School Dental Health Programme

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SCHOOL DENTAL

HEALTH PROGRAMME

Dept. of Pedodontics and Preventive Dentistry

Christian Dental College

Wednesday, 4th

May, 2011 Harsimran Singh Sethi

09.00am Final Year P.G. Resident


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The school based oral health program provides an opportunity to reach the largest number of children

during early stages of development when habit patterns can be more easily modified. The school setting

also provides an environment conducive to learning and reinforcement for a considerable period of time

and allows the teacher to use various strategies for inducing children to participate in appropriate

preventive oral health actions.

School health is an important branch of community health. It is an economical and powerful means of

raising community health in future generations. In 1885, William Fisher published a paper entitled

Compulsory Attention to the Teeth of School Children. Following this, British dental Association

appointed a committee to investigate child dental health. The subsequent reports were an important

step towards the initiation and development of a School dental Service. On July 23 rd 1898, School

Dentists Society was formed in London.

History

The beginning of School health service in India dates back to 1909, when for the first time medical

examination of children was carried out in Baroda city. The Bhore committee in 1946 reported that

School Health Service were practically non-existent in India, and where they existed, were in an

underdeveloped state.

In 1953, the secondary Education committee emphasized the need for school nutritional programs. In

1960, the government of India constituted a School Health committee and submitted its report in 1961.

In Jan 1982, the task force constituted by the Government of India to accomplish the School Health

Survey, submitted its report, according to which only 14 states had some progress with their own health

department budget.

Definition of School Health services

The committee on Terminology of the American association for Health, Physical Education and

recreation (1951) has defined school Health services as the procedures established to appraise the

health status of pupils and school personnel, to counsel pupils, parents, and others concerning appraisal

findings, to encourage the correction of remedial defects, to assist in identification and education of

handicapped children, to help prevent and control disease and to provide emergency service for injury

or sudden sickness.

Aspects of a School health Service

Health appraisal Health counseling Emergency care and first aid

Curative Services School health education Maintenance of school health records

Objectives

To help every school child appreciate the importance of a healthy mouth. To help every school child

appreciate the relationship of dental health to general health & appearance. To encourage the


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observance of dental health practices, including personal care, professional care, proper diet, & oral

habits. To enlist the aid of all groups & agencies interested in the promotion of school health. To

correlate dental health activities with the total school health program. To stimulate the development of

resources to make dental care available to all children & youth. To stimulate dentists to perform

adequate health services for children.

Ideal Requirements

Be administratively sound. Be available to all school children. Provide the facts about dentistry & dental

care. Aid in development of favorable attitudes toward dental health. Provide environment for

development of psychomotor skills necessary for tooth brushing. Include primary preventive dentistry

program. Provide screening methods.

Advantages of a school based program

Dunning has pointed out the advantages as:

The children are available for preventive or treatment procedures. School Clinics are less threatening

than private offices. A school dental program facilitates central education on dental subjects. The dental

service supplements the nursing services by helping to provide total health care for school children.

A school primary preventive dentistry program should not impose an excess or unusual teaching burden

on teachers and should be cost effective in manpower, money and material and should produce

observable results.

These guidelines can be met by considering three different levels of care. These Levels of Care are: -

The first level program involves only participation by the existing staff and superimposes on

additional time commitment other than that expected within the present school curriculum.

The dental hygienist/dental nurse are the key individual to the accomplishment of the next level

of sophistication in this program, as the training focuses on the delivery of preventive procedures.

The third and final level of preventive dentistry sophistication is the identification and referral

for early treatment of pathology.

ELEMENTS OF A SCHOOL DENTAL HEALTH PROGRAM

Improving school-community relations: - One of the first steps in organising a school dental health

program is the formation of a community dental health council or advisory community. It should include

broad representation from parents, teachers, health officers and community leaders. These

communities are important in improving the school-community relations and make people realize the

importance of dental health and the school administrations concern in the promotion of dental health.


