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Dentistry has a rich institutional history, including professional associations, educational institutions, and government involvement in the regulation of the professions, and the provision of services through public health agencies.

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These institutions at various times have both enabled and hindered the evolution of dental therapy as a profession in Canada. The decision to move the dental program to the private sector, a switch which took place in , has had a negative impact on the oral health of children in Saskatchewan. Reports released in prompted newspaper headlines stating that Saskatchewan children had third-world teeth [ 22 ]. Although organized dentistry had embraced dental therapy into private practices in Saskatchewan and Manitoba, at least in a limited way, there was still strong resistance to the profession in other parts of Canada.

The Ad Hoc Committee on Dental Auxiliaries, formed in , had twelve members, including both lay people and professionals. The composition of the committee demonstrates that the interests of organized dentistry were well represented. Only one member of the committee represented dental auxiliaries, while the Canadian Dental Association was able to nominate four dentists to represent private practice.

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It is also interesting to note that the individual chosen to represent dental auxiliaries was, in fact, a dentist [ 5 ]. This is far from surprising, especially given the recognized status of the profession of dentistry in comparison to the other oral health professions. The Canadian Dental Hygienist Association president wrote to the chairperson of the Ad Hoc committee requesting that dental hygienists be represented on the committee, rather than being represented by a dentist who spoke on behalf of all dental auxiliaries. Her request was acknowledged but not granted. The inability to obtain direct representation on the ad hoc committee and to have a voice at future decision-making tables may be one reason why the scope of practice of dental hygiene was not expanded to include the dental therapy skillset.

In addition, private practice dentists were beginning to realize the economic advantages of having dental hygienists in their practice and may have been unwilling to lose them to government positions in remote communities. While the Health Council of Canada argued in favor of supporting the dental therapist model [ 37 ], opposition to the decision to close the training institution was relatively weak and unorganized.

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He wondered why the decision to close the training institution for dental therapists was made given that the oral health of his constituents was so poor. Minister Aglukkaq deflected the question by stating that the federal government invested in research and continued to increase health transfers to the provinces and territories, as the provincial governments were in a better position to know how to invest the money [ 40 ].

Unfortunately, Mr. Bevington did not have a strong lobby of concerned citizens voicing their concern. The weak political lobby of the Inuit and First Nations communities who were most directly affected by the closure meant that the backlash against the decision was not felt across the political landscape. This geographic issue is one of the factors limiting these subpopulations access to appropriate health care, as it is often difficult to recruit and retain health providers in remote locations [ 41 ]. The original dental therapy programs were designed to attract Inuit and First Nations students who would return to their communities but it is not clear how many students accepted into these programs were not Inuit or First Nations status.

In addition, the unique cultural perspectives held by Inuit and First Nations people are often not well understood by non-Indigenous health care providers. These perspectives have evolved out of a history of federal government policies that limited the autonomy and power of Inuit and First Nations people. This is one reason why there may be benefits to having indigenous patients receiving services within their own communities [ 42 ].

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Perhaps more importantly, health care in Canada falls predominantly under provincial jurisdiction, however, services for Inuit and First Nations people are largely the responsibility of the federal government and services are covered under its non-insured health benefits program. This blended responsibility for health care makes addressing equity issues less than straightforward as the division of federal and provincial powers creates a policy legacy that constrains future policy options.

Policies designed to address equity issues in individual provinces have therefore evolved independently as windows of opportunity arose in various provinces leaving a patch-work of policies and access to care across the country. Preventive oral health services are provided by dental therapists and dental hygienists in most provinces and just dental hygienists in Ontario and Quebec. While the program is innovative in creating community oral health workers to assist these health professionals, its long-term success will be impacted by the limited availability of dental therapists.

In addition, the initiative is limited to communities that agree to make the program truly community-based leaving almost half of the Inuit and First Nations Communities without the program in place. The program therefore does not ensure access to acute care and it remains unclear whether there has been an actual reduction in disease. Will dental therapy rise from the ashes? Despite general support for policies that would enhance equity for dental care, overcoming the power and influence of the dominant interests to reinstate funding for a dental therapy program in Canada seems unlikely.

