance are more likely to say they have received fillings (31%), relative to those who do not have coverage (20%).

Priority Groups

• Relative to the average, people from racialized communities report having received fillings at a higher rate (30% vs. 24%).

Demographics

• Younger respondents, aged 18 to 34, are more likely to say they have received fillings (31%) when compared to those who are older (24% for 35-44 and 21% for 45+). Younger respondents are also more likely to report having had a tooth extraction (17% for age 18-34) within the past 12 months, relative to those who are 35 to 44 (12%) and 45 to 64 (10%).

About half of parents with children under 18 years of age report that their child has received a dental cleaning (49%) within the past 12 months. Nearly equal proportions say their child/children under 12 has received fillings (29%) or a fluoride treatment (27%). Dental procedures mentioned less frequently include tooth extractions (15%) and dental sealants (13%).

Significant differences are not noted as small base sizes preclude any further analysis.

Tooth decay is the most common diagnosis among respondents with over a quarter (28%) reporting they have been diagnosed within the past few years. Notably, under one in five reports being diagnosed with gingivitis (16%) – fewer than half of those who reported experiencing bleeding gums in the past year (35%, see Table 17). Under one in ten report having been diagnosed with gum disease (9%), edentulism (5%) or oral cancer (1%).

Variations include the following:

Insurance Status

• Those without access to dental insurance are more likely to report having been diagnosed with tooth decay (30%) within the past few years, relative to those without (23%).

Priority Groups

• Persons with a disability are more likely to report a diagnosis of gingivitis (20%), relative to the average (16%).
• Seniors are more likely to report having been diagnosed with tooth decay (34%), compared to the average (28%). By contrast, they are less likely to report a diagnosis of gingivitis (10%).

Demographics

• Those who only visit a dental office when it is required or an emergency are more likely to say they have been diagnosed with tooth decay (33%), relative to those who visit an oral health professional at least once every 12 months (28%).
• Respondents with year-round access to an oral health professional in their community are more likely to report a diagnosis of tooth decay (29%), when compared to those who do not have year-round access in their community (23%).

C. Access to and Use of Dental services

Just under three quarters of respondents have access to a dentist for themselves and/or other family members, although this varies significantly between those who are insured (90%) and those who do not have dental insurance (63%). Insurance status not only impacts the likelihood of having access to a dentist, but also the likelihood of having visited a dentist within the last year (77% among those who are insured versus 48% among those not insured) and of visiting on at least a yearly basis or more often (80% among those who are insured versus 49% among those not insured). Notably, the likelihood of one's children having visited the dentist within the last year or the frequency that the child/children visit the dentist's office does not appear to be affected by insurance status.

Most say that they visit the dentist or an oral health professional for regular check-ups and cleaning, although again those with insurance are more likely to indicate this relative to those without dental coverage (90% vs. 75%, respectively). Similarly, insured respondents are more likely to visit for tooth fillings compared to those who are uninsured (52% vs. 38%), and this aligns with the data on those reporting having had a filling within the last 12 months. These are also the two main reasons why parents take their children to the dentist.

1. Access to Dental Services and Frequency of Visiting

To gauge access to dental care services, respondents were asked whether they currently have a dentist or oral health professional who provides dental services for themselves and their family. The majority (71%) have access to dental services, with most having a dentist or oral health professional either only for themselves (39%) or for their whole family (27%). Only 4% have a dentist only for their child/children. Overall, three in ten (29%) do not have a dentist or oral health professional.

There are a number of variations based on insurance status and across priority and demographic groups.

Insurance Status

• A much higher proportion of those with dental insurance have access to a dentist and/or oral health professional relative to those without insurance (90% vs. 63%, respectively).

Priority Groups

• Parents with children aged 12-17 (50%) and children under 12 years of age (43%) are also more likely to have access for the whole family, and less so just for themselves (11% and 14%, respectively), compared to the average.
• Across other priority groups, those who identify as having a disability and/or people from racialized communities are more likely to not to have access to a dentist (34%).