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Conducting dental inspections: -

Dental inspections are necessary because: Dental inspection is an opportunity for individual health

education. Dental inspection also provides baseline information upon which the treatment program can

be built. Positive findings on inspection serve as motivation for dental health measures.

Benefits of dental inspections: It serves as a basis of school dental health instructions. It builds a positive

attitude in the child towards the dentist and the dental care. The child is motivated to seek adequate

professional care. Baseline and cumulative data is obtained. Status of dental needs is ascertained.

Limitations of dental inspections: School inspections may be treated as comprehensive treatment by

parents and complete treatment by a family dentist may not take place. It is desirable for parents to be

present for dental inspections, which is not always feasible in schools.

Conducting Dental health education: - A school dental health Program should include a suggested

formal approach to teaching dental health in the classrooms. The dentist serves as the expert resource

person to strengthen the teachers classroom instruction program.

Performing specific programs: -

Tooth brushing programs

In school tooth brushing programs, it is necessary to distinguish between the mechanical action of tooth

brushing and the desired objective of plaque removal. In a classroom program, groups of 6-8 children

can be taught brushing techniques and then, the children may be asked to chew a disclosing tablet.

Once plaque deposit areas are revealed, the instructor can teach guided brushing.

Classroom based fluoride programs

Fluoride Mouthrinse Program: - A once a week fluoride mouth rinse program can be instituted.

The rinse should be non-sweetened and non-flavoured and are advised for grades 1-12 and not below.

5ml of a 0.2% of the rinse is dispensed into a plastic cup and the children are instructed to rinse for a

minute.

Fluoride tablet program: - One tablet is given to each student. The students chew, then swish

the 2.2 mg sodium fluoride around the mouth for a minute and then swallow. The swish and swallow

technique allows the benefit of a topical application. The daily tablet is more effective than a weekly

rinse.

School water fluoridation programs

School water fluoridation programs make fluoride available to children, for whom dental caries is a

major problem, as compared to older age groups. The amount of fluoride added to school drinking

water must be greater than that used in communal water supplies since children are in school for

shorter hours than at home. 40% reduction in dental caries is reported.


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In 1954, a school water fluoridation pilot study was initiated at St Thomas V.S. Virgin Islands, by the U.S.

Public Health Service division of dental health. The school water was fluoridated slightly over 3 times the

optimum indicated for the community water. After 8 years, students showed 22% less caries experience

than children drinking non-fluoridated school water. Despite various studies documenting the

effectiveness of school water fluoridation, it has not been widely implemented. One major disadvantage

of school water fluoridation is also that children do not receive its benefits until they begin school.

Nutrition as part of school dental policies

School lunch programs/mid-day meals are designed to provide the child with an intake of nutrients that

approximate one third of the daily intake of essential carbohydrates, proteins, fats, minerals and

vitamins.

The school dietician, dental hygienist, or teacher can aid sugar discipline through counselling. Emphasis

cannot be on total restriction of sugars; it should be on reducing the frequency of intake and selecting

sugar products that are rapidly cleared from the mouth.

MID DAY MEAL PROGRAM OF GOVERNMENT OF INDIA: - It is to provide free food grains at

3kg/child/month to children of class 1st

to 5th

of government schools.

Objectives of the Program

To improve enrolment & attendance To reduce school drop outs

To improve child health by increasing nutrition level

Sealant placement: -

The placement of pit and fissure sealants is ideally suited for a school dental health program. 1 st and 2nd

grades (because the 1st

molars are sufficiently erupted), 6th

and 7th

grades (because 2nd

molars are

erupted) would be desirable grades to intervene to prevent pit and fissure lesions. Sealant placement,

followed by an application of fluoride, helps provide a continuous protection of the whole tooth.

Science fairs: -

Local and state dental associations can organise science fairs, painting competitions, best smile and

teeth competitions where students can exhibit projects. Literature should be provided for students,

outlining possible dental projects and offering assistance of local dentists to help students develop

projects. Such projects increase awareness among students and the community at large.

Referral for dental care

Many schools do not provide dental care within the school itself, such schools have to refer children to a

dentist for proper dental treatment. Most schools also require the patients to be notified in writing of

dental problems.


