ABSTRACT
Objective
The Interim Canada Dental Benefit (CDB) provided financial support to families to cover dental care expenses for children < 12 years of age. The purpose of this study was to investigate oral health professionals' (OHPs) views of the Interim CDB.
Methods
OHPs in Manitoba, Canada were invited by e‐mail to complete an online questionnaire. Data analysis included descriptive statistics (frequencies, means, and standard deviations), bivariate analysis (chi‐squared and t‐test), and multivariable logistic regression. A p‐value < 0.05 was considered significant.
Results
Overall, 383 OHPs participated, the majority being women (80.9%), from metropolitan areas (77.8%), and working for 16.6 ± 12.9 years. Main respondents included dentists (24.3%), dental hygienists (23.3%), and dental assistants (38.7%). Awareness of the benefit was high (92.7%) yet 45.8% were uncertain whether it increased public awareness of children's oral health. Encouragement to apply was low (39.3%), although 56.5% believed that the Interim CDB improved access to children's oral care. Multivariate logistic regression showed that rural OHPs encouraged application 43% more than those working in urban areas. Significantly more positive responses were observed among rural‐based OHPs and women toward the benefit's ability to improve access to oral health for children.
Conclusions
Overall, awareness was high among the OHPs, but uncertainty remained whether the benefit improved access to care for young children. OHPs in rural areas were more likely to believe that the Interim CDB improved access to care and were more likely to promote the program to families.
Keywords: dental insurance, health policy, health services accessibility, public health dentistry, universal health care
1. Introduction
Affordability has been identified as a significant domain of access to care, including oral health [1]. Access to affordable oral health care for children has been a longstanding concern in Canada. To address this, the Federal Government announced the Interim Canada Dental Benefit (CDB) in March 2022 as a temporary financial support program, intended to bridge the gap until the implementation of the Canadian Dental Care Plan [2]. Over $400 million were distributed [3]. The benefit targeted families with children under the age of 12 years, who were without private dental insurance, and had an annual adjusted family net income (AFNI) under $90,000 [4]. Upon approval, families with AFNI under $70,000 received $650 per child; annual incomes between $70,000 and $79,999 received $390 per child; and families with annual incomes between $80,000 and $89,999 received $260 per child [5].
Overall, uptake of the Interim CDB was quite favorable in the province of Manitoba. Based on previous studies, the average participation rate of children in Canada was 67.8 (per every 1000 children) for Regular period 1 [6] and 59.6 for Regular period 2 [7, 8], while in Manitoba, rates were above the national averages for both periods (77.1 and 74.9 for Regular periods 1 and 2, respectively) [7]. This high acceptance of the Interim CDB by Manitoban parents may be due to the lack of provincial dental program for children since 1993, when the Children's Dental Program was discontinued [9].
Despite the Federal Government's efforts to implement the benefit seamlessly, applicants were required to meet nine eligibility criteria, which may have led to confusion among families [4]. Oral health professionals (OHPs) in Canada may have played a key role in informing parents about the Interim CDB. Given their involvement in delivering care under the program, their perspectives are essential for evaluating the benefit's effectiveness. Notably, the CDB introduced a funding model that had not been previously implemented in Canada. As such, it is important to critically assess this approach to identify what worked well and what could be improved if similar models are adopted in the future.
Understanding how OHPs perceived the benefit, and how they believe it supported children in accessing dental care, provides valuable insight into the program's impact. Therefore, the purpose of this study was to explore the views of OHPs in Manitoba, Canada, regarding the Interim CDB.
2. Methods
This study was approved by the University of Manitoba's Health Research Ethics Board (HS26028/H2023:180). The questionnaire was developed by the study team, including Health Canada staff, and was guided by questions included in a survey conducted by the Strategic Counsel on behalf of Health Canada's Oral Health Branch [3, 10], as well as previous survey tools developed by members of the research team, designed to assess access to oral health care for priority populations among OHP in Manitoba, Canada [11, 12, 13]. The drafted survey was reviewed in detail by the team and by Health Canada's Oral Health Branch. The final version was reached through consensus of all team members and stakeholders. The questionnaire contained 44 questions, both open and close‐ended, intended to investigate the characteristics and views of OHPs. The questionnaire included seven sections: (1) Demographic characteristics; (2) awareness of the Interim CDB; (3) views on the application process; (4) awareness about families receiving the Interim CDB; (5) awareness of families utilizing the Interim CDB; (6) challenges with the Interim CDB; and (7) suggestions for the Interim CDB.
OHPs in Manitoba, Canada were invited by e‐mail to participate by completing an online questionnaire through Microsoft Forms (Microsoft Inc., USA). The target population included all licensed dentists, dental hygienists, dental assistants, dental therapists, and dental receptionists, from both private practices and community‐based dental public health clinics. The study relied on convenience sampling methods to obtain respondents.
The survey was administered from June until November of 2023. Links to the survey were distributed on behalf of the research team by the Manitoba Dental Association (MDA), College of Dental Hygienists of Manitoba (CDHM), and Manitoba Dental Assistants Association (MDAA). Each sent out a minimum of three reminders to their members. Invitations to other members of the dental team were facilitated by these organizations and their members. Respondents outside of Manitoba were excluded from this study.
Data were exported from Microsoft Forms to Excel (Microsoft Inc., USA) and statistical analyses were performed using Number Cruncher Statistical Software (NCSS Version 24.0.2; Kaysville, UT). Descriptive statistics including frequencies, means, and standard deviations (SD) were calculated. Bivariate analyses included chi‐squared tests and t‐tests. Dental therapists were not included when testing for statistical differences in responses while stratifying for roles due to sample size limitations. For the one participant that opted not to disclose their professional role, information was considered missing, and it was only used on totals for demographic characteristics. Multivariate logistic regression analysis was performed for two key outcomes (questions) to predict the odds of obtaining a positive response while adjusting for gender, location of the dental office (urban vs. rural, determined based on their postal code), the number of years in practice, and role of the dental team member. Dental therapists were excluded only while adjusting for roles due to small sample size. The first model explored the outcome of whether participants “encouraged parents/patients to apply for the Interim CDB.” In contrast, the second model focused on the outcome of whether participants “believe the Interim CDB improves access to oral health care for young children.” Results from multivariate logistic regression were reported as regression coefficients, odds ratios (ORs), and 95% confidence intervals (95% CIs). For all tests, p‐value ≤ 0.05 was considered significant.
3. Results
Overall, 401 individuals responded, of whom 18 were excluded for not practicing within Manitoba at the time of study, making it 383 participants in total. The mean number of years in practice was 16.6 (±12.9), most respondents self‐identified as women (80.9%) and worked in a dental office in an urban area (77.8%) (Table 1). Among respondents, 24.3% were dentists, 23.3% dental hygienists, 38.7% dental assistants, 11.8% receptionists, and 1.8% dental therapists.
TABLE 1.
Characteristics of respondents.
| Questions 1–4: Demographics | n (%)/total = 383 | |
|---|---|---|
|
Gender a |
Man | 64 (16.7%) |
| Woman | 310 (80.9%) | |
| Prefer not to answer | 7 (1.8%) | |
| Other | 2 (0.6%) | |
|
Main position |
Dentist | 93 (24.3%) |
| Dental therapist | 7 (1.8%) | |
| Dental hygienist | 89 (23.3%) | |
| Dental receptionist | 45 (11.8%) | |
| Dental assistant | 148 (38.7%) | |
|
Number of years in clinical practice b (only for clinicians) |
Overall | 16.6 (12.9) |
| Dentist | 18.1 (13.3) | |
| Dental therapist | 15.0 (17.9) | |
| Dental hygienist | 18.0 (12.6) | |
| Dental assistant | 16.5 (12.5) | |
|
Area based on postal code of office |
Urban | 298 (77.8%) |
| Rural | 57 (14.9%) | |
| Urban/rural | 1 (0.3%) | |
| Not reported | 27 (7.0%) | |
Trans/gender diverse group added to “other” category; not used for gender analysis due to small sample size (< 5).
