Socio-demographic predictors of not having private dental insurance coverage: machine-learning algorithms may help identify the disadvantaged.

BACKGROUND: For accessing dental care in Canada, approximately 62% of the population has employment-based insurance, 6% have some publicly funded coverage, and 32% have to pay out-of pocket. Those with no insurance or public coverage find dental care more unaffordable compared to those with private insurance. To support the development of more comprehensive publicly funded dental care programs, it is important to understand the socio-demographic attributes of all those, who find dental care unaffordable. METHODS: This study is a secondary analysis of the data collected from Ontarians during the latest available cycle of the Canadian Community Health Survey (2017-18), a cross-sectional survey that collects information on health status, health care utilization, and health determinants for the Canadian population. First, bivariate analysis was conducted to determine the characteristics of Ontarians who lack dental insurance. Afterwards, we employed machine learning (ML) to analyze data and identify risk indicators for not having private dental insurance. Specifically, we trained several supervised ML models and utilized Shapley additive explanations (SHAP) to determine the relative feature importance for not having private dental insurance from the best ML model [the gradient boosting (GBM)]. RESULTS: Approximately one-third of Ontarians do not have private insurance coverage for dental care. Individuals with an income below $20,000, those unemployed or working part-time, seniors aged above 70, and those unable to afford to have their own housing are more at risk of not having private dental insurance, leading to financial barriers in accessing dental care. CONCLUSION: In the future, government-funded programs can incorporate these identified risk indicators when determining eligible populations for publicly funded dental programs. Understanding these attributes is critical for developing targeted and effective interventions, ensuring equitable access to dental care for Canadians.

Is private insurance enough to address barriers to accessing dental care? Findings from a Canadian population-based study.

BACKGROUND: In Canada, as in many other countries, private dental insurance addresses financial barriers to a great extent thereby facilitating access to dental care. That said, insurance does not guarantee affordability, as there are issues with the quality and level of coverage of insurance plans. As such, individuals facing barriers to dental care experience poorer oral health. Therefore, it is important to examine more keenly the socio-demographic attributes of people with private insurance to particularly identify those, who despite having insurance, face challenges in accessing dental care and experience poorer oral health. METHODS: This study is a secondary data analysis of the most recent available cycle (2017-18) of the Canadian Community Health Survey (CCHS), a national cross-sectional survey. Univariate analysis was conducted to determine the characteristics of Ontarians with private insurance (n = 17,678 representing 6919,814 Ontarians)-bivariate analysis to explore their financial barriers to dental care, and how they perceive their oral health. Additionally, logistic regressions were conducted to identify relationships between covariates and outcome variables. RESULTS: Analysis shows that the majority of those with private insurance do not experience cost barriers to dental care and perceive their oral health as good to excellent. However, specific populations, including those aged 20-39 years, and those earning less than $40,000, despite having private dental insurance, face significantly more cost barriers to access to care compared to their counterparts. Additionally, those with the lowest income (earning less than $20,000 annually) perceived their oral health as "fair to poor" more than those earning more. Adjusted estimates revealed that respondents aged 20-39 were six times more likely to report cost barriers to dental care and ten times more likely to visit the dentist only for emergencies than those aged 12-19. Additionally, those aged 40-59 were two times more likely to report poorer oral health status compared to those aged 12-19. CONCLUSION: Given the upcoming implementation of the Canadian Dental Care Plan, the results of this study can support in identifying vulnerable populations who currently are ineligible for the Plan but can be benefitted from the coverage.

Detecting dental caries on oral photographs using artificial intelligence: A systematic review.

OBJECTIVES: This systematic review aimed at evaluating the performance of artificial intelligence (AI) models in detecting dental caries on oral photographs. METHODS: Methodological characteristics and performance metrics of clinical studies reporting on deep learning and other machine learning algorithms were assessed. The risk of bias was evaluated using the quality assessment of diagnostic accuracy studies 2 (QUADAS-2) tool. A systematic search was conducted in EMBASE, Medline, and Scopus. RESULTS: Out of 3410 identified records, 19 studies were included with six and seven studies having low risk of biases and applicability concerns for all the domains, respectively. Metrics varied widely and were assessed on multiple levels. F1-scores for classification and detection tasks were 68.3%-94.3% and 42.8%-95.4%, respectively. Irrespective of the task, F1-scores were 68.3%-95.4% for professional cameras, 78.8%-87.6%, for intraoral cameras, and 42.8%-80% for smartphone cameras. Limited studies allowed assessing AI performance for lesions of different severity. CONCLUSION: Automatic detection of dental caries using AI may provide objective verification of clinicians' diagnoses and facilitate patient-clinician communication and teledentistry. Future studies should consider more robust study designs, employ comparable and standardized metrics, and focus on the severity of caries lesions.

