SCHOOL HEALTH PROGRAMMES

Dr.preyas joshi3rd Year postgraduate student

Deptt. Of Public Health DentistryRajasthan Dental College & Hospital

Contents Introduction

Basic considerations

Historical background

School health

Integrating oral health within various components of a school health

programme

School based programs

Specific programs

Conclusions

References

INTRODUCTION

HEALTH

• Health is a state of complete physical, mental and social well-

being and not merely the absence of disease or infirmity.

(WHO 1948)

• Amplified to include the ability to lead a “socially and

economically productive life” (WHO 1978)

ORAL HEALTH

• A standard of health of the oral and related tissues which

enables an individual to eat, speak and socialize without active

disease, discomfort, or embarrassment and which contributes

to general well-being.

(UK Department of health, 1994)

What is a Health Promoting School(HPS)?

• A health promoting school is one that constantly

strengthens its capacity as a healthy setting for living,

learning and working.

(World Health

Organization)

• A health promoting school:

Fosters health and learning with all the measures at its

disposal.

Engages health and education officials, teachers, teachers'

unions, students, parents, health providers and community

leaders in efforts to make the school a healthy place.

Strives to provide a healthy environment, school health

education, and school health services along with

school/community projects and outreach, health promotion

programmes for staff, nutrition and food safety programmes,

opportunities for physical education and recreation, and

programmes for counselling, social support and mental health

promotion.

Implements policies and practices that respect an individual's

well being and dignity, provide multiple opportunities for

success, and acknowledge good efforts and intentions as well

as personal achievements.

Strives to improve the health of school personnel, families and

community members as well as pupils; and works with

community leaders to help them understand how the

community contributes to, or undermines, health and

education.

School Health Program

• A comprehensive SCHOOL HEALTH PROGRAM is an

integrated set of planned, sequential, school-affiliated strategies,

activities, and services designed to promote the optimal

physical, emotional, social, and educational development of

students. The program involves and is supportive of families

and is determined by the local community, based on community

needs, resources, standards, and requirements. It is coordinated

by multidisciplinary team and is accountable to the community

for program quality and effectiveness.1

1. Allensworth, D., Lawson, E., Nicholson, L., and Wyche. J. (Eds.). (1997). School & Health: Our Nation’s Investment (p. 2). Washington, D.C.:

National Academy Press.

Models

• There are a variety of models that have been used to describe

the components of a school health program.

1. The Three-Component Model: Originating in the early 1900s

and evolving through the 1980s, the three-component model is

considered the traditional model of a school health program,

consisting of the following basic components:

• Health education

• Health services, and

• A healthful environment.

2. The Eight-Component Model: In the 1980s, the three-component

model was expanded into an eight-component model—

traditionally referred to as a “comprehensive school health

program”—consisting of the following components:

• Health education

• Health services

• Healthy school environment

• physical education

• nutrition services

• health promotion for school staff

• counseling, psychological, and social services

• parent and community involvement.

3. Full-Service Schools: In recent years, additional models,

definitions, and descriptions have emerged that build on

previous models, including the full-service school model. In

addition to quality education, a full-service school model

involves a one-stop, seamless institution, where the school is

the center for providing a wide range of health, mental health,

social, and/or family services.2

2. Diane D. Allensworth et al. The Comprehensive School Health Program: Exploring an Expanded Concept. Journal of School Health

1987;57(10):409-12.

School Health Through the Early Twentieth Century

• During the colonial period, only limited attention was paid to

any aspect of school health.

• Benjamin Franklin advocated a "healthful situation" and

promoted physical exercise as one of the primary subjects in

the schools that were developing during his time. 

• Samuel Moody, headmaster of the Dummer Grammar School,

which opened in 1763 as the first private boarding school,

taught the value of exercise and participated in it himself.

• Prior to the mid-1800s, however, public education was still in

a formative stage and efforts to introduce health into the

schools were isolated and sparse.

• School health professionals often state that the ''modern school

health era" began in 1850.

• In that year, the Sanitary Commission of Massachusetts,

headed by Lemuel Shattuck, produced a report that had a

significant impact on school health.

Lemuel Shattuck: Architect of American Public Health

• On the 100th anniversary of Lemuel Shattuck's 1850s Report

of the Sanitary Commission of Massachusetts, Winslow

praised the Report as “the most outstanding single ‘Book of

Prophesy’ in the history of public health.”

• Most of the recommendations of the Shattuck Report are now

standard components of American public health practice.

Shattuck was not just a “prophet” of American public health,

but its most influential architect.

• The report states the following:

Every child should be taught early in life, that, to preserve his own life and

his own health and the lives and health of others, is one of the most

important and constantly abiding duties. By obeying certain laws or

performing certain acts, his life and health may be preserved; by

disobedience, or performing certain other acts, they will both be destroyed.