Unless an alternative training program is introduced in the near future, it is very likely that dental therapy will cease to exist as a Canadian profession within the generation.

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Despite this, Canadian educational institutions possess substantial capacity to expand existing dental and dental hygiene programs to either include dental therapy training or expand the training of dental hygienists. Given that the federal government has responsibility for Inuit and First Nations health and the provincial governments have responsibility more broadly for both health care and education, any country-wide policy change would require leadership from the federal government and cooperation from the provincial governments.

As a result, it remains highly unlikely that a window of opportunity for policy change will open any time soon. So what other policy options exist? We have seen that such incremental change can be a practical alternative to more radical policy change [ 44 ]. The provinces have demonstrated an increasing willingness to support the expanded scope of practice of various professions as an approach to enhancing access to health care services as well as a means to controlling costs [ 45 , 46 ].

Based on this experience, expanding the scope of practice for dental hygienists may be may a viable, if only incremental, policy option for enhancing access to case for Inuit and First Nations communities. The global interest in the model of dual certification as a dental therapist and a dental hygienist makes incorporating dental therapy training into dental hygiene schools a viable option to consider.

The research indicates that this model has great potential, not only to supply dental therapists to publicly funded positions, but also to increase the procedures that a dentist could perform in a private practice setting. The PEW research centre recently published an infographic on expanding the dental workforce which reported that additional procedures could be performed by a dentist practicing in a solo, private practice in one year by adding a dental hygienist provider with dental therapy training to the office staff [ 47 ].

Providing advanced designation and training to dental hygienists to provide expand their scope of practice could potentially prepare them well to work more independently in northern and remote communities, thus ensuring that Inuit and First Nations communities have access to at least basic services. Through a policy analysis of the rise and fall of the dental therapy profession in Canada we seek to advance our understanding of the policymaking process, past policy change, and the likelihood of future policy change that will enhance equity of access to dental health care for first nations and Inuit in Canada.

The continued inability of many Inuit and First Nations Canadians to access appropriate oral health care providers in their home communities raises serious concerns about both equity of access and the health of these populations. Obtaining equity in access to health care services is generally thought of as a shared value within Canadian society. However, policy change is rarely achieved based on the strength of evidence or lobbying of government officials. It is essential that the complexities of the political process are fully taken into consideration if real change is to occur [ 6 ].

In this, and many other situations, the failure to implement effective policy solutions is complicated by the overlapping jurisdictions between the federal and provincial governments and the absence of leadership in coordinating an effective response. Whenever we see a policy problem that requires the coordinated attention of both the federal and provincial governments we can generally expect continued inadequate policy action.

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VL carried out the data collection, conducted the historical review and analysis, prepared the first draft of the paper and assisted with editing the paper. GR guided the analysis, interpreted the results and assisted with editing the paper. Both authors approved the final manuscript. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Victoria Leck, Email: ac. Glen E. Randall, Phone: , Email: ac. National Center for Biotechnology Information , U.

Int J Equity Health. Published online Jul Victoria Leck and Glen E. Author information Article notes Copyright and License information Disclaimer.

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Corresponding author. Received Nov 23; Accepted Jul This article has been cited by other articles in PMC. Abstract Background Inequality between most Canadians and those from Inuit and First Nations communities, in terms of both access to oral health care services and related health outcomes, has been a long-standing problem. Methods A policy analysis of the rise and fall of the dental therapy profession in Canada was conducted using historical and policy documents. Results The closure of the last dental therapy program in Canada has the potential to further reduce access to dental care in some Inuit and First Nations communities.

Conclusion In the absence of federal government leadership, the most viable option forward may be incremental policy change.

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Background While health care in Canada is generally of high quality, there are several vulnerable subpopulations that continue to experience poor health compared to the average Canadian. Methods There is an extensive body of research addressing a wide range of equity issues, including those relating to Inuit and First Nations communities in Canada. The policy stream: Dental therapists A potentially effective alternative approach to ensuring adequate dental care in Inuit and First Nations communities has been to utilize dental therapists.

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