Challenges associated with implementation of a school-based tooth-brushing and fluoride varnish programme in a diverse and transient urban population.

Public health competencies being illustrated; Planning, delivery and evaluation of health improvement programmes, addressing health inequalities, awareness of cultural impacts on health and wellbeing. Smile4Life, a schools-based, evidence informed oral health promotion programme, was designed to address high levels of oral health need and inequality within a UK City. The aims of the pilot described were to test the feasibility of delivering the programme (supervised tooth-brushing, take home kits, educational resources and application of fluoride varnish) in six culturally diverse schools in disadvantaged neighbourhoods, and evaluate its impact on caries prevalence. High levels of participation were achieved (98% positive consent) however only 44% received more than one application of fluoride varnish. A reduction in decay prevalence and improved oral hygiene was observed. This paper examines the challenges faced in working with transient and culturally diverse population groups, working effectively with schools to deliver an effective intervention for this population, and in responding effectively across agencies to address safeguarding concerns.

Evaluation of a Comprehensive Oral Health Services Program in School-Based Health Centers.

Objectives In 2011, the Maternal and Child Health Bureau, within the Health Resources and Services Administration, awarded a 4-year grant to increase access to and assure the delivery of quality oral health preventive and restorative services to children. The grant was awarded to organizations serving high-need communities through school-based health centers (SBHCs). This article describes an independent evaluation investigating program efficacy, integration, and sustainability. Methods Program process and outcomes data were gathered from interim and final reports. Interviews with key informants were conducted by phone, and analyzed in NVivo qualitative software. Results Students had great need for comprehensive services: on average, 45% had dental caries at enrollment. Enrollment increased from 5000 to more than 9700, and the percent receiving preventive services increased from 58 to 88%. Results of the analytically weighted linear regression show statistically significant increases in the proportion of enrollees who had their teeth cleaned in the past year (t(4) = 5.19, ß = 8.85, p < 0.05) and those receiving overall preventive services (t(4) = 13.52, ß = 10.93, p < 0.01). Grantees integrated into existing programs using clear, consistent, and open communication. Grantees sustained the full suite of services beyond the grant period by increasing billing and insurance claims while still offering free and reduced-cost services to those uninsured or otherwise unable to pay. Conclusions for Practice This project demonstrates that access to comprehensive oral health care for children can be expanded through SBHCs. State Title V Block Grant and other similar federal initiatives can learn from the strategic approaches used to overcome challenges in the school-based environment.

Saskatchewan's school-based dental program staffed by dental therapists: a retrospective case study.

OBJECTIVES: The poor oral health of Saskatchewan's children, in concert with a significant shortage of dentists, prompted the province in the early 1970s to seek an alternative method of addressing the oral health care needs of children. The result was the Saskatchewan Health Dental Plan (SHDP), which trained and employed dental therapists in school-based clinics to provide basic dental care to all children. The program was initiated over the opposition of Saskatchewan's dentists. The purpose of this research was to provide information and data previously not documented in the refereed dental literature regarding the only school-based program staffed by dental therapists to ever exist in North America. METHODS: This case study reviews the program's planning, opposition, implementation, and achievements based on a comprehensive review of published articles as well as a search of the grey literature. Additionally, Saskatchewan Health provided annual reports for each year of the program's existence. RESULTS: During its thirteen years of existence, the school-based program proved popular with parents and achieved significant success in providing necessary dental care for children. It was terminated in 1987 by the newly elected provincial Conservative government, which was not supportive of such social programs. CONCLUSIONS: The SHDP serves as a successful model of school-based dental care for children. However, the termination of the plan demonstrates the vulnerability of publicly funded dental health programs to conflicting political ideologies and special interest groups.