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Blanket referral: - In this program, all children are given referral cards to take home and

subsequently to the dentist, who signs the cards upon completion of examination or treatment or both.

The signed cards are then returned to the school nurse, or the classroom teacher, who plays an

important role in following up referrals.

Follow-up of dental inspection

Issuance of referral slips is of little importance to children if steps are not taken to follow up dental

therapy. The dental hygienist is a good candidate to follow up dental examinations. Classroom teachers

may also be allotted for this purpose. It is also important that someone from school health services co-

ordinate the work of various teachers.

ADVANTAGES OF SCHOOL BASED DENTAL PROGRAMS

School dental health programs can bring school children when they are gathered in school for non

dental reasons. A combination of education and health facilities is practical both ideologically and

logistically. Higher utilization of dental care services has been obtained by this method than any other.In addition, the childrens daily contact with the dental personnel in other roles has a lasting effect on

their attitudes towards dentistry in general. By providing certain basic dental services at govt expense,

low income groups are also able to afford dental care of a specialized nature when necessary.

SCHOOL DENTAL CLINICS

School dental health clinics are less threatening to children, since they are in familiar surroundings. The

location of dental clinics in school premises favours dental health education. Members of the dental

health team can engage in classroom teaching and also reinforce their message at the chair-side. School

dental health clinics also facilitate peer review, either at the informal level or formal level. When

associated with medical clinics, medical problems of children can be addressed simultaneously.

DISADVANTAGES OF SCHOOL BASED DENTAL CLINICS

a) Short school hours and frequent vacations make full time employment of dental personneldifficult and thus make availability of personnel a problem.

b) One-chair dental clinics as seen in older school programs have proven insufficient to address thehealth needs of the entire school.

VARIOUS SCHOOL BASED DENTAL PROGRAMS

TEXAS STATEWIDE PREVENTIVE DENTISTRY PROGRAM- TATTLE-TOOTH PROGRAM

Program Development

The Tattle-tooth program was first developed in the 1970s as a cooperative effort between Texas oral

health professional organizations, through a grant from the Dept. of Health and Human Services to the


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bureau of dental health. This program was initially implemented with approx 50,000 children in Texas

per year.

In 1985, the Texas legislature mandated that the essential elements for comprehensive health education

be incorporated in the curriculum state-wide. In 1989, the Bureau of Dental Health developed a new

program, Tattletooth II-A for grades kindergarten through six. In 1993, a pre-school programme titledSuperbrush was completed by the Bureau of Dental Health.

The pre-school curriculum was designed for use with personnel in head start programs, pre

kindergarten, public and private child care centres, public school programs and family day care homes.

The curriculum contains:

1. Children-directed activities that children do largely on their own2. Teacher- directed activities that teachers do with children on large or small scale groups

Program Philosophy and goals

To reduce dental caries and develop positive dental habits to last a lifetime in participants. To convince

students at preventing dental diseases is important and can be done by them. To focus on dental health

as part of total health.

Program implementation

Dental hygienists serve as technical consultants for school districts and promote dental education.

Supported materials are available for teachers and program hygienists. Teachers are trained to present

dental health information for school-aged children. They are also encouraged to invite a dental

professional to demonstrate brushing and flossing in the classrooms. A field trip to a dental office is

strongly recommended for kindergarten children.

NORTH CAROLINA STATEWIDE DENTAL PUBLIC HEALTH PROGRAM

Program development

The need for an oral health program was realised as early as 1918 in North Carolina and oral hygiene

was added to the North Carolina Public Health Program. In 1970, the North Carolina Dental Society

passed resolutions advocating a strong preventive disease program embracing school and community

fluoridation, fluoride treatment of school children, continuing education on prevention for dental

professionals and plaque control education in schools and communities.

