• Chantel Ramraj, Laleh Sadeghi, Herenia P Lawrence, Laura Dempster, and Carlos Quiñonez.
• Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada. chantel.ramraj@utoronto.ca
• Plos One. 2013 Jan 1; 8 (2): e57377.

ObjectiveTo explore trends in access to dental care among middle-income Canadians.MethodsA secondary data analysis of six Canadian surveys that collected information on dental insurance coverage, cost-barriers to dental care, and out-of-pocket expenditures for dental care was conducted for select years from 1978 to 2009. Descriptive analyses were used to outline and compare trends among middle-income Canadians with other levels of income as well as national averages.ResultsBy 2009, middle-income Canadians had the lowest levels of dental insurance coverage (48.7%) compared to all other income groups. They reported the greatest increase in cost-barriers to dental care, from 12.6% in 1996 to 34.1% by 2009. Middle-income Canadians had the largest rise in out-of-pocket expenditures for dental care since 1978.ConclusionsThis study suggests that affordability issues in accessing dental care are no longer just a problem for the lowest income groups in Canada, but are now impacting middle-income earners as a consequence of their lack of, or decreased access to, comprehensive dental insurance.

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