School-based Oral Health Program Research Articles

Expanding School-based Oral Health Programs in the Carolinas: Challenges and Opportunities

School-based oral health programs are an effective approach to population-based care and a stalwart of public health, especially in rural and underserved communities. Lessons learned during the COVID-19 pandemic have informed contemporary strategies and policies to ensure integration into the delicate dental safety net in the Carolinas.

Nourishing Smiles: Challenges and Lessons Learned from Implementing an Interprofessional School-based Oral Health and Nutrition Literacy Program for Adolescents

Nourishing Smiles: Challenges and Lessons Learned from Implementing an Interprofessional School-based Oral Health and Nutrition Literacy Program for Adolescents

Effectiveness of school oral health programs in children and adolescents: an umbrella review.

To evaluate the systematic reviews assessing the effectiveness of any type of school-based oral health programs in children and adolescents. A two-staged search strategy comprising electronic databases and registries based on systematic reviews was employed to evaluate the effectiveness of school-based interventions. The quality assessment of the systematic reviews was carried out using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) tool. The Corrected Covered Area was used to evaluate the degree of overlap. Nine reviews were included in this umbrella review. The Critical Covered Area reported moderate overlap (5.70%) among the primary studies. The assessment of risk of bias revealed one study with a high level confidence; one with moderate whereas all other studies with critically low confidence. Inconclusive evidence related to improvements in dental caries and gingival status was reported whereas, plaque status improved in a major proportion of the reviews. Knowledge, attitude, and behavior significantly increased in students receiving educational interventions when compared to those receiving usual care. The evidence points to the positive impact of these interventions in behavioral changes and clinical outcomes only on a short term basis. There is a need for long-term follow-up studies to substantiate the outcomes of these interventions.

The effectiveness of medical nurses in treating children with silver diamine fluoride in a school-based caries prevention program.

The sustainability of school-based oral health programs depends on the utilization of effective, efficient treatments and the availability of a trained clinical workforce. The objective of this study was to determine whether registered nurses are comparable to dental hygienists in the application and effectiveness of silver diamine fluoride (SDF) and fluoride varnish (FV) for the prevention of dental caries. CariedAway was a school-based study of SDF and FV versus dental sealants and atraumatic restorations. Within the SDF + FV arm, participants were treated by either a licensed dental hygienist or a registered nurse, both under the supervision of a paediatric dentist. Although initial treatment assignment in CariedAway was randomized, assignment to provider was not. The proportion of children who remained caries free after 2 years was assessed for non-inferiority using two-group proportion tests, adjusting for the clustering effect of schools. A total of 417 children with no untreated caries at baseline were analysed including 298 treated by hygienists and 119 by nurses. The proportion of children who remained caries free after 2 years was 0.81 and 0.80 for those treated by hygienists and nurses, respectively, for a difference of 0.01 (95% CI = -0.07, 0.098) and within the pre-determined non-inferiority margin. Nurses may be effective in treating children with silver diamine fluoride and other fluoride varnishes in school-based oral health programs.

Current knowledge about early childhood caries in the gulf cooperation council with worldwide reflection: Scoping review of the scientific literature (2010-2021).

Early childhood caries (ECC) is one of the most prevalent chronic childhood diseases affecting the primary teeth of children younger than 6 years of age. The disease etiology is complex and includes social, biological, and dietary factors. This review aims to explore the knowledge of ECC prevalence globally and locally within the Gulf Cooperation Council (GCC) countries during the years 2010-2021. Another aim is to explore oral health promotion programs with more focus on the GCC region. A search was conducted in PubMed, Medline, Scopus, the Cochrane Collaboration database, and Google Scholar to identify relevant studies published between 2010 and 2021 using specific keywords. Studies that utilized both the World Health Organization criteria and International Caries Detection and Assessment System for dental caries assessment were included. The included studies indicated considerable variation in the reported prevalence of ECC. While developed countries show low prevalence, countries in the GCC and other Arab countries show a high prevalence of ECC. Many oral health promotion programs were identified globally including oral health education, nutritional programs, the use of fluoride and pit-and-fissure sealants, and inter-professional population-based oral health promotion and prevention programs such as school-based oral health programs, motivational interviewing, and anticipatory guidance. ECC remains a significant problem in many parts of the world including the GCC region. Oral health prevention programs have been established within the GCC region. Nevertheless, the GCC region has some unique characteristics that need to be investigated to contextualize the western model of the dynamics of ECC prevention and promotion programs locally.