Years (mean ± SD).
As one participant did not disclose their professional oral health designation, the remainder of the results focus on 382 participants. Responses to questions about awareness of the Interim CDB are reported in Table 2. Awareness of the Interim CDB was high (92.7%), with most respondents learning about the program from the MDA (48.4%), followed by TV/radio (33.5%) and Federal Government communications or website (30.4%). Despite this, only 37.7% strongly agreed or agreed that they had received enough information about the Interim CDB. Meanwhile, 67.8% of respondents disagreed that the information provided by the Federal Government was clear. Knowledge gaps were evident: The majority of respondents did not know parents could apply for the benefit after treatment was provided (54.5%), were unaware that clients could be eligible even if they had received other governmental dental benefits (73.8%), and that the Canada Child Benefit (CCB) was a requirement for Interim CDB eligibility (67.0%).
TABLE 2.
Associations between dental personnel answers and awareness questions about the Interim CDB.
| Questions 5–22: Awareness section | Position of participant (n/%) | χ 2 test | |||||
|---|---|---|---|---|---|---|---|
| Total | Dentist | Dental hygienist | Dental therapist | Dental assistant | Dental receptionist | p | |
| Are you aware of the Federal Government Interim CDB? | |||||||
| Yes | 354 (92.7) | 90 (96.8) | 84 (94.4) | 5 (71.4) | 132 (89.2) | 45 (95.6) | 0.16 a |
| No | 27 (7.1) | 3 (3.2) | 5 (5.6) | 2 (28.6) | 15 (10.1) | 2 (4.4) | |
| Did not answer | 1 (0.3) | 0 | 0 | 0 | 1 (0.7) | 0 | |
| How did you learn about the Interim CDB? | |||||||
| Family/friends | |||||||
| Yes | 41 (10.7) | 9 (9.7) | 6 (6.7) | 1 (14.3) | 18 (12.2) | 7 (15.6) | 0.39 |
| No | 341 (89.3) | 84 (90.3) | 83 (93.3) | 6 (85.7) | 130 (87.8) | 38 (84.4) | |
| TV/radio | |||||||
| Yes | 128 (33.5) | 32 (34.4) | 36 (40.5) | 3 (42.9) | 44 (29.7) | 13 (28.9) | 0.34 |
| No | 254 (66.5) | 61 (65.6) | 53 (59.6) | 4 (57.1) | 104 (70.3) | 32 (71.1) | |
| Social media | |||||||
| Yes | 84 (22.0) | 20 (21.5) | 24 (27.0) | 0 | 30 (20.3) | 10 (22.2) | 0.68 |
| No | 298 (78.0) | 73 (78.0) | 65 (73.0) | 7 (100.0) | 118 (79.7) | 35 (77.8) | |
| Newspaper | |||||||
| Yes | 55 (14.4) | 21 (22.6) | 9 (10.1) | 1 (14.3) | 18 (12.2) | 6 (13.3) | 0.071 |
| No | 327 (85.6) | 72 (77.4) | 80 (89.9) | 6 (85.7) | 130 (87.8) | 39 (86.7) | |
| Federal Government communication or website | |||||||
| Yes | 116 (30.4) | 31 (33.3) | 25 (28.1) | 5 (71.4) | 41 (27.7) | 14 (31.1) | 0.80 |
| No | 266 (69.6) | 62 (66.7) | 64 (71.9) | 2 (28.6) | 107 (72.3) | 31 (68.9) | |
| Patient | |||||||
| Yes | 32 (8.4) | 4 (4.3) | 8 (9.0) | 0 | 13 (8.8) | 7 (15.6) | 0.17 |
| No | 350 (91.6) | 89 (95.7) | 81 (91.0) | 7 (100.0) | 135 (91.2) | 38 (84.4) | |
| Manitoba Dental Association | |||||||
| Yes | 185 (48.4) | 66 (71.0) | 11 (12.4) | 2 (28.6) | 79 (53.4) | 27 (60.0) | < 0.0001 |
| No | 197 (51.6) | 27 (29.0) | 78 (87.6) | 5 (71.4) | 69 (46.6) | 18 (40.0) | |
| College of Dental Hygienist of Manitoba | |||||||
| Yes | 57 (15.0) | 4 (4.3) | 47 (52.8) | 2 (28.6) | 1 (0.7) | 4 (8.9) | < 0.0001 |
| No | 324 (84.8) | 89 (95.7) | 42 (47.2) | 5 (71.4) | 147 (99.3) | 41 (91.1) | |
| Manitoba Dental Assistant Association | |||||||
| Yes | 35 (9.2) | 1 (1.1) | 4 (5.6) | 0 | 27 (18.4) | 2 (4.4) | < 0.0001 |
| No | 348 (91.1) | 92 (98.9) | 85 (94.4) | 7 (100.0) | 121 (81.6) | 43 (95.6) | |
| Did not hear about the benefit | 12 (3.1) | 1 (1.1) | 1 (1.1) | 0 | 10 (6.8) | 0 | 0.0175 |
| Other | 17 (4.5) | 4 (1.1) | 3 (0.8) | 0 | 8 (2.1) | 2 (0.5) | 0.91 |
| Did not answer | 1 (0.3) | 0 | 0 | 0 | 1 (0.7) | 0 | 0.67 |
| I feel that I have received enough information about the Interim CDB | |||||||
| Strongly agree | 31 (8.1) | 11 (11.8) | 6 (6.7) | 3 (42.9) | 6 (4.1) | 5 (11.1) | 0.31 a |
| Agree | 113 (29.6) | 30 (32.3) | 21 (23.6) | 1 (14.3) | 45 (30.4) | 16 (35.6) | |
| Neutral | 93 (24.4) | 20 (21.5) | 28 (31.5) | 1 (14.3) | 35 (23.7) | 9 (20.0) | |
| Disagree | 101 (26.4) | 23 (24.7) | 21 (23.6) | 0 | 44 (29.7) | 13 (28.9) | |
| Strongly disagree | 43 (11.3) | 9 (9.7) | 13 (14.6) | 2 (28.6) | 17 (11.5) | 2 (4.4) | |
| Did not answer | 1 (0.3) | 0 | 0 | 0 | 1 (0.7) | 0 | |
| Did you know that the Interim CDB is only for < 12 years‐old children? | |||||||
| Yes | 304 (79.8) | 75 (80.7) | 71 (79.8) | 5 (71.4) | 118 (79.7) | 35 (77.8) | 0.99 a |
| No | 76 (19.9) | 17 (18.3) | 18 (20.2) | 2 (28.6) | 30 (20.3) | 9 (20.0) | |
| Did not answer | 2 (0.5) | 1 (1.1) | 0 | 0 | 0 | 1 (2.2) | |
| Did you know that receiving the Canada Child Benefit is a requirement to be eligible to receive the Interim CDB? | |||||||
| Yes | 125 (32.7) | 27 (29.0) | 25 (28.1) | 2 (28.6) | 45 (30.4) | 26 (57.8) | 0.0023 a |
| No | 256 (67.0) | 66 (71.0) | 64 (71.9) | 5 (71.4) | 102 (68.9) | 19 (42.2) | |
| Did not answer | 1 (0.3) | 0 | 0 | 0 | 1 (0.7) | 0 | |
| Did you know that children with private dental insurance are not eligible to receive the Interim CDB? | |||||||
| Yes | 266 (69.6) | 74 (79.6) | 62 (69.7) | 3 (42.9) | 96 (64.9) | 31 (68.9) | 0.13 a |
| No | 115 (30.1) | 19 (20.4) | 27 (30.3) | 4 (57.1) | 51 (34.5) | 14 (31.1) | |
| Did not answer | 1 (0.3) | 0 | 0 | 0 | 1 (0.68) | 0 | |
| Did you know that parents/caregivers must be Canadian citizens or permanent residents of Canada to be eligible to receive the Interim CDB? | |||||||