Demographics

• Women are more likely than men to say they have access to dental services for their whole family (29% vs. 25%, respectively).
• Younger respondents aged 18-34 (45%) and older respondents aged 65+ (42%) are more likely to have a dentist or oral health professional only for themselves, compared to those 34-44 years of age (32%).
• Those with lower educational attainment, including high school or less, are less likely to currently see a dentist (67%), compared to those who have completed post secondary studies (74% college/trades; 72% university).
• Those who are unemployed are more likely to say they do not have a dentist (39%) relative to the average (29%).
• A much higher proportion of those who must travel to another community for services (57%) or are only able to access dental care at certain times (56%) say they do not currently have a dentist or an oral professional, compared to those who have access year-round (23%).
• Lower income households (making less than $70,000 per year) are more likely not to have access to a dentist or oral health professional (31%), compared to those making $70,000 to $79,000 (19%) or $80,000 to $89,000 (20%) annually.

Region and Community Type

• Respondents residing in Quebec (75%) and Ontario (74%) are most likely to have access to a dentist or oral health professional compared to other regions in Canada. Access to dental services is particularly low in Atlantic Canada (61%).
• Those residing in remote communities are also less likely to have access to a dentist or oral health professional (46% say they do not currently have access).

To better understand when children initially receive dental services, parents with a child/children under the age of 12 were asked at what age they first visited a dentist or oral health professional. A slim majority of parents indicate having taken their child to the dentist sometime after they reached 3 years of age or older (54%). About one third of parents took their child when they were less than 3 years of age (30%) while 6% were unable to recall when their child/children had an initial visit, and 11% indicated that their child had never visited the dentist.

Significant differences are not noted as small base sizes preclude any further analysis.

In terms of the last time respondents have visited the dentist either for themselves or for their children, a majority have visited a dental office or oral health professional within the past year, and a plurality within the past six months.

The following charts (Tables 23, 24 and 25) show that a higher proportion of those with a child/children aged 12-17 years old (76%) or under 12 (67%) have visited a dentist within the last 12 months or more often (for their children's needs), compared to a smaller proportion (57%) who have visited within the last year for their own dental needs.

Significant variations are highlighted below:

Insurance Status

• Those without access to dental insurance are less likely to have visited the dentist within the past six months (33%) compared to those with insurance (59%).

Priority Groups

• Seniors (aged 65+) are more likely to have visited the dentist within the past six months (46%), relative to the average (41%).
• Persons with disabilities are more likely to indicate that their last visit to the dentist was five or more years ago (17%).

Demographics

• Those who have completed post-secondary education (44%) are more likely to say that they have visited the dentist in the last 6 months, compared to those with a high school diploma or less in terms of their educational attainment (36%).
• Similarly, those with household incomes over $70,000 are more likely to have visited a dentist in the last 6 months (56% $70,000 to $79,000; 53% $80,000-$89,000), compared to those with incomes less than $70,000 (38%).
• Those who have regular access to dental services are more likely to say their last visit has been in the past 6 months (44%) or 12 months (17%), compared to those who do not have regular access (24% and 12%, respectively).
• A greater proportion of Anglophones say they last visited a dentist within the past 6 months (43%), compared to Francophones (36%).

Region and Community Type

• A higher proportion of those living in Ontario, compared to other regions of the country, are more likely to have visited a dental office within the last six months (46%).

Significant differences are not noted as small base sizes preclude any further analysis.

Significant differences are not noted as small base sizes preclude any further analysis.

Similar to respondents' patterns in terms of the last time they have visited the dentist, a majority frequent the dentist on a yearly basis or more often for their children's dental needs (86% for children aged 12-17 and 83% for children under age 12), although less so for their own dental needs (58%).

Almost one quarter say they visit the dentist or an oral health professional for themselves only when it's necessary (16%) or when they have a dental emergency (10%). Just 5% say they never visit the dentist themselves.

Insurance Status

• Those with insurance visit the dentist more frequently. Four in five (80%) with access to dental coverage visit the dentist as frequently as once a year, while only half (49%) without coverage visit the dentist at the same frequency,
• A higher proportion of those without access to dental insurance say they will only go to the dentist when it's required (19% vs. 7% with insurance) and/or when they have a dental emergency (13% vs. 3% with insurance).

