Taylor Gowans, Sephora Djomo, Manisha Sharvananthan
Project Smile Global
3 September 2024
Access to oral health care varies significantly depending on where individuals reside. Geography can impact access to oral healthcare services through factors such as a country's policy on dental coverage, the number of certified dentists in particular areas, and the availability of necessary tools and technology. This article discusses specific examples of how access to oral healthcare differs across various regions.
Dental coverage is a significant barrier to oral healthcare, as dental services can be very costly, and a lack of adequate public or private coverage often deters many individuals from seeking care. Dental insurance packages vary depending on employer and government policies worldwide. Individuals are more likely to seek treatment if they know that it will be covered by some form of insurance, especially if the process is straightforward . Public coverage is generally preferred as it requires less work from the patient to utilize it. In contrast, private insurance usually has a coverage limit and reimburses the patient, meaning they must pay out of pocket first.
In Europe, dental coverage varies significantly across countries (Henschke et al.). In a particular study by Henschke et al., it was noted that adult dental coverage across EU countries differs widely. Out of the 32 EU countries, only five — Belgium, Denmark, Germany, the Netherlands, and Spain – offer public coverage (Henschke et al.). Sixteen countries either lacked current oral epidemiological data or had outdated information, making it difficult to assess the status of dental coverage (Henschke et al.). Germany was found to have the most extensive public coverage for adults, with nearly all preventive and major procedures being publicly funded (Henschke et al.). Denmark and the Netherlands provide many options for oral care reimbursement for children, while Spain has partial coverage options for both children and adults (Henschke et al.). Overall, European dental coverage is far more comprehensive than in North America, especially for children. There is evidence to show that oral health status is higher in countries with more comprehensive plans, and that dental coverage has a significant impact on an individual’s likelihood to seek essential oral treatment (Henschke et al.)
In Canada, dental coverage has traditionally been private, separate from the country's universal healthcare system. Usually, dental care was paid for by either the patient's own personal insurance or by their employer's insurance. This caused many individuals to postpone or ignore vital care and made accessing oral healthcare stressful and expensive. However, in 2024, the Canadian government introduced the Canadian Dental Care Plan, a government-funded program that is comprehensive and covers major and preventative treatments (Menon et al.). While this plan is open to the public, there are certain criteria an individual needs to meet to qualify for this coverage (Menon et al.). When the plan first became available, it was offered only to those aged 65 and over, and coverage was given based on an individual's annual income (Menon et al.). This meant that if an individual made over $90,000 CAD each year, they would either not be compensated or would receive less coverage (Menon et al.). These criteria do exclude many citizens; however, this plan is one of the most comprehensive publicly funded oral care plans in Canadian history. This plan will eventually be expanded to all citizens, starting with those aged 18 and younger, and eventually covering all age groups, with procedures being covered at 40%, 60%, and 100% rates (Menon et al.). Despite some qualification barriers, this plan can have a tremendous impact for individuals who require extensive care but cannot afford it otherwise.
Another notable problem within the Canadian dental care system besides the age group exclusion criteria of the Canadian Dental Care Plan, includes geographical barriers. The region in which citizens live within Canada can majorly influence oral health. People who live in urban areas within Canada often have easier access to dental care facilities compared to those living in rural regions (Allison). For example, although Quebec provides public dental care coverage for children under 10 years of age, there are still issues with oral health care access. It has been observed that only 31% of children in Quebec who are 0-4 years old have received oral health care, which highlights the ongoing problem of uneven geographic distribution and the shortage of dental professionals in certain areas (Allison).
The lack of infrastructure and transportation methods are two major geographic factors that restrict oral health care access. In remote areas, long travel distances and limited transportation systems make it difficult for individuals to receive regular or emergency dental care. For example, in rural regions of western Australia, the small population size of towns does not justify the establishment of dental service infrastructure (Barnett et al.). As a result, residents rely on visiting mobile dental units, which are useful resources but can still pose a challenge to access due to their irregular and limited availability (Kruger et al.). When these mobile clinics are not available, people in remote areas must often travel long distances to metropolitan cities with better access to dental care, where there are 74.9 dentists per 100,000 people, compared to 20.7 per 100,000 in remote areas (Sloan et al.). Residents may also turn to other healthcare providers, including pharmacists and emergency departments within their community when these trips are not possible, which typically only provide patients with temporary pain relief (Cohen et al.).
Fig. 1. Sloan et al, Dentists per 100,000 population by geographic region in Australia, 2024
This situation is not unique to Australia; many rural areas worldwide face similar challenges that create barriers to achieving optimal oral health, emphasizing disparities between urban and rural populations. For instance, a study in rural Mexico found that geographic isolation leads to higher rates of tooth decay, with an average DMFT (Decayed, Missing, and Filled Teeth) score of 4.02. This is due to a lack of nearby dental facilities, limited preventive care education, and inadequate access to piped potable water (Maupome et al.). This showcases how infrastructure, such as roads and clean water access, significantly influences oral health outcomes in these communities (Maupome et al.).
To conclude, geography has a significant impact on shaping access to oral health care while revealing disparities in urban and rural areas across the world. With the uneven distribution of dental professionals and infrastructure in rural Australia and Mexico and the variable dental coverage in Europe and Canada, these factors greatly influence the oral health outcomes of individuals by creating barriers to dental care. Initiatives such as the development of the Canadian Dental Care Plan and the use of mobile clinics in Western Australia are promising steps in addressing these challenges; however, some barriers continue to persist, particularly in remote areas. These rural communities struggle with geographic isolation, which leads to limited resources for transportation and dental infrastructure that exacerbate disparities in dental healthcare. Addressing these systemic geographic factors is critical for challenging global health inequities and improving oral health outcomes for all individuals, regardless of location.
Works Cited
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Barnett, Tony, et al. “The relationship of primary care providers to dental practitioners in rural and remote Australia.” BMC Health Services Research, vol. 17, no. 515, 2017, pp. 1-13, https://doi.org/10.1186/s12913-017-2473-z
Cohen, Leonard, et al. “Comparison of patient visits to emergency departments, physician offices, and dental offices for dental problems and injuries.” Journal of Public Health
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