About half of the dental plan's preauthorization requests are denied — what a stalled approval costs a dental student

On September 25 the Canadian Dental Association published the findings of its two-year assessment of the Canadian Dental Care Plan. Dr. Kirk Preston, the association's president, used the occasion to argue that the program's next phase turns on a question the plan's enrolment totals leave open: whether people who hold coverage can actually get care. The full paper, From Coverage to Care, follows on Parliament Hill on October 6. 12

Three of the findings it previewed land inside dental school clinics: a treatment approval that comes back denied, a hygienist or dental assistant who cannot be hired, and a national oral-health survey system that has gone quiet.

Health Canada updated its CDCP statistics page on September 15 with figures valid to August 31. For the 2026–27 benefit period the plan counts 4,764,250 enrolled members and 900,606 who have used their coverage to receive care, with 29,293 oral health providers participating. Since the plan opened, 7,535,054 people have been enrolled for at least one benefit period, and 4,830,986 have used the coverage. 3

One accounting change decides how these numbers compare with older coverage. Health Canada's tables for the two earlier benefit periods counted approved applicants; the current tables count unique enrolled members, which removes repeat applications and renewals. On the new basis, 2025–26 holds 6,321,601 enrolled members and 3,962,119 who received care, against an archived 6,562,659 approved applicants for the same year. The CDA's assessment cites the larger of those figures when it describes more than 6.5 million people enrolled in 2025–26 and nearly four million receiving care. 13

Before the plan pays for a crown, a set of dentures, a root canal or an extraction, the clinic often has to ask permission first. Preauthorization is the CDCP's version of predetermination: a provider submits the treatment plan, dated radiographs, a periodontal chart and the clinical rationale, and Sun Life adjudicates the request against criteria set by Health Canada. A decision usually holds for 12 months, and for some preventive and periodontal services for up to 24. A declined request can go back for reconsideration. 4

The services that carry that requirement include specialist examinations, restorative work, endodontic treatment, scaling and root planing beyond the plan's limits, partial and complete dentures, oral surgery, and sedation. 4

The CDA's assessment reports that approximately half of completed preauthorization requests are denied, and that 71% of the dentists it surveyed said a denial had affected a patient's oral health outcome. 1

A private practice absorbs a denial by booking someone else into the chair. A dental school clinic runs on treatment plans built to satisfy competency requirements, and those plans unfold over months. Western University's Schulich School of Medicine & Dentistry tells prospective patients that each appointment may run up to three hours, that they should be available for at least one clinic session every week, and that two missed appointments with less than 48 hours' notice can end their care at the clinic. 5 A student who loses a patient in the middle of a plan has to find another one, screen them, take a full history and start a fresh diagnosis, and the clinical credit the student was working toward moves further out.

The Dental Benefits Guide lists dental schools and educational institutions for oral health professions among the providers that can bill the plan, so the preauthorization paperwork runs through the school's own clinic staff. 4

The assessment puts Canada's shortage of dental hygienists and dental assistants at an estimated 7,200 vacancies, and places those shortages outside major urban areas. More than 90% of dentists now participate in the plan. 1

Hygiene and assisting staff decide how many chairs a school clinic can run and how much of the floor one instructor can supervise. The same shortfall reaches the community placements that federal training money pays for. The Oral Health Access Fund aims its projects at rural, remote, Northern and Indigenous communities, which is where the CDA says recruitment is hardest. 6

The fund is three-year money, announced in November 2025 at more than $35 million for 30 projects, alongside a longer-term envelope for care access and prevention. Its June 2026 round added projects in Northern, Indigenous and underserved communities. 67

Dr. Preston says the federal government now operates no dedicated national oral health surveys, which leaves the country unable to show whether the plan is improving oral health, which communities remain without care, or where the program needs to change. 1

Health Canada's own baseline report, published August 31, is built to describe the period before the plan existed. It compares the Canadian Oral Health Survey and the Canadian Community Health Survey between 2018 and 2024, and it states its purpose as monitoring the plan's impact from a documented starting point. 8

The starting point it documents: 31% of people in Canada held no insurance for dental expenses before the plan, rising to 42% of people in households under $90,000 against 18% at or above that income. Between 2018 and 2024, avoiding a dental visit because of cost rose from 29% to 34% in the lower-income group and held at 12% to 13% above it. Among people with low incomes, 39% had gone more than a year without seeing an oral health professional, compared with 20% of those with high incomes. The people who could become eligible for the plan reported persistent mouth pain at 30% against 22% across the population, and avoiding certain foods at 26% against 16%. 8

Three-year training grants are aimed at those gaps, and the case to renew them after the money runs out would rest on outcome evidence that no survey is currently collecting. The University of Saskatchewan's USASK-DATE program, which covers the share of treatment that the CDCP leaves to patients who qualify only partly for it, runs until its federal funding is exhausted. 9

Affordability still shapes behaviour at the front desk. In the CDA's surveys, 37% of eligible CDCP patients reported financial barriers to care, and 59% believed their coverage meant dental care would be completely free. 1 The same research found 88% of CDCP patients describing their experience positively, and the share of Canadians reporting no dental insurance falling from 35% to 25% over two years. 1

The complete paper arrives October 6 with more than 30 recommendations, grouped around four areas: the oral health workforce, clearer information for patients about costs and coverage, more transparent preauthorization decisions with reasons attached to denials, and the national surveys that would show whether the spending is working. 12

For a dental school, the four areas map onto the three things a clinic needs to finish a case: an approval, a team, and a reason for the funding to continue.