This study is the first to examine the characteristics of dental care use in Ontario. The results demonstrated that male gender, Aboriginal status, low educational attainment, low household income, and no dental insurance were significantly positively associated with poor dental care use. Likewise, those who smoked, seldom had alcohol, had less frequent teeth brushing, poor health of teeth and mouth, and had diabetes were at significantly increased odds of poor dental care use.
Among various age groups, those older than 18 years were at increased odds of not visiting a dentist within the past year and visiting only for emergencies. This was in accordance with Bhatti et al. whose results suggested a decline in frequency of dental visit as an individual ages . The findings of this study revealed that females were more likely to visit a dentist within the past year and not for emergency purposes, compared to males. Such gender differences in dental care utilization can be attributed to the positive attitudes and greater knowledge of oral health towards dental visits among females . Also, as suggested by previous studies, females were more proactive in maintaining healthy teeth and gum, and more likely to show preventive dental visit behaviors .
Individuals of Aboriginal status were more likely to report visiting a dentist in cases of emergency compared to non-Aboriginal people. This reflects the reluctance of Aboriginals to seek regular dental care and delay receiving immediate treatment until symptoms are severe . This reluctance to use dental care might originate from racialized views and stereotypes toward Aboriginal individuals that make them feel unwelcome at the dental office . The finding of the current study is in concordance with a study by Slater on public oral health care among Aboriginal Australians, that found that those of Aboriginal status were more likely to seek emergency services rather than preventive dental care services .
Consistent with previous literature, smokers were found to be less likely to report visiting a dentist within the past year than non-smokers . Our results also suggested that those who smoked usually visited a dentist for emergencies only compared to non-smokers. This could be due in part to the fact that smokers tend to engage in health-seeking behavior rather than preventive care behavior, even though regular dental visits are highly recommended for averting future periodontal disease, tooth loss, and other oral health complexities . Interestingly, our results revealed that those who consumed alcohol at least once per week were less likely to report having poor dental care use. This result was not in concordance with a longitudinal study in Sweden, which found that individuals with high alcohol use reported having more irregular dental visits than those with lower alcohol use In fact, previous studies have been inconsistent on the relationship between alcohol use and oral health, with the literature showing an overall weak association between alcohol consumption and risk of caries and periodontitis . On the other hand, light or moderate alcohol use was found to be positively associated with frequent dental checkups and with having more filled teeth in a study by Wu et al.  using NHANES data. Therefore, those who consumed alcohol were more likely to obtain dental fillings. A possible explanation for the relationship between heavy alcohol consumption and dental care use is that alcohol may enhance the release of fluoride from certain restorative materials in fillings, thereby reducing susceptibility to more dental caries by reducing oral cariogenic flora , and therefore requiring those who consume it to have less dental visits. Further research is needed to elucidate the role of alcohol consumption duration, patterns and volume in relation to dental care use and oral health outcomes.
The present study identified that less frequent teeth brushing and poor oral health of teeth and mouth were significantly associated with poor dental care use, as expected. This is in concordance with Muirhead et al. , who suggested that persons with poor oral health reported less dental care utilization, possibly resulting from the fear of dental cost treatment or the anxiety associated with the pain of treatment. This finding affirms that self-perception of oral health needs rather than actual oral health status is a predictor of dental care use. This fits in with Muirhead et al’s  “paradox of need”, where working poor individuals with worse self-rated oral health or who had a perceived need for treatment were poor dental care service users.
We also found that subjects with diagnosed diabetes were more likely to visit the dentist for emergency purposes only. This could be explained by fewer dental visits among diabetic patients due to lack of perceived need, cost barriers, and fear or anxiety , which may result in the development of serious dental or periodontal diseases that signifies an urgency for an emergency visit. Moreover, evidence suggests that people with diabetes are at increased prevalence of tooth decay and periodontitis, because of high levels of glucose in saliva that leads to proliferation of bacteria and occurrence of oral health complications . Interventions may need to be tailored to subpopulations within the community who are at high risk of experiencing dental problems.
The study had several strengths. To our knowledge, this is the first provincially representative study that examined the relationship between various demographic, socio-economic, health behavior, oral health and other health related factors and dental care use in Ontario. This study also utilized a large sample size allowing for ample statistical power, with population weights accounting for nonresponse bias. Confounding bias was minimized due to the variety of potential covariates that were controlled for in the analysis. However, some limitations are present. Given that this study is a secondary analysis, no information regarding other important dental health variables such as number of decayed/missing/filled teeth, flossing habits, and depth of periodontal pockets was available. Moreover, all variables, including the main outcome, were self-reported and the accuracy of responses is subject to recall bias. Lastly, the cross-sectional nature of the study design does not allow us to infer causality.