Priority Groups

• Only visiting the dental when there is an emergency is reported more frequently by those who identify with a disability (14%) relative to the average (10%).

Demographics

• Men are more likely to visit the dentist about every three months (7%) compared to women (5%).
• Respondents who have to travel to another community for dental care (18%), are divorced, separated or widowed (16%), have a lower educational attainment of high school or less (13%), are not employed (12%), and/or have an annual household income less than $70,000 (11%) are more likely to say they only go to the dentist when there is an emergency.

Region and Community Type

• Residents of Quebec are more likely than those living in any other region to say that they visit the dentist once a year (30%).
• In line with Ontarians' general patterns of when they last visited the dentist, they are also more likely to say they frequent the dentist every six months (27%), compared to the average (21%), and specifically when compared to Atlantic Canada (21%), Quebec (17%) and Manitoba/Saskatchewan (17%).
• A higher proportion of Atlantic Canada residents say they only visit a dentist in the case of a dental emergency (17%) relative to any other region across the country.

Significant differences are not noted as small base sizes preclude any further analysis.

Significant differences are not noted as small base sizes preclude any further analysis.

2. Use of Dental Services

When it comes to scheduling dentist appointments, the vast majority of parents with children under 18 years of age (87%) indicate they have some involvement in booking these appointments for their children. Three in five (60%) parents say they schedule dental appointments for their children 'all of the time', meanwhile another two in five (21%) say they do so 'most of the time'. Only 13% of parents say that someone else schedules appointments for their child/children.

While there are either no significant differences or small base sizes preclude sub-analysis by insurance status, priority groups, or region there are some evident gender and employment differences when it comes to booking dental visits.

• Women are more likely to say they schedule appointments for their children under 18 years of age 'all of the time' than men (71% vs. 45% respectively).
• Parents who are either not employed or are not in the workforce are more likely to say they book their child's/children's dental appointments all the time (71%) compared to those who are employed (57%).

The next series of questions asked respondents to select the reasons for visiting a dentist or oral health professional, both for themselves and, as applicable, their children under the age of 18. Overall, the most common reason for their visit is for regular check-ups and/or cleanings for oneself (81%) or for their children (84%). Over two in five say they visit the dentist to receive fillings for themselves (43%) or their children aged 12-17 (40%). This was less commonly cited, however, as a reason for one's child under age 12 (29%) to visit the dentist. A similar pattern holds for urgent dental needs – 43% cite this as a reason for visiting a dentist themselves, 29% for their children under 12 years of age, and 24% for their child/children between the ages of 12-17. Visiting the dentist for needs related to dental sealants and fluoride treatments is more common for children (26% for children under 12 years of age and 25% for children aged 12-17) compared to the general population (19%). Orthodontic treatments are cited by about one in ten or fewer respondents.

By insurance status and across priority and demographic groups, key differences are as follows:

Insurance Status

• Respondents with dental insurance are much more likely to visit the dentist for preventative dental services such as regular check-ups and cleanings (90% vs. 75% without insurance), fillings (52% vs. 38%) and sealants and fluoride treatments (22% vs. 16%).

Priority Groups

• There are limited differences across priority groups, with the exception of seniors (aged 65+) who are more likely to have visited a dentist or oral health professional for fillings (50%) and urgent dental needs (50%), relative to the average (43% for both). This could be attributed to various provincial and municipal programs across the country that cover these specific costs related to dental care for seniors.

Demographics

• Women are more likely to visit the dentist for regular cleanings (83%) compared to men (78%).
• Those with a higher educational attainment (post-secondary or greater) are more likely to say they visit a dentist for regular check-ups/cleanings (86% university; 82% college vs. 74% high school or less), for fillings (47% university; 45% college vs. 38% high school or less) and for sealants/fluoride treatments (20% university/college vs. 15% high school or less).
• Those with an annual household income of $70,000 or less are less likely to visit a dentist for regular cleanings (79%) compared to those with annual household incomes over $70,000 annually (91% $70,000 to $79,000; 86% $80,000 to $89,000).
• Francophones are more likely than Anglophones to say that they go for routine cleanings and check ups (85% vs. 79% respectively).
• Those who have access to a dentist are more likely to go for routine services such as check-ups/cleanings (84%) and fillings (44%), compared to those who do not (62% and 36%, respectively)
• A higher proportion of respondents who are not in the workforce (47%) versus employed (40%) say they visit for urgent dental needs.