In 1973, a report prepared for the North Carolina Dental Society defined the extent of dental disease

problem and resulted in the initiation of a 10- year program to reduce dental disease. In the same year,

a coalition of several agencies set up a committee that was responsible for developing a practical plan

for a program in schools. With the North Carolina Oral Health Survey in 1986, the Oral Health section

started the process of establishing new long range goals for the state that reinforce and expand on

those started in 1973.


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Program philosophy and goals

1. The North Carolina Oral Health Sections goals are based on prevention and education. Primaryprevention and education are considered to be the most effective means of decreasing dental

disease and promoting oral health.

2. School-age children are the primary focus.3. Fluoride and sealants are recognised as the most effective public health measures for

preventing dental caries.

Program Implementation

Teachers are trained to present dental health information for school-age population. The priorities are

community water fluoridation, fluoride mouth rinse programs and sealants. Public health dental staff

provides training and consultative services to teachers, parents, professionals and community. Several

teaching aids are used- videotapes, guides and exhibits.

SCHOOL HEALTH ADDITIONAL DEVELOPMENT PROGRAM (SHARP)

This program was developed in Philadelphia where the lowest rate for correction of physical defects

prevailed. The purpose of the program was to motivate parents into initiating action for correction of

defects in their children through effective utilization of community resources.

BRIGHT SMILES BRIGHT FUTURES (COLGATE)

Colgate Oral Pharmaceuticals have developed an oral health educational program to teach children

about caring for their teeth through proper oral hygiene, diet and physical activity. The program

enhances childrens self esteem while giving them information about taking care of their oral health.

Available material includes books, videos, posters, stickers, charts and guides for teachers or

professionals administering the program. In several communities, a mobile van staffed by volunteer

dental professionals provides dental attention on wheels, screening children and providing referrals for

additional needed treatment and aims to provide dental care and information to children at risk for

dental problems.

CRESTS FIRST GRADE ORAL HEALTH EDUCATION PROGRAM

Since 1961, Proctor and Gamble (P&G) has been providing the curriculum resources to schools

throughout America. The curriculum encourages youngsters to go for regular dental check-ups and

invites dental professionals to participate in classroom instruction.

Each year, Crest kits containing toothbrushes and toothpaste samples have been provided for children in

more than 20,000 classrooms. Materials are sent to participating schools each year in time for National

Childrens Dental Health month (Feb). P&G also provides educational materials for professional and

patient use.


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COORDINATED SCHOOL HEALTH PROGRAMS

One proven strategy for reaching low-income children most at risk for dental caries is through school

based programs with supporting linkages with health care professionals and other dental partners in the

community. In 1998, the National Centre for Chronic Disease Prevention and Health Promotion at CDC,

Division of Oral Health, provided funding support to state educational agencies.

The educational agencies in these states partnered with their state health depts. to promote, develop,

expand and evaluate school based models, integrating oral health into their existing Coordinated School

Health Programs (CSHPs). In 1999, the CDCs division of Oral Health provided 3 year funding to four US

states. These models serve as a foundation of a comprehensive integrated and sustainable approach to

address oral health needs of school aged children

DENTAL PROGRAMS IN PUNJAB

A survey conducted by the Health Department during the year 1989-90 revealed that nearly 84.4 % of

the State's population was suffering from one or the other Dental diseases. It was noticed that this

alarming rise in the Dental diseases was mainly due to the lack of awareness among the people about

the prophylactic, interceptive and curative treatment available in the existing infrastructure of the

Dental Health Care Services in the State.

It was also noticed that the Dental Surgeon population ratio was 1: 30000 in the urban areas. But the

ratio in the rural areas is 1:1.19 lacs. To provide the best of the Dental Health Care Services to the

people of the State, the Punjab Govt. has launched INTENSIVE DENTAL HEALTH CARE PROGRAMME for

school children, school teachers and general public, which is first of its kind in the country.

To reach the far-flung areas of each district one mobile Dental Clinic Van was provided to give

interceptive and curative treatment to the people at their doorstep. To monitor and implement all the

dental programmes it was proposed to establish a post of District Dental Health Officer for all the

districts of the State.