| Yes | 222 (58.1) | 58 (62.4) | 42 (47.2) | 3 (57.1) | 90 (60.8) | 29 (64.4) | 0.10 |
| No | 160 (41.9) | 35 (37.6) | 47 (52.8) | 4 (42.9) | 58 (39.2) | 16 (35.6) | |
| Are you aware of the financial/income cut‐offs for parents/caregivers to receive the Interim CDB? | |||||||
| Yes | 208 (54.5) | 57 (61.3) | 48 (53.9) | 4 (57.1) | 73 (49.3) | 26 (57.8) | 0.32 |
| No | 174 (45.6) | 36 (38.7) | 41 (46.1) | 3 (42.9) | 75 (50.7) | 19 (42.2) | |
| Are you aware that the Federal Government (Canada Revenue Agency) sent letters to parents who receive the Canada Child Benefit informing them about the Interim CDB? | |||||||
| Yes | 74 (19.4) | 17 (18.3) | 10 (11.2) | 1 (14.3) | 30 (20.3) | 16 (35.6) | .0097 |
| No | 308 (80.6) | 76 (81.7) | 79 (88.8) | 6 (85.7) | 118 (79.7) | 29 (64.4) | |
| Did this letter create any challenges for your office, such as creating confusion for the parents/caregivers? | |||||||
| Yes | 91 (23.8) | 15 (16.1) | 26 (29.2) | 3 (42.9) | 34 (23.0) | 13 (28.9) | 0.12 a |
| No | 277 (72.5) | 76 (81.7) | 57 (64.0) | 4 (57.1) | 109 (73.7) | 31 (68.9) | |
| Did not answer | 14 (3.7) | 2 (2.2) | 6 (6.7) | 0 | 5 (3.4) | 1 (2.2) | |
| Did you take part in any presentation about the Interim CDB to learn more about it (e.g., webinars, videos, and lectures)? | |||||||
| Yes | 55 (14.4) | 15 (16.1) | 12 (13.5) | 0 | 22 (14.9) | 6 (13.3) | 0.95 |
| No | 327 (85.6) | 78 (83.9) | 77 (86.5) | 7 (100.0) | 126 (85.1) | 39 (86.7) | |
| If you selected “yes” to the previous question, who organized the presentation? If “no” to the previous question, select N/A | |||||||
| Healthy smile presentation | |||||||
| Yes | 29 (7.6) | 9 (9.7) | 5 (5.6) | 1 (14.3) | 12 (8.1) | 2 (14.3) | 0.62 |
| No | 353 (92.4) | 84 (90.3) | 84 (94.4) | 6 (85.7) | 136 (91.9) | 43 (95.6) | |
| Community group | |||||||
| Yes | 13 (3.4) | 3 (3.2) | 3 (3.4) | 1 (14.3) | 4 (2.7) | 2 (4.4) | 0.95 |
| No | 369 (96.6) | 90 (96.8) | 86 (96.63) | 6 (85.7) | 144 (97.3) | 43 (95.6) | |
| Local dental association | |||||||
| Yes | 23 (6.0) | 8 (8.6) | 5 (5.6) | 1 (14.3) | 5 (3.4) | 4 (8.9) | 0.30 |
| No | 359 (94.0) | 85 (91.4) | 84 (94.4) | 6 (85.7) | 143 (96.6) | 41 (91.1) | |
| National dental association | |||||||
| Yes | 17 (4.5) | 5 (5.4) | 5 (5.6) | 3 (42.9) | 1 (0.7) | 3 (6.7) | 0.09 |
| No | 365 (95.6) | 88 (94.6) | 84 (94.4) | 4 (57.1) | 147 (99.3) | 42 (93.3) | |
| Federal Government (CRA) | |||||||
| Yes | 4 (1.1) | 2 (2.2) | 0 | 0 | 2 (1.4) | 0 | 0.46 |
| No | 378 (99.0) | 91 (97.9) | 89 (100.0) | 7 (100.0) | 146 (98.7) | 45 (100.0) | |
| Not applicable; N/A | |||||||
| Yes | 306 (80.1) | 72 (77.4) | 73 (82.0) | 2 (28.6) | 125 (84.5) | 34 (75.6) | 0.41 |
| No | 76 (19.9) | 21 (22.6) | 19 (18.0) | 5 (71.4) | 23 (15.5) | 11 (24.4) | |
| Other | 2 (0.5) | 0 | 0 | 0 | 1 (0.7) | 1 (2.2) | 0.33 |
| Did not answer | 2 (0.5) | 0 | 0 | 0 | 1 (0.7) | 1 (2.2) | 0.33 |
| Have you visited the Government of Canada website for more information about the Interim CDB? | |||||||
| Yes | 163 (42.7) | 45 (48.4) | 36 (40.5) | 6 (85.7) | 46 (31.1) | 30 (66.7) | 0.0002 a |
| No | 218 (57.1) | 48 (51.6) | 52 (58.4) | 1 (14.3) | 102 (68.9) | 15 (33.3) | |
| Did not answer | 1 (0.3) | 0 | 1 (1.1) | 0 | 0 | 0 | |
| Do you believe public awareness in children's oral health has increased because of the Interim CDB? | |||||||
| Yes | 59 (15.5) | 17 (18.3) | 14 (15.7) | 0 | 22 (14.9) | 6 (13.3) | 0.35 |
| No | 147 (38.5) | 40 (43.0) | 32 (36.0) | 4 (57.1) | 49 (33.1) | 22 (48.9) | |
| Don't know | 175 (45.8) | 35 (37.6) | 43 (48.3) | 3 (57.1) | 77 (52.0) | 17 (37.8) | |
| Did not answer | 1 (0.3) | 1 (1.1) | 0 | 0 | 0 | 0 | |
| Did you know that parents/caregivers need to keep receipts from the dental office after using the Interim CDB funds in case the government asks? | |||||||
| Yes | 232 (60.7) | 65 (69.9) | 44 (49.4) | 6 (85.7) | 86 (58.1) | 31 (68.9) | 0.017 a |
| No | 149 (39.0) | 27 (29.0) | 45 (50.6) | 1 (14.3) | 62 (41.9) | 14 (31.1) | |
| Did not answer | 1 (0.3) | 1 (1.1) | 0 | 0 | 0 | 0 | |
| Would you agree that the information provided by the Federal Government to the public about the Interim CDB was clear? | |||||||
| Yes | 120 (31.4) | 32 (34.4) | 24 (27.0) | 1 (14.3) | 46 (31.1) | 17 (37.8) | 0.58 a |
| No | 259 (67.8) | 61 (65.6) | 65 (73.0) | 6 (85.7) | 99 (66.9) | 28 (62.2) | |
| Did not answer | 3 (0.8) | 0 | 0 | 0 | 3 (2.0) | 0 | |
| Are you aware that your clients with dental care expenses that have not been fully reimbursed under another federal, provincial, or territorial government program, are eligible to apply for Interim CDB as long they meet all other criteria? | |||||||
| Yes | 99 (25.9) | 23 (24.7) | 18 (20.2) | 2 (28.6) | 41 (27.7) | 15 (33.3) | 0.37 a |
| No | 282 (73.8) | 70 (75.3) | 71 (79.8) | 5 (71.4) | 106 (71.6) | 30 (66.7) | |
| Did not answer | 1 (0.3) | 0 | 0 | 0 | 1 (0.7) | 0 | |
| Where do you want to see more information regarding the Interim CDB? | |||||||
| Schools/daycares | |||||||
| Yes | 253 (68.0) | 57 (62.0) | 49 (56.3) | 4 (57.1) | 110 (76.9) | 33 (76.7) | 0.0032 a |
| No | 119 (32.0) | 35 (38.0) | 38 (43.7) | 3 (42.9) | 33 (23.1) | 10 (23.3) | |
| Doctor's office | |||||||
| Yes | 188 (50.5) | 48 (52.2) | 43 (49.4) | 3 (42.9) | 74 (51.8) | 43 (46.5) | 0.92 a |
| No | 184 (49.5) | 44 (49.5) | 44 (50.6) | 4 (57.1) | 69 (48.3) | 23 (53.5) | |
| Dental office | |||||||
| Yes | 282 (75.8) | 65 (70.7) | 67 (77.0) | 2 (28.6) | 118 (82.5) | 30 (69.8) | 0.12 a |