Region and Community Type

• A higher proportion of those residing in Quebec (85%) say they would visit a dentist or an oral health professional for regular cleanings compared to the average (80%) and specifically to Alberta (77%) and Atlantic Canada (75%) where these ratings are lower overall.

Significant differences are not noted as small base sizes preclude any further analysis.

Significant differences are not noted as small base sizes preclude any further analysis.

Regardless of whether the visit is for oneself or one's child/children, the most common methods of payment for dental services are by credit card (44% and 40%, respectively) or in cash/by debit (28% and 29%, respectively). Over one quarter of respondents say the costs of dental services are partially covered through other methods (such as a private insurance, social assistance, or a disability support program) for their children (26%) or themselves (25%). Meanwhile, less than one in five say their costs are fully covered through these same methods – either for their children (17%) or oneself (12%).

Insurance Status

• As might be expected, those with access to dental insurance were much more likely to say that their costs are either partially (60%) or fully (17%) covered, compared to those without coverage (11% and 9% respectively). Instead, those without insurance were more likely to pay for such services via credit card (46% vs. 40% with coverage), cash or debit (33% vs. 19%) or to visit a free dental clinic (5% vs. 1%)

Priority Groups

• Parents with younger children are more likely to pay in cash for dental services (40%), compared to those with children aged 12-17 (33%)
• A greater proportion of seniors report using a credit card (54%) to pay for their dental care
• Persons with disabilities were also more likely to report having their costs fully covered (19%), likely through a disability support program

Demographics

• Looking across other demographic groups, those more likely to pay using a credit card include those with household incomes of $70,000 to $89,000 (55% vs. 42% less than $70,000 annually), Francophones (49% vs. 42% Anglophones) and those with post-secondary educational attainment (55% university; 47% college vs. 32% high school or less)

Region and Community Type

• By region, Atlantic Canadians are more likely than residents of any other province to pay in cash/debit (42%), meanwhile those residing in Quebec are the most likely to pay by credit card (54%)
• Looking at community type, urban dwellers are more likely to pay using a credit card (45%) compared to those in more rural settings (42%). A higher proportion of the latter group instead say they pay cash for their dental services (38% vs. 28% of those living in an urban setting)

D. Barriers to Accessing Dental Care

To assess, in detail, the barriers that exist to accessing dental care services for oneself and one's child/children two follow up questions were asked of respondents. Overall, the primary barriers to accessing dental care are related to the costs associated with the services. Of note, a higher proportion of respondents without access to insurance report paying for dental services in cash (33% vs. 19% for those with insurance), while the vast majority of those who are insured report that their costs are partially covered (60% vs. 11% for those without insurance).

In line with the above-noted findings, the cost of the service (64%) and lack of insurance (47%) are mentioned far more frequently as barriers to visiting the dentist by those without insurance compared to those with insurance (42% and 15%, respectively).

1. Barriers to Regular Dental Visits for Adults and Children Under Age 18

Asked to select from a list of 12 statements which, if any, prevents themselves from visiting the dentist on a regular basis, more than half indicate it is costs of the services (57%) and over one third (38%) say it is because due to a lack of insurance coverage for these expenses. The costs of travelling to/from the dentist is also a top barrier, cited by approximately one in five (22%) respondents. Other secondary barriers, cited with less frequency, include the anxiety or fear of visiting a dental office (17%) and long waitlists to access a dentist/oral health professional (11%). Almost two in ten (18%) say that they visit the dentist regularly for themselves.

Insurance Status

• Those without access to dental insurance cite several more barriers to visiting the dentist than those with insurance, with the most predominant being the costs of services (64% vs. 42%) and a lack of insurance (47% vs. 15%).