Necesidad de programas de salud oral para preescolares en Atención Primaria / The need for preschool oral health programs in primary care

Actualmente, la caries continúa siendo un importante problema en Salud Pública, no sólo por su repercusión en el estado de salud general, sino también, por los altos gastos sanitarios y sociales que genera. En menores de 6 años y en dentición temporal, sólo disponemos de los datos nacionales obtenidos de la única Encuesta Nacional de Salud Oral en preescolares, promovida por el Consejo General de Dentistas de España en el año 2007 y cuyos resultados evidencian una prevalencia de caries del 17% a los tres años y del 26,2% a los 4 años de edad. La mejora de la atención bucodental infantil, se debe en parte, a programas específicos de salud oral en nuestro territorio nacional, siendo la población preescolar una excepción. Por todo ello, serían necesarios realizar nuevos estudios epidemiológicos a edades más precoces y en todo el ámbito nacional para así determinar la necesidad de programas de salud oral destinados a esta población infantil (AU)

Currently, caries remains a major public health problem, not only for its impact on the overall health status but also because of the high health and social costs generated. In children under 6 years and temporal dentition, we just have the national data of the National Survey of Oral health in preschool, promoted by the General Council of Dentists of Spain in 2007 and whose results show a caries prevalence of 17% at three years and 26.2% at 4 years old. The improvement in child oral health care is partly due to specific oral health programs in our country, with the exception of the preschool population. Therefore, it would be necessary to make new epidemiological studies in younger ages and throughout the national level to determine the need for oral health programs aimed at the children (AU)

[Motivation for Prevention in Childhood as a Basis for long-Term Dental Health: The Augsburg Model]. / Motivation zur Prävention im Kindesalter als Basis für eine nachhaltige Zahngesundheit - Das Augsburger Modell.

Oral health promotion programs have been shown to be more effective the earlier they are started. In the city of Augsburg, the activities of the School Dental Service were replaced by a cooperation model in 2001, which provides a reasonable combination of group and individual dental prophylaxis. Three epidemiological evaluations show continuously increasing rates of natural healthy primary teeth in preschool children of all population groups. The Augsburg cooperation model "child and youth dental health" represents a practice-oriented approach in accordance with the new German prevention law.

Effectiveness of an Alternative Dental Workforce Model on the Oral Health of Low-Income Children in a School-Based Setting.

OBJECTIVES: We evaluated the effect of an alternative dental workforce program-Kansas's Extended Care Permit (ECP) program--as a function of changes in oral health. METHODS: We examined data from the 2008 to 2012 electronic medical records of children (n = 295) in a Midwestern US suburb who participated in a school-based oral health program in which preventive oral health care was delivered by ECP dental hygienists. We examined changes in oral health status as a function of sealants, caries, restorations, and treatment urgency with descriptive statistics, multivariate analysis of variance, Kruskal-Wallis test, and Pearson correlations. RESULTS: The number of encounters with the ECP dental hygienist had a statistically significant effect on changes in decay (P = .014), restorations (P = .002), and treatment urgency (P = .038). Based on Pearson correlations, as encounters increased, there was a significant decrease in decay (-0.12), increase in restorations (0.21), and decrease in treatment urgency (-0.15). CONCLUSIONS: Increasing numbers of encounters with alternative providers (ECP dental hygienists), such as with school-based oral health programs, can improve the oral health status of low-income children who would not otherwise have received oral health services.

Prevalence of Occlusal Traits in the Deciduous Dentition of Children of Kaski District, Nepal.

INTRODUCTION: The prevalence of occlusal traits varies among various populations. Ethnic, genetic and environmental factors are the major contributors, with a role in the specific cause of malocclusion. The aim of this epidemiological study was to assess the prevalence of occlusal traits in the deciduous dentition of children of Kaski District,Nepal. METHODS: A total of 506 children (251 girls, 255 boys), aged 3-5 years, were assessed. The occlusion examination was carried out by three examiners, in the school camps,community dental care centre and general health camps, utilizing a mouih mirror and probe. Intra investigator error was calculated using kappa statistics. The data were analyzed by the statistical program SPSS version 17 using the Chi-square test. RESULTS: The present study studied occlusal traits of 506 children (251 girls, 255 boys), aged 3-5 years. The study result showed that bilateral mesial step seen in 40.3%,bilateral flush terminal plane in 33.5%, bilateral distal steps in 8.5%,mesial step one side and flush terminal other side in 12.7%,mesial step one side and distal step other side in 2.6%,flush terminal one side and distal step other side in 2.4%,anterior crossbite in 3%,posterior crossbite in 0.4% and non-spaced dentition in 20% children. CONCLUSIONS: Mesial step was the most prevalent followed by straight terminal plane and the distal terminal plane showed least prevalence. There were diverse traits for malocclusion. There was no significant difference(p>0.05) in occlusal traits between male and female children.

