Long wait times for specialized dental care remain a persistent challenge across Canada, particularly for patients with complex or accessibility needs.
In this Q-and-A, Dr. Mario Brondani — professor and chair of the Division of Dental Public Health at the University of British Columbia’s Faculty of Dentistry — explains what is driving the bottleneck and what could help ease it. While some of his insights appear in the feature story, “Empathy-driven dental clinic sees uptick in patients with accessibility needs,” this Q-and-A presents his full analysis.
Brondani, who also coordinates the Population and Education Research Team at the UBC’s faculty of dentistry, focuses his work on dental public health, education and geriatrics. He has published collaboratively more than 150 peer-reviewed publications and book chapters, and served as president of the Canadian Association of Public Health Dentistry from 2017 to 2019.
His work — and that of his trainees — centres on bridging clinical dentistry and social responsibility, with a focus on equity and systemic barriers to care, including poverty and stigma, as well as the role of community service learning and self-reflection in professional development. He maintains active research collaborations with more than 20 academic institutions worldwide.
Here is the Q-and-A:
Question 1: From a policy perspective, why does the current mix of private dental practice and public programs often fail to adequately serve patients with disabilities?
a) Fragmented financing with minimal public share and “payer of last resort” design.
Until very recently, Canada used to fund only a small fraction of dental care publicly — about 6%[i] of total dental expenditures before the Canadian Dental Care Plan (CDCP) — leaving most care to private insurance and out‑of‑pocket payments. This structure was among the least publicly financed in the OECD (Organization for Economic Cooperation and Development) and led to access gaps for equity-deserving groups, including people with disabilities. The CDCP is said to improve affordability as a federal plan for uninsured people with income thresholds, not as universal [ii]first‑dollar coverage. Policy analysts have warned that such a payer‑of‑last‑resort model can still leave gaps for complex needs if providers opt out or fees are misaligned. Of note, the CDCP eligibility is based on filing taxes[iii]: between 10 and 12% of Canadians do not file taxes for many reasons, and many of these are equity-deserving communities [iv]who need the most care – they fall under the inverse care law.
b) Mismatch between public fee schedules and private practice economics.
Provincial/territorial public dental schedules and new CDCP benefit grids typically reimburse below many provincial fee guides (as suggested by their respective Dental Associations), which could discourage provider participation. However, enrolment is close to 98% of active oral health providers as of March 2026. That is, the private sector delivers the CDCP as a ‘public’ system. Moreover, there are co-pays (within the CDCP itself) and balance billing (as the provider can charge the difference between the CDCP and the provincial fee guide) – but usually those benefiting from the CDCP the most might not have disposable income enough to pay for the ‘balance’. That all aside, providers might choose not to see patients with disabilities when there is the need for time‑intensive complex care that requires extended visits, specialized equipment, or additional team supports. Low or misaligned reimbursement continue to be a barrier to provider participation in disability care.
c) Workforce preparation and incentives are insufficient for special care dentistry.
General dentists report limited training/comfort treating patients with intellectual and developmental disabilities or with complex behavioural/medical needs since their undergraduate training. [v]Clinics often lack adaptive equipment or trained staff, and longer appointments are financially disincentivized [vi]under fee‑for‑service. In terms of specialization, if indeed desired, special care dentistry lacks formal specialty status and structured training capacity in North America, contributing to shortages of capable providers. It is recognized as a specialty in Australia and the UK, for example.
d) Structural access barriers compound financial ones.
Most people with disabilities may also face transportation, physical accessibility, sensory/communication barriers, and the need for longer desensitization appointments or sedation, which many general practices [vii]do not accommodate. The World Health Organization’s oral health strategy emphasizes integrating oral health into primary care and Universal Health Care with disability‑inclusive service design. Canada’s largely private delivery makes such integration uneven, unattainable.
e) Historically weak integration with mainstream health systems and social care.
Many Canadians have documented persistent oral health inequalities, with cost and coverage gaps particularly affecting equity-deserving populations (including persons with disabilities and many Indigenous communities). The lack of a coherent, integrated policy framework for dental services within public health and disability services contributes to unmet needs. Canada also does not have a national dental public health system aside from siloed efforts at microlevel – cities and municipalities.
Bottom line: A financing design that relies on private practice (that is now delivering the CDCP) and limited public benefits, combined with lower reimbursements for time‑intensive care, insufficient special‑care training/incentives, and accessibility/communication barriers, systematically underserves patients with disabilities—even as overall health spending grows.
