The Role of Dental Treatment in Welfare-to-Work

Background: Social assistance recipients in Canada receive limited dental care in order to meet health needs and to promote the move from welfare-to-work. Policy advocates argue for the expansion of such services for similar reasons. However, the hypothesis that dental care can improve the chances of employment has been rarely tested. This project was designed to provide policy makers better understanding about the relationship between dental treatment and employment outcomes among social assistance recipients of Ontario, Canada. Methods: First, we conducted a systematic review of the relevant existing literature. Then we designed a retrospective cohort study using large administrative data (total n = 8742) from five Ontario regions and from the province’s social assistance ministry. We also conducted an exploratory pilot study of a convenience sample of assistance recipients (n = 30) using a pre- and post-dental treatment survey. Results: Systematic review revealed minimal and weak evidence concerning the idea that dental services can improve employment outcomes. Our retrospective cohort study showed no significant difference in employment outcomes between treatment and no-treatment group (adjusted odds ratio = 0.93; 95% CI: 0.83-1.03). However, over the one year, people who received treatment (124% increase) had significantly better trajectory (p=0.0014) of leaving assistance as compared to their counterparts (83% increase). Our pilot study revealed that both oral health related quality of life (OHRQoL) and job-seeking self-efficacy (JSS) improved significantly after receiving dental care and there was a significant correlation between these two outcomes. Conclusion: Our research suggests that at one year, dental treatment does not appear to be significantly associated with leaving social assistance for employment. However, people who received dental treatment appeared to be particularly disadvantaged and dental treatment may have helped to level them up in terms of employment outcomes over time. Also, our results indicate that OHRQoL and JSS are correlated.Ph.D