Community-Academic Partnership to Improve the Oral Health of Underserved Schoolchildren in Rural North Carolina.

Dental caries is the most common chronic illness for children. Caries can reduce the quality of life, cause missed classroom hours, and decrease cognition. Strategies to improve children's oral health must be evidence-based, developed, and implemented in consultation with communities. A community-academic partnership was formed between East Carolina University School of Dental Medicine and the Bertie County Public School District to develop and implement a school-based oral health prevention program using the PRECEDE-PROCEED Model. The PRECEDE component involved social, epidemiological, environmental, educational, ecological, administrative, and policy factors that informed the development of the oral health program. The PROCEED component consisted of implementation and evaluation. School-based oral health programs can increase access to care for vulnerable children and improve learning. The application of the PRECEDE-PROCEED model proved to be a valuable method for developing, implementing, and evaluating a school-based oral health program.

Development and Feasibility Testing of CATCH Healthy Smiles, an Oral Health Promotion Intervention for Prevention of Dental Caries Among Elementary School Children.

We present results of the development and feasibility testing of CATCH Healthy Smiles, a school-based oral health program, among children in grades K-2 in Houston, Texas. Study design was cross-sectional (N = 2 schools; N = 125 parent-child dyads; 31 kindergarteners, 42 first graders, and 52 second graders). CATCH Healthy Smiles program was implemented by trained school teachers in the 2016-2017 school year. Trained dentists conducted dental assessments to measure dental caries increment score (d3mfs). Parent-reported 24-hour dietary recalls and surveys assessed child and parent behavioral, environmental, and psychosocial factors. Logistic regression analysis assessed factors associated with caries experience adjusting for covariates. Of the 113 children with complete dental assessments, 54% children in grade K, 62% in first grade, and 73% in second grade had caries experience. Children with caries experience had a higher body weight (AdjOR = 1.13, 95% confidence interval [CI]: 1.02-1.29), were less likely to be girls (AdjOR = 0.22, 95% CI: 0.05-0.82), had greater odds of difficulty drinking hot or cold beverages because of dental problems (AdjOR = 13.13, 95% CI: 1.09-275.14), greater frequency of consuming sugar-sweetened beverages (AdjOR = 11.53, 95% CI: 2.10-87.19), greater odds of receiving government assistance (AdjOR = 14.62, 95% CI: 2.74-119.81), and lower odds of seeing a dental provider (AdjOR = 0.11, 95% CI: 0.02-0.45). Process evaluation showed that 100% of the CATCH Healthy Smiles lessons and activities were taught in the two schools with a high degree of program fidelity and acceptability across the schools, children, and parents. These data will be used to conduct a subsequent fully powered cluster randomized controlled trial.

A Technical Assistance Curriculum for Expanding Sustainable School-Based Oral Health Programs in the Carolinas' Dental Safety Net.

PurposeSchool-based oral health programs (SBOHPs) provide opportunities to address oral health inequities by providing convenient access points for care. No published guidelines on SBOHP implementation existed. Our work describes how philanthropic, public, and academic organizations partnered to support dental safety net providers with designing comprehensive SBOHPs in North and South Carolina.DescriptionA multi-sector leadership team was established to manage a new SBOHP philanthropic-funded grant program organized into two phases, Readiness and Implementation, with the former a 6-month planning period in preparation of the latter. Readiness included technical assistance (TA) delivered through coaching and 15 online learning modules organized in four domains: operations, finance, enabling services, and impact. Organizations could apply for implementation grants after successful TA completion. Process evaluation was used including a Readiness Stoplight Report for tracking progression.AssessmentTen Readiness grantees completed the TA. A variety of models resulted, including mobile, portable and fixed clinics. Descriptive analysis was conducted on the readiness stoplight reports. Components of the operation and finance domains required were the most time-intensive, specifically the development of policy manuals, production goals, and financial performance tracking.ConclusionThe program’s structure resulted in (a) a two-state learning community, (b) SBOHP practice and policy alignment, and (c) coordinated program distribution. TA improvements are planned to account for COVID-19 threats, including school closures, space limitations, and transmission fears. Telehealth, non-aerosolizing procedures, and improved scheduling and communication can address concerns. Organizations considering SBOHPs should explore similar recommendations to navigate adverse circumstances.

