As Canada’s federal dental care program expands coverage, more residents without dental insurance are getting access to dental care. However, providers say delays in the pre-authorization process and paperwork issues make it difficult for some dental procedures to proceed.
More than half (52%) of pre-authorization requests were rejected between November 2024 and June 2025, according to Health Canada.
While most basic treatments, such as cleanings or fillings, do not require pre-authorization, more complex procedures, such as crowns or partial dentures, must be approved in advance and the clinic must provide additional materials, including X-rays and dental records, to prove medical necessity.
Dr. Bruce Ward, president of the Canadian Dental Association and a Vancouver dentist, said many dentists are confused by the rejections they receive when they prepare the materials they submit to private insurance in the past. He noted that the rejection rate for the program is much higher than that for private insurance.
The federal dental care program costs billions of Canadian dollars and is designed to reimburse treatment costs for Canadian residents who make less than $90,000 a year and do not have private dental insurance.
Since the full expansion of the program, people aged 18 to 64 have been covered. The Department of Health said that so far 5.2 million people have been approved, but only about 2.2 million have received treatment.
Ward mentioned that some patients received unexpected bills after treatment, and some areas have experienced backlogs of appointments.
Despite this, service providers generally believe that the program provides much-needed dental services to a large number of people, and the process is gradually improving. Currently, dental clinics must submit pre-authorization applications through Sun Life, which is the government-designated insurer.
Ward pointed out that some clinics have to wait weeks or even months to receive a response, and Sun Life often requires additional documents, further extending the processing time.
“A lot of people are waiting for approval of crowns,” Ward said. “There are a lot of applications waiting in line.” The Department of Health explained that the reasons for rejections and delays are various, including higher than expected applications and incomplete information.
In addition, many service providers also pointed out that there were technical problems with the initial submission software, but most of them have been resolved. The government also said that it is working to simplify the process and strengthen guidance for providers.
Currently, 80% of pre-authorization applications can be processed within 7 working days, and more than 90% of items such as basic cleanings and fillings do not require pre-authorization.
However, Donna Wells, professional practice manager of the Canadian Dental Hygienists Association, said the program still needs to be improved in terms of preventive care. For example, adults can only be reimbursed for one hour of dental cleaning services per year, while teenagers can only get 15 minutes.
“Some patients have not had oral care for many years because financial factors have become a barrier for them,” Wells pointed out. She also mentioned that many additional applications are still rejected.
With the expansion of the program in June, more than one million people have registered for the program, of which about 95,000 have received actual dental treatment. But this has also led to a backlog of services in areas such as the Atlantic provinces.
“This program is really great, but it also puts pressure on service providers,” said Natalie Marsh, vice president of the Canadian Dental Assistants Association and a dental assistant from North Sydney, Nova Scotia. Her clinic has appointments until spring 2026.
“A lot of patients haven’t seen a dentist for many years, and when they come, they need to deal with a lot of problems,” she added.
Providers also remind patients that the program doesn’t mean all treatment is free. The federal government’s reimbursement rates are often lower than provincial recommendations, and clinics charge provincial rates, resulting in the difference that patients have to pay.
“We had a patient come in a few weeks ago and was very upset because they mistakenly thought they were 100% covered,” Ward said, adding that all patients, including seniors, need to reapply for coverage every year.
Despite the challenges, Ward calls the national dental care program “excellent” overall. Other oral health groups have expressed similar sentiments.
“For a lot of people, this program is a ray of hope that they can afford their oral care,” Ward said. “It’s really meaningful. There are definitely some growing pains, but it’s moving in the right direction.”