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School dental programs

Health Factors: Access to Care
Decision Makers: Educators State Government Grantmakers Healthcare Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 1-9% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

School dental programs include screening students for dental needs, sealant programs to protect students’ permanent molars, fluoride treatment, and other preventive dental care. Services can be provided by dental professionals, often those employed by Federally Qualified Health Centers (FHQCs), via mobile vans parked at schools, or stationary or portable equipment within schools; services may be provided only in schools or students may be linked to clinics for additional care. Programs often serve school districts with high proportions of low income children and districts in rural areas (CG-Oral health, ASTDD-Isman 2011).

Expected Beneficial Outcomes

Reduced cavities
Increased access to oral health care

Evidence of Effectiveness

There is strong evidence that school dental programs prevent cavities, especially for low income children (CG-Oral health, CDC-Gooch 2009, Simmer-Beck 2015, Carpino 2016, Niederman 2008).

Sealant programs substantially reduce cavity formation in sound, pitted, and fissured teeth (Tinanoff 2015, CG-Oral health), especially for children in low income families (CG-Oral health, CDC MMWR-Griffin 2016). Effects are strongest when programs seal the newly erupted molars of second and sixth graders (CDC-Gooch 2009), treat children with the highest risk of cavity development, and perform services directly in schools rather than at local clinics (CG-Oral health). Sealants appear to stay on teeth longer when programs use two-person teams to apply them (CDC-Gooch 2009), though additional personnel costs may reduce the number of students a program can serve (Scherrer 2007).

Fluoride supplements (Cochrane-Tubert 2011), toothpastes, mouth rinses, gels, or varnishes also prevent cavities, though students may be most likely to use toothpaste (Cochrane-Marinho 2015); sealants appear to be more effective than fluoride varnishes (Cochrane-Ahovuo-Saloranta 2016). Fluoride treatments may increase the risk of fluorosis for children under age six (Pizzo 2007, Prystupa 2011); additional research is needed regarding potential adverse effects of swallowing fluoride gels (Cochrane-Marinho 2015, Ammari 2007).

School-based dental programs may reduce costs by performing screenings and applying sealants during the same visit (CG-Oral health), and programs serving larger schools can reduce costs by employing an extra assistant and chair so that dentists and hygienists can move from one sterilized station to the next. Reducing supervision requirements for dental hygienists can also reduce the cost of sealant programs in many states (Scherrer 2007); school dental programs that employ dental hygienists to assess oral health and apply sealants cost less than programs with dentists in these roles (CG-Oral health, Neidell 2016).

The CDC considers preventively sealing all low income children’s molars a cost-effective strategy (CDC-Gooch 2009); sealant programs are most cost-effective when focused on children with high risk of cavities (Tinanoff 2015). Overall, school-based sealant programs appear to become cost saving within two years (CG-Oral health). In Connecticut, Federally Qualified Health Centers (FQHCs) appear to have saved 50% per dental patient by treating children in their schools rather than in clinics (Bailit 2012a).

Services delivered via school partnerships with mobile dental clinics appear to reduce cavities among underserved children in rural areas (Enciso 2015).

Implementation

United States

Sixteen states support mobile preventive care, 25 states support restorative care, and 60% of state oral health programs sponsor fluoride varnishes for young children. As of 2010, 78% of states had dental sealant programs (ASTDD-Isman 2011).

School dental programs may be supported by a variety of private and public entities. Boston University, for example, runs five city wide preventive dental programs, providing dental screenings, fluoride and sealant applications, and oral health education in 61 schools (Boston School-based dental). St. David’s Foundation in Central Texas provides dental care across six school districts via one of the largest mobile dental fleets in the country (St. David's Dental Program). Multnomah County, OR and Dupage County, IL have programs tailored to serve low income children (Multnomah-School oral health, Dupage County-Oral health).

Wisconsin

The Wisconsin Seal-A-Smile program, part of the Children’s Health Alliance of Wisconsin, provides grants for school-based and school-linked dental sealant programs. During the 2014-2015 school year, Seal-A-Smile sealed molars for over 25,000 children in 850 Wisconsin schools. Wisconsin allows dental hygienists to apply sealants (WI-Seal a Smile).

Implementation Resources

ASTDD-Isman 2011 - Isman B. Mobile and portable dental services in preschool and school settings: Complex issues. Sparks: Association of State and Territorial Dental Directors (ASTDD); 2011: Issue Brief. Accessed on February 24, 2017
Big Smiles Dental - Big Smiles Dental. Dental care right outside your classrooms. Accessed on February 24, 2017
Mobile-Portable dental manual - Hill L, Jackson M, Teutsch M, et al. Mobile-portable dental manual. Washington, DC: Association of State and Territorial Dental Directors (ASTDD), National Maternal & Child Oral Health Resource Center (OHRC), Georgetown University. Accessed on January 20, 2016

Citations - Description

ASTDD-Isman 2011 - Isman B. Mobile and portable dental services in preschool and school settings: Complex issues. Sparks: Association of State and Territorial Dental Directors (ASTDD); 2011: Issue Brief. Accessed on February 24, 2017
CG-Oral health - The Guide to Community Preventive Services (The Community Guide). Oral health. Accessed on February 24, 2017