Priority Groups

• Parents of children under 18 are more likely to cite several of the items as barriers including the costs of travel to/from the dental office (30% with children under age 12, 26% with children between 12-17 years old), anxiety or fear (24% and 23% respectively), lengthy waitlists (24% and 16% respectively), a general lack of time (18% and 14% respectively), and trouble finding care for their child/children (13% and 7% respectively).
• Those from racialized communities face a number of cost-related barriers compared to the general population including a lack of insurance (42%) and the costs of getting to a dental office (31%).
• A higher proportion of those who identify with a disability face several barriers. These are mostly predominantly with the expenses related to travelling to/from the dental office (27%), anxiety or fear (20%), the location of the dental office (13%), an inability to access to a dentist or oral health professional (12%), and accessibility-related issues (8%).

Demographics

• Women are more likely to face barriers related to the costs of getting to/from the dental office (23% vs. 19% of men), having fear or anxiety about to going to the dentist (19% vs. 14% of men), and being unable to miss school or work (10% vs. 7% of men).
• Those under the age of 45 are more likely to cite several barriers that impact their ability to visit a dentist. Older respondents aged 65+ or between the ages of 45-64 are more likely to say they visit the dentist regularly (29% and 21% respectively) compared to younger generations (8% aged 35-44; 7% aged 18-34).
• Those earning less than $70,000 in annual household income are more likely to cite barriers related to costs, such as the costs of dental services (59%) and lack of insurance (39%) compared to higher earners (42% and 24% for those with a household income of $80,000 to $89,000).
• Lack of insurance is more of a barrier for those who are university (43%) or college educated (38%), compared to those who have a high school or lower educational attainment (33%).
• Unemployed individuals are more likely to face barriers related to cost including the cost of service (70%) and a lack of insurance (52%) compared to those who are employed (57% and 37%, respectively). Employed individuals, instead, more often cite barriers related to time, such as an inability to miss work/school (13%), long waitlists (13%) or just not having the time (13%), compared to those who are not employed/not in the workforce (4%, 7%, and 5% respectively).
• Those living with others are more likely to cite costs as a barrier (64% living in a household of 5 or more and 59% living in a household with 2-4 people) compared to those who are living alone (53%)
• Anglophones, compared to Francophones, are more likely to cite lack of insurance (39% vs. 34%) and costs of travelling to/from a dentist's office (26% vs. 12%) as barriers.

Region and Community Type

• Those living in Manitoba and Saskatchewan (53%) and Ontario (54%) are less likely to cite cost as a barrier, compared to residents of Quebec (60%) and Atlantic Canada (61%).

Later in the survey, parents were asked a similar question, as to what prevents them from taking their child/children under the age of 18 to a dental office or oral health professional on a regular basis. As indicated in Tables 36 and 37 below, responses were similar to the barriers faced by the broader population (although not as high) including the costs of service (48% with children between 12-17 years of age, 47% with children under 12); a lack of insurance (28% and 26%; respectively) and travel-related costs (15% and 20%; respectively).

Not being able to miss school or work, was mentioned more often as a barrier to regular visits for children under age 18 (12% with children 12-17 years of age and 16% children under age 12), compared to the general population (9%).

Secondary barriers when it comes to children visiting the dentist include one's child/children having anxiety or being fearful of the dentist (16% with children under 12; 11% with children aged 12-17) and a general lack of time (15% and 11%, respectively).

Additional sub-level analysis is limited given the relatively small number of respondents overall, who responded to these two questions.

E. Views on the Canadian Dental Care Plan

Although there is some variability in levels of awareness, a good proportion of respondents overall have heard of the new federal plan on dental care (about two in five) mainly through the news/media. There are opportunities to raise awareness, particularly among key target audiences such as: racialized communities, the younger cohort (aged 18-34), households with low socio-economic status (especially those with household incomes less than $20,000), and eligible Canadians residing in rural or remote communities that are quite some distance from the nearest dental clinic (e.g., more than 100 km).

The program seems to have sparked interest among a number of the key target audiences. While about one third of all respondents who have heard of the program have looked for information about it, this is higher among those without dental insurance, parents of children under age 18, and people with a disability, in addition to those residing in larger households. Notably seniors are less likely to have looked for information.

