Report authored by the Chief Medical Health Officer (CMHO), April 2025
Oral health in the Fraser Health region: Opportunities for action
Oral health is a key part of overall health and well-being. This report presents data, evidence and best practices intended to start conversations about improving the oral health of our population. With strengthened collaboration across sectors and strategic action in a variety of areas we can improve health outcomes in our communities.
Oral health issues do not affect everyone equally.
The oral health of the population is monitored through local, provincial and national dental surveys. In B.C., a Kindergarten Dental Survey is carried out every three years by dental professionals to monitor the oral health status of children. Information on the oral health status of youth and adults is usually gathered through self-report.
These surveys show that oral health issues are more common among low-income communities, Indigenous populations and seniors.
Childhood cavity rates in Fraser Health vary across neighbourhoods.
Percentage of kindergartners with current or previous cavities by neighbourhood, 2022-2023 school year
Data Sources:
- Fraser Health Kindergarten Dental Survey 2022-2023.
- Geographic unit: HELP neighborhoods from UBC.
- Projection: UTM Zone 10N.
- Prepared by: Population Health Observatory, Fraser Health, November 2024.
Childhood cavities affect children in all demographic groups, but rates are higher in neighbourhoods with lower incomes.
Childhood cavity rates in Fraser Health neighbourhoods by household income level.
Median family income quintiles
If you have difficulties reading the graph. Click here for the image version.
Data Sources:
- Paris, Kindergarten Dental Survey data 2022-2023 combined with Census 2021 Profile.
- Kindergarten Dental Survey data 2015-2016 and 2018-2019 combined with Census 2016 Profile.
We can also see differences in access to dental care across populations.
The percentage of people who have visited a dental professional in the last 12 months can vary significantly depending on the population.
Racialized population
Immigrant status
Indigenous identity
Gender diversity
Functional difficulties
Data Sources:
- Statistics Canada, 2022, Canadian Community Health Survey.
How do we currently support oral health in B.C.?
There is a mix of public and private providers delivering oral health care services in B.C. The majority are provided by private dental professionals with a smaller portion delivered through the public health care system.
While some people can easily access dental health resources, others face significant physical, financial or social barriers that prevent them from accessing the care they need. There are a number of programs in B.C. working to improve the availability, accessibility and acceptability of services so that everyone has the opportunity to experience good oral health.
Universal programs
Universal programs aim to provide services or benefits to all members of a population, regardless of their individual circumstances. Scroll across the examples below to learn more about universal programs in B.C.
Oral health promotion and health education
Health education plays a key role in encouraging good dental hygiene. B.C. health authorities have developed resources on topics like flossing, brushing, preventive dental care and common oral health conditions.
Although these resources are easily available online and have been translated into multiple languages they could be further tailored to meet the information needs of diverse cultural groups.
Dental screening in schools
As the Fraser Health dental team conducts the B.C. Kindergarten Dental Survey, they are also identifying individual children who have oral health concerns. If the screening identifies that a child may need dental care then the family will receive a letter letting them know that they should seek care and outlining the support that Public Health can offer to navigate dental access programs.
The kindergarten survey only occurs every three years, meaning that two out of three kindergarteners may not benefit from this additional screening and no students in older grades are screened. (See spotlight below for information on additional screening by Fraser Health).
Community water fluoridation
Fluoride is a mineral that strengthens the tooth’s surface, which helps to prevent cavities from forming. It can be added to drinking water at low levels to ensure everyone has access to fluoride’s dental health benefits.
Despite substantial evidence on the safety and efficacy of community water fluoridation, no communities in the Fraser Health region are currently fluoridating their water.
Equity-based dental access programs
Equity-based dental access programs can help to ensure that populations facing barriers to care are able to access the services they need. Scroll across the examples below to learn more about equity-based dental access programs in B.C.
Low-income individuals and families
The Canadian Dental Care Plan (CDCP) and the B.C. Dental Supplement are important funding programs which support dental care access for low-income individuals and families who do not have access to dental insurance.