By knowing and avoiding the causes of disease, disease itself will be

avoided, and he may enjoy health and live; by ignorance of these causes

and exposure to them, he may contract disease, ruin his health, and die.

Everything connected with wealth, happiness and long life depends upon

health; and even the great duties of morals and religion are performed

more acceptably in a healthy than a sickly condition.

• When New York City was faced with an outbreak of smallpox

in the 1860s, no mechanism was in place to provide free

vaccinations to those who needed them, so the Board of

Health turned to the schools. Education officials agreed to

permit inspection of school children to determine whether or

not they had been vaccinated, and in 1870, smallpox

vaccination became a prerequisite to school attendance 

• In 1902,

New York City provided for the routine inspection of all

students to detect contagious eye and skin diseases, and

employed school nurses to help the students' families seek and

follow through with treatment.

Lillian Wald demonstrated in New York City that nurses

working in schools could reduce absenteeism due to

contagious diseases by 50 percent in a matter of weeks.

• In 1906, Massachusetts made medical inspection compulsory

in all public schools, a step that ushered in broad-based

programs of medical inspections in which school nurses and

physicians participated.

• By 1911, there were 102 cities employing cadres of school

nurses.

• In 1913, New York City alone had 176 school nurses.

• As late as 1914, school inspectors were not allowed to touch

children, and inspections were done with children fully

clothed.

• In 1915, the New York Board of Education introduced a new

requirement that all children entering school must undergo a

physical examination without clothing. This requirement met

some resistance, with critics declaring it immoral to strip

children for medical purposes.

• The prevalence of tuberculosis in the United States had a

significant impact on school health during the early part of the

century. Particularly notable was the development and spread

of "open-air classrooms“ — wide open to the outside air,

even in the middle of winter — in all major cities, under the

supervision of both medical and education personnel.

• In 1915, the National Tuberculosis Association enlisted school

children in the Christmas Seal drive. A child who bought or

sold 10 cents worth of seals was enrolled as a "Modern

Health Crusader" and received a certificate with four "health

rules."

11 daily “health chores” for Modern Health Crusaders

1. Wash hands before each meal; clean fingernails.

2. Brush teeth after breakfast and the evening meal.

3. Carry handkerchief and use it to protect others when coughing

or sneezing.

4. Avoid accidents; look both ways when crossing the street.

5. Drink four glasses of water, but no tea, coffee, or any harmful

drink.

6. Eat three wholesome meals; drink milk.

7. Eat some cereal or bread, green (watery) vegetable and fruit,

but no candy or "sweets" unless at the end of the meal.

8. Go to the toilet at regular times.

9. Sit and stand straight.

10. Spend 11 hours in bed, with windows open.

11. Have a complete bath and rub yourself dry.

School Health from World War I(1914) to the 1960s

• World War I marked a turning point in the history of school

health programs. Prior to this period, programs had a narrow

focus emphasizing inspection, hygiene, negative messages,

and didactic instruction about anatomy and physiology. 

• However, the advent of the war made the problems of poverty

more visible: malnutrition, poor physical condition, and the

abysmal state of the health and welfare of many of the

country's children.

• New health promotion philosophies and movements began

to spring up to replace the outmoded methods; these new

approaches were based on using motivational psychology and

an understanding of behavior. 

• The Child Health Organization was one of the most active

groups devoted to the health of children, and the organization

conducted a nationwide campaign to raise the health standard

of the American School Child.

• In 1922, in collaboration with the U.S. Department of the

Interior and the Bureau of Education, the organization

published and widely distributed…..

”The Rules of the Health Game”

• In the 1920s, more than 73 percent of the surveyed schools

taught health directly under the name of "health" or "hygiene,''

while 108 cities reported correlating content in their health

curriculum to such other subjects as language, civics, reading,

physical education, general science, and art.

• During the following decades, the health education curriculum

included topics such as nutrition, personal health habits,

diseases, exercise, alcohol and tobacco, family health, and sex

education.

• In 1936, New York City Board of Education set aside a day as

Health Day, during which teachers checked children's height,

weight, vision, hearing, and teeth. Teachers then had the

responsibility for trying to get any defects corrected. 

• The 1948 National School Health Bill, which was designed to

provide federal aid to school health, was defeated partly

because of the opposition of the medical profession whose

members feared that funds would be provided for services to

students who would otherwise have paid private practitioners.

