Many middle-income earners can’t afford dental care in Canada


An increasing number of middle-income earners in Canada have difficulties affording dental care, according to a recent study1 by a team of University of Toronto researchers.

The study examined trends in the affordability of dental care for middle-income Canadians, defined according to total household income and the number of people in the family (e.g., a household of one or two people earning a combined annual income of $15,000–$29,999 would be considered middle-income earners).  The study reviewed data on self-reported dental insurance coverage, cost-barriers to dental care, and out-of-pocket expenditures for dental care, based on data from a series of Statistics Canada surveys conducted between 1978–2009.

According to the study’s results, by 2009 middle-income Canadians experienced the greatest decrease in affordability of dental care compared to all other income groups. Middle-income earners had the lowest levels of dental insurance coverage (48.7%) and had equivalent levels of dental insurance for full- and part-time jobs.  In contrast, national averages for all incomes show that more full-time workers have dental benefits (72.6%) compared to part-time workers (64.7%).

But insured or not, financial barriers were an issue for middle-income Canadians—almost 20% of insured workers and half of uninsured workers reported cost-barriers to dental care. Overall, about one-third of middle-income earners reported cost barriers to dental care by 2009. And by 2008 middle-income earners experienced the greatest rise in out-of-pocket dental expenditures since 1978.

Dr. Carlos Quiñonez, the study’s senior author, says changes in the labour market have been detrimental to middle-income earners: “In order to stay competitive globally, large firms have begun to offer more part-time and temporary work arrangements, which allows them to not offer dental benefits at all, or they have reduced the amount or robustness of dental benefits for existing employees or new full-time hires.”

The finding that middle-income Canadians find it difficult to afford dental care—even if they have insurance—can be explained by two factors, according to Dr. Quiñonez. “Incomes among the low and middle income segments of our society have stagnated since the 1980s. In real dollars, people simply can’t afford what they used to.” This decrease in purchasing power is compounded by “dental care prices that have risen well above inflation over the same time period.”

For dentists, the conclusion that an increasing number of middle-income earners aren’t getting the dental care they need because they can’t afford it raises questions about the oral health status of many Canadians. Dr. Quiñonez says: “Access to preventive and curative dental care can play an important role in improving people’s oral health. Without it, Canadians don’t have the opportunity to maximize their health.”  

As for what the profession can do to remove or reduce cost-barriers to dental care, Dr. Quiñonez offers: “I believe the dental profession can play the most important and productive role in shaping how we finance and deliver dental care in Canada. We should be advocating for mandatory dental insurance in all work arrangements, and more progressive approaches to public dental care programs, so that they reach beyond the traditional groups we view as most in need.”


  1. Ramraj C, Sadeghi L, Lawrence HP, Dempster L, Quiñonez C. Is Accessing Dental Care Becoming More Difficult? Evidence from Canada’s Middle-Income Population. PLoS ONE. 2013; 8(2): e57377.