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26
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2017
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Issue 2
I
ssues and
P
eople
Can you tell us about the Healthy Smile Happy
Child initiative?
It started in 2000, partly in response to the increasing
demand for operating room time and the growing wait
list for dental surgery. One of our members stressed
that we should be working more upstream, that we
couldn’t just be reactive. In other words, we had to
be able to anticipate needs and raise community
awareness, and by doing so hopefully lead to improved
oral health.
We started by working with four communities. We
assessed the oral health knowledge of parents and
the oral health status of preschoolers. We then shared
our findings with the communities and we provided
capacities for them—including a project coordinator—
to move forward with ideas. Some communities opted
for posters showing the quantity of sugar in drinks
often put in bottles and sippy cups, others went for
games and fact sheets. Five years later, we reassessed
the communities to get a sense of the changes that
had since happened. Attitudes and knowledge have
improved. There wasn’t a huge impact on the dental
findings, but we saw a modest—yet statistically
significant—improvement in the prevalence of severe
ECC. It was encouraging evidence that listening to
communities and following through can help. We’re
now hoping to scale up the program to include Metis
and First Nations communities.
How do you get buy-in from stakeholders?
Some recognize the value proposition right away and
are committed from day one, others need to reflect on
the role they can play. A challenge when working with
a new community group is building trust. Some of our
partners facilitate that brokering of relationship for us;
our allies help us network and develop relationships
with new communities. If I didn’t have this network to
rely on, I think I’d be struggling to find communities
interested in working and applying to a grant related to
oral health.
When you work with communities, sometimes it’s
about giving up control and listening to what they
want and value. You don’t have to abandon all of your
principles and ideas, but you must incorporate their
ideas and wishes into the project. For example, one of
our long-time team members from a rural community
suggested that creating short YouTube videos might be
a good way to make sure new employees know about
the Healthy Smile Happy Child program. They might
not come to an orientation session, but they might
have 5 minutes to watch a video. We followed through
and had summer students work on that last year.
Dental benefits aside, what are some of the
access to care barriers?
One barrier often faced by low-income and working-
poor families is that their work schedules often conflict
with clinic hours. Taking a child in for care often means
taking time off from work, and that can translate into
a loss of much-needed income. We cannot expect all
patients to be able to come to our practices during
regular business hours. For 15 years now, I’ve been
doing an evening clinic twice a week—it’s our only
community-based program in the province with an
after-hour service. Transportation and childcare are
other issues that add to the “cost” of visiting the dentist.
I know it’s an uncomfortable topic, but there’s also
stigmatization. Sometimes people perceive that they’re
not being treated fairly. They may think that we’re
shaming them when we ask that they bring along their
income tax information. But I know that we need that
information to see if they qualify for the program, yet if
it’s not done discreetly, it can cause embarrassment.
Also, having dental insurance doesn’t mean you’re
financially off the hook. When a specialist tells a
parent they need to prepay for their child’s surgery,
it can become a real struggle financially. Not many
families can easily write that cheque and just wait for
reimbursement.
When it comes to refugees and new immigrants, there
can also be a language barrier. We’ve been blessed that
the Winnipeg Regional Oral Health Authority employs
When you work with communities, sometimes it’s
about giving up control and listening to what they
want and value. You don’t have to abandon all of
your principles and ideas, but you must incorporate
their ideas and wishes into the project.