National School Lunch Act

• When many World War II draftees were found to suffer from

nutritional deficiencies, the federal government in 1946 passed

the National School Lunch Act to provide funds and surplus

agricultural commodities to assist schools in serving nutritious

hot lunches to school children. It was not until 1966, however,

that a pilot school breakfast program was established, and the

program was not made permanent until 1975.3

3. The National Academies Press website: http://www.nap.edu/read/5153/chapter/4Accessed on 03/01/2016

“In the long view, no nation is healthier than its children, or more prosperous than its farmers.”

– Harry Truman

President of the United States of America

(On signing the 1946 NSLA)

India

• In ancient India, schools were in the form of Gurukuls.

Gurukuls were traditional Hindu residential schools of

learning; typically the teacher's house or a monastery.

• During the Mughal rule, Madrasa’s were introduced in India

to educate the children of Muslim parents. 

• Under the British rule in India, Christian missionaries from

England, USA and other countries established missionary and

boarding schools throughout the country. Later as these schools

gained in popularity, more were started and some gained

prestige. These schools marked the beginning of modern

schooling in India and the syllabus and calendar they followed

became the benchmark for schools in modern India. Today

most of the schools follow the missionary school model in

terms of tutoring, subject / syllabus, governance etc.with minor

changes.

1875, AmritsarSikh girls enrolled in a school run by the Church Missionary School

• School health is an important branch of community health.

• An Economical and powerful means of raising community

health.4

• Developed over past 70 years.......

Narrower concept of medical examination

Broader concept of comprehensive care

4. Park K. Textbook of Preventive and Social Medicine. 22nd Ed. Jabalpur; M/s Banarsidas Bhanot Publishers. 2013

Historical Development (The Indian Context)

• The beginning of school health services in India dates back to

1909, when for the first time medical examination of the

school children was carried out in Baroda(Vadodara) city.

• The Bhore committee (1946) reported that school health

services were practically non-existent in INDIA, and where

they existed, they were in an under-developed state.4

Sir Joseph William Bhore 1878 - 1960

J.W. Bhore, Chairmanship of the Health Survey and Development CommitteeEstablished in 1943 by the British colonial government

• 1953 – the secondary education committee emphasized the need

for medical examination of pupils and school feeding

programmes.

• 1960 – The government of India constituted a School Health

Committee to assess the standards of health and nutrition of

school children and suggest ways and means to improve them.

• 1961 – The committee submitted its report, which contains many

useful recommendations.4

The 1st Asian Declaration on Oral Health Promotion for School Children

July 19, 2001 - “Tokyo Declaration”

• Declaration stated that this conference will be held on a

regular basis.

To exchange information

To Build a cooperative system

Improve oral health among children

Contribute to the well-being of mankind5

5. World Health Organization website: http://www.who.int/oral_health/events

Accessed on 03/01/2016,2016

The 2nd Asian conference oforal health promotion for school children

- February 21-23, 2003

• Theme: "Prospectus for our Future Generation"

• Took place in Ayutthaya, Thailand.

• Participants from South East Asia (SEARO) and Western Pacific

(WPRO) regions discussed how to share experiences related to

continuous implementation of school oral health programmes

within the framework of the WHO Global School Health Initiative.

• “Ayutthaya Declaration”: Oral health is an integral part of

general health and essential for quality of life for children.

• Called upon national authorities in health and education to

ensure the implementation of systematic school health

programmes for promoting oral health and general health in

children.

Bangalore Declaration

• Global workshop on "Prevention and promotion of oral

health through schools“.

• Took place on 27-28th January, 2005 in Bangalore.

• Called upon national authorities in health and education to

ensure implementation of school-based oral health

programmes for children.

• Established school health programmes should be strengthened.

• Emphasis to risk factors common to oral disease and chronic

diseases and health promotion.

Health Problems of The School Child4

(1) Malnutrition

(2) Infectious diseases

(3) Intestinal parasites

(4) Diseases of skin, eye and ear; and

(5) Dental caries

Objectives of School Health Services4

1. Promotion of positive health

2. Prevention of diseases

3. Early diagnosis, treatment and follow-up of defects

4. Awakening health consciousness in children

5. Provision of healthful environment.

Aspects of School Health Service4

1. Health appraisal of school children and school personnel

2. Remedial measures and follow-up

3. Prevention of communicable diseases

4. Healthful school environment

5. Nutritional services

6. First aid and emergency care

7. Mental health

8. Dental health

9. Eye health

10. Health education

11. Education of children with special needs.

12. Proper maintenance and use of school health records.

Ideal Requirements of a School Health Programme

• Be Administratively sound

• Available to all children

• Provide facts about Health and health care

• Aid in development of favorable attitude towards health

• Provide environment for development of psychomotor skills

• Include primary preventive programs

• Provide screening methods

• Ensure treatment

ADVANTAGES

1. Can bring comprehensive health care to school children

2. Students can be accessed during their formative years

3. School clinics are less threatening

4. Children’s daily contact with Health personnel

5. Makes it easy to maintain General health in adult life

6. Regular Healthcare attendance pattern can be instilled

7. Expenses and time involved in transportation to clinics can

be saved

8. Parents don’t have to lose the working day

9. Cost-effective

10. Health of school staff, families and community members can

be enhanced.