Operational Considerations of School-Based Oral Health Programs During COVID-19

Madridge Journal of Dentistry and Oral Surgery (MJDL) is a peer-reviewed scientific journal dedicated to the dissemination of new knowledge and information on all sciences relevant to dentistry and to the oral cavity and associated structures in health and disease.

An Exploratory Qualitative Study of Parents’ Views on a School Oral Health Program

Introduction: School-based oral health programs enhance the oral health knowledge, practices and attitudes of children by employing oral health education, promotion, prevention, treatment and/or referral services to reduce the prevalence of oral diseases among school children. Periodic evaluation of School Oral Health Programs is essential to assess the impact of the program, its effectiveness, acceptability and to promote quality improvement. Objective: To explore the parents’ views on Asnani (My Teeth) School Oral Health Program. Materials and Methods: This descriptive, exploratory, cross sectional study was conducted among parents of children in public primary schools of Qatar, who had participated in Asnani (My Teeth) School Oral Health Program. Primary data on parents’ views, experiences, opinions and suggestions towards Asnani School Oral Health Program was obtained utilizing open-ended questionnaires. Thematic analysis was employed for the organization of the rich descriptive data, while deriving at themes which convey the explicit and implicit interpretation of the data collected. Results: Qualitative responses from 359 parents revealed five principal themes i.e. Perceived value, Reinforcement of Oral Health Education and Promotion, Frequent dental check-ups, Continuity of care and Additional school-based activities. Conclusion: Perceptions of parents regarding the Asnani School Oral Health Program disclosed in this study provide valuable insights about their acceptability of this school based oral health program. The results are also encouraging as the parents realize the importance of oral health for their children and recommended need for reinforcement of the oral health education and promotion.

Effect of oral health initiatives on reduction in oral morbidities in Ashram schools of Wardha district– A cluster randomized trial

Ashram schools are residential schools developed for underprivileged groups of society who are weak in organizations and economically poor. In general, in all the states, the major obstacle is lack of provision of capacity building and teachers training in serving of the Ashram schools. 8 ashram schools were then randomly divided into control group and intervention group. In the control group, end line oral health assessment using the WHO assessment form 2013 was carried out without any health promotion program. In the intervention group, the oral health care module specifically designed for ashram schools, were implemented. In this group, end line oral health assessments were carried out. Treatments of the minor ailment, oral health program, behaviour change communication model for the schools were implemented. The need-based oral health module was developed for tribal students. The effect size for the intervention was 17.3% indicating 17.3% reduction in dental caries due to intervention (95%CI: -12.3% to-21.62%). The effect was statistically significant. The effect size for the intervention was -43.2 %. Indicating 43.2 % reduction in periodontal diseases due to intervention(95%CI: (-50.7% to -34.1%). The effect was statistically significant. The magnitude of fluorosis in the control group increased by 4.8 % from 28.85% to 33.64 %. During the same time, the magnitude in intervention arm decreases by 3.5% from 47.71 % to 44.20 %. The success of the school-based oral health program depends on the repetition and reinforcement of the program, independent of the dentists, peer leaders and the teachers. It was concluded from this study that the presence of teachers and peers, can influence the study majorly.

Protective factors for caries of a school-based oral health program in Bangkok, Thailand: a retrospective cohort study