AIMS AND OBJECTIVE:

To bring down the incidence of oral and dental diseases to less than 40%. To bring down the Decayed

Missed Filled Teeth (D.M.F.T.) in School children of 6 12 years less than two. To achieve 25 % reduction

in number of persons without teeth after the age of 60 Years. To provide one dental clinic to serve the

population of 30,000 in the rural areas by opening 354 new Dental Clinics by the end of five years

plan. To provide total oral health coverage to all the school going children in the age group of 6 - 12

years. To provide Dental Health Education Training to all the primary school teachers, medical &

paramedical personnel. To organize special Dental Health Fortnights. To provide on the spot diagnostic

preventive interceptive & curative Dental Health Care Services to the people in the far flung rural

areas of the state and the school children through fully equipped Mobile Dental Clinic Vans.


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INTENSIVE DENTAL HEALTH CARE PROGRAMME: - Punjab is the only state in India which has launched

Intensive Dental Health Care Programme in the year 1989-90.

Under this Programme one sub-division is selected and the schools are covered block wise. After

covering the whole Sub-division the next Sub-division is taken up. At present three Medical Officers

(School Health Clinic-I, Intensive Dental Health Care Programme-I & P.H.C. Medical Officers (Dental) I)visits the schools as per the detailed programs circulated to them.

The Special feature of this Programme is that in addition to the imparting of Dental Health Education

training to the School children & detailed Oral Health check up, each child is given a mouth rinse with

the freshly prepared 2 % solution of sodium fluoride to arrest the initiation & progress of dental caries

and this process is repeated after every six months.

For school Children:

Targets and achievements are as under:

Year Target Achievements Children found

suffering from various

Dental Diseases

% age of children found

suffering from various

Dental Diseases

2005-06 2.5 Lacs 342213 123905 36.2

2006-07 3.0 Lacs 403880 127494 31.6

2007-08(Upto Dec. 07) 3.25 Lacs 212891 80215 37.7

The children suffering from Dental Diseases are provided necessary Dental treatment on the Mobile

Dental Clinic Vans. One day dental health education training workshop/camps are being held for primary

school teacher, Medical and Paramedical Personnel so as to update their knowledge about commonly

prevailing Dental diseases among the School children and their preventive measures to be taken.

Imparting of Dental Health Education to School Teachers, Medical and Paramedical Personnel:

Year Target Achievement

2005-06 6500 9505

2006-07 7000 10468

2007-08 (upto Dec. 07) 7500 4771


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Mobile Dental Clinic Van: Since the incidence of Dental Diseases is very high amongst the school

children particularly in rural areas, curative Dental Health Care Services and effective Prophylaxis against

Dental Caries can only be provided on the Dental Chair. So, it was decided to establish seventeen Mobile

Dental Clinics in the State (one for each District) so as to provide curative and prophylactic Dental Health

Care Services in the far-flung rural areas of the State and also to provide effective prophylaxis against

Dental Caries to the children in the Schools.

No. of Patients examined by the Mobile Dental Van during the year 2005-06 to 2007-08 are as under

Year Target Achievement

2005-06 70000 114287

2006-07 80000 90026

2007-08(upto Dec 07) 85000 44601

REFERENCES

1. Burt BA, Eklund SA (2005). Dentistry, Dental Practice and Community. 6th edition2. Jong AW (1994). Community Dental Health.3rd edition3. Haag JH (1972). School Health Program. 3rd edition4. Hiremath (2009). Textbook of Preventive and Community Dentistry. 2nd edition5.

Peter S (2009). Essentials of Preventive and Community Dentistry. 4

th

edition6. Yazdani R, Vehkalahti MM et al. School-based education to improve oral cleanliness and gingival

health in adolescents in Tehran, Iran. Int J Paediatr Dent. 2009 Jul;19(4):274-81

7. Shenoy RP, Sequeira PS. Effectiveness of a school dental education program in improving oralhealth knowledge and oral hygiene practices and status of 12- to 13-year-old school children.

Indian J Dent Res 2010 Apr-Jun;21(2):253-9.

Documents

School Dental Health Programme