Disparities in the availability of dental care in metropolitan Toronto

The availability of dentists as a barrier to access to care has not been thoroughly explored, particularly in large cities. In this study, we aimed to identify disparities in the availability of dentists in Canada's largest urban centre, Toronto, and explore whether distributional disparities are associated with underlying factors, such as affordability as measured by average household income.

Geocoded data on number of dentists and population estimates for metropolitan Toronto's forward sortation areas (FSA) were used to calculate dentists per 100,000 population. Dentist density and average annual household income by FSA were then mapped using geographic information system techniques. Pearson testing was used to identify associations of various factors with dentist density. Significance testing was performed to compare average dentist to population ratios in high (> $100,000) and low ($40,000-$60,000) income FSAs.

Communities with high household incomes and high dentist density were clustered in central Toronto. Income-based disparities in dentist distribution were also observed. Compared with low-income FSAs, dentist density increased by a factor of 2.47 in the highest income FSAs. Dentist density also increased with income and education but decreased with immigrant level.

Dentist availability may be linked to demographic factors, including affordability. The income-based disparity in availability in Toronto was as high as that observed elsewhere between rural and urban communities.