School oral health program -PHD

1. SUBMITTED BY
Nesheena v k
3rd year
PSM DENTALCOLLEGE
SCHOOL DENTAL HEALTH PROGRAMMES

2. * Introduction
* Definition
* Aspects of school health programs
* Objectives
* Ideal requirements
* Advantages
* Elements/Components
* Some school oral health programs
* WHO’s global school health initiative
* Incremental care
* Comprehensive care
* Conclusion
CONTENTS

3. School health is an important aspect of any
community health program. It is an economical and
powerful means of raising community health in future
generations.
Towards the end of the nineteenth century, William
Fisher, a dentist of England was so concerned by the high
caries experience and lack of treatment in the child
population that he devoted much time campaigning for
compulsory inspection and treatment of children in schools.
The beginning of school health service in India dates
back to 1909, when for the first time medical examination
of school children was carried out in Baroda city.
The Bhore Committee in 1946 reported that School
Health Services were practically no existent in India, and
where they existed, were in an underdeveloped state.
INTRODUCTION

4. In 1953, the Secondary Education Committee emphasized the
need for school nutrition programs.
In 1960, the Government of India constituted a
School Health Committee, and submitted its report in 1961.
In January 1982, a Task Force constituted by the Government of
India to propose an intensive
School Health Service Project, submitted its report.
The "Tokyo Declaration" was made on July 19th,
2001 at the 1st Asian Conference on Oral Health Promotion for
School Children, held in Tokyo.
The "Ayutthaya Declaration" was made on February
23rd, 2003 at the 2nd Asian Conference of Oral Health
Promotion for School Children held in Ayutthaya, Thailand.
The “Bangalore declaration" was made on January
28th, 2005 at the CAMHADD/WHO workshop on prevention and
promotion of oral health through schools held at Bangalore.

5. DEFINITION
School Health Services
are defined as the "procedures established
1. to appraise the health status of pupils and school personnel
2. to counsel pupils, parents, and others concerning appraisal findings
3. to encourage the correction of remediable defects
4. to assist in the identification and education of handicapped children
5. to help prevent and control disease and
6. to provide emergency service for injury or sudden sickness".
(by The Committee on Terminology of the American Association for
Health, Physical Education, and Recreation 1951)

6. Health appraisal:
It is defined as "the process of determining the total health status of the
child through such means as health histories, teacher and nurse
observations, screening test; and medical, dental and psychological
examinations". Teachers have far more contact with school children
than do physicians and dentists.
Health counselling:
Following appraisal comes health counselling, which is defined as "the
procedure by which nurse, teachers, physicians, guidance personnel,
and others interpret to pupils and parents, the nature and significance
of the health problem and aid them in formulating a plan of action
which will lead to solution of the problem"
Emergency care and first aid
Since teachers are the first to realize any emergency in a school, they
should be trained in handling simple emergencies such as traumatic
injuries to teeth during contact sports.
ASPECTS OF SCHOOL HEALTH SERVICE
1)
2)
3)

7. School health education:
It is the process of providing learning experiences for the
purpose of influencing knowledge, attitudes, or conduct relating
to individual or community health. It should cover the aspects of
(a) personal hygiene (b) environmental health and (c) family life
Maintenance of school health records:
These records are useful in analyzing and evaluating school
health programs and to provide a useful link between the home,
the school and the community.
Curative services:
They include regular dental check ups and prompt treatment
wherever possible and referral for special problems.
4)
5)
6)

8. 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 and appearance.
To encourage the observance of dental health practices, including
personal care, professional care, proper diet, and oral habits.
To enlist the aid of all groups and 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 and youth.
To stimulate dentists to perform adequate health services for children.
OBJECTIVES
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9. A school oral health program should
1). Be administratively sound
2). Be available to all children
3). Provide the facts about dentistry and dental care, especially about
self- care preventive procedures
4). Aid in the development of favourable attitudes toward dental health
5). Provide the environment for the development of psychomotor skills
necessary for tooth brushing and flossing
6). Include primary preventive dentistry programs-prophylaxis, fluoride
programs, and use of pit-and- fissure sealants
7). Provide screening methods for the early identification and referral of
pathology
8). Ensure that all discerned pathology is expeditiously treated
IDEAL REQUIREMENTS

