Abstract

Geographic, gender, and other imbalances in the healthcare workforce have been documented across countries at all levels of development. Compared with research on medical and nursing professionals, however, evidence has been limited on the dental workforce. The knowledge gap may be related to oral ill-health remaining a widely neglected population health challenge, despite the global burden of oral diseases being excessive and showing few signs of improvement over time. Given the large proportions of dental providers working in the private sector in most countries, population census data are a particularly valuable (but for the most part underused) source to help support dental workforce planning. This study leverages microdata from the latest 2021 Canadian population census, conducted by Statistics Canada. We analyze a set of key indicators of workforce imbalances among dental providers, based on the statistical taxonomy of the National Occupational Classification. The census data tallied 3.4 active dentists aged 25-54 per 10,000 population, supported by an allied workforce of 1.7 dental hygienists/therapists and 1.6 dental assistants for every dentist. Linking the person-level census data to the geocoded Index of Remoteness revealed all three occupational groups were underrepresented in rural practice. The workforce-to-population ratios in the most urbanized parts of the country compared with more rural and remote areas were 1.9 times higher among dentists, 1.2 times higher among dental hygienists/therapists, and 1.3 times higher among dental assistants. Descriptive analysis showed the dentistry workforce had achieved gender parity numerically (51% women), but further multivariate analysis using Blinder-Oaxaca decompositions exposed women dentists still earned 21% (95% CI: 11-32%) less on average than men, adjusting for location and other professional and personal characteristics. Despite women representing 97% of dental hygienists/therapists, they earned 26% (95% CI: 13-42%) less on average than men, a significant difference that was largely unexplained by the measured predictors. The latter unexplained residual is often attributed in the literature to effects of gender discrimination and other structural problems in the labour market. While there is no “ideal” number or distribution of dental providers in national health systems, this observational study quantified important geographic and gender imbalances in the dental workforce in Canada. More cross-nationally comparable research is needed to inform and benchmark innovative approaches for equity-oriented dental workforce planning and financing, often critically overlooked in public policy for oral health services capacity building on the path to achieving the health-related Sustainable Development Goals.