Among parents of children under 12 years of age who have no insurance, 14% say they have already applied for the interim Canada Dental Benefit^[5], while 47% said they intend to apply. Moreover, there is widespread support for the program across all sub-groups of the eligible population who have not already applied for the CDB.

Key aspects of the plan which would encourage eligible Canadians to apply include the coverage, better dental health for themselves and their families, an easy enrollment process, more knowledge of and reliable information about the Plan. These tend to be the main motivators across all sub-groups, although the need for urgent dental care is a stronger motivator for women, parents of children under the age of 18 and those without insurance.

1. Awareness of a New Government of Canada Program on Dental Care

When asked whether they had heard of a new program from the Government of Canada on dental care, over two in five respondents (43%) say they have (Table 38). Just over half (53%) indicated they were not aware of such a program and a small percentage (4%) were unsure.

Awareness of the new program does not vary by insurance status. However, there are other significant variations across priorities groups and demographics as follows:

Priority Groups

• Parents of children between the ages of 12 and 17 are more likely to have heard of the program (53%), compared to parents of children under 12 (47%) and to those respondents without children (41%).
• This is also true for seniors aged 65+ (52%).
• By contrast, people from racialized communities are less likely to indicate awareness of the new program (34%).

Demographics

• Men (46%) are more likely than women (40%) to say they have heard about the program.
• Awareness of the program generally increases with age (18-34 (31%); 35-44 (40%); 45-64 (45%); 65+ (52%)).
• Those with some college/trades education (45%) as well as those with a university education (50%) are more likely to have heard of the program, compared to those with a high school education (34%).
• By household income, those with an annual household income of under $20,000 are much less likely to be aware of the new program, relative to those with household incomes between $80,000 to just under $90,000 annually (34% vs. 52%, respectively). For others, with incomes between $20,000-<$80,000, the proportion of those who have heard of the program ranges from 41% to 49%.
• Awareness of the program is higher among those who are non-Indigenous or not a member of a racialized community (46%), while lower among Indigenous respondents (31%) and racialized communities (34%), as noted above.
• Respondents who have access to an oral health professional exhibit higher levels of awareness compared to those who do not (45% vs. 32%, respectively).
• Notably, those who reside under 5 kilometres from a dental clinic are more likely to be aware of the program relative to those who live more than 100 kilometres from the nearest dental clinic or oral health professional (46% vs. 33%, respectively).

There are no variations across regions or by community type with respect to awareness of the program.

As shown in Table 39, awareness of a new dental program appears to have been generated primarily via the news and/or in the media (72% of respondents recall hearing about the program via this source). There was also some penetration via social media (18%), advertising (16%) and word-of-mouth through family and friends (10%). Relatively few heard about the program from a healthcare provider (4%) or an oral health professional (4%). Similar numbers also recall hearing something about the program on the Canada Revenue Agency (CRA) website or in information which was available when accessing their CRA account (4%) and a similar percentage recall hearing about it from a government source, whether on a website or through correspondence (3%). A few recall hearing about the program on a blog (3%). Recall from other sources was limited to 1% or less.

While there were no variations by insurance status, other significant differences were apparent:

Priority Groups

• Racialized communities exhibit somewhat higher levels of awareness via social media (29%).
• Seniors (aged 65+) are the group most likely to have heard about the program through the news/media (87%).
• Parents of children under 12 (25%) and parents of children 12-17 (21%) were more likely than parents of older children (15%) or those with no children (15%) to say they had heard about a new program from an advertisement.

Demographics

• Men (76%) are more likely than women (67%) to say they heard about the program on the news/media.
• Across age groups, those aged 65+ (87%) and those aged 45-64 (75%) are more likely to have heard about the program on the news and/or in the media, relative to those aged 35-44 (60%) and those 18-34 years of age (48%). Social media is mentioned more often by those in the youngest age cohort, 18-34 (30%), compared to those aged 45-64 (18%).
• Parents with children who are 18 years of age or older are more likely to have heard about the program on the news (74%), compared to those with younger children aged 12-17 (55%) or under 12 years of age (45%).
• Single-person households (79%) are more likely than those with 2-4 members (69%) and those with 5+ members (59%) to have heard something on the news/media.

There are no significant differences by region or community type.