ObjectivesThe aim of the study was to assess protective factors of a school-based oral health preventive program on caries in permanent teeth in students and to identify other risk and protective factors associated with caries in this group. Study designThis is a retrospective cohort study. MethodsA total of 433 students were examined in the 1st grade and followed up until the 6th grade. Each student was annually assessed for caries as per the World Health Organization index. Binary simple and multiple logistic regressions were performed to assess risk or protective factors with a P-value ≤0.05. ResultsIn 1st graders, the caries prevalence in deciduous teeth was 87.2%, and the mean decayed, missing and filled teeth (dmft) index was 6.44 (±4.4); in 6th graders, the caries prevalence in permanent teeth was 51.7%, and the mean DMFT was 1.37 (±1.84). Protective factors for caries in permanent teeth were complete participation in the program, receiving fluoride varnish >4 times, and sealant applications on all first molars. Risk factors were female sex and caries prevalence in deciduous teeth. After multiple logistic regression, sealant application only remained significant, with an odds ratio (OR) of 0.19 (95% confidence interval [CI] = 0.06–0.63, P = 0.007), and for risk factor, caries prevalence in deciduous teeth only remained significant, with an OR of 5.44 (95% CI = 2.23–13.27, P < 0.001). ConclusionsThere is an association between deciduous dentition caries and permanent dentition caries. Early prevention in school settings by applying fluoride varnish and dental sealants onto molars is protective and feasible. The study suggests that regular fluoride varnish and sealant applications should be extended to similar low-income area schools.

Advancing Oral Health Equity Through School-Based Oral Health Programs: An Ecological Model and Review.

In the United States and elsewhere, children are more likely to have poor oral health if they are homeless, poor, and/or members of racial/ethnic minority and immigrant populations who have suboptimal access to oral health care. As a result, poor oral health serves as the primary marker of social inequality. Here, the authors posit that school-based oral health programs that aim to purposefully address determinants of health care access, health and well-being, and skills-based health education across multiple levels of influence (individual/population, interpersonal, community, and societal/policy) may be more effective in achieving oral health equity than programs that solely target a single outcome (screening, education) or operate only on the individual level. An ecological model is derived from previously published multilevel frameworks and the World Health Organization (WHO) concept of a health-promoting school. The extant literature is then examined for examples of evaluated school-based oral health programs, their locations and outcomes(s)/determinant(s) of interest, the levels of influence they target, and their effectiveness and equity attributes. The authors view school-based oral health programs as vehicles for advancing oral health equity, since vulnerable children often lack access to any preventive or treatment services absent on-site care provision at schools. At the same time, they are incapable of achieving sustainable results without attention to multiple levels of influence. Policy solutions that improve the nutritional quality of children's diets in schools and neighborhoods and engage alternative providers at all levels of influence may be both effective and equitable.

Impact evaluation of a school-based oral health program: Kuwait National Program

BackgroundThis study evaluated the relationship between enrolment in a school-based oral health prevention program (SOHP) and: 1) children’s dental health status and oral health-related quality of life (OHRQoL), and 2) mothers’ oral health (OH) knowledge, attitude, practice, and OHRQoL.MethodsThis cross-sectional study, in the Kuwait Capital, included 440 primary school children aged 11 to 12 years and their mothers. Participants were classified into two groups: SOHP and non-SOHP. The SOHP group had been enrolled in the prevention program for at least 3 years: children had twice-a-year applications of fluoride varnish and fissure sealants if needed; mothers had, at least, one oral health education session. The non-SOHP group had negative consents and had not been exposed to the prevention program activities. Dental examinations were performed at schools using portable dental units. Caries experience was determined using the decayed (D/d), missing (M/m), and filled (F/f) teeth (T/t)/surface (S/s) indices. Children’s OHRQoL was assessed using a self-administered validated Child Perceptions Questionnaire 11–14 (CPQ11–14). Mothers’ OH knowledge, attitude, practice, and OHRQoL were also assessed. After Bonferroni correction, a p-value of less than 0.05 was considered statistically significant for caries experience measures while a p-value of less than 0.013 was considered statistically significant for OHRQoL subscales and mothers’ OH knowledge, attitude, practice, and OHRQoL.ResultsMean (SD) DT/dt, DMFT/dmft and DMFS/dmfs were 1.41 (1.66), 2.35 (2.33), and 4.41 (5.86) for SOHP children, respectively. For non-SOHP children, the means were 2.61 (2.63), 3.56 (3.05), and 7.24 (7.78), respectively. The difference between the SOHP and non-SOHP was statistically significant (p < 0.001). Children enrolled in the program had a higher number of sealed and restored teeth. No significant differences were found in CPQ11–14 scores or subscale scores between the two groups. No significant difference in mothers’ OH knowledge, attitude, practices or OHRQoL was found between SOHP and non-SOHP groups (P > 0.013).ConclusionEnrolment in the SOHP prevention services was associated with a positive impact on children’s caries level with no significant impact on mothers’ knowledge, attitude, practice, or OHRQoL.