Oral health care for children in countries using dental therapists in public, school-based programs, contrasted with that of the United States, using dentists in a private practice model.

The United States faces a significant problem with access to oral health care, particularly for children. More than 50 countries have developed an alternative dental provider, a dental therapist, practicing in public, school-based programs, to address children's access to care. This delivery model has been demonstrated to improve access to care and oral health outcomes while providing quality care economically. We summarize elements of a recent major review of the global literature on the use of dental therapists, "A Review of the Global Literature on Dental Therapists: In the Context of the Movement to Add Dental Therapists to the Oral Health Workforce in the United States." We contrast the success of a school-based model of caring for children by dental therapists with that of the US model of dentists providing care for children in private practices.

Promoting oral health of children through schools--results from a WHO global survey 2012.

This paper reviews the range of school-based approaches to oral health and describes what is meant by a Health Promoting School. The paper then reports the results of a World Health Organization global survey of school-based health promotion. Purposive sampling across 100 countries produced 108 evaluations of school oral health projects spread across 61 countries around the globe. The Ottawa Charter for Health Promotion noted that schools can provide a supportive environment for promoting children's health. However, while a number of well-known strategies are being applied, the full range of health promoting actions is not being used globally. A greater emphasis on integrated health promotion is advised in place of narrower, disease- or project-specific approaches. Recommendations are made for improving this situation, for further research and for specifying an operational framework for sharing experiences and research.

Impact of dental therapists on productivity and finances: III. FQHC-run, school-based dental care programs in Connecticut.

In many developed countries, the primary role of dental therapists is to care for children in school clinics. This article describes Federally Qualified Health Center (FQHC)-run, school-based dental programs in Connecticut and explores the theoretical financial impact of substituting dental therapists for dentists in these programs. In schools, dental hygienists screen children and provide preventive services, using portable equipment and temporary space. Children needing dentist services are referred to FQHC clinics or to FQHC-employed dentists who provide care in schools. The primary findings of this study are that school-based programs have considerable potential to reduce access disparities and the estimated reduction in per patient costs approaches 50 percent versus providing care in FQHC dental clinics. In terms of substituting dental therapists for dentists, the estimated additional financial savings was found to be about 5 percent. Nationally, FQHC-operated, school-based dental programs have the potential to increase Medicaid/CHIP utilization from the current 40 percent to 60 percent for a relatively modest increase in total expenditures.

A comprehensive school-based/linked dental program: an essential piece of the California access to care puzzle.

California children suffer more from dental disease than any other chronic childhood disease. Disparities in access and oral health are disproportionately represented among children from minority and low-income families. A comprehensive school-based/linked dental program is one essential ingredient in addressing these problems. Described here are the goals, program elements, and challenges of building a seamless dental services system that could reduce barriers care, maximize resources, and employ best practices to improve oral health.

Reaching the Texas dental goals of healthy people 2010.

BACKGROUND: The U.S. Department of Health and Human Services has promoted Healthy People 2010, which is a set of national health objectives for the nation to achieve over the first decade of the new century (1). Texas has not yet met its target of 50 percent of 8-year-old children with dental sealants having been placed on their 6-year molars, which is one of the Healthy People 2010 goals. An assessment of the dental needs of children in Tarrant County, Texas, was initiated by the JPS Health Network (named after John Peter Smith). The JPS Health Network established the Healthy Smiles program to address the dental needs of the students in this county because a school based dental sealant program would be effective in reducing dental decay. METHODS: Approved Title One elementary schools in Tarrant County were scheduled for dental screenings, education, and fluoride and dental sealant applications. Students were given visual dental screenings and classified as to future dental needs. First grade students received fluoride varnish and second and third grade students received fluoride and dental sealants. RESULTS: For the 2010-2011 school year: A total of 28,322 students were seen by dental professionals from the JPS Health Network; 8,348 dental sealants were placed; and 11,825 fluoride applications were given by dental staff. CONCLUSIONS: The JPS Health Network Healthy Smiles Program proved to be an effective way to deliver oral preventive care and dental education to a large number of low-income students. CLINICAL IMPLICATIONS: Dental caries prevention programs such as Healthy Smiles could help Texas reach its goals for improved oral health for the children of Texas.

