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Example 3: Los Dientes Saludables: Improving the Number of Healthy Smiles in Our Community



Poor oral health can have a significant impact on one's quality of life. It can mean living with chronic pain, difficulty eating and speaking, and loss of self-esteem. Within our Latino community, more than 50% of adults have untreated dental decay and significantly fewer of our children have dental sealants to protect their teeth than the national average. While most residents recognize the importance of oral health, they give many reasons for neglecting them. They can't afford dental care. There's no dentist in their neighborhood. Doctors' hours conflict with their work schedules and they can't afford to take time off. The dentist doesn't speak their language. They have no dental insurance. Los Dientes Saludables formed to address shared barriers to dental care in order to promote healthy smiles throughout our community and greater total health.


Too few residents in our community have access to dental care.


The problem was framed as too few residents in our community have access to dental care. We chose to frame it in reference to the root condition or concern, not in terms of a specific solution ("Too few residents in our community can afford dental care" or " There are too few dental professionals in our community"). While these framings point to potential interventions, they increase the possibility of conflict over means and could potentially divide the initiative. However, framing the problem as "too few residents having access to dental care" helps potential opponents (over the means) find common ground in the desired outcome.


Ask questions about the issue/problem/goal to identify key behaviors and actors and their consequences:

Behaviors (and actors) that contribute to the problem of too little access to dental care in our Latino community include:

  • Community residents - may not practice good preventive behaviors; have limited transportation and financial resources; may have language barrier with dental professionals
  • Dental professionals - do not have translators in offices; not located in our community or in areas convenient to public transportation; do not provide sliding scale fees or payment plans
  • Educators/teachers - oral health education not a priority; do not promote good oral health practices during school hours
  • Employers - not providing dental insurance; not allowing flex time for attending dental appointments
  • Dental schools - not actively recruit minority candidates; not requiring diversity awareness classes

This analysis suggests the need for a comprehensive intervention in which the behavior and practices of many people and institutions need to be modified in order to successfully increase access to oral health care.

A variety of people are affected by the need for better access to oral health care. They include: a) Latino children (primary tooth loss can lead to the need for orthodontics, poor preventive practices can lead to permanent tooth loss), b) Latino adults (poor oral hygiene can affect job acquisition and performance, tooth loss may result in chronic pain and difficulty speaking), c) dental professionals (who lose business, may be required to do more restorative care than preventive), and d) employers (may lose manpower to sick days, have greater turnover of employees due to excessive absences).

Oral health is an essential part of an individual's total health. Tooth decay and loss results in chronic pain and loss of self-esteem. The level of untreated dental problems is significantly greater in the Latino community than the white community, and the incidence of poverty and poor education only increases the gap in access. Increasing our community residents' access to preventive and restorative dental care will benefit their total health.

Analyze "root" causes of the issue or problem to identify the conditions/behaviors and related interventions that might contribute to improvement. (But why? analysis):

The problem is that too few residents have access to dental care.

  • "But, why?" Because they can't get to a dentist; because they can't communicate with the dentist; because they can't afford to pay for the services; because there are no dentists in their neighborhood
  • "But, why?" (Choosing one possible reason: Because they can't afford to pay for the services)
  • Because their jobs do not provide dental insurance and dental offices require immediate payment for services without insurance
  • "But, why?" Because their employers have decided it is too expensive to pay for insurance; dental offices think it is too much of a hassle to offer payment plans or sliding fee scales

Based on this analysis of root causes, we can identify some specific conditions/behaviors and related interventions that might contribute to improvement. These include:

  • Too few dentists have offices in the Latino community (offer tax incentives to attract businesses
  • Too few employers offer dental insurance (lobby local businesses to include dental benefits as part of a comprehensive insurance plan; advertise availability of CHIP and Medicaid dental programs)
  • The importance of oral health is not promoted (promote oral health education in schools; encourage preventive dental health practices)
  • Lack of translators in dental offices (publicly praise multilingual dental professionals and encourage others to follow suit)
  • Available dental office hours are too restrictive (lobby local dentists to provide late week night and weekend hours for office visits)
  • Too few payment options for services exist (set up a fund from which individuals can draw from to pay for immediate services and repay over time)


Forces that are keeping the situation the same include: a) the problem is not widely recognized, b) the people most affected by it feel they lack significant political and economic power to influence the business and public health sector, and c) oral health professionals do not consider it a priority. Some forces that are causing things to change include: a) the growing influence of the Latino community politically, and b) national and regional public health initiatives addressing access and disparities in health care among ethnic minorities.


Our priority issue is to increase access to affordable dental care for those in our community. We know that poor oral health can significantly diminish one's quality of life by causing chronic pain, difficulty eating and speaking, and loss of self-esteem. Recent studies have even suggested that poor oral health is related to such chronic diseases as heart disease and stroke and higher risks of low birth weight and premature births. Seeing the interrelationships among oral and multiple health issues suggests the value of increasing the opportunity for dental care among the residents of our community.