About one-third (32%) of those who have heard of a new program on dental care looked for information on it within the last 3 months (Table 40). The remainder (68%) have not.

Insurance Status

• Respondents who do not have access to dental insurance are more likely to have looked for information about the new program (34%) relative to those with insurance (27%). Those with dental coverage through a public insurance program are also more likely to have looked for information (37%), compared to those who have access to private dental insurance (25%).

Priority Groups

• Among the priority groups, those who are more likely to have looked for information about the program include:
  • Parents of children under age 12 (56%) as well as those with children aged 12-17 (48%), compared to the average (32%).
  • Respondents with a disability (38%) relative to those who do not have a disability (30%).
• Seniors, on the other hand, are less likely to have done so (22%).

Demographics

• Across demographic groups, those more likely to sought additional information include:
  • Women (35%) as compared to men (29%);
  • Younger respondents, aged 18-34 (45%) or 35-44 (42%) versus those aged 45-64 (30%) or 65+ (22%); and
  • Families with 5 or more members in the household (48%) as well as those with 2-4 members (34%), compared to single-person households (24%).

There are no variations across regions or by community type on this question.

Respondents who had heard about the program were asked what they know about it (Table 41). The features or aspects of the program that stand out most for these respondents include that the program is aimed at covering dental expenses for children (32%) and that it is intended to help low-income families specifically those with household incomes under $90,000 annually (21%). One in ten, or slightly fewer, indicate that they don't qualify for the program (11%), that the program targets seniors (10%) and/or children under the 12 years of age (8%). Others mention free dental care for children (8%), that the program is government-run (6%), general financial assistance to offset the cost of dental care (5%), and assistance for those who don't have private insurance (5%). Additional comments were provided but by less than 1% to 3% of respondents. Miscellaneous unrelated comments were aggregated into an 'other' category and make-up 7% of all comments. Another 14% of respondents indicate that they had not heard much about the program or could not offer any particular details.

There are a few variations based on insurance status, by priority groups and other demographic and regional variables.

Insurance Status

• Those without insurance are more likely than those who have dental coverage to mention that that the program covers dental expenses for children (34% vs. 26%, respectively).

Priority Groups

• People with a disability are more likely to have heard something related to dental coverage for children and families – 37% in this sub-group heard that the program provides dental services for children, higher than the average (32%).
• Seniors are more likely to note that the program provides dental coverage for seniors/the elderly compared to the average (17% vs. 10%, respectively). At the same time, a higher proportion of seniors (18%) say they haven't heard much or are unaware of the details compared to the average (14%).

Demographics

• Those sub-groups exhibiting higher awareness of the program's focus on covering dental care expenses for children include:
  • Women (36%), compared to men (27%);
  • Respondents aged 45 and older as compared to those aged 18 to 34 (32% among those aged 65+; 36% among those aged 45-64; 22% among those aged 18-34);
  • Those with a university education (38%) as well as those with some college education or a trades certificate (32%) relative to those with a high school education (24%);
  • Single-person households (39%) compared to those with 2-4 members (29%); and
  • Respondents with access to an oral health professional (33%) compared to those without (23%).

Region and Community Type

• This aspect of the program is also more well known among respondents residing in Alberta (42%) relative to those in Ontario (29%), Atlantic Canada (29%) and Manitoba/Saskatchewan (25%).

2. Uptake of the Canada Dental Benefit

Respondents with children under 12 years of age who have no dental insurance were asked if they had applied to the CDB. Just over half (61%) say they have either already applied (14%) or that they are planning to do so (47%), as shown in Table 42. About one third (39%) have not applied and do not plan to and another 17% are 'not sure.'

Given the small base size of parents with children under 12 years of age without dental insurance, there are few significant differences among the various subgroups. That said, men are just as likely as women to say they have already applied for the benefit (14% vs. 13%) and are somewhat more likely than women to say they plan to do so (50% vs. 45%).

3. Attitudes towards the Canadian Dental Care Plan

Respondents who were not eligible for the CDB and those who were eligible but had not already applied were given a brief description of the CDCP and asked whether they support or oppose the Plan. The results shown in Table 43 indicate high levels of support for the program (82%) with over half saying they 'strongly support' (58%) the program and another 23% who 'somewhat support' it. A small proportion (11%) are indifferent, saying they 'neither support nor oppose' the Plan. Very few 'somewhat/strongly oppose' it (4%) or aren't sure (4%).