ARE SCHOOL-BASED ORAL HEALTH PROGRAMMES EFFECTIVE ???

• School environments have a significant impact on sustainable

healthy behaviours.

• Without supportive environments, optimal oral health for

children cannot be realised.

• A well designed and implemented programme which links

curriculum with oral health promotion in school and

community is likely to produce health gains.

• Considerable evidence to support effectiveness of well-

conducted school-based oral health interventions worldwide.6

• In the regions of Americas, the US Surgeon General Report

(2000) documents that most school-based or community-wide

oral health prevention programmes are beneficial and cost-

effective.

6. WHO information series on school health. Oral Health Promotion: An Essential Element of a Health-Promoting School. Geneva: World

Health Organisation; 2003.

• Most school-based or school-linked fluoride and fissure sealant

programmes are effective. Particularly for children with high risk of

caries.

• Along with community-based and media-based activities, school-

based programmes are effective in preventing or delaying smoking

onset in 20-40% of adolescents.

• Schools that adopt and implement principles of a ‘Health-Promoting

School’ have lower proportion of children with dental caries and

dental trauma.6

• In India, oral health education has been integrated into school

curriculum

• Aims to provide dental knowledge and to empower children to

take control over their own health.

• Compared with the control groups, the test groups showed a

significant improvement in knowledge and oral hygiene.6

• There are three main divisions recognized in the field of

school health:

1. School health services

2. School health education

3. Healthful school living7

7. Dunning JM. Principles of dental public health. 4th edition. London: Harvard university press; 1986.

SCHOOL HEALTH SERVICES

School health services are procedures established to:

Appraise health status of pupils and school personnel

Counsel pupils, parents, and other concerning appraisal

findings.

Encourage correction of remediable defects.

Assist in identification and education of children with special

needs.

Help prevent and control diseases.

Provide emergency services for injury or sudden sickness.

SCHOOL HEALTH EDUCATION

• It is the process of providing learning experiences for the

purpose of influencing knowledge, attitudes, or conduct

relating to individual and community health.

HEALTHFUL SCHOOL LIVING

Designates provision of a safe and healthful environment.

Organization of a healthful school day.

Establishment of interpersonal relationships favourable to

emotional, social and physical health.

An addition to healthful school living has been school water

fluoridation at an increased concentration where public water

supplies are not available for community fluoridation.7

• Stanley B. Heifetz et al. (1983) conducted a study to determine

if fluoridating a school's water supply at seven times the

optimum amount (5 parts per million over a 12-year period )

recommended for community fluoridation produces greater

benefits than the currently recommended 4.5 times.

A caries reduction rate of 39% was observed.8

8. Stanley B. Heifetz et al. Effect of School Water Fluoridation on Dental Caries: Results in Seagrove, NC, After 12 Years. The Journal of the

American Dental Association 1983;106(3):334-37.

Health appraisal, Counselling & Follow through

• The starting point for school health services is.............

health appraisal, which has been defined as:

“The process of determining the total health status of the child

through such means as health histories, teacher and nurse

observations, screening tests, and medical, dental, and

psychological examinations.”

• Following appraisal comes health counselling and follow

through.

• Health counselling is defined as “the procedure by which

nurses, teachers, physicians, guidance personnel, and others

interpret to pupils and parents the nature and significance of

health problem and aid them in formulating a plan of action

which will lead to solution of the problem.”7

Planning the Intervention6

• The key steps to consider in planning oral health intervention

are:

Establishing a School Health Team and a Community

Advisory Committee.

Obtaining political, parental and community commitments.

Establishing supportive school health policies.

Setting goals and objectives.

School Health Team6

• Should comprise a balance of representatives including:

Students

Parents

School administrators

Teachers and school staff

Members of teachers’ representative organisations

PTA representatives

Food service providers

Health care providers

Policies that are Useful in School Oral Health

• Oral health education within school curriculum

• Oral hygiene

• Healthy eating policies including canteen, vending machines

• Violence and bullying

• Trauma and emergency care

• Fluorides

• Safe water and sanitation

• Infection control

• Safe environment

• Exercise

• Smoking and tobacco use

• Alcohol and substance abuse6

Community Commitment

• Development and maintenance of oral health interventions are

influenced by level of support from local community.