Utilization of a Mobile Dental Vehicle for Oral Healthcare in Rural Areas.

Oral diseases remain one of the major global public health challenges, and the worldwide urban–rural disparities in oral health are significant. Residents in rural areas generally suffer from a higher prevalence and severity of dental caries and periodontal disease, yet they face numerous difficulties and barriers in accessing oral healthcare. Conventional strategies, such as building of dental clinics or, hospitals, or the provision of outreach services by using disposable materials, are neither practical nor effective in rural settings. Mobile dental vehicles (MDVs) have been proposed as an alternative strategy to supplement the traditional oral healthcare in many regions. They have usually been utilized in school-based oral health programs, providing dental care to the homeless or migrants, and screening programs for the population for various oral diseases. Due to their high mobility, MDVs are particularly valuable for the underserved populations living in rural areas. The advance of dental devices enables MDVs to be operated in a self-sufficient manner. This allows the MDV to function almost as well as a conventional dental clinic, providing a variety of dental treatments, including scaling, restoration, and oral surgery. This article discusses the use of MDVs as a solution to urban–rural inequality in receiving oral healthcare.

Comparison of the Effect of Two Oral Hygiene Education Approaches on the Gingival Health and Dental Plaque of Boarding School Students in Fariman, Iran

Introduction: The school-based oral health programs are an opportunity to inspire positive attitudes and proper oral health behavior in students. The purpose of this study was to compare the effects of two oral health education methods on the oral health of boarding high school students in Fariman, Iran. Methods: In this interventional study, 345 students were randomly divided into three groups, namely self-led (control), teacher-led (instructed by teachers), and peer-led (instructed by students). All students were subjected to Simplified Oral Hygiene Index (OHI-S), Gingival Index (GI), Plaque Index (PI) measurements before and three months after the intervention. The data were analyzed using the paired t-test, the Kruskal-Wallis, and the Chi-square tests. The P-value less than 0.05 was considered to be significant. Results: The results of the study showed a significant decrease regarding the scores of all three indices (P<0.001) in the peer-led group, compared to the self-led intervention. According to the paired sample t-test analyses following the intervention, there was a significant decrease in the mean OHI-S , GI, and PI in all three groups (P<0.001), peer-led group (P<0.001), and peer-led and self-led groups (P<0.001), respectively. Conclusion: Due to the significant decline in all three indices of the peer-led group compared to the other two groups, using talented students as “oral and dental health assistants” may be an effective approach for promotion of oral and dental hygiene among teenagers. However, there is aneed to conduct more research in this field of study.

An assessment of strategies to control dental caries in Aboriginal children living in rural and remote communities in New South Wales, Australia

BackgroundA community-led oral health service for Aboriginal people in Central Northern NSW identified the need for oral health promotion, as well as dental treatment; in three remote communities with limited access to dental services. A three-stage plan based on the Precede-Proceed model was used to develop a school-based preventive oral health program. The program will be piloted in three schools over 12 months aimed at improving the oral health of local Aboriginal children.MethodsThe proposed program includes four components: daily in-school toothbrushing; distribution of free fluoride toothpaste and toothbrushes; in-school and community dental health education and the installation of refrigerated and chilled water fountains to supply a school water bottle program. Primary school children will be issued toothbrushing kits to be kept at school to facilitate daily brushing using a fluoride toothpaste under the supervision of trained teachers and/or Oral Health Aides. School children, parents and guardians will be issued free fluoride toothpaste and toothbrushes for home use at three-monthly intervals. Four dental health education sessions will be delivered to children at each school and parents/guardians at local community health centres over the 12 month pilot. Dental education will be delivered by an Oral Health Therapist and local Aboriginal Dental Assistant. The program will also facilitate the installation of refrigerated and filtered water fountain to ensure cold and filtered water is available at schools. A structured school water bottle program will encourage the consumption of water. A process evaluation will be undertaken to assess the efficiency, feasibility and effectiveness of the pilot program.DiscussionThe proposed program includes four core evidence-based components which can be implemented in rural and remote schools with a high Aboriginal population. Based on the Precede-Proceed model, this program seeks to empower the local Aboriginal community to achieve improved oral health outcomes.Trial registrationTRN: ISRCTN16110292 Date of Registration: 20 June 2018.