Towards equitable dental care in Canada: Lessons from the inception of Medicare.

Dental care in Canada is primarily financed through private insurance plans and out-of-pocket payments. While Canada is internationally recognized for Medicare, a publicly-funded health insurance system that covers hospital and physician-provided services at the point of care, it remains one of the least equitable Organization for Economic Co-operation and Development countries in terms of affordable access to dental care. Approximately one third of Canadians do not have access to dental insurance, including half of low-income individuals, and individuals with the greatest dental care needs are often unable to reliably access dental services. Select populations-such as children, Indigenous peoples, seniors, and persons living with disabilities-receive some level of publicly-funded dental services, amounting to approximately 6% of total dental spending nationwide. Despite the evolution of Medicare, dental care has been largely excluded from federal health legislation following World War II. However, in March 2022, the Liberal Party of Canada partnered with the federal New Democratic Party to advance common legislative goals, including a long-term nationwide dental program for low- and middle-income families. As an interim measure, Bill C-31 was signed into law on 17 November 2022, and created the Canada Dental Benefit, which provides a fixed transfer payment to individuals with an annual household income under $90,000. This commentary reviews the origins of Canadian Medicare, discusses the factors that led to the continued exclusion of dental care from federal health legislation, examines the newly-minted Canada Dental Benefit, and explores the potential for expanded public funding in Canadian dental care.

Dentistry's social contract and dental students' moral inclusiveness.

BACKGROUND: Under dentistry's social contract with the public, dental professionals have a social responsibility to address the oral health needs of the population at large. However, dental education places little emphasis on such moral commitments. By ascertaining dental students' stance regarding these notions, we may be able to inform changes in dental education. This paper thus explores dental students' comprehension of dentistry's social contract using the concepts of moral inclusion, moral community and empathy. METHODS: A cross-sectional online survey collected information from undergraduate dental students at the Faculty of Dentistry, University of Toronto (N = 430). Moral inclusion was assessed through the breadth of students' moral community by computing a "moral inclusion score" (MIS) from Likert scale responses to statements that asked students about their duty of care for different population groups, wherein a higher MIS indicated a broader moral community and in turn greater moral inclusiveness. Empathy was assessed using Likert scale responses to statements that gauged the extent to which students understood the effect of social determinants on people's health. Association of the MIS with environmental, institutional and student-related factors was also investigated using non-parametric tests and linear regression. RESULTS: The survey yielded a response rate of 51.4% (n = 221). Overall, students in this sample were morally inclusive and displayed empathy. Regression results showed that the MIS was most strongly associated with choosing a small town/rural area as a future practice location (ß = 4.76, 95% CI: 0.52, 9.01) and viewing patients as consumers (ß = -3.71, 95%CI: -7.13, -0.29). CONCLUSION: Students in this sample made morally inclusive choices, which implied that they had a basic understanding of the obligations under dentistry's social contract. Improving knowledge and experience with regards to addressing the social and economic determinants of oral health and access to oral health care may positively influence students' perceptions of their professional duties under the social contract.

Teledentistry use during the COVID-19 pandemic: perceptions and practices of Ontario dentists.

BACKGROUND: Teledentistry has demonstrated to expedite oral health consultations, diagnosis, and treatment planning while mitigating COVID-19 transmission risk in dental offices. However, the use of teledentistry by clinicians remains suboptimal. Therefore, this study aimed to determine the perceptions and practices of teledentistry among dentists during the COVID-19 pandemic in Ontario, Canada, and identify associated factors. METHODS: A cross-sectional study using an online 39 item survey was conducted among Ontario dentists in December 2021. The questionnaire inquired about socio-demographic attributes, as well as perceptions of teledentistry use during the pandemic, and its future application. Descriptive statistics including frequency distribution of categorical variables and univariate analysis of continuous variables were conducted. Chi-square test was used determine the associations between professionals' attributes such as age, gender, years of practice, and location of practice, and respondents use of teledentistry. SPSS Version 28.0 was used for statistical analysis. RESULTS: Overall, 456 dentists completed the survey. The majority were general dentists (91%), worked in private practices (94%), were between 55 and 64 years old (33%), and had over 16 years of professional experience (72%). Approximately 49.3% reported using teledentistry; 13% started before the pandemic, and 36% during the pandemic. The most common reason for non-utilization was a lack of interest (54%). Respondents identified patient triage, consultation, and patient education as the three most important uses of teledentistry. Female dentists (p < 0.05), dentist working in private practice (p < 0.05), and those who worked in a single dental office (p < 0.05) adopted teledentistry more during the pandemic. Respondents who accessed more resources were more likely to report greater utilization of teledentistry, while those who reported being unconformable with teledentistry (p < 0.05) reported less utilization. Additionally, participants who reported feeling comfortable discussing teledentistry with others (p < 0.05), were more inclined to use it in the future. CONCLUSIONS: Participants expressed mixed perceptions toward teledentistry with more than half indicating it is reliable for patient triaging and patient follow-ups. Despite the increased utilization during the COVID-19 pandemic, participants' lack of interest in teledentistry emerged as a barrier to its use. More education and knowledge dissemination about teledentistry's areas of application and technical aspects of use can increase interest in this tool, which may lead to a greater uptake by dental professionals.