Body mass index measurement in schools: partnering with oral health.

OBJECTIVES: The purpose of this review was to examine methodological similarities and differences in states that have implemented joint school-based oral health/body mass index (BMI) surveillance. METHODS: Individuals in states with joint oral health/BMI surveillance were interviewed by e-mail and phone on the following: how the collaboration came about, survey methodology, rewards for participation, BMI data collection methods, data forms, BMI results, how BMI data were utilized, lessons learned, and challenges. RESULTS: Nine states were represented in this review (Colorado, Georgia, Illinois, Maine, New Hampshire, North Dakota, Ohio, Wisconsin, and Wyoming). All states collected surveillance data among third-grade children through selecting a random, stratified sample of elementary schools. These states also used state-specific BMI protocols, including use of standardized, calibrated equipment to measure height/weight. Many states also used local support to implement the surveillance program and used external sources for statistical support. Differences among these states included types of rewards used, mode of consent, and parties involved in the collaboration. The most common uses of the BMI data include: assessing the magnitude of the problem, informing programs, allocation of resources, identification of priority areas for prevention research, support for grant applications, and program evaluation. CONCLUSIONS: Although there are some minor differences among states that have implemented joint school-based oral health/BMI surveillance, there are overarching similarities such as survey design and standardization of BMI measures. States considering implementing BMI surveillance efforts can use this review as a starting point to consider attributes such as program effectiveness and methods to improve or enhance surveillance systems already in place.

Satisfaction with school dental service provided by mobile dental squads.

Feedback on satisfaction with dental care is vital for continuous improvement of the service delivery process and outcome. The objective of this study was to assess the satisfaction with school dental service (SDS) provided via mobile dental squads in Selangor, Malaysia, under 4 domains of satisfaction: patient-personnel interaction, technical competency, administrative efficiency, and clinic setup using self-administered questionnaires. Among the 607 participants who had received treatment, 62% were satisfied with the services provided. In terms of domains, technical competency achieved the highest satisfaction score, whereas clinic setup was ranked the lowest. As for items within the domains, the most acceptable was "dental operator did not ask personal things which were not dentally related," whereas privacy of treatment was the least acceptable. In conclusion, whereas children were generally satisfied with the SDS, this study indicates that there are still areas for further improvement.

The development of a directed population approach to tackle inequalities in dental caries prevalence among secondary school children based on a small area profile.

BACKGROUND: It has been observed that the prevalence of dental caries among children has declined in the last decade in Germany. However, despite of these improvements there is still a proportion of children suffering from dental decay. AIMS: The aims of this study were to evaluate if a social gradient in the prevalence of dental caries exists and, based on those findings, to develop a strategy to target those children with heightened risk to develop dental caries in order to assist oral health care professionals to refocus the current uniform school-based dental health programme to a caries preventive strategy based on a directed population approach. DESIGN: A representative, random sample of 12-year olds in Freiburg (Germany) was examined and dental caries was recorded using WHO criteria. Educational attainment of the child's parents was used as an indicator of socio-economic status and classified by use of the CASMIN Educational Classification. RESULTS: A total of 322 children participated. An examination of dental caries score revealed that its distribution was positively skewed. For this reason this study provides summary analyses based on medians and a non-parametric rank-sum test. The Kruskal-Wallis H-test showed a significant difference between median scores across the different educational levels (p-value = 0.015) which was due to lower dental caries levels in children with non-deprived social background. CONCLUSIONS: In order to reduce current social inequalities in child oral health the current uniform school-based dental health programme at secondary school level should be developed to a targeted school-based screening and prevention programme.