School-Based Oral Health Promotion: A ThoroughReview

Objectives Schools are considered as important platforms for oral health promotion worldwide. Oral diseases are preventable and any focus on schoolchildren can minimize suffering, reduce inequity, and create productive years of healthy adulthood later on. Hence, we need to explore oral health promotion methods conducted within the school systems in different countries. This is especially required for developing countries with limited resources.Methods The PubMed database was searched for English peer-reviewed articles published from January 2000 to June 2017 with available abstracts, specifically focusing on primary school children aged between 7 and 12 years. “Oral health”, “health promotion” and “school” were used as keywords in our search strategy. Relevant papers were selected and reviewed by two independent readers using predefined exclusion criteria, firstly on the basis of abstracts, secondly by assessing full-text papers.Results From a total of 257 articles, 22 were eligible for analysis. Of all oral health related activities implemented in schools, oral health education was mentioned in most studies (n=15) followed by supervised tooth brushing program in schools with fluoride toothpaste (n=5), administration of fluoride (varnish/gel) (n=3), provision of nutritious food (n=3), multimedia game or campaign (n=3), and tooth examination with screening (n=3).Conclusion Improvement of children’s oral health related to school-based oral health programs is the result of a combination of several interventions. The governments and other policy makers should consider implementing some appropriate health promotion schemes in schools, which take local needs and resources into account

A school-based public health model to reduce oral health disparities.

Although dental decay is preventable, it remains the most common pediatric chronic disease. We describe a public health approach to implementing a scalable and sustainable school-based oral health program for low-income urban children. The Los Angeles Trust for Children's Health, a nonprofit affiliated with the Los Angeles Unified School District, applied a public health model and developed a broad-based community-coalition to a) establish a District Oral Health Nurse position to coordinate oral health services, and b) implement a universal school-based oral health screening and fluoride varnishing program, with referral to a dental home. Key informant interviews and focus groups informed program development. Parent surveys assessed preventative oral health behaviors and access to oral health services. Results from screening exams, program costs and rates of reimbursement were recorded. From 2012 to 2015, six elementary schools and three dental provider groups participated. Four hundred ninety-one parents received oral health education and 89 served as community oral health volunteers; 3,399 screenings and fluoride applications were performed on 2,776 children. Sixty-six percent of children had active dental disease, 27 percent had visible tooth decay, and 6 percent required emergent care. Of the 623 students who participated for two consecutive years, 56 percent had fewer or no visible caries at follow-up, while only 17 percent had additional disease. Annual program cost was $69.57 per child. Using a broad based, oral health coalition, a school-based universal screening and fluoride varnishing program can improve the oral health of children with a high burden of untreated dental diseases.

Oral health knowledge and attitudes of primary school teachers toward school-based oral health programs in Abha-Khamis, Saudi Arabia

Background: The effectiveness of school-based dental health programs has been vastly reported. The objective of the present study was to assess the oral health knowledge and attitudes of primary school teachers in Saudi Arabia and to identify any barriers in implementing school oral health programs. Methodology: A pretested self-administered questionnaire was used to assess the oral health knowledge and attitudes of primary school teachers including barriers in implementing school oral health programs. Results: A total of 61 primary schools were included in the present study with responses from 1186 teachers. The mean oral health knowledge score among primary school teacher of Abha-Khamis was found to be 16 ± 2.7. The overall attitude of primary school teachers regarding implementing school-based oral health program was found to be positive on Likert scale. The responses for barriers in implementing school oral health program were almost equally distributed: lack of material resources (21%), lack of professional training (25%), lack of availability of time (25%), lack of support from school administration (22%), and teacher's attitude was least perceived as a barriers (7%). Conclusions: The oral health knowledge among primary school teachers was found to be good with positive attitudes toward school-based oral health programs. The most significant barriers in implementing a school oral health program were administrative barriers. There is a need for concerned school authorities and health policy makers to address these barriers and to promote oral health in the community.