• Community participation is particularly important to ensure

the issues are addressed adequately and effectively.

• Creates a sense of community ownership.

• Dental health programmes succeed, not because they are

grafted onto a community by a group of experts, but because

community has come to want the programme.6

Parental Support & Commitment

• Parents influence their children’s oral health directly by

providing a home environment that is conducive to oral

health.

• Parents and other significant family members should be

educated about importance of oral health consequences of

oral diseases and preventive oral health practices.6

INTEGRATING ORAL HEALTH WITHIN VARIOUS COMPONENTS OF A

SCHOOL HEALTH PROGRAMME

A comprehensive school programme should include:

• Healthy school environments

• School health education

• School health services

• Nutrition and food services

• Physical education and sports

• Mental health and well being

• Health promotion for school staff

• School and community relationships and collaboration6

HEALTHY SCHOOL ENVIRONMENT

• In health-promoting schools, emphasis is placed on supportive

school environment.

• Physical and Psychosocial

• Should be supportive to each other.

Physical Environment:

Safe water and sanitation

Health dietary practices

Health supportive environment

Outside vendor policy

Psychosocial Environment:

Refers to social and psychological conditions that strengthen

health education potential of the school community.

Support for health promotion

Teachers as role models

Peer reinforcement

SCHOOL HEALTH EDUCATION6

The primary goals:

• Help children develop personal lifelong skills

• Raise health consciousness

• Improve understanding and healthy attitudes

• Promote healthy behaviours

• Reduce risks of oral diseases

Oral Health Education Curriculum6

Topics covered:

• Teeth and their functions

• Dental plaque and tooth decay

• Sugar and dental health

• Personal care of teeth and gums

• Fluorides

• Nutrition

• Dental visits

Educational Goals6

1. KNOWLEDGE

• Name the basic functions of teeth

• Explain why each function is important

• Give details of the two sets of teeth

• Describe number and the importance of primary teeth

• Explain why primary teeth are shed and replaced by

permanent teeth.

• Identify which permanent tooth erupts first and its importance

• Name healthy and unhealthy foods related to teeth

• Describe how to remove plaque

2. ATTITUDES

• Appreciate the importance of teeth and oral functions

• Demonstrate a positive attitude towards oral health

• Demonstrate a positive attitude towards dental team

3. BEHAVIOUR

• Practise proper oral hygiene care

• Restrict the amount and frequency of sugar intake

• Adopt a regular check-up routine

• Oral health education should be combined with efforts

addressing other health issues such as tobacco use, violence,

healthy nutrition etc.

SCHOOL HEALTH SERVICES

• School health services, help screen, prevent, control and

monitor oral diseases and conditions, as well as maintain good

oral health.

• Oral health teams work collaboratively with primary health

care team to provide accessible oral health services to

students.

SCREENING

• Screening of teeth and mouth enables early detection, and

timely interventions

• Leads to substantial cost savings

• Important in planning and provision of school oral health

services as well as health services.

• Signs of some general health conditions can also be identified

through oral health screening.6

• Not necessarily performed by dentist or dental auxiliaries.

• Can be effectively carried out by trained school health nurses,

school teachers, or community workers.

• Can form part of oral and general health education and self

care programmes in school curriculum.6

Classification of screening examinations(WHO, 1962)

Type 1, Complete dental examination with all aids

• This involves a very complete examination using mouth

mirror and explorer, good illumination, full mouth

radiographs, and lab investigations.

• Obviously unsuited to case finding in entire school

populations because of the expense and time involved.

• Moreover, dentist responsible for treatment will wish to make

his own final examination in order to construct a logical

treatment plan.

Type 2, Limited examination using mouth mirror and explorer,

bite-wing x-rays, and, if necessary, periapical x-rays

• Adapted to school dental health programs on a continuing

basis, but not for all children every year.

• May suffice (be enough or adequate) in mouths with

uncomplicated dental disease

• Seldom subject to danger of false negative findings which are

found in Types 3 and 4.

Type 3, Inspection using mouth mirror and explorer and adequate

illumination (epidemiological surveys)

• Lends itself very well to school procedures.

• Can be performed either by a dentist or by a dental hygienist.

• Identifies major dental needs in most instances.

• Can be vehicle for excellent individual health education.

• Can be performed on school premises with portable equipment

• Hygienist can combine it with dental prophylaxis or with topical

fluoride treatment.

Type 4, Screening using tongue depressor and available

illumination

• Dental case finding at its quickest.

• But lowest efficiency.

• Yet needed sometimes where dental personnel are not

available.

• Where school physicians or school nurses are called upon to

identify most serious cases of dental disease.