| No | 90 (24.2) | 27 (29.4) | 20 (23.0) | 5 (71.4) | 25 (17.5) | 13 (30.2) | |
| Community centers | |||||||
| Yes | 190 (51.1) | 48 (52.2) | 41 (47.1) | 1 (14.3) | 78 (54.6) | 22 (51.2) | 0.75 a |
| No | 182 (48.9) | 44 (47.8) | 46 (52.9) | 6 (85.7) | 65 (45.5) | 21 (48.8) | |
| Community newspapers | |||||||
| Yes | 188 (50.5) | 44 (47.8) | 43 (49.4) | 2 (28.6) | 78 (54.6) | 21 (48.8) | 0.74 a |
| No | 184 (49.5) | 48 (52.2) | 44 (50.6) | 5 (71.4) | 65 (45.5) | 22 (51.2) | |
| Social media | |||||||
| Yes | 227 (61.0) | 51 (55.4) | 55 (63.2) | 1 (14.3) | 92 (64.3) | 28 (65.1) | 0.52 a |
| No | 145 (39.0) | 41 (44.6) | 32 (36.8) | 6 (85.7) | 51 (35.7) | 15 (34.9) | |
| Other | 23 (6.2) | 9 (2.4) | 7 (1.9) | 0 | 5 (1.3) | 2 (0.5) | |
| Did not answer | 10 (2.6) | 1 (1.1) | 2 (2.3) | 0 | 5 (3.4) | 2 (4.4) | |
| Did you know that parents/caregivers can apply for the Interim CDB after receiving dental treatment? | |||||||
| Yes | 172 (45.03) | 54 (58.1) | 36 (40.5) | 2 (28.6) | 57 (38.5) | 23 (51.1) | 0.0139 a |
| No | 208 (54.5) | 38 (40.9) | 53 (59.6) | 5 (71.4) | 90 (60.8) | 22 (48.9) | |
| Did not answer | 2 (0.5) | 1 (1.1) | 0 | 0 | 1 (0.7) | 0 | |
“Did not answer” excluded from calculation.
Differences between the types of respondent and awareness elements of the Interim CDB were observed (Table 2). Among the types of respondents, dental receptionists were significantly more aware about receiving the CCB as a mandatory criterion (p = 0.0023). Receptionists reported to have visited the Government website for information more than others (p = 0.0002). Dentists and receptionists mentioned the MDA significantly more as a source of knowledge for the benefit, while the CDHM was the most reported by hygienists. Although dental assistants were more likely to learn about the benefit from the MDAA (18.4%), a greater number of assistants referred to the MDA as their primary source of information (53.4%). Dental hygienists and dental assistants were significantly more unaware of the possibility to apply for the benefit after children had already received dental treatment (59.6% and 60.8%, respectively).
Table 3 presents responses to questions about the Interim CDB application process. Over half (57.1%) reported having very little or no knowledge about the eligibility criteria, and 62.8% indicated they were unable to describe the application process to clients. Few OHPs were aware that clients could reapply for Interim CDB in July 2023 (26.4%), and fewer suggested that clients reapply for the additional payment before July 1, 2023 (12.3%). Only 39.3% encouraged parents to apply for the Interim CDB.
TABLE 3.
Associations between dental personnel answers and questions about application of the Interim CDB.
| Questions 23–28: Application procedure section | Position of participant (n/%) | χ 2 test | |||||
|---|---|---|---|---|---|---|---|
| Total | Dentist | Dental hygienist | Dental therapist | Dental assistant | Dental receptionist | p | |
| How knowledgeable do you feel about the eligibility criteria/screening questions for the Interim CDB application? | |||||||
| A lot | 29 (7.6) | 6 (6.5) | 9 (10.1) | 2 (28.6) | 9 (6.1) | 3 (6.7) | 0.14 |
| Somewhat | 134 (35.1) | 39 (41.9) | 28 (31.5) | 2 (28.6) | 43 (29.1) | 22 (48.9) | 0.11 a |
| Very little | 132 (34.6) | 30 (32.3) | 28 (31.5) | 2 (28.6) | 56 (37.8) | 16 (35.6) | |
| Not at all | 86 (22.5) | 17 (18.3) | 24 (27.0) | 1 (14.3) | 40 (27.0) | 4 (8.9) | |
| Did not answer | 1 (0.3) | 1 (1.1) | 0 | 0 | 0 | 0 | |
| Have you encouraged parents to apply for the Interim CDB? | |||||||
| Yes | 150 (39.3) | 49 (52.7) | 24 (27.0) | 3 (42.9) | 51 (34.5) | 23 (51.1) | 0.001 a |
| No | 229 (60.0) | 44 (47.3) | 65 (73.0) | 4 (57.1) | 94 (63.5) | 22 (48.9) | |
| Did not answer | 3 (0.8) | 0 | 0 | 0 | 3 (2.0) | 0 | |
| How would you describe the application process for your clients? | |||||||
| Easy | 26 (6.8) | 9 (9.7) | 3 (3.4) | 0 | 10 (6.8) | 4 (8.9) | 0.53 a |
| Moderate | 69 (18.1) | 20 (21.5) | 13 (14.6) | 3 (42.9) | 22 (14.9) | 11 (24.4) | |
| Difficult | 46 (12.0) | 9 (9.7) | 13 (14.6) | 2 (28.6) | 17 (11.5) | 5 (11.1) | |
| Don't know | 240 (62.8) | 55 (59.1) | 60 (67.4) | 2 (28.6) | 98 (66.2) | 25 (55.6) | |
| Did not answer | 1 (0.3) | 0 | 0 | 0 | 1 (0.7) | 0 | |
| Did you know that your patients/clients can request an interpreter service when they apply for the Interim CDB? | |||||||
| Yes | 57 (14.9) | 18 (19.4) | 10 (11.2) | 2 (28.6) | 17 (11.5) | 10 (22.2) | 0.14 a |
| No | 323 (84.6) | 75 (80.7) | 78 (87.6) | 5 (71.4) | 130 (87.8) | 35 (77.8) | |
| Did not answer | 2 (0.5) | 0 | 1 (1.1) | 0 | 1 (0.7) | 0 | |
| Are you aware that your clients can reapply for the Interim CDB program in July 2023? | |||||||
| Yes | 101 (26.4) | 32 (34.4) | 21 (23.6) | 1 (14.3) | 31 (21.0) | 16 (35.6) | 0.06 a |
| No | 278 (72.8) | 60 (64.5) | 68 (76.4) | 6 (85.7) | 115 (77.7) | 29 (64.4) | |
| Did not answer | 3 (0.8) | 1 (1.1) | 0 | 0 | 2 (1.4) | 0 | |
| Have you ever suggested your client reapply before July 1, 2023 for an additional payment if the treatment costs covered by the Interim CDB has been used up and treatment is remaining? | |||||||
| Yes | 47 (12.3) | 12 (12.9) | 8 (9.0) | 4 (57.1) | 17 (11.5) | 6 (13.3) | 0.84 a |
| No | 332 (86.9) | 81 (87.1) | 80 (89.9) | 3 (42.9) | 129 (87.2) | 39 (86.7) | |
| Did not answer | 3 (0.8) | 0 | 1 (1.1) | 0 | 2 (1.4) | 0 | |
“Did not answer” excluded from calculation.