Question 2: Many clinics that provide specialized care for patients with complex needs report long waiting lists. What policy or system changes could help reduce these wait times?
Why the waits?
- Supply–demand imbalance & referral bottlenecks. Few clinics are configured for complex disability care (space, equipment, OR/sedation access, trained providers and teams – a major issue as discussed above). This constrained supply meets rising need, creating persistent queues. Data show long waits across specialty care, and dentistry requiring hospital time competes for scarce OR resources.
- Time‑intensive visits reduce throughput. Complex cases often require extended appointments, multi‑disciplinary planning and behaviour guidance, lowering daily capacity compared with routine care.
- Financing misalignment. When reimbursement does not reflect the time/complexity (chair time, extra staff, interpreters, desensitization), clinics face a throughput vs. viability trade‑off that prolongs waits.
- Downstream effects from broader system waits. Where general anesthesia or hospital dentistry is required, dental cases are placed behind other surgical volumes. Provincial data show substantial waits for dental surgery in hospitals, which should not be the delivery choice for such treatments In the first place.
- Pandemic backlog and general specialist bottlenecks. Post‑COVID disruptions [viii]and broader Canadian specialty access problems contribute to delayed assessments and treatment initiation.
What could help to reduce waits?
- Pay for complexity and team‑based care
Adopt enhanced fees or bundled payments for complex disability care that explicitly fund longer appointments, case management, behavioural supports, and auxiliary communication aids—reducing the financial penalty for seeing complex patients. Adequate, targeted reimbursement are necessary to expand provider participation and capacity.- CDCP and provincial plans could pilot complex‑care modifiers and case rates for special care dentistry (including medically necessary sedation), aligned with Sun Life’s CDCP grids and preauthorization pathways. But of course, closer monitoring with key set-out outcome measures are essentials to gauge this initiative.
- Grow the workforce and formalize special‑care competencies
Create new/increase existing residency/fellowship slots and continuing education [ix]in special care dentistry; embed disability care competencies and interprofessional rotations in predoctoral curricula (with hands-on opportunities[x]); consider a recognized special‑care track to attract trainees. Professional calls for recognition and dedicated training capacity support this direction for inclusive oral health.- Leverage Health Canada’s Oral Health Access Fund: This initiative is already funding patient recruitment supports, mobile outreach, and rural/remote placements in some provinces via university projects to expand hands‑on training and mobile clinics that offload pressure from tertiary centres.
- Integrate oral health into primary/community care and disability services
Establish embedded dental teams within community health centres, long‑term care, and disability service hubs; fund mobile/teledentistry triage and desensitization visits to reduce no‑shows and prepare patients before scarce clinic time; promote interdisciplinary models of care that shows improved patient experience when longer visits, accessible furniture, desensitization and team‑based pathways are used.- WHO’s Global Oral Health Action Plan [xi]urges integration with primary care and UHC—Canadian adoption would support better triage and earlier intervention, shortening waits for tertiary clinics.
- Expand hospital dentistry blocks and anesthesia access for dentistry
Create protected OR blocks for dental GA and develop regional dental sedation hubs to clear backlogs for patients who cannot be treated awake. Data show significant queues for dental surgery that could be mitigated by dedicated throughput strategies. - Standardize accommodations and fund communication supports
Require and fund auxiliary aids (e.g., ASL interpreters, captioning, communication devices) and sensory/environmental adaptations. There are frameworks on effective communication that Canadian clinics can emulate voluntarily while provinces develop parallel accessibility standards.- Practical guidance shows interpreter costs should be covered and not shifted to the patient—clarifying and funding this in public dental programs would prevent delays due to ad hoc arrangements.
- Data and accountability
Mandate routine reporting of special‑care wait times, denial rates, and outcomes across programs, aligned with suggested access indicators and monitoring framework, to target investments where waits are longest.
Net effect: Aligning payment with complexity, expanding the trained workforce, integrating services in community settings, and funding accessibility/communication supports are the most direct levers to shorten wait lists while improving quality.
Question 3: With the rollout of the CDCP, do you believe additional policy support is needed for patients with complex disabilities — such as individuals with severe autism or Deaf patients who require communication accommodations?