REFERRAL

• For services that cannot be offered in school, school oral

health services can provide referrals to other school services,

such as counselling and other general health issues and to local

health services, specialist care and other community agencies,

as appropriate.

Blanket Referral

• A program that has proved effective in many schools is

‘BLANKET REFERRAL’ of all children to their family

dentists.

• All children are given referral cards to take home and

subsequently to dentist, who signs the card upon completion of

examination, treatment or both. The signed cards are then

returned to the school nurse, or classroom teacher.

Excuses from School for Treatment

• The National Education Association recommends that children

should be excused to keep office appointments with the

physician or dentist during school hours.7

PC

Abuses of the system can be

avoided by using excuse forms

with space for relevant details

to assure that appointment was

actually kept.

• Two good reasons for such an excuse:

1. First, child is a more cooperative patient when medical and

dental services are provided during early or middle part of

day.

2. Second, physicians and dentists can provide better service

when entire day is available for services to children and they

do not have to crowd their child patients into afterschool

hours and Saturdays/Holidays.7

SCHOOL BASED PROGRAMMES

Tooth Brushing Programs9

• In a classroom 6-8 children can be taught as a group.

9. Peter S. Essentials of preventive and community dentistry. 4th ed. New Delhi: Arya(Medi) Publishing House; 2010.

• Mastery of 450 angulations and short vibratory strokes can

then be repeated on an oversize dentoform model.

• Emphasis on the need to follow a definite brushing sequence

to ensure that all tooth surfaces are brushed.

• P.E. Petersen et al. (2015) conducted a two-year study to

assess the benefits of an enhanced oral health promotion

program combined with a closely supervised tooth brushing

program in 15 schools of southern Thailand. 3,706 pre-school

children were recruited: 8 schools with 1,766 children as

controls; 7 schools with 1,940 children in the intervention

groups. The DMFT and DMFS increments were 1.19 and 1.91

for the control group and 1.04 and 1.59 for the intervention

groups. These represent 12.6% and 16.8% reductions in caries

respectively.10

10. P.E. Petersen et al. School-based intervention for improving the oral health of children in southern Thailand. Community Dental Health

2015;32(1):44–50

• The Indian Association of Public Health Dentistry (IAPHD)

had decided to celebrate NATIONAL TOOTH BRUSHING

DAY on 7thNovember of each year and had requested each

college in India to adopt this day.

Fluoride Mouth-rinse Program

• In this program, rinsing with a 0.2 percent neutral NaF

solution once a week is performed under supervision in

classrooms.

• A 0.2 percent NaF solution is prepared by mixing 3 gm NaF

with 1,500 ml tap water.

• 10 ml that each child uses for weekly rinsing contains 9 mg

fluoride.11

11. Leske GS, Ripa LW. Guidelines for establishing a fluoride mouth-rinsing caries prevention program for school children. Public Health Rep.

1977;92(3):240-4.

• Premeasured packet of NaF powder is added to a pre-marked

container.

• Container is closed and shaken for 10 to 15 seconds to

dissolve all of powder.

• Cap is then replaced with a pump that is calibrated to deliver

10 ml of solution.

• Each child receives a disposable cup containing 10 ml of

fluoride solution and a paper napkin.

• Teacher times the rinse for 60 seconds.

• Children are reminded to swish the solution, to use cheek

pressure to force the fluid between the teeth, and not to

swallow the solution.

• After 60 seconds, children expectorate into paper cups, wipe

their mouths with napkins, and stuff them into the cups to

absorb the solution.

• Cups and napkins are then collected in a disposable bag that is

then tied and deposited in waste basket.

FLUORIDE TABLET PROGRAM

• One tablet given to each student.

• Student chews and swishes 2.2 mg NaF (1 mg fluoride) tablet

for one minute and then swallows.

• Swish-and-swallow technique not only provides benefits of a

topical application but also provides systemic benefits.

• Daily tablet is more effective than weekly rinse.9

Half-Strength

SCHOOL WATER FLUORIDATION

• In areas lacking public water supplies and where fluoride is

not naturally present in the well water, school fluoridation

programs have been shown to be effective and safe.

• Reductions of up to 39% in the rate of dental decay have been

reported.12

12. Avery KT et al. School water fluoridation. J Sch Health. 1979;49(8):463-5.

• The amount of fluoride added to school water supply 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.

• A major disadvantage is that the children do not receive

benefits until they begin school.

optimal level of fluoride in community water systems/recommended ratio of

fluoride to water: 0.7 parts per million.

• Endemic fluorosis remains a challenging and extensively

studied national health problem in India.