Dentists and dental receptionists were significantly more likely to have encouraged parents to apply for the Interim CDB (52.7% and 51.1%, respectively, p = 0.001) than other providers. These were also the professionals most aware of the possibility of re‐application for the benefit in 2023. Regarding their level of knowledge about the benefit, receptionists reported the most positive answers (“a lot” and “somewhat” combined, 55.6%), while the most negative was observed from dental assistants (“very little” and “not at all” combined, 64.8%).
Table 4 reports responses to questions about receiving and utilizing the Interim CDB. Half of the respondents did not know whether the amounts that parents received from the Interim CDB cover the dental costs for children (50.5%). The majority of OHPs did not know whether their offices saw patients who claimed the Interim CDB (64.4%) while 57.3% responded that they did not know how many patients used the Interim CDB in their offices. Additionally, most participants did not feel confident in providing information about the Interim CDB to parents/caregivers (54.2%). However, 56.5% did believe that the Interim CDB improves access to oral health care for children.
TABLE 4.
Associations between professionals and questions about receiving and using the Interim CDB.
| Question 29: Receiving the Interim CDB section | Position of participant (n/%) | χ 2 test | |||||
|---|---|---|---|---|---|---|---|
| Total | Dentist | Dental hygienist | Dental therapist | Dental assistant | Dental receptionist | p | |
| Generally, do the amounts parents/caregivers receive from Interim CDB cover the dental costs for their child? | |||||||
| Yes | 47 (12.3) | 12 (12.9) | 9 (10.1) | 5 (71.4) | 16 (10.8) | 5 (11.1) | 0.12 a |
| No | 138 (36.1) | 44 (36.1) | 25 (28.1) | 2 (28.6) | 50 (33.8) | 17 (37.8) | |
| Don't know | 193 (50.5) | 36 (38.7) | 54 (60.7) | 0 | 80 (54.1) | 23 (51.1) | |
| Did not answer | 4 (1.1) | 1 (1.1) | 1 (1.1) | 0 | 2 (1.4) | 0 | |
| Questions 30–36: Using the Interim CDB section | Position of participant (n/%) | χ 2 test | |||||
|---|---|---|---|---|---|---|---|
| Total | Dentist | Dental hygienist | Dental therapist | Dental assistant | Dental receptionist | p | |
| Do you know if your office sees patients/clients who have claimed the Interim CDB? | |||||||
| Yes | 134 (35.1) | 42 (45.2) | 25 (28.1) | 4 (57.1) | 49 (33.1) | 14 (31.1) | 0.10 a |
| No | 246 (64.4) | 51 (54.8) | 62 (69.7) | 3 (42.9) | 99 (66.9) | 31 (68.9) | |
| Did not answer | 2 (0.5) | 0 | 2 (2.3) | 0 | 0 | 0 | |
| Is your office receiving more requests from parents for appointments for their children < 12 years of age since the introduction of the Interim CDB? | |||||||
| Yes | 47 (12.3) | 9 (9.7) | 10 (11.2) | 2 (28.6) | 18 (12.2) | 8 (17.8) | 0.21 |
| No | 167 (43.7) | 45 (48.4) | 35 (39.3) | 2 (28.6) | 60 (40.5) | 25 (55.6) | |
| Don't know | 168 (44.0) | 39 (41.9) | 44 (49.4) | 3 (42.9) | 70 (47.3) | 12 (26.7) | |
| Do you feel you are receiving enough updates on the Interim CDB? | |||||||
| Yes | 47 (12.3) | 15 (16.1) | 8 (9.00) | 0 | 18 (12.2) | 6 (13.3) | 0.53 |
| No | 228 (59.7) | 53 (57.0) | 58 (65.2) | 4 (57.1) | 83 (56.1) | 30 (66.7) | |
| Don't know | 107 (28.0) | 25 (26.9) | 23 (25.8) | 3 (42.9) | 47 (31.8) | 9 (20.0) | |
| Are you confident in providing the Interim CDB information to parents/clients? | |||||||
| Very confident | 27 (7.1) | 7 (7.5) | 2 (2.3) | 2 (28.6) | 11 (7.4) | 5 (11.1) | 0.0499 |
| Somewhat confident | 148 (38.7) | 42 (45.2) | 27 (30.3) | 4 (57.1) | 54 (36.5) | 21 (46.7) | |
| Not confident | 207 (54.2) | 44 (47.3) | 60 (67.4) | 1 (14.3) | 83 (56.1) | 19 (42.2) | |
| Do you believe the Interim CDB improves access to oral health care for young children? | |||||||
| Yes | 216 (56.5) | 54 (58.1) | 43 (48.3) | 2 (28.6) | 93 (62.8) | 24 (53.3) | 0.18 a |
| No | 78 (20.4) | 21 (22.6) | 19 (21.4) | 3 (42.9) | 22 (14.9) | 13 (28.9) | |
| Don't know | 87 (22.8) | 18 (19.4) | 26 (29.2) | 2 (28.6) | 33 (22.3) | 8 (17.8) | |
| Did not answer | 1 (0.3) | 0 | 1 (1.1) | 0 | 0 | 0 | |
| In your dental office, can you provide a rough estimate of how many patients have used the Interim CDB? | |||||||
| 0 | 50 (13.1) | 11 (11.8) | 8 (9.0) | 1 (14.3) | 26 (17.6) | 4 (8.9) | 0.0003 |
| < 10 | 59 (15.5) | 12 (12.9) | 11 (12.4) | 3 (42.9) | 17 (11.5) | 16 (35.6) | |
| 10–24 | 16 (4.2) | 8 (8.6) | 1 (1.1) | 0 | 6 (4.1) | 1 (2.2) | |
| 25–49 | 12 (3.1) | 4 (4.3) | 2 (2.3) | 1 (14.3) | 4 (2.7) | 1 (2.2) | |
| 50–74 | 8 (2.1) | 2 (2.2) | 1 (1.1) | 1 (14.3) | 2 (1.4) | 2 (4.4) | |
| 75–100 | 6 (1.6) | 1 (1.1) | 5 (5.6) | 0 | 0 | 0 | |
| > 100 | 12 (3.1) | 2 (2.2) | 0 | 1 (14.3) | 6 (4.1) | 3 (6.7) | |
| Don't know | 219 (57.3) | 53 (57.0) | 61 (68.5) | 0 | 87 (58.8) | 18 (40.0) | |
| Among you child patients who have received the Interim CDB, please rank from 1 to 3, which group of children you have treated the most (1 being the most and 3 the least) | |||||||
| Children (1); infants (2); preschoolers (3) | 8 (2.1) | 0 | 3 (3.4) | 0 | 5 (3.4) | 0 | 0.06 a |
| Children (1); preschoolers (2); infants (3) | 56 (14.7) | 11 (11.8) | 11 (12.4) | 1 (14.3) | 22 (14.9) | 11 (24.4) | |
| Infants (1); children (2); preschoolers (3) | 9 (2.4) | 1 (1.1) | 2 (2.3) | 0 | 6 (4.1) | 0 | |
| Infants (1); preschoolers (2); children (3) | 21 (5.5) | 4 (4.3) | 4 (4.5) | 0 | 8 (5.4) | 5 (11.1) | |
| Preschoolers (1); children (2); infants (3) | 46 (12.0) | 13 (14.0) | 15 (16.9) | 5 (71.4) | 6 (4.1) | 7 (15.6) | |
| Preschoolers (1); infants (2); children (3) | 11 (2.9) | 2 (2.2) | 1 (1.1) | 0 | 7 (4.7) | 1 (2.2) | |
| Did not answer | 231 (60.5) | 62 (66.7) | 53 (59.6) | 1 (14.3) | 94 (63.5) | 21 (46.7) | |
“Did not answer” excluded from calculation.