The impact of dental care programs on healthcare system and societal outcomes: a scoping review.

BACKGROUND: Dental diseases have detrimental effects on healthcare systems and societies at large. Providing access to dental care can arguably improve health outcomes, reduce healthcare utilization costs, and improve several societal outcomes. OBJECTIVES: Our objective was to review the literature to assess the impacts of dental care programs on healthcare and societal outcomes. Specifically, to identify the nature of such programs, including the type of services delivered, who was targeted, where services were delivered, and how access to dental care was enabled. Also, what kind of societal and healthcare outcomes have been attempted to be addressed through these programs were identified. METHODS: We conducted a scoping review by searching four databases, MEDLINE, EMBASE, CINAHL, and Sociological Abstracts. Relevant articles published in English language from January 2000 to February 2022 were screened by four reviewers to determine eligibility for inclusion. RESULTS: The search resulted in 29,468 original articles, of which 25 were included in the data synthesis. We found minimal evidence that answers our proposed research question. The majority of identified programs have demonstrated effectiveness in reducing medical and dental healthcare utilization (especially for non-preventive services) and avert more invasive treatments, and to a lesser degree, resulting in cost-savings. Moreover, some promising but limited evidence about program impacts on societal outcomes such as reducing homelessness and improving employability was reported. CONCLUSION: Despite the well-known societal and economic consequences of dental problem, there is a paucity of studies that address the impacts of dental care programs from the societal and healthcare system perspectives. MESH TERMS: Delivery of Health Care, Dental Care, Outcome assessment, Patient acceptance of Health Care.

Does Vaping Increase the Risk of COVID-19 Transmission and Make Individuals Who Vape Susceptible to Infection and Prone to Severe Illness? A Review.

The predominant mode of transmission of SARS-CoV-2 virus and coronavirus disease 2019 (COVID-19) is aerosols, and e-cigarettes/vaping products are a source of aerosols. There is a public health concern that the use of these products may increase the risk of COVID-19 transmission, susceptibility to COVID-19 and severity of the disease. Based on a review of existing literature, we found emerging evidence that suggests that people who vape are at higher risk of COVID-19, and, because of compromised lung function, their susceptibility to the disease and the severity of outcomes is increased. Aerosols generated by vaping products could be involved in the transmission of the virus when people are close to others who have been diagnosed with COVID-19 and are vaping. These findings may be useful to health care professionals, including dental professionals, in providing evidence to support informing patients about vaping and how the use of vaping products impacts the risk of COVID-19 transmission, infection susceptibility and severity of illness.

Domestic violence and abuse related emergency room visits in Ontario, Canada.

BACKGROUND: Hospitals' emergency rooms (ERs) are generally the first point of contact of domestic violence and abuse (DVA) victims to the health care system. For efficient management and resource allocation for ERs to manage DVA-related emergencies in Canada, it is important to quantify and assess the pattern of these visits. METHODS: Aggregate DVA-related ER visits data, using relevant ICD-10-CA codes, from 2012 to 2016 were retrieved from IntelliHealth Ontario. The 2011 ON-Marg (Ontario Marginalization) indices were linked at the Dissemination Area level to ER data. Descriptive analyses including total number and rate of visits per 100,000 people were calculated, stratified by age and sex. The Slope Index of Inequality (SII) and Relative Index of Inequality (RII) were also assessed. RESULTS: From 2012 to 2016, 10,935 (81.2% by females and 18.8% by males) DVA-related visits were made to ERs in Ontario. An annual average of 25.5 visits per 100,000 females and 6.1 visits per 100,000 males was observed. Residential instability and deprivation were significant predictors of DVA-related ER visits. No particular site of injury was indicated in 38.5% of visits, 24.7% presented with cranio-maxillofacial (CMF) trauma in isolation, 28.9% presented with non-CMF injuries, and 7.9% visits presented with both CMF and non-CMF injuries. CONCLUSION: This study identified that the burden of DVA-related ER visits is large enough to warrant timely public health interventions, and observed that certain populations in Ontario experience more DVA and/or are more prone to its impact. Our findings have important implications for various stakeholders involved in planning and implementing relevant policies and programs.

