Beyond Coverage – Re-imagining Oral Health Justice with Indigenous Peoples
Our First Student Blog
When I volunteered at a dental clinic during the summer of 2024, my dentist had told me a story involving a seven-year-old Cree girl from Alberta. At just 7 years old, the girl had already lost four of her baby teeth to severe decay. Her mother, balancing part-time work and caring for three other children, didn’t have dental insurance. The nearest dental clinic was a six-hour drive away, and the only time she had ever seen a dentist was when her gums became so swollen and painful that she could no longer eat.
The sad ending to this story is that it isn’t unique; it reflects a troubling reality faced by many Indigenous children and families across Canada. A 2019 study led by York University found that 28% of Indigenous people in Ontario only seek dental care in emergencies, a number that signals deep systemic failure. Among First Nations participants, the rates were even higher. This over-reliance on emergency care not only results in preventable suffering but also contributes to long-term health complications and heightened financial burdens for families and the healthcare system. The girl’s story, as told by my dentist, is not an outlier—it’s a symptom of a deeper, systemic failure.
The roots of this crisis run far deeper than access to oral care alone. Many indigenous communities lack access to preventive measures such as fluoridated water, which has long been proven to reduce dental decay. For example, a 2017 study found that only 2.3% of First Nations people had access to fluoridated water compared to nearly 39% of Canadians using community water supplies. The absence of fluoridated water is not coincidental, as Canada has had a long history of ongoing systemic neglect rooted in colonial policy and jurisdictional fragmentation.
In residential schools, Indigenous children were often denied access to hygiene, including dental care, while also being forcibly removed from their communities and traditional knowledge systems. Today, the integration trauma from such policies contributes to high rates of depression, which in turn has led to reduced attention to health, including oral care. In many remote communities, the loss of access to local food sources and rates of inflation have also made it extremely difficult to maintain proper nutrition, contributing to poor oral health. These are only a few examples of policies and legacies that have contributed to the marginalization of Indigenous communities.
To ensure equitable change, Canada must go beyond expanding dental coverage and commit to working with Indigenous advocates, leaders, and voices to build long-term, sustainable policies. This includes investing in programs that reflect Indigenous knowledge and ways of living, collaborating with experts, and recognizing that solutions cannot be solely shaped through a Western lens. Dental care for Indigenous communities is a shared responsibility between the federal and provincial governments, yet this dual accountability has too often resulted in finger-pointing and systemic neglect. The federal government offers limited oral care through the Non-Insured Health Benefits program for eligible Indigenous individuals, while the provincial governments are responsible for delivering these services. Despite this structure, many on-reserve and remote communities, especially, have voiced chronic under-funding, inconsistent care, and persistent service gaps.
Recent efforts like the expansion of the Canadian Dental Care Plan (CDCP) signal progress in addressing the oral health gaps. With over 3.4 million Canadians already approved, and 1.7 million having accessed care, the program is set to expand the age group to reach uninsured adults aged 18-64 by the end of 2025. While promising on the surface, increased coverage alone does not guarantee universal or equitable impact.. Beyond insurance status, indigenous communities, particularly those who live on reserve, face unique challenges such as a lack of transportation and service providers. As mentioned before, the challenges, such as fluoridated water, lack of culturally appropriate care, and systemic under-funding, are not solved by insurance alone. If the CDCP is to be truly transformative, like it says, it has to be accompanied by targeted policies that address these deeper structural gaps and meaningfully engage Indigenous communities in shaping how care is delivered.
Oral health is not separate from overall health; it is essential to it. Yet, for a long time, it has been sidelined in Canadian healthcare policy and is viewed as an optional luxury rather than a human right. This bias, shaped by decades of privatization, has contributed to systemic neglect, especially harming Indigenous communities. If Canada is serious about reconciliation and health equity, it must integrate dental care as a core part of public health policy. This means funding and delivering care that is accessible, culturally safe, and co-created with Indigenous communities; not for them, but with them. A commitment to structural reform, accountability, and justice must match the expansion of dental coverage. Anything less will only continue the cycle of neglect, repeating the story of the young Cree girl and many others like her.
Authors: Yara Shaban and Ashleen Parmar