Citations - Evidence

Ammari 2007 - Ammari JB, Baqain ZH, Ashley PF. Effects of programs for prevention of early childhood caries: A systematic review. Medical Principles and Practice. 2007;16(6):437–42. Accessed on February 24, 2017
Bailit 2012a* - Bailit HL, Beazoglou TJ, DeVitto J, McGowan T, Myne-Joslin V. Impact of dental therapists on productivity and finances: III. FQHC-Run, school-based dental care programs in Connecticut. Journal of Dental Education. 2012;76(8):1077-81. Accessed on February 24, 2017
Carpino 2016* - Carpino R, Walker MP, Liu Y, Simmer-Beck M. Assessing the effectiveness of a school-based dental clinic on the oral health of children who lack access to dental care: A program evaluation. The Journal of School Nursing. 2016:1-8. Accessed on March 8, 2017
CDC MMWR-Griffin 2016 - Griffin SO, Wei L, Gooch BF, Weno K, Espinoza L. Vital signs: Dental sealant use and untreated tooth decay among U.S. school-aged children. Morbidity and Mortality Weekly Report (MMWR). 2016;65(41):1141-1145. Accessed on March 8, 2017
CDC-Gooch 2009 - Gooch BF, Griffin SO, Gray SK, et al. Preventing dental caries through school-based sealant programs: Updated recommendations and reviews of evidence. Journal of the American Dental Association. 2009;140(11):1356–65. Accessed on February 24, 2017
CG-Oral health - The Guide to Community Preventive Services (The Community Guide). Oral health. Accessed on February 24, 2017
Cochrane-Ahovuo-Saloranta 2016* - Ahovuo-Saloranta A, Forss H, Hiiri A, Nordblad A, Mäkelä M. Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents (Review). Cochrane Database of Systematic Reviews. 2016;(1):CD003067. Accessed on February 24, 2017
Cochrane-Marinho 2015* - Marinho VCC, Worthington HV, Walsh T, Chong LY. Fluoride gels for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews. 2015;(6):CD002280. Accessed on February 24, 2017
Cochrane-Tubert 2011* - Tubert-Jeannin S, Auclair C, Amsallem E, et al. Fluoride supplements (tablets, drops, lozenges or chewing gums) for preventing dental caries in children. Cochrane Database of Systematic Reviews. 2011;(12):CD007592. Accessed on February 24, 2017
Enciso 2015* - Enciso R, Sundaresan S, Yekikian M, Mulligan R. Oral health status of children attending a mobile dental clinic—A comparative study. Journal of Health Care for the Poor and Underserved. 2015;26(4):1418–1427. Accessed on February 24, 2017
Neidell 2016* - Neidell M, Shearer B, Lamster IB. Cost-effectiveness analysis of dental sealants versus fluoride varnish in a school-based setting. Caries Research. 2016;50(Suppl 1):78–82. Accessed on February 24, 2017
Niederman 2008* - Niederman R, Gould E, Soncini J, et al. A model for extending the reach of the traditional dental practice: The ForsythKids program. The Journal of the American Dental Association. 2008;139(8):1040-1050. Accessed on March 8, 2017
Pizzo 2007* - Pizzo G, Piscopo MR, Pizzo I, Giuliana G. Community water fluoridation and caries prevention: A critical review. Clinical Oral Investigations. 2007;11(3):189–93. Accessed on February 24, 2017
Prystupa 2011* - Prystupa J. Fluorine - A current literature review. An NRC and ATSDR based review of safety standards for exposure to fluorine and fluorides. Toxicology Mechanisms and Methods. 2011;21(2):103–70. Accessed on February 24, 2017
Scherrer 2007 - Scherrer CR, Griffin PM, Swann JL. Public health sealant delivery programs: Optimal delivery and the cost of practice acts. Medical Decision Making. 2007;27(6):762–71. Accessed on February 24, 2017
Simmer-Beck 2015* - Simmer-Beck M, Walker M, Gadbury-Amyot C, et al. Effectiveness of an alternative dental workforce model on the oral health of low-income children in a school-based setting. American Journal of Public Health. 2015;105(9):1763–1769. Accessed on February 24, 2017
Tinanoff 2015* - Tinanoff N, Coll JA, Dhar V, et al. Evidence-based update of pediatric dental restorative procedures: Preventive strategies. Journal of Clinical Pediatric Dentistry. 2015;39(3):193–197. Accessed on February 24, 2017

Citations - Implementation

ASTDD-Isman 2011 - Isman B. Mobile and portable dental services in preschool and school settings: Complex issues. Sparks: Association of State and Territorial Dental Directors (ASTDD); 2011: Issue Brief. Accessed on February 24, 2017
Boston School-based dental - Boston University, Henry M. Goldman School of Dental Medicine. School-based oral health programs: 5 city wide prevention programs operating in 61 Boston schools. Accessed on February 24, 2017
Dupage County-Oral health - Dupage County Health Department, IL. Oral health services. Accessed on February 24, 2017
Multnomah-School oral health - Multnomah County, OR. School and community oral health: A field-based program that promotes oral health, disease prevention, and access to dental care for children. Accessed on February 24, 2017
St. David's Dental Program - St. David’s Foundation. St. David’s Dental Program: Bringing mobile dental clinics to high needs schools and social service agencies in Central Texas. Accessed on February 24, 2017
WI-Seal a Smile - Children’s Health Alliance of Wisconsin. Oral health: Wisconsin Seal-A-Smile program. Accessed on February 24, 2017

Page Last Updated

March 8, 2017

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