Situational analysis of dental caries and existing oral health care of children and adolescents in Hubei Province, People's Republic of China: implications for change.

PURPOSE: (1) To evaluate trends in dental caries of children and adolescents of Hubei Province and Wuhan Municipality over the last two decades. (2) To conduct a situational analysis of existing oral health care and to recommend changes to improve this care for children. MATERIALS AND METHODS: An analysis was performed on data from national oral health surveys carried out in China at the provincial level, and data on 12-year-old children of Wuhan Municipality. A review of the literature was conducted on available and utilised oral health care facilities by children. RESULTS: In 1983, the mean decayed, missing and filled teeth (DMFT) of 12-year-olds in Hubei Province was 1.0, and in 1995 it was 0.6. The studies in Wuhan Municipality in 1993-1995 among 12-year-olds reported DMFT values ranging from 0.7-1.5, however different methods of caries assessment were performed in the various studies making comparisons difficult. The caries prevalence and the mean dmft score of 5-year-old children in 1995 in Hubei Province were 69% and 3.6, respectively. The percentage of untreated caries for all age groups in Hubei Province was very high. CONCLUSIONS: Analysis of epidemiological information over the last two decades does not provide any conclusive evidence supporting either an increasing or decreasing trend of dental caries in the child and adolescent population of Hubei Province and Wuhan Municipality. There is, however, a clear need to prevent the incidence of dental caries from increasing and to provide care to address the treatment needs of pre-school and school-age children. The promotion of twice-daily tooth brushing with fluoride toothpaste at maternal and child health care centres, and the establishment of daily tooth brushing with pea-size amounts of fluoride toothpaste in the pre-school and primary school setting are recommended preventive strategies. Establishment of school-based oral health promotion should be accompanied with the provision of Atraumatic Restorative Treatment (ART) sealants and ART restorations which can be provided by dental nurses at dramatically lower costs than the traditional high-tech approach.

Should dental hygienists replace dental directors in screening high-needs children?

PURPOSE: The purpose of this research was to determine whether dental hygienists are as effective as dental directors in screening high-needs children who require emergency care. METHODS: In 2000, the Community Dentistry Health Services Research Unit (CDHSRU) at the University of Toronto completed a prospective cohort study to determine whether care proposed by dental directors exposed to evidence-based practices was significantly different from the care provided by dental hygienists who screened children enrolled in the provincially mandated Children in Need of Treatment (CINOT) program. RESULTS: The dental directors and dental hygienists each prepared a treatment plan for the 71 children enrolled in this study. These plans were analyzed using a paired t-test model after being translated into relative value units (RVU). It was determined that there was no statistically significant difference between the overall dental treatment proposed by the dental hygienists and the treatment proposed by the dental directors (p=.749). A similar analysis stratified by subject site and by service type also showed no significant differences. CONCLUSIONS: The results suggest that dental hygienists are equally as effective as dental directors in screening high-needs children and may be capable of assuming the role of first point of contact for children within high-need dental programs.

Efficiency of a schoolchildren program for oral care.

The aim of this investigation was to evaluate the efficiency of an oral school program, applied during 3 years. DMFT index, the component D and CTNI of a sample of 590 children (Group I, aged 12.0 +/- 1.1 years) which received regular oral treatment during 3 consecutive years were compared with the same indicators of 586 children (Group II, aged 12.6 +/- 1.0 years) without treatment. The cost-benefit ratio of the current required treatments in both groups was calculated. Results revealed: (a) in Group I the component D of DMFT was 0.9 +/- SEM = 0.3, and in Group II, 5.5 +/- SEM = 1.5; and (b) the cost-benefit ratio of the required treatment for Group I ranged from 1.5 to 7.5 times lower than that required for cumulative pathology resolution in groups lacking preventive coverage. It seems advisable to introduce management strategies to change spontaneous demand into programmed care with a strong preventive component. The accomplishment of this regular school program appears to contribute to strengthen equity and could reduce the differences in oral health care among schoolchildren at different social risk.