How Often Are Dental Care Workers Exposed to Occupational Characteristics that Put Them at Higher Risk of Exposure and Transmission of COVID-19? A Comparative Analysis.

INTRODUCTION: Occupational characteristics of dental care - including closed environment, proximity to staff and patients and the use of aerosol-generating procedures - put workers at high risk of COVID-19 exposure and transmission. We describe the frequency of workplace situations that potentially increase the risk of exposure to COVID-19 in dental care compared with other occupations including health care. METHODS: We conducted a cross-sectional study using sociodemographic and occupational data from the 2016 Canadian census linked to workplace characteristics from the Occupational Information Network (O*NET) dataset. We assessed frequency of workplace indicators using an intensity score from 0 (low) to 100 (high) from O*NET on exposure to infection or disease, physical proximity to others, indoor controlled environments, standard protective equipment and specialized protective equipment. RESULTS: In 2016, 87 815 Canadians worked in the 5 dentistry occupations of interest: dentists; denturists; dental hygienists and dental therapists; dental technologists, technicians and laboratory assistants; and dental assistants. These occupations were routinely ranked in the top 10 of all occupations examined in terms of exposure to workplace indicators that increase the risk of exposure to COVID-19. Dental hygienists and dental therapists, dental assistants, dentists and denturists, rank as the top 4 occupations, in that order, with the highest exposure to disease or infection and physical proximity to others combined. CONCLUSIONS: Compared with other occupations, dental care workers are at a higher risk of occupational exposure to COVID-19. These results support the development of workplace guidance to reduce the risk of COVID-19 transmission and enhance the well-being of the dental care workforce.

What non-clinical factors influence the general dentist-specialist relationship in Canada?

BACKGROUND: The general dentist-specialist relationship is important for effective patient care and the professional environment. This study explores the non-clinical factors that may influence the general dentist-specialist relationship in Canada. METHODS: A cross-sectional web-based survey of a sample of general dentists across Canada was conducted (N ≈ 11,300). The survey collected information on practitioner (e.g., age, gender, years of practice) and practice (e.g., location, ownership) factors. Two outcomes were assessed: not perceiving specialists as completely collegial and perceiving competitive pressure from specialists. Binary and multivariable logistic regression analysis was conducted. RESULTS: A total of 1328 general dentists responded, yielding a response rate of 11.7%. The strongest associations for perceiving specialists as not completely collegial include being a practice owner (OR = 2.15, 95% CI 1.23, 3.74), working in two or more practices (OR = 1.69, 95% CI 1.07, 2.65), practicing in a small population center (OR = 0.46, 95% CI 0.22, 0.94), and contributing equally to the household income (OR = 0.47, 95% CI 0.26, 0.84). The strongest associations with perceiving medium/large competitive pressure from specialists include having a general practice residency or advanced education in general dentistry (OR = 2.00, 95% CI 1.17, 3.41) and having specialists in close proximity to the practice (OR = 2.52, 95% CI 1.12, 5.69). CONCLUSION: Practitioner and practice factors, mostly related to business and dental care market dynamics, are associated with the potential for strained relationships between general dentists and specialists in Canada. This study points to the need for dental professional organizations to openly discuss the current state of the dental care market, as it has important implications for the profession.

Providing dental insurance can positively impact oral health outcomes in Ontario.