While both the CDCP and the B.C. Dental Supplement contribute to closing the coverage gap left by the Canada Health Act, the need to prove eligibility to access these funds can create a significant barrier for some populations. The funding provided also may not cover the cost of all necessary services.
First Nations communities
Status First Nations people in B.C. have access to dental benefits through the program known federally as Non-Insured Health Benefits. The First Nations Health Authority (FNHA) also offers a range of dental programs to support First Nations communities, such as the Children’s Oral Health Initiative, and some communities receive funding to operate their own community oral health programs and services.
First Nations Peoples may still face barriers to access, due to social inequities in health care access and anti-Indigenous racism and discrimination that exists within the health care system.
Newcomers to Canada
The majority of newcomers to Canada, including temporary foreign workers, international students and economic migrants, will be responsible for funding their own health and dental care when they first arrive in Canada. Refugees receive some assistance sooner through the Interim Federal Health Program (IFHP).
Newcomers become eligible for provincial Medical Services Plan (MSP) coverage after six months of continuous residency in B.C.; however, MSP only covers medically necessary oral health procedures. This may leave newcomers (and other British Columbians) with unmet oral health care needs if they lack access to other dental insurance.
Additional population gaps
Many populations still face barriers to dental care, including people with disabilities, pregnant individuals and people from racialized communities, some of whom may have had past negative experiences in health care settings.
There is an opportunity to improve the cultural safety, inclusivity and accessibility of dental in B.C. through training for dental health professionals, infrastructure improvements to dental clinics and programs that reduce financial barriers to access. This may encourage more people to seek care.
What can water fluoridation contribute to our oral health?
Communities in Canada have been adding fluoride to their water since 1945. Decades of research have shown that community water fluoridation (CWF) is a safe and effective measure to prevent cavities. Despite the evidence, some people continue to question the value of CWF.
Dental health studies from Alberta have shown that CWF can have a significant impact on childhood cavity rates and can also contribute to reducing inequities in children’s oral health.
What happened in Calgary?
Trends over time in prevalence of dental cavities in primary teeth among grade 2 students in Calgary and Edmonton.
If you have difficulties reading the graph. Click here for the image version.
Data Sources:
- McLaren et al. (2022). Fluoridation cessation and children's dental caries: A 7-year follow-up evaluation of Grade 2 schoolchildren in Calgary and Edmonton, Canada. Community dentistry and oral epidemiology, 50(5), 391–403.
While some people can access fluoride through personal oral health products such as toothpaste or mouthwash, not everyone has equal access to these products. Given the high cost of treating oral health concerns in the health care system, it is important that as a community we take steps to ensure everyone has an opportunity to experience good oral health.
The path to better oral health.
Poor oral health has negative impacts on the individual, the health care system and society as a whole. There is an opportunity for public health authorities, dental health professionals and other health and social service providers to collaborate and support improved oral health across the population. To achieve this goal, we propose the following actions:
Strengthen public education
1
Increase public awareness of good oral health behaviours by developing client resources tailored to diverse populations; building knowledge of oral health promotion across health and social service providers; and ensuring that the public is receiving accurate information about fluoride and water fluoridation.
Improve data collection
2
Support ongoing review and improvement of the B.C. Kindergarten Dental Survey and consider expanding the school-based surveys to include 12-year-olds.
Enhance dental public health leadership
3
Improve the capacity of dental public health leadership for consultation, collaboration and coordination. This will help to develop robust, standardized oral health strategies, initiatives and programs in B.C.
Expand access to care
4
Continue to build awareness of the barriers that exist for diverse clients attempting to access dental care and the need to provide programming that addresses these inequities.
Support community water fluoridation
5
Assess local communities' level of support for community water fluoridation and take action to implement water fluoridation or address community concerns as needed. Support reviews of current legislation and infrastructure programs to identify opportunities to reduce barriers to implementing community water fluoridation.
Support better dental health for all
Many people don't realize that poor oral health can lead to infections, heart disease and even diabetes and no one should have to suffer from painful cavities or untreated gum disease simply because they can't afford a dentist. By working together to expand dental access, improve public awareness and invest in prevention we can support good oral health for everyone in our community.
All references are included in the downloadable report.