Short answer is yes. The CDCP is a major advance for affordability but does not, by itself, guarantee capacity, accessibility, or appropriate accommodations for people with complex disabilities. Three areas warrant added support, including:
(i) Adequacy of coverage for complex care and provider participation
CDCP covers a broad range of services and allows preauthorization and frequency exceptions in some cases, but reimbursement is based on national benefit grids that may lag provincial fee guides (although the difference can be changed to the patient balance billing) and do not automatically compensate for extended behavioural support time, interdisciplinary coordination, or interpreter services. Evidence suggests insufficient incentives depress participation in public dental plans for adults with disabilities; targeted payment reforms (complexity modifiers, bundled payments, add‑ons for accommodations) could perhaps improve uptake.
(ii) Accessibility and communication accommodations
For Deaf patients, equal access requires qualified interpreters or alternative auxiliary aids. Incorporating such services into Federal and provincial programs would reduce deferrals and improve safety and consent.
People with severe autism often need desensitization visits, sensory‑adapted environments, longer appointments, and sometimes GA; programs should explicitly fund pre‑visit planning, extra time, and environmental adaptations to reduce crisis‑driven care. Clinical and policy literature on special needs dentistry and disability care underscores these supports.
(iii) Coordinated system supports beyond insurance
Barriers for persons with disabilities are not solely financial; they include transportation, physical access, and provider readiness/training. Calls have been made for disability‑inclusive primary care integration and workforce training, and complementary policies alongside the CDCP.
Health Canada has begun funding training and outreach through the Oral Health Access Fund, but these initiatives are early and their results are yet to be seen; expanding and institutionalizing them would help patients with complex needs actually use their CDCP coverage (as long as they file taxes for eligibility[xii]).
Recommended policy add‑ons to the CDCP for complex disabilities
- Complex‑needs fee codes/modifiers (behaviour guidance, desensitization, case management) and bundled payments that recognize longer time and interprofessional coordination; align preauthorization criteria to clinical need rather than rigid frequency limits.
- Funded accommodations: dedicated CDCP line items for interpreters/communication aids, sensory adaptations, and extended appointments—modeled on effective‑communication standards—so clinics are not financially penalized for doing the right thing.
- Regional special‑care hubs and hospital blocks: create designated special care dentistry hubs with GA/sedation access and outreach/mobile teams, linked to community agencies for smoother transitions and reduced waits.
- Training and accreditation: expand funded residencies/fellowships in special care, require disability competencies in accreditation standards, and consider recognizing a special care dentistry pathway to grow capacity.
- Monitoring and equity targets: adopt disability‑specific access indicators and targets (waits, provider participation, unmet need) within CIHI dashboards and align with WHO’s monitoring framework to guide continuous improvement.
Concluding remarks
Until recently, Canada’s traditional reliance on private dental delivery with minimal public financing has left structural gaps for people with disabilities—gaps that will not be closed by coverage alone. The CDCP makes a crucial dent in financial barriers, but to translate eligibility into timely, appropriate care, policy must also (1) pay for complexity, (2) expand and train the workforce, (3) fund accommodations and accessibility, (4) integrate oral health into community and disability services, and (5) track results. These steps could help to shorten queues and improve outcomes for Canadians with disabilities.
Related: CDCP ends 2025 with a milestone — but challenges persist
Related: The senior-friendly dental office environment: How and why it is essential
[i] https://link.springer.com/article/10.17269/s41997-023-00800-6
[ii] https://irpp.org/wp-content/uploads/2023/06/Toward-a-Universal-Dental-Care-Plan-Policy-Options-for-Canada.pdf
[iii] https://onlinelibrary.wiley.com/doi/pdf/10.1111/ger.12813
[iv] https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1619845/full
[v] https://www.nidcr.nih.gov/health-info/developmental-disabilities
[vi] https://www.ncd.gov/report/incentivizing-oral-healthcare-providers-to-treat-patients-with-intellectual-and-developmental-disabilities/
[vii] https://pubmed.ncbi.nlm.nih.gov/40119583/
[viii] https://www150.statcan.gc.ca/n1/pub/82-003-x/2024002/article/00002-eng.htm
[ix] https://pubmed.ncbi.nlm.nih.gov/25951768/
[x] https://onlinelibrary.wiley.com/doi/pdf/10.1111/ger.12813
[xi] https://www.dentalhealth.ie/assets/files/pdf/who_global_strategy_oral_health_2023_to_2030.pdf