Response to the Plan is strongly positive, with about three-quarters or more across all sub-groups expressing support. Support for the CDCP is higher among the following groups:

Insurance Status

• Those without access to dental insurance (84%), compared to those who have coverage (76%)
• Respondents who have access to a public dental plan (84%), compared to those who are covered through a private dental plan (76%)

Demographics

• University-educated respondents (85%) as compared to those with a college/trades (80%) or high school education (80%)

Region and Community Type

• Atlantic Canadians (89%), relative to those in Quebec (84%), Ontario (80%), Alberta (77%) and Manitoba/Saskatchewan (75%)

Support for the Plan is lower among:

Demographics

• Indigenous respondents (72%)

4. Motivators to Applying for the Canadian Dental Care Plan

Respondents would be encouraged to apply for the CDCP for a variety of reasons, primarily the offer of financial assistance to cover part or all of costs related to dental care (51%) and the prospect of better dental health for themselves (45%) and their families (24%). As shown in Table 44, respondents would also be incentivised if the enrollment process was easy (42%) and if they were provided with a good understanding of the Plan (36%) or had easy access to reliable information about the Plan (34%). Urgent dental needs would be an additional motivator for many (31%).

Other key motivators include expanded eligibility criteria (24%), regular access to an oral health professional (21%) and a recommendation by their healthcare provider (17%). Various other motivators also have some impact but are mentioned by fewer than 10% of respondents.

Insurance Status

• Those without dental insurance are more likely to be motivated by each of the following:
  • Dental coverage (52% among those without dental insurance vs. 46% among those who have insurance);
  • Dental health (49% vs. 35%);
  • An easy enrollment process (44% vs. 35%);
  • A good understanding of the Plan (38% vs. 30%);
  • Easy access to reliable information about the Plan (37% vs. 29%);
  • Urgent dental needs (33% vs. 26%); and
  • Regular access to a dentist or oral health professional (23% vs. 17%).

Priority Groups

• Compared to the average, parents of children under the age of 18 would be more encouraged to apply for the Plan based on:
  • The health of their family (45% among those with children aged 12-17; 39% among those with children under age 12);
  • If their children had urgent dental needs (28% and 22% for each of the two groups, respectively); and
  • If they had more than one eligible child requiring dental care (21% and 19%).
• Persons with a disability are more likely to apply for the plan as a result of the coverage (55%), their own dental health (52%), better knowledge of the Plan (41%), a requirement for urgent dental care (36%), expansion of the eligibility requirements (30%), a recommendation from their healthcare provider (22%), and closer proximity to a dentist (12%).
• Those in racialized communities are more likely to be motivated by the health of their family (30%), relative to the average.
• Seniors respond to many of the same motivators as those with disabilities, including: the coverage (56%), their own dental health (49%), easy access to reliable information (45%), a good understanding of the plan (42%), and closer proximity to a dentist (11%).

Demographics

• Women are more likely than men to be motivated by the following:
  • A good understanding of the Plan (38% vs. 33%);
  • Easy access to reliable information (38% vs. 31%); and
  • Urgent dental needs (33% vs. 29%).
• Those in larger households are more likely to be encouraged by the health of their family (45% among those with household of 5+ members; 28% among households with 2-4 members; 11% among single-person households).
• Those with limited access to a dentist or the services of an oral health professional (e.g. residing 100+ km from a dental clinic and/or must travel to another community to access these services) would respond positively to virtually all the motivators.

Region and Community Type

• In general, a higher percentage of those residing in British Columbia/the North say they would be motivated by many of the factors relative to those in other regions. Atlantic Canadians are also more likely to respond to the dental coverage offered (56%) compared to other regions and to the need for urgent dental care (38%).

F. Profile of Respondents

The following tables outline the total responses and breaks by access to insurance, gender, parents of children under 18 and priority groups for all demographic questions asked as part of the survey.

1. Demographic Profile in Brief