BACKGROUND: Universal coverage for dental care is a topical policy debate across Canada, but the impact of dental insurance on improving oral health-related outcomes remains empirically unexplored in this population. METHODS: We used data on individuals 12 years of age and older from the Canadian Community Health Survey 2013-2014 to estimate the marginal effects (ME) of having dental insurance in Ontario, Canada's most populated province (n = 42,553 representing 11,682,112 Ontarians). ME were derived from multi-variable logistic regression models for dental visiting behaviour and oral health status outcomes. We also investigated the ME of insurance across income, education and age subgroups. RESULTS: Having dental insurance increased the proportion of participants who visited the dentist in the past year (56.6 to 79.4%, ME: 22.8, 95% confidence interval (CI): 20.9-24.7) and who reported very good or excellent oral health (48.3 to 57.9%, ME: 9.6, 95%CI: 7.6-11.5). Compared to the highest income group, having dental insurance had a greater ME for the lowest income groups for dental visiting behaviour: dental visit in the past 12 months (ME highest: 17.9; 95% CI: 15.9-19.8 vs. ME lowest: 27.2; 95% CI: 25.0-29.3) and visiting a dentist only for emergencies (ME highest: -11.5; 95% CI: - 13.2 to - 9.9 vs. ME lowest: -27.2; 95% CI: - 29.5 to - 24.8). CONCLUSIONS: Findings suggest that dental insurance is associated with improved dental visiting behaviours and oral health status outcomes. Policymakers could consider universal dental coverage as a means to support financially vulnerable populations and to reduce oral health disparities between the rich and the poor.

The Use of Fluoride Varnish in Primary Care in Ontario: A Qualitative Study.

OBJECTIVES: Fluoride varnish (FV) has been shown to prevent dental caries. Physicians and nurses may be ideally situated to apply FV during well-child visits. Currently, public health units across Ontario have been successfully piloting this intervention. Yet, challenges remain at both the political and practice levels. The objectives of this research were to understand the perspectives of key stakeholders on making FV application a routine primary care practice in Ontario and to consider the potential enabling factors and barriers to implementation. METHODS: In this qualitative study, 16 key stakeholders representing medicine, nursing, dentistry, dental hygiene, public health and government were interviewed. Interview data were transcribed and coded, and a conceptual framework for implementing change to daily health care practice was used as a guide for thematic analysis. RESULTS: Our findings suggest that there is an opportunity for interdisciplinary care when considering children's oral health. There is also motivation and acceptance of this specific intervention across all fields. However, we found that concerns related to funding, knowledge and interprofessional relationships could impede implementation and limit any potential short- or mid-term window for meaningful policy and practice change. CONCLUSION: With respect to introducing FV into medical practice for children under 5 years of age, the many factors required to implement immediate change are arguably not in alignment. However, policymakers and practitioners are motivated and have identified opportunities for change that may form the foundation for this program in the future.

Dentists' Capacity to Mitigate the Burden of Oral Cancers in Ontario, Canada.

BACKGROUND: In Canada, although the incidence of smoking-related oral cavity cancers has decreased, oropharyngeal cancers associated with human papilloma virus (HPV) are on the rise. During their routine interactions with patients, dentists have the opportunity to intervene. This study was conducted to assess dentists' capacity to prevent and detect oral cancers and to identify the barriers and facilitators that affect this capacity. METHODS: A 25-item, self-administered questionnaire was emailed to Ontario dentists through their regulatory body. It aimed to assess their perceptions about various aspects of oral cancer prevention and detection, including their knowledge, attitudes and practices. A binary logistic regression model was constructed for each modifiable risk factor (smoking, alcohol use, HPV) to identify the predictors of dentists' readiness to discuss with patients the connection between risk factors and oral cancers. RESULTS: Of the 9975 dentists contacted, 932 completed the survey. Most respondents (92.4%) believed that they are adequately trained to recognize the early signs and symptoms of oral cancer. However, only 35.4% of respondents said that they are adequately trained to obtain biopsy samples from suspected lesions. In addition, only a small proportion (< 40%) of the dentists believed that they are adequately trained to address relevant risk factors. Compared with dentists who said that they are adequately trained and currently assess a given risk factor, the odds of discussing the risk factor were consistently and significantly lower among those who said that they are inadequately trained (OR: smoking 0.11, alcohol 0.52, HPV 0.36) and among those who do not currently assess that risk factor (OR: smoking 0.12, alcohol 0.22, HPV 0.23). CONCLUSIONS: This study suggests that the capacity of Ontario dentists to detect and prevent oral cancers is limited by lack of training in using oral cancer screening tools and addressing risk factors. To mitigate this barrier, dentists' capacity could be enhanced by improving their training in detecting oral cancers and their readiness to assess and address the risk factors.

Acute and chronic diabetes complications associated with self-reported oral health: a retrospective cohort study.