10. 1). The school based dental health programs can bring comprehensive
dental care including preventive measures to schoolchildren where
they are gathered anyway for nondental reasons in the largest
possible numbers.
This is particularly advantageous in dentist - deprived areas.
2). School clinics are less threatening than private offices since the
children are in familiar surrounding
3). If the children can be maintained in a state of good dental health it
will be relatively easy to maintain their dental health in adult life.
4). A regular dental attendance pattern in early life will be continued
after school age.
5). Utilizing dental auxiliaries can further reduce the cost
ADVANTAGES

11. ELEMENTS/COMPONENTS of school oral health program
• Improving school- community relation
• Conducting dental inspection
• Conducting health education
• Performing specific programmers'
• Referral for dental care
• Follow-up of dental inspection

12. One of the first steps in organizing a dental health program is
the formation of an advisory committee. It should include
broad representation from parents, teachers, school
administrators, dental professionals, health officers and
community leaders.
The task of these committees is
To appraise and publicize the dental needs of the school children
To address the school administration's concern in the promotion
of oral health.
To make people realize the importance of dental health.
1). Improving school-community relations:

13. In a situation where the extent of dental diseases
among school children is found to be 95% or more, a
program of dental inspection becomes a matter of
debate. A few are of opinion that it would be a mere
waste of resources (money, manpower, material and
time) to examine for a disease which occurs almost
universally and which demands treatment. The other
sections are in favour of dental inspections.
2. Conducting dental
inspections:

14. 1. It serves as a basis for school dental health instruction.
2. It builds a positive attitude in the child toward the dentist and
dental care.
3. The child and the parent are motivated to seek adequate
professional care,
4. Teachers, students, and dentists concerned with dental health
may use the dental inspection as a fact-finding experience.
5. Baseline and cumulative data for evaluation of the school
dental health program are made available.
6. Provides information as to the status of dental needs to plan a
sound dental health program.
Benefits of school dental
inspections:

15. 1. Parents and children frequently accept the inspections to be
comprehensive and depend entirely upon it rather than a
complete dental examination by the family dentist
2. Sometimes the school inspections may tend to discourage
rather than promote the development of the habit of visiting
the dentist at an early age.
3. It is desirable for parents to be present during dental
examinations. This procedure is not always feasible in school
inspections.
Limitations:

16. Three phases in dental health education ;(a)Dental health
instructions (b). Dental health services
(c). Dental health treatment including preventive
procedure
A school dental health program should include a suggested formal approach
to teaching dental health in the classroom. The dentist serves as the expert
resource person to strengthen the teacher's classroom instruction program.
He should give each teacher sincere attention. This is important in developing
proper attitudes and personal dental health practices by the teacher which
can be passed on to the classroom.
3). CONDUCTING DENTAL HEALTH EDUCATION

17. 4). Performing specific programs
1. Tooth brushing programmes
2. Classroom-based fluoride programmes
3. School water fluoridation programmes
4. Nutrition as a part of school preventive
dentistry programmes
5. Sealants placement
6. Science fair

18. • In the classroom, 6-8 children can be taught as a group. Each is given a cup. a
napkin, and a kit containing a disclosing tablet, a toothbrush, and a tube of
fluoride dentifrice.
The children are demonstrated how to remove some imaginary dirt from between
the cuticle and the thumbnail.
The mastery of the 45 0 angulations and the short vibratory strokes can then be
repeated on an oversize dentoform model.
Next, the children are asked to chew a disclosing tablet and to swish it around the
mouth for 30 seconds. They are then encouraged to look at each other's teeth
with appropriate emphasis on the fact that the red stain colors the plaque in which
the bacteria live.
Next a magnifying mirror is passed around so the participants can note that their
teeth are no different from those of their neighbours i.e. all people have plaque.
Guided brushing can then begin, with the instructor establishing the sequence of
teeth to be brushed.
At the end, the mirror is again passed around
to show that progress has been made.
A.Brushing programs