No statistical differences were observed among providers about how many patients they have seen who have used the Interim CDB. The majority of OHPs did not provide any estimate at all (57.3%) and among those who responded, < 10 patients (36.2%) were the most reported answer, followed by 0 patients (30.7%). We observed a similar pattern while asking to rank the age groups of patients who received the benefit and were treated the most. No significant difference was found across roles and most OHPs (60.5%) did not provide an answer. Among those who responded, children (6–12 years) were the age group most frequently seen by providers, followed next by preschoolers (2–5 years), and then by infants (1–23 months), the least.
OHPs opinion did not differ statistically among roles whether the amounts provided were sufficient to cover treatment costs; over 50% of participants answered as “don’t know.” Similarly, there were no differences among provider types and their beliefs in whether the benefit improved access to oral health care for young children. However, there were statistical differences regarding confidence in providing information on the interim CDB to parents. Dental receptionists appeared to have the most confidence in providing information, while dental hygienists seemed to be the least confident (p = 0.049).
Table 5 reports findings about challenges and suggestions for the Interim CDB. Overall, 26.4% of OHPs indicated that they encountered challenges when assisting clients regarding the Interim CDB. A “lack of practical resources to educate parents” was the most mentioned challenge. Most OHPs reported no challenges in getting parents to book appointments (73.3%) or to pay for dental care for their children after receiving the benefit (63.9%). Nearly 70% of participants were unaware that the government's fact sheets were available in multiple languages. A large majority (79.8%) believed that the benefit should be paid directly to the clinic, instead of going to parents.
TABLE 5.
Associations between dental personnel opinion about challenges and suggestion toward Interim CDB.
| Questions 37–40: Challenges with the Interim CDB section | Position of participant (n/%) | χ 2 test | |||||
|---|---|---|---|---|---|---|---|
| Total | Dentist | Dental hygienist | Dental therapist | Dental assistant | Dental receptionist | p | |
| Do you have challenges when assisting your clients regarding Interim CDB? | |||||||
| Yes | 101 (26.4) | 30 (32.3) | 28 (31.5) | 4 (57.1) | 20 (13.5) | 19 (42.2) | 0.0004 a |
| No | 80 (20.9) | 20 (21.5) | 15 (16.9) | 3 (42.9) | 31 (21.0) | 11 (24.4) | |
| N/A | 198 (51.8) | 43 (46.2) | 45 (50.6) | 0 | 95 (64.2) | 15 (33.3) | |
| Did not answer | 3 (0.8) | 0 | 1 (1.1) | 0 | 2 (1.4) | 0 | |
| If you answered “yes,” check all that apply | |||||||
| I'm too busy/dental practice is too busy | |||||||
| Yes | 57 (14.9) | 11 (11.8) | 16 (18.0) | 0 | 21 (14.2) | 9 (20.0) | 0.52 |
| No | 325 (85.1) | 82 (88.2) | 73 (82.0) | 7 (100.0) | 127 (85.8) | 36 (80.0) | |
| Lack of promotional materials in the office | |||||||
| Yes | 63 (16.5) | 19 (20.4) | 21 (23.6) | 3 (42.9) | 11 (7.4) | 9 (20.0) | 0.0032 |
| No | 319 (83.5) | 74 (79.6) | 68 (76.4) | 4 (57.1) | 137 (92.6) | 36 (80.0) | |
| Lack of practical resources to educate parents | |||||||
| Yes | 125 (32.7) | 33 (35.5) | 33 (37.1) | 1 (14.3) | 37 (25.0) | 21 (46.7) | 0.0292 |
| No | 257 (67.3) | 60 (64.3) | 56 (32.9) | 6 (85.7) | 111 (75.0) | 24 (53.3) | |
| Was not aware of the Interim CDB | |||||||
| Yes | 24 (6.3) | 2 (2.2) | 6 (6.7) | 2 (28.6) | 8 (5.4) | 6 (13.3) | 0.07 |
| No | 358 (93.7) | 91 (97.9) | 83 (93.3) | 5 (71.4) | 140 (94.6) | 39 (86.7) | |
| No interest/uncomfortable providing dental care for children | |||||||
| Yes | 14 (3.7) | 2 (2.2) | 4 (4.5) | 2 (28.6) | 2 (1.4) | 4 (8.9) | 0.07 |
| No | 368 (96.3) | 91 (97.9) | 85 (95.5) | 5 (71.4) | 146 (98.7) | 41 (91.1) | |
| Shortage of support staff in office | |||||||
| Yes | 63 (16.5) | 14 (15.1) | 15 (16.9) | 1 (14.3) | 23 (15.5) | 10 (22.2) | 0.73 |
| No | 319 (83.5) | 79 (85.0) | 74 (83.2) | 6 (85.7) | 125 (84.5) | 35 (77.8) | |
| Client language barrier | |||||||
| Yes | 82 (21.5) | 20 (21.5) | 20 (22.5) | 1 (14.3) | 30 (20.3) | 11 (24.4) | 0.94 |
| No | 300 (78.5) | 73 (78.5) | 69 (77.5) | 6 (85.7) | 118 (79.7) | 34 (75.6) | |
| No challenges; N/A | |||||||
| Yes | 89 (23.3) | 24 (25.8) | 11 (12.4) | 0 | 48 (32.4) | 6 (13.3) | 0.0015 |
| No | 293 (76.7) | 69 (74.2) | 78 (87.6) | 7 (100.0) | 100 (67.6) | 39 (86.7) | |
| Other reason(s) | 26 (6.8) | 4 (4.3) | 6 (6.7) | 1 (14.3) | 8 (5.4) | 7 (15.6) | 0.07 |
| Did not answer | 140 (36.7) | 31 (33.3) | 39 (43.8) | 1 (14.3) | 56 (37.8) | 13 (28.9) | 0.31 |
| Are you facing any challenges in getting parents/caregivers to book appointments for their children's dental care after they receive the Interim CDB? | |||||||
| Yes | 62 (16.2) | 20 (21.5) | 14 (15.7) | 2 (28.6) | 16 (10.8) | 10 (22.2) | 0.11 a |
| No | 280 (73.3) | 64 (68.8) | 63 (70.8) | 5 (71.4) | 116 (78.4) | 32 (71.1) | |
| Did not answer | 40 (10.5) | 9 (9.7) | 12 (13.5) | 0 | 16 (10.8) | 3 (6.7) | |
| Are you facing any challenges in getting parents/caregivers to pay for their children's dental care after they receive the Interim CDB? | |||||||
| Yes | 88 (23.0) | 22 (23.7) | 25 (28.1) | 3 (42.9) | 26 (17.6) | 12 (26.7) | 0.14 |
| No | 244 (63.8) | 59 (63.4) | 47 (52.8) | 4 (57.1) | 104 (70.3) | 30 (66.7) | |
| Did not answer | 50 (13.1) | 12 (12.9) | 17 (19.1) | 0 | 18 (12.2) | 3 (6.7) | |
| If yes, please select all that apply | |||||||