BACKGROUND: Oral health is associated with diabetes, but the chances of experiencing acute or chronic diabetes complications as per this association is unknown in Canada's most populous province, Ontario. This study assesses the impact of self-reported oral health on the likelihood of experiencing acute and chronic complications among a cohort of previously diagnosed diabetics. METHODS: A retrospective cohort study was conducted of diabetics (n = 5183) who participated in the Canadian Community Health Survey 2003 and 2007-08. Self-reported oral health status was linked to health encounters in electronic medical records until March 31, 2016. Multinomial regression models determined the odds of the first acute or chronic complication after self-report of oral health status. RESULTS: Thirty-eight percent of diabetics reporting "poor to fair" oral health experienced a diabetes complication, in comparison to 34% of those reporting "good to excellent" oral health. The odds of an acute or chronic complication among participants reporting "poor to fair" oral health status was 10% (OR 1.10; 95% CI 0.81, 1.51) and 34% (OR 1.34; 95% CI 1.11, 1.61) greater respectively, than among participants experiencing no complications and reporting "good to excellent" oral health. CONCLUSION: Self-reporting "poor to fair" oral health status is associated with a greater likelihood of chronic complications than acute complications. Further research regarding the underlying causal mechanisms linking oral health and diabetes complications is needed.

Addressing health inequities in Ontario, Canada: what solutions do the public support?

BACKGROUND: As public opinion is an important part of the health equity policy agenda, it is important to assess public opinion around potential policy interventions to address health inequities. We report on public opinion in Ontario about health equity interventions that address the social determinants of health. We also examine Ontarians' support and predictors for targeted health equity interventions versus universal interventions. METHODS: We surveyed 2,006 adult Ontarians through a telephone survey using random digit dialing. Descriptive statistics assessed Ontarians' support for various health equity solutions, and a multinomial logistic regression model was built to examine predictors of this support across specific targeted and broader health equity interventions focused on nutrition, welfare, and housing. RESULTS: There appears to be mixed opinions among Ontarians regarding the importance of addressing health inequities and related solutions. Nevertheless, Ontarians were willing to support a wide range of interventions to address health inequities. The three most supported interventions were more subsidized nutritious food for children (89%), encouraging more volunteers in the community (89%), and more healthcare treatment programs (85%). Respondents who attributed health inequities to the plight of the poor were generally more likely to support both targeted and broader health equity interventions, than neither type. Political affiliation was a strong predictor of support with expected patterns, with left-leaning voters more likely to support both targeted and broader health equity interventions, and right-leaning voters less likely to support both types of interventions. CONCLUSIONS: Findings indicate that the Ontario public is more supportive of targeted health equity interventions, but that attributions of inequities and political affiliation are important predictors of support. The Ontario public may be accepting of messaging around health inequities and the social determinants of health depending on how the message is framed (e.g., plight of the poor vs. privilege of the rich). These findings may be instructive for advocates looking to raise awareness of health inequities.

An exploratory pilot study to assess self-perceived changes among social assistance recipients regarding employment prospects after receiving dental treatment.

BACKGROUND: Strengthening self-efficacy in job-seeking among individuals with dental problems has been identified as an important factor in facilitating job procurement and maintenance. There is no knowledge about whether receiving dental treatment improves someone's self-efficacy in seeking a job. This work explores this relationship. METHODS: An exploratory pilot study of a convenience sample of 30 social assistance recipients of Ontario, Canada, was conducted using a pre- and post-dental treatment survey, which included both quantitative and qualitative components. The survey included two validated instruments Oral Health Impact Profile (OHIP-14) and Job-Seeking Self-efficacy scale (JSS). Changes in scores of both scales following dental treatment were calculated. Pearson correlation was performed between OHIP-14 and JSS scores. Qualitative data were transcribed and interrelated ideas were grouped together to generate themes. RESULTS: Mean scores for OHIP-14 (23.4 to 6.7, p < 0.001, effect size: 1.75) and median scores for JSS (4.9 to 5.5, p = 0.002, effect size: 0.40) changed significantly after receiving dental treatment. A significant negative correlation (-0.56, p = 0.001) was observed between OHIP-14 and JSS scores indicating that job-seeking self-efficacy improves with improvement in oral health related quality of life (OHRQoL). Qualitative analysis reveals participants' physical and psychosocial impacts of dental problems; barriers experienced in accessing dental care and seeking a job; and changes perceived after receiving dental care. CONCLUSION: Results of our survey indicate that social assistance recipients experience negative impacts of dental problems and perceive improvements in OHRQoL and job-seeking self-efficacy after receiving dental treatment.