19. 1) Fluoride ‘mouth – rinse’ program:
A once-a-week mouth rinse can be expected to result in 20% to 40% reduction in
dental caries.
The kit used in the program consists of fluoride rinsedispenser, cups, napkins and
plastic disposal bags.
The dispenser is graduated so that 2.0 gm of packaged sodium fluoride powder
can be placed in the jug and water added to the 1000-ml mark.
The rinse should be non-sweetened and non-flavored to discourage swallowing.
Rinsing programs are advised for grades 1 to 12 but not below.
Five ml of the rinse is dispensed into each cup and all the children are
instructed to rinse the solution in the mouth for 1 minute, after which they are to spit
carefully into the cup.
The napkin is used to wipe the mouth, after which it is forced into the bottom
of the cup to absorb all fluid. One of the students then collects the cups.
Fluoride mouth-rinsing programs received official recognition of safety from
the FDA in 1974 and by the Council on Dental Therapeutics of the ADA in 1975.
B).Classroom-based fluoride programs:

20. 2). Fluoride tablet program:
One tablet is given to each student The student
then chews and swishes the 2.2 mg sodium
fluoride (1 mg fluoride) tablet in the mouth for a
minute and then swallows. The swish-and-
swallow technique not only provides the
benefits of a topical application but also
provides the optimum systemic benefit during
the period of tooth development and
maturation.

21. • This procedure makes the fluoride available to children,
for whom dental caries is a primary 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, i.e.,
4.5 times the optimum concentration since children are
in school for shorter hours and less water is consumed
during that time. For Individuals not served by a public
water supply, alternative methods such as fluoridating
the individual school water I supply must be considered.
A major disadvantage is that children do not receive
benefits until they begin school.
C). School water fluoridation programs

22. • School lunch programs are designed to provide the child with
an intake of nutrients that approximate one third of the daily
intake of essential carbohydrates, proteins, fat, minerals, and
vitamins. Sugar discipline can be aided through counseling by
the school dietician, dental hygienist or teacher. Emphasis
cannot be on a total restriction of sugars. Instead, it should
focus on reducing the frequency of intake and selecting sugar
product that are rapidly cleared from the mouth
D). Nutrition as a part of school preventive
dentistry programs:

23. The objectives of the program
1. To improve enrolment and attendance
2. To reduce school drop outs.
3. To improve child health by increasing nutrition level.
4. To improve learning levels of children

24. The placement of pit-and-fissure sealants is ideally suited for a school program.
First, second, 6th and 7th standards would be desirable levels to selectively intervene
to prevent pit-and- fissure lesions. (1st and 2nd standards, because- First permanent
molars are sufficiently erupted to place the sealant. 6th and 7th standards - 2nd
permanent molars). Sealant placement, when coupled with a follow-up application of
fluoride, in addition to the classroom fluoride mouth- rinse or fluoride tablet program,
helps- provide a continuous protection of the whole tooth.
A science fair not only helps in educating and motivating school children to
improve their oral health but also provides an excellent opportunity for dentistry to
contribute substantially to the building of a growing reservoir of students who may
some day choose a career in dentistry.
E) . Sealant placement:
F) . Science fairs:

25. 5) Referral for dental care:
In a few schools dental care is provided at the school itself. However if only emergency
treatment is provided, for eg, If the dental auxiliary places eugenol - soaked cotton in a child's
cavity to relieve the pain, the parent does not see the child in pain and might conclude that the
school has taken care of the dental problem. Therefore the parent should be informed and made
to understand that such emergency treatment is not a cure and she will have to visit the dentist
of her choice for proper dental treatment.
"Blanket" referral:
A program that has proved to be effective in many schools is 'blanket' referral of all
children to their family dentists. In this program, all children are given referral cards to take home
and subsequently to the dentist, who sign the cards upon completion of examination, treatment,
or both. The signed cards are then returned to the school nurse, or classroom teacher, who plays
an important role in following up the referrals with the child and parents.
The mere issuance of referral slips to children will be of little value if steps are not taken
to make it clear that the school is interested in defect correction. This needs a good follow-up
system. The dental hygienist is the logical person to conduct such follow-up examinations.
Leave concessions from school for dental treatment are strongly recommended.
6) Follow-up:

26. SOME SCHOOL ORAL HEALTH PROGRAMS
1. “Learning about your oral health” – prevention oriented
school programme
2. “TATTLETOOTH PROGRAM" - TEXAS STATEWIDE PREVENTIVE
DENTISTRY PROGRAM
3. ASKOV DENTAL DEMONSTRATION
4. NORTH CAROLINA STATEWIDE PREVENTIVE DENTAL HEALTH PROGRAM
5. SCHOOL HEALTH ADDITIONAL REFERRAL PROGRAMME (SHARP)
6. TEENAGE HEALTH EDUCATION TEACHING ASSISTANTS PROGRAM
(THETA Program)
7. WORLD HEALTH ORGANIZATION’S (WHO’S) GLOBAL SCHOOL HEALTH
INITIATIVE

27. :
This program was developed by the 'American Dental
Association' (ADA) and their consultants in coordination with the
1971 ADA House of delegates and is presently available to school
systems throughout the United States of America.
"Learning about Your Oral Health" is a comprehensive program
covering current dental concepts.
“LEARNING ABOUT YOUR ORAL HEALTH” – A PREVENTION
ORIENTED SCHOOL PROGRAM

28. The primary goal of this program
is to develop the knowledge, skills and attitudes needed for prevention of dental diseases among
school children.
Implementation of the program:
The program fs divided into five levels, each level having its own defined specific content The five
different levels are:
The core material for each of the five levels is self-contained in a teaching packet that allows the
classroom teacher to adapt the presentation to the needs of the students. Each teaching packet
includes.
A teacher's self-contained guide on "dental health facts" with a section on handicapped children
A glossary of dental health terms
A curriculum guide featuring content, goals, behavioral objectives and suggested activities for
other classes
Five lesson plans for the preschool level and seven or more lesson plans for each of the other
levels
Four overhead transparencies
Twelve spirit masters (for copying)
Methods and activities for parental involvement
* Preschool (designed for children too young to read).
* Level I (kindergarten through grade 3).
* Level II (grades 4 through 6).
* Level III (grades 7 through 9).
* Level IV (grades 10 through 12).

29. The Tattletooth Program was developed in 1974-1976 as a cooperative effort
between Texas Dental health professional organizations, the Texas Department of
Health and the Texas Education Agency through a grant from the
Department of Health and Human Services to the Bureau of Dental Health. The
program was pilot tested inl975 and field tested in spring I97£in schools within the
state of Texas.
In l989, the Bureau of dental health developed a new program to replace the
existing Tattletooth Program. This was called Tattletooth II - A New Generation for
Grades K – 6.
Three videotapes were produced as part of the teacher-training package.
The first videotape familiarizes the teachers with the lesson format and
content.
A second videotape, "Brushing and Flossing" was developed for the dual
purpose of teacher training and as an educational unit to be used by the teacher
with the students.
A third videotape provides teachers with additional background information
as a means of preparing them to teach the lessons.
“TATTLETOOTH PROGRAM" - TEXAS STATEWIDE PREVENTIVE DENTISTRY PROGRAM

30. The program embraces the six elements of effective
lesson design; anticipatory set, setting the objective,
input modelling, checking for understanding, guided
practice and independent practice.
The basic goal of the program is to reduce dental
disease and develop positive dental habits to last a
lifetime. The major thrust of Tattle tooth is to convince
students that preventing dental disease is important
and that they can do it.
Program philosophy and goals:

31. The Texas Department of Health employs 16 hygienists in the eight public
health regions to implement the Tattle tooth Program.
The hygienists instruct teachers using videotapes designed for teacher
training and provide them with a copy of the curriculum.
Health promotion activities are encouraged and publicized within the school
community.
Teachers are encouraged to invite a dental professional to demonstrate
brushing and flossing in the classroom.
A field trip to a dental office is strongly recommended for kindergarten
children.
Bulletin board suggestions, a book list, films and videotapes are available on a
free loan for appropriate grade levels,
Other resources used are a list of companies providing supplementary
classroom resources and a comprehensive glossary of vocabulary words
written for the teacher in English or Spanish that are used in all grade levels.
Program implementation:

32. Program evaluation:
The students in grades 3, 5, 7, 9 and 11 were given the Texas Assessment of Academic
Skills (TAAS) by the Texas Education agency, to satisfy the legislative requirement that
student performance be assessed.
Teacher evaluation is done annually by principals and supervisors using a 65-item
checklist.
A major field test conducted in 1975 and 1976 studied 15,000 children in 18
educational service regions. Results of single exposure to the program revealed that,
Dental health knowledge was significantly increased at all grade levels.
Plaque levels were decreased by approximately 15% in a randomly selected sample of
2,142 children.
Over 80% of the teachers judged the program to be helpful and effective, but
evaluation questions suggested that they felt a need for additional technical help in
brushing and flossing.
In l989, a state wide summative evaluation of the seven levels of the Tattletooth II
curriculum was conducted. The results showed,
Teacher-student interaction was present as a result of the format
Student responses to the curriculum were positive or very positive.
Approximately 94% of the teachers felt that teaching oral health can have a positive
effect on children's dental health habits.

33. ASKOV DENTAL DEMONSTRATION
Askov is a small farming community with a population mostly of
Danish extraction. It showed very high dental caries in the Initial
surveys made in 1943 and 1946.
During the period from 1949 to 1957, the Section on Dental
Health of the Minnesota Department of Health supervised a
demonstration school dental health program in Askov, including
caries prevention and control, dental health education and
dental care.
All recognized methods for preventing dental caries were used in
the demonstration with the exception of communal water
fluoridation since until 1955 Askov had no communal water
supply.

34. Dental care was rendered by a group of five dentists from nearby
communities employed by the Minnesota Department of Health.
These dentists also gave topical fluoride treatments.
Findings available through a 10 year period revealed
28% reduction in dental caries in deciduous teeth of children
aged 3 to 5 years
34% reduction in caries in the permanent teeth of children 6 to
12 years old
14% reduction in permanent teeth of children 13 to 17 years old.
Improvements in filled-tooth ratios
The cost of the program was greater and the caries reductions
smaller when compared with water fluoridation.

35. In 1970, the North Carolina Dental Society passed resolutions
advocating a strong preventive dental disease program
embracing school and community fluoridation, fluoride
treatments for school children, plaque control education in
schools and communities and continuing education on
prevention for dental professionals.
In 1973, Frank. E. Law prepared a report for the North Carolina
Dental Society that defined the extent of the dental disease
problem and this resulted in the initiation of a 10-year program
to reduce dental disease.
NORTH CAROLINA STATEWIDE PREVENTIVE DENTAL HEALTH
PROGRAM

36. Program philosophy and goals:
This program is a unique public and private partnership
dedicated to the mission of assuring conditions in
which North Carolina citizens can achieve optimal oral
health. The program activities include preventive and
educational components to modify the behavior
patterns of individuals to improve their oral health
habits through dietary changes, tooth brushing and
flossing.

37. Objectives that will facilitate attainment of the goals include:
Appropriate use of fluoride
Health education in schools and communities
Availability of public health dental staff in all counties
Program implementation:
This program is unique in that, it is designed to reach several segments of the
population: young children, parents, teachers, dental professionals and community
leaders.
In the year 1990, services delivered through the program included
The fluoridation of water supplies of 130 rural schools,
Weekly fluoride mouth rinse for more than 416,000 students in 1,051 schools.
Screening and referral for more than children.
Dental health education was presented to 361,000 children and adults.
More than 33,000 dental sealants were applied.
Teachers are believe to be the key in the educational program.
Program evaluation
Evaluation is a necessary ongoing process to measure the effectiveness of the dental
health program.