• In 1991, 13 of India’s 32 states & territories were reported to have

naturally high concentrations of fluoride in water (Mangla,1991),

but this had risen to 17 by 1999 (UNICEF, 1999).13

13. J. Fawell et al. Fluoride in Drinking-water. World Health Organization 2006. IWA Publishing. London, UK

• The most seriously affected areas are Andhra Pradesh, Punjab,

Haryana, Rajasthan, Gujarat, Tamil Nadu and Uttar Pradesh

(Kumaran, et al., 1971; Teotia et al., 1984).

• The highest concentration observed to date in India is 48 mg/l

in Rewari District of Haryana (UNICEF, 1999).13

• In Rajasthan, fluoride concentrations have been found to vary

between 0.6 mg/l and 69.7 mg/l (Gupta, 1999).

• The prevalence of dental fluorosis has been investigated in

Rajasthan by Choubisa et al. (1997).

• Prevalence rates were observed in 15 tribal villages with

fluoride concentrations of 0.3–10.8 mg/l.

• At mean fluoride concentrations of 1.4 and 6 mg/l, dental

fluorosis was seen in 25.6 per cent and 84.4 per cent of school

children (< 16 years) and 23.9 per cent and 96.9 per cent of

adults respectively.14

14. SL Choubisa. Endemic fluorosis in southern rajasthan, india. Fluoride 2001;34(1):61-70

• The studies made by Rajasthan Voluntary Health Association

in 1994 has showed that the total number of villages having

fluoride problem in Rajasthan is 2433 covering nearly 2.6

million population. Moreover, nearly 30,000 people are

drinking water with concentration of 10.0 mg/l of fluoride.15

• The permissible limit is 1.5 mg/l according to the Public

Health Engineering Department (CPHED), Government of

India and the World Health Organization.

15. Hussain J et al. fluoride in drinking water in Rajasthan and its ill effects on human health. Journal of Tissue Research 2004;4(2):263-73.

SCHOOL-BASED SEALANT PROGRAMS

• Sealants prevent tooth decay and also stop cavities from

growing.

• The Surgeon General’s report on oral health indicates that

sealants can reduce decay in school children by more than 70

percent.

• Especially important for reaching children from low-income

families who are less likely to receive private dental care.

16. http://www.cdc.gov/oralhealth/topics/dental_sealant_programs Accessed on 06/01/2016

• Findings from scientific studies clearly show that school

dental sealant programs work to stop tooth decay.

• Based on this evidence, the following recommendations are

provided for practitioners in school-based programs:

Seal pit-and-fissure tooth surfaces that are sound or have early

decay, prioritizing first and second permanent molars.

Use visual assessment to differentiate surfaces with the earliest

signs of tooth decay from more advanced lesions.

X-rays are not needed solely for sealant placement.

A toothbrush can be used to help clean the tooth surface before

acid etching.

When resources allow, have an assistant help the dental

professional place sealants.

Provide sealants to children even if follow-up examinations

for every child cannot be guaranteed.

A fissure sealant is defined as a material that is placed in

the pits and fissures of teeth in order to prevent or control

the development of dental caries.

LIST OF EQUIPMENT AND MATERIAL17

• Basic requirements for a school-based fissure sealant programme:

• Equipment

Portable cutting unit with oil-less compressor

Oil-free 3-way syringe

Vacuolyser and suction tips

Light cure equipment (if using light cure resin)

Portable chair

Portable light

Basic dental instruments

• Materials17

Self-cure or light cure composite resin kit (Opaque/tinted) or

Glass Ionomer Cements

Cotton rolls

White stones for occlusal adjustment of sealant

Articulating paper

Petroleum Jelly / Vaseline (if using glass ionomer cement)

Dentine conditioner (if using glass ionomer cement)

17. SCHOOL-BASED FISSURE SEALANT PROGRAMME. Second Edition. Ministry of Health, Malaysia. 2003

NUTRITION AS A PART OFSCHOOL ORAL HEALTH PROGRAM

• The Mid Day Meal is the world’s largest school feeding

programme reaching out to about 12 crores children in over

12.65 lakh schools.18

18. http://mdm.nic.in/ Accessed on 6 january, 2016

• The Midday Meal Scheme is a school meal programme of the

government of India designed to improve the nutritional status

of school-age children nationwide.

• The central and state governments share the cost of the

Midday Meal Scheme, with the centre providing 75 percent

and the states 25 percent.

The nutritional guidelines for the minimum amount of food and

calorie content per child per day are:

• In 1925, a Mid Day Meal Programme was introduced for

disadvantaged children in Madras Municipal Corporation.

• By the mid 1980s three States viz. Gujarat, Kerala and Tamil

Nadu and the UT of Pondicherry had universalized a cooked

Mid Day Meal Programme with their own resources for

children studying at the primary stage

• By 1990-91 the number of States implementing the mid day

meal programme with their own resources on a universal or a

large scale had increased to twelve states.