| Clients already spent the benefit funds on something else | |||||||
| Yes | 56 (14.7) | 16 (17.2) | 12 (13.5) | 2 (28.6) | 21 (14.2) | 5 (11.1) | 0.79 |
| No | 326 (85.3) | 77 (82.8) | 77 (86.5) | 5 (71.4) | 127 (85.8) | 40 (88.9) | |
| Clients delay paying their outstanding balance, waiting for the second payment in July | |||||||
| Yes | 34 (8.9) | 8 (8.6) | 8 (9.0) | 4 (57.1) | 7 (4.7) | 4 (15.6) | 0.12 |
| No | 348 (91.1) | 85 (91.4) | 81 (91.0) | 3 (42.9) | 141 (95.3) | 38 (84.4) | |
| Client refuses to pay for any other reason | |||||||
| Yes | 36 (9.4) | 12 (12.9) | 8 (9.0) | 1 (14.3) | 13 (8.8) | 2 (4.4) | 0.43 |
| No | 346 (90.6) | 81 (87.1) | 81 (91.0) | 6 (85.7) | 135 (91.2) | 43 (95.6) | |
| No challenges; N/A | |||||||
| Yes | 109 (28.5) | 32 (34.4) | 15 (16.9) | 0 | 53 (35.8) | 9 (20.0) | 0.0051 |
| No | 273 (71.5) | 61 (65.6) | 74 (83.2) | 7 (100.0) | 95 (64.2) | 36 (80.0) | |
| Other | 15 (3.9) | 2 (2.2) | 5 (5.6) | 0 | 5 (3.4) | 3 (6.7) | 0.49 |
| Did not answer | 168 (44.0) | 37 (39.8) | 45 (50.6) | 1 (14.3) | 64 (43.2) | 21 (46.7) | 0.50 |
| Are you aware Interim CDB fact sheets are available in multiple languages? | |||||||
| Yes | 110 (28.8) | 34 (36.6) | 18 (20.2) | 5 (71.4) | 42 (28.4) | 11 (24.4) | 0.12 a |
| No | 267 (69.9) | 59 (63.4) | 69 (77.5) | 2 (28.6) | 104 (70.3) | 33 (73.3) | |
| Did not answer | 5 (1.3) | 0 | 2 (2.3) | 0 | 2 (1.4) | 1 (2.2) | |
| Question 41: Suggestion for the Interim CDB section | Position of participant (n/%) | χ 2 test | |||||
|---|---|---|---|---|---|---|---|
| Total | Dentist | Dental hygienist | Dental therapist | Dental assistant | Dental receptionist | p | |
| Do you believe that the funds should be paid directly to the clinic, like some other insurance practices may allow, instead of parents? | |||||||
| Yes | 305 (79.8) | 66 (71.0) | 77 (86.5) | 4 (57.2) | 128 (86.5) | 30 (66.7) | 0.0001 a |
| No | 66 (17.3) | 25 (26.9) | 9 (10.1) | 3 (42.9) | 15 (10.1) | 14 (31.1) | |
| Did not answer | 11 (2.9) | 2 (2.2) | 3 (3.4) | 0 | 5 (3.4) | 1 (2.2) | |
“Did not answer” excluded from calculation.
Dental receptionists reported significantly more challenges when assisting clients with the Interim CDB (42.2%), followed by dentists (32.3%) and hygienists (31.5%) (p = 0.0004). Additionally, dental receptionists were less likely to believe that funds should be paid directly to the clinic (31.1%) (p = 0.0001).
Potential associations between responses to key variables including the gender of the respondent and whether the OHPs practiced in an urban or rural setting were evaluated. OHPs from rural areas were significantly more aware about children with private insurance not being eligible (82.5% vs. 68.4% urban, p = 0.03) and about the ability to apply for the benefit after receiving treatment (59.7% vs. 44.3% urban, p = 0.03). Despite most of the participants answering to not know how to describe the overall application for their clients (62.4%), urban providers were significantly more likely to describe it as “hard” (13.1% vs. 1.8% rural, p = 0.007). OHPs working in rural clinics were significantly more likely to believe that the Interim CDB would improve access to oral health for young children (82.1% vs. 51.3% urban, p = 0.0001), and were more likely to encourage more parents/caregivers to apply for the benefit (52.6% vs. 37.6% urban, p = 0.04). Significant results were also observed when comparing responses with gender. However, these could just be an effect due to the difference in gender distribution (as men only accounted for 16.7% of participants).
Table 6 presents findings from the two multivariate logistic regression models controlling for number of years in practice, gender, location of clinic (urban vs. rural), and type of member of the dental team. Model 1 showed that rural OHPs were strongly more likely to believe in the Interim CDB's ability to improve access to oral health care for children (p = 0.0002), while respondents self‐reported as men were approximately 30% less likely to believe in it when compared to respondents self‐identified as women (p = 0.047). For calculation purposes, answers given on Model 1 as “don't know” were considered as “no.” For Model 2, it was estimated that OHPs working in rural areas were 43% more likely to have encouraged parents to apply for the Interim CDB. Additionally, dentists were 86% more likely to have motivated parents compared to hygienists (p = 0.008). On the other hand, hygienists were estimated to have encouraged parents 34% more than dental assistants (p = 0.03).
TABLE 6.
Multivariate logistic regression models for answers adjusted for demographic parameters.
| Variable | Regression coefficient | Odds ratio | 95% CI for odds ratios | p |
|---|---|---|---|---|
| Model 1 | Do you believe the Interim CDB improves access to oral health for young children? a , e | |||
| Intercept | 0.40 | — | — | — |
| No. of years in practice | −0.008 | 0.99 | 0.97–1.01 | 0.37 |
| Man b | −0.35 | 0.70 | 0.49–0.99 | 0.047 |
| Rural c | 0.71 | 2.03 | 1.41–2.93 | 0.0002 |
| Dentist d | 0.31 | 1.35 | 0.85–2.16 | 0.19 |
| Assistant d | 0.08 | 1.09 | 0.75–1.57 | 0.66 |
| Receptionist d | −0.005 | 0.99 | 0.59–1.67 | 0.98 |
| Model 2 | Have you encouraged parents/patients to apply for the Interim CDB? a | |||
| Intercept | 0.21 | — | — | — |
| No. of years in practice | −0.0004 | 1.00 | 0.98–1.02 | 1.00 |
| Man b | −0.17 | 0.84 | 0.59–1.19 | 0.35 |
| Rural c | 0.36 | 1.43 | 1.06–1.94 | 0.02 |
| Dentist d | 0.62 | 1.86 | 1.18–2.93 | 0.008 |
| Assistant d | −0.41 | 0.66 | 0.46–0.97 | 0.03 |
| Receptionist d | 0.51 | 1.66 | 0.99–2.78 | 0.053 |
No.
Woman.
Urban.