38. SCHOOL HEALTH ADDITIONAL REFERRAL PROGRAMME (SHARP)
(Motivation through home visits)
This program was instituted in Philadelphia with the purpose of
motivating parents into initiating action for correction of defects
in their children through effective utilization of community
resources. The project was carried out by district nurses with the
cooperation of school personnel. The nurses made daytime visits
to families in which the mothers were at home. Working parents
were contacted by phone. The one-to-one basis of health
guidance between parent and health worker established better
rapport between school and home.

39. TEENAGE HEALTH EDUCATION TEACHING ASSISTANTS
PROGRAM (THETA Program)
Developed by the National Foundation for the prevention of oral
disease for the Department of Health and Welfare, Division of
Dental Health.
Philosophy
Dental personnel train high school children to teach preventive
dentistry to elementary school children.
Goals
To give knowledge & skills to young children.
Allows high school children to develop understanding of young
children.
Introduces them to career opportunities.

40. COLGATE’S BRIGHT SMILES, BRIGHT FUTURES
"The Colgate Bright Smiles, Bright Futures" oral health
educational program worldwide was developed to teach children
positive oral health habits of basic hygiene, diet and physical
activity. This program also encourages dental professionals,
public health officials, civic leaders and most importantly,
parents and educators to come together to emphasize the
importance of oral health as part of a child's overall physical and
emotional development.
The Teachers Training Program is an integral part of the School
Dental Health Program, conducted regularly across the country
to promote preventive dental health care.

41. WHO's Global School Health Initiative, launched in
1995, seeks to mobilize and strengthen health
promotion and education activities at the local,
national, regional and global levels. The Initiative is
designed to improve the health of students, school
personnel, families and other members of the
community through schools.
WORLD HEALTH ORGANIZATION’S (WHO’S) GLOBAL SCHOOL
HEALTH INITIATIVE

42. Incremental care may be defined as "periodic care so
spaced that increments of dental disease are treated at
the earliest time consistent with proper diagnosis and
operating efficiency, in such a way that there is no
accumulation of dental needs beyond the minimum.”
In private practice, six months is the commonest,
though not the only interval between visits. In public
health programs, one-year intervals are usually
implemented.
INCREMENTAL CARE

43. Advantages:
Lesions of dental caries are treated before there has
been a chance for pulpal involvement.
Periodontal disease is intercepted at or near the
beginning.
Topical and other preventive measures are maintained
on a periodic basis.
Bills for dental services are equalized and regularly
spaced.
The program avoids the high expenditure of late dental
care

44. Disadvantages
Time consuming
Restorative dentistry is more time consuming on a piecemeal
basis than upon a wholesale basis
Attention to deciduous teeth:
Much laborious restorative work may be performed upon
deciduous molars at a time when permanent successors have
already started calcification and are controlling factors in
mandibular growth.
Increasing likelihood of interruption in children's dental health
programs:
Mobility of the children along with their families tends to
interrupt programs for dental or maintenance care

45. COMPREHENSIVE CARE
Comprehensive dental care is the meeting of accumulated dental needs at
the time a population group is taken into the program (initial care) and the
detection and correction of new increments of dental disease on a
semiannual or other periodic basis (maintenance care).
Services are provided not only to eliminate pain and infection but also to
Restore serviceable teeth to good functional form,
Replace missing teeth,
Provide maintenance care for the control of early lesions of dental disease
Provide preventive measures, educational and otherwise, so that the
population may experience a lower prevalence of disease.

46. CONCLUSION
A school oral health program should not impose an excess or unusual
teaching burden on the teachers, it should be cost effective in manpower,
money, and material and it should produce observable results.
Since children are often the most important victims of dental diseases,
programs aimed at dental health of the school children are of great
importance in promoting oral health of the community.

47. THANK YOU