• By the year 1997-98 the programme introduced in all blocks of

the country.

• It was further extended in 2002 to cover not only children in

classes I -V of Government, Government aided and local body

schools, but also children studying in EGS (Education

Guarantee Scheme).

• Central Assistance under the scheme consisted of free supply of

food grains @ 100 grams per child per school day, and subsidy

for transportation of food grains up to a maximum of Rs 50 per

quintal

Mid-Day Meal improves three areas:

1. School attendance

2. Reduced dropouts

3. A beneficial impact on children's nutrition.

• Meal should be a supplement and not substitute to home diet.

• Meal should supply at least 1/3 of total energy requirement,

and ½ of protein need.4

• Meal should be such that it can be easily prepared in schools, not

involving any complicated cooking process.

• Locally available food should be used.

• Menu frequently changes to avoid monotony.

• Food grains at rate of 3 Kgs minimum per child are provided per

month (300 k cal and 8-12 grams of protein per day).

• Central Government supplies full requirement of food grains for

programme free of cost.4

SPECIFIC PROGRAMMES

“Learning about Your Oral Health”

A prevention-oriented school program

• Development:

“Learning about Your Oral Health” was developed by

ADA and its consultants in response to a request from 1971

ADA house of delegates.

Comprehensive program.

Materials for preschool, primary and secondary schools

have been developed for educators to facilitate inclusion of

preventive dentistry into school health curricula.19

19. Jong AW. Community dental health. 3rd edition. Missouri: Mosby Inc.; 1993.

Primary goal :

• To develop knowledge, skills, and attitudes for prevention of

dental diseases.

• First priority of program was to develop effective plaque

control knowledge and skills.

• Next consideration is given to increasing knowledge regarding

diet and dental health.

• Emphasis on understanding role of sugar and starch.

Other areas:

• Significance of fluoride

• Oral safety

• Consumer health concepts

• Role of dental professionals

• Oral health in relationship to total health

• Community dental programs

• Program format is divided into five levels with specific

content defined for each level.

• The levels are divided by grades:

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)

• Core material for each of five levels is self-contained in a

teaching packet.

• Allows classroom teacher to adapt presentation to needs of the

students.

Each packet includes:

1. A teacher's self-contained guide on "dental health facts"

with a section on children with special needs.

2. A glossary of dental health terms.

3. A curriculum guide featuring content, goals, behavioural

objectives, and suggested activities for other classes.

4. Five lesson plans for preschool level and seven or more

lesson plans for each of the other levels.

5. Four overhead transparencies

6. 12 spirit masters (Blind tasting competitions)

7. Methods and activities for parental involvement

• Supplementary printed material and films coordinated with

each level have also been developed.

• In addition, ADA, in cooperation with American Cancer

Society, has developed and produced a rock video on dangers

of using smokeless tobacco.

• Geared for junior and senior high students, as well as for adult

audiences.

Texas state-wide preventive dentistry program:

“Tattle tooth II, A New Generation”

DEVELOPMENT:

• The Tattletooth Program was developed in 1974-76.

• Cooperative effort between Texas dental health professional

organizations, the Texas education agency, and the Texas

Department of Health.

• In its original format this program was used by approximately

500,000 children in Texas per year before the new program

was completed in 1989.

• In 1989, the Bureau of Dental Health developed a mostly new

program, Tattletooth II, A New Generation for Grades K-6.

• So named because characters in the artwork for grades

kindergarten through second were from the old curriculum.

• New curriculum was modified to reflect recommendations

obtained from formative evaluator process.

• Separate lesson plans were developed for each grade.

• Three videotapes were produced as part of the teacher training

package.

• The first videotape familiarizes teachers with lesson format

and content.

• Second videotape “Brushing and Flossing,” was developed for

dual purpose:

teacher training

instructional unit to be used by teacher with students.

• Third videotape provides teachers with additional background

information as a means of preparing them to teach the lessons.

• In addition to the curriculum, a public relations plan was

formulated

• Materials were developed to aid in implementation of the

program.

• Two news releases were written:

1. One was targeted toward parents and designed for local

newspapers

2. Other was aimed at readership of professional education

journals.

• A letter to school principals and nurses was sent out as part of

a package distributed annually by the Bureau of Maternal and

Child Health.

PROGRAM PHILOSOPHY AND GOALS

Basic goal:

• to reduce dental disease and to develop positive dental habits

to last a lifetime.

• Major thrust of Tattletooth is to convince students that

preventing dental disease is important and that they can do it.

• Tattletooth II embraces the six elements of effective lesson

design:

1. anticipatory set,

2. setting the objective,

3. input modeling,

4