Hygienist.
“Don't know” was considered as “no.”
4. Discussion
This survey of Manitoba OHPs provided insight into their views about the Interim CDB. While there was considerable awareness regarding the program, respondents lacked knowledge of various aspects of the benefit. Specifically, their understanding about the eligibility and application criteria appeared to be very limited, suggesting that communication from the Federal Government to dental offices may not have been effective. Despite such setbacks, the benefit was generally well received by the surveyed personnel. OHPs from rural areas were very appreciative of it as results showed they were more likely to believe that the Interim CDB improved access to oral care and were more likely to encourage parents to apply, when compared to urban‐based professionals.
Access to dental care in rural areas is shaped by several factors, such as geographical distance, inadequate transportation, and even weather and seasonality [14]. Availability of dental professionals and lack of specialized care are also important factors that disrupt access to dental care in rural areas [14]. Considering all challenges, it is understandable that the Interim CDB was received optimistically by these OHPs.
Respondents indicated that the benefit was a welcome relief for families challenged by oral care access for their children. More than half of respondents believed that the Interim CDB effectively contributed to providing access to care. Supporting that finding, a recent study revealed strong uptake of the Interim CDB by Manitoba families with children under 12 years of age [8]. For instance, reported participation rates for children in Manitoba without private or public dental insurance were 433.3/1000 children for the first period and 473.7/1000 children for the second period of the Interim CDB [8].
Overall, interest from OHPs to understand the benefit's criteria and application process appeared limited. Less than half of respondents indicated that they had visited the Canadian government website to learn more about Interim CDB. Dentists and receptionists were more likely to search for additional information about the Interim CDB than other members of the dental team. Dentists and receptionists were also more likely to encourage parents to apply for the benefit than hygienists and assistants. This might suggest that information was not distributed evenly to dental professionals, possibly not reaching all dental hygienists.
Effective communication with and among all members of the dental team is crucial to ensure that they are well‐informed about new dental insurance policies for Canadians, including the Canadian Dental Care Plan. Having such information enables providers to inform the public more effectively. With respect to the Interim CDB, had policy makers provided more detailed information, this would have enabled OHPs to understand the application process without the need to search for more specifics. Consequently, dental professionals could have been more engaged in supporting parents to apply for the benefit. Indeed, when questioned about the challenges assisting clients with the Interim CDB, the most cited reason was the “lack of practical resources to educate parents.”
Implementing national dental insurance programs for priority populations is a noble and necessary endeavor. However, it can present challenges for the public as well as oral health care providers. The Medicaid program in the United States has assisted many low‐income individuals access care, but dental providers have reported some struggles with Medicaid underfunding and programmatic issues [15, 16]. Good support for government interventions to increase oral health access for its citizens exists, not only making oral health care more accessible, but also more affordable and available, as has been reported among dentists in Nigeria [17]. Many dental providers do understand the importance of the social contract they have with the public, specifically to increase access to oral health care for priority populations, including young children, adults with special healthcare needs, and seniors [11, 12, 13]. Canadian OHPs appear ready and willing to support federal interventions such as to make universal dental care a reality, however they are currently experiencing human resources problems and operational barriers that limit their ability to expand their services [18].
Despite the good intentions behind the initiative, the rapid pace by which the Interim CDB was developed may have contributed to communication challenges. The benefit was a result of political pressure applied to the governing liberal minority, announced in March 2023 and fully implemented 7 months later, in October [19]. It is likely that time was insufficient to rollout a clear communication plan on the Interim CDB, for both the public and dental personnel.
Another relevant aspect to be addressed is the Interim CDB's structure. Receiving the benefit in cash required parents to save the money for the dental care or to reimburse any payments that were made upfront. This could have been an issue for parents who were not able to manage their finances, and the money for the benefit may have been used for other household purposes. The current Canadian Dental Care Plan, however, is an insurance program where the eligible costs are billed directly to the government, thereby avoiding this situation [20]. In fact, most dental professionals in this present study agreed that would be a better option to have the benefit to be paid directly to the clinic.
This study is not without limitations. Since samples were obtained by convenience, they are bound to statistical bias and may not be representative of the entire dental personnel in Manitoba. Additionally, the response rate could be considered low as Manitoba has approximately 600 registered dentists, 884 registered hygienists, and 1150 dental assistants. Since most survey invitations reached participants through their dental associations, the total number of OHPs originally invited is unknown. This prevents us from estimating true response rates, evaluating biases associated with the characteristics of nonrespondents, and acknowledging possible overestimation from the regression models. Specifically, for dental therapists, their exclusion from comparisons with the other OHPs was necessary because of the low number of responses. Nevertheless, therapists do see children in their daily practice, which makes excluding their opinion unfortunate. Response bias is also a potential limitation. Those who responded to the survey might have been more motivated to participate because they are very interested in children's oral health, or they might have a more favorable view of the Interim CDB. The potential for recall bias also exists in this survey. Respondents' answers to survey questions may differ from actual Interim CDB uptake by families in their offices because they relied solely on their recollection of events. Interestingly, over 80% of participants self‐declared as women. This seems to be in agreement with recent research that evaluated the imbalances of Canadian dental providers' characteristics [21]. Dental hygiene and dental assisting continue to be strongly women‐dominated professions (approximately 97%), while dentistry is more balanced (51% women) [21]. Lastly, our study focused on professionals in Manitoba, so their answers may not be entirely generalizable to other OHPs in Canada.
This study explored the views of OHPs in Manitoba regarding the Interim CDB. While awareness of the benefit was high among respondents, substantial knowledge gaps were evident, particularly concerning eligibility criteria and the application process. Many OHPs, especially dental hygienists and assistants, expressed limited confidence in providing guidance to families, often citing a lack of practical educational resources. This highlights shortcomings in federal communication and outreach efforts during the rollout of the benefit. Despite this, most providers agreed that the Interim CDB improved oral care access for young children. Notably, OHPs practicing in rural areas were more likely to view the Interim CDB as beneficial in improving access to care and were more proactive in encouraging families to apply. These findings align with broader challenges to dental care access in rural regions, underscoring the critical value of such financial supports in underserved communities. The structure of the Interim CDB, which required reimbursement to parents rather than direct payment to providers, may have limited its effectiveness for some families. A large proportion of OHPs favored a model where funds are paid directly to clinics—an approach that has since been adopted under the Canadian Dental Care Plan.
Although the benefit was viewed positively overall, especially as a short‐term measure, the findings suggest that future funding models, including the Canadian Dental Care Plan, must be paired with robust, clear, and targeted communication strategies to ensure effective implementation. Nevertheless, policy makers should consider investing in closer, more effective communication with OHPs. Offering training for all dental team members, promoting role‐specific instruction for new dental policies, and implementing feedback mechanisms are some options to be explored. Continued evaluation of federal dental programs will be essential to optimize access, equity, and positive outcomes in oral health care for Canadian children.
Funding
This work was supported by the Canadian Institutes of Health Research (CH4‐192589).
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgments
Dr. Schroth holds a Canadian Institutes of Health Research (CIHR) Applied Public Health Chair in “Public Health Approaches to Improve Access to Oral Health Care and Oral Health Status for Young Children in Canada.” Operating funds for this survey are supported by this CIHR Applied Public Health Chair award. The authors declare that the research was conducted in the absence of any commercial relationships that could be construed as a potential conflict of interest. We also would like to acknowledge Dr. Mary‐Frances Wright, Lisette Dufour, and the staff from Health Canada's Oral Health Branch for the guidance and contributions to our study.
Data Availability Statement
Research data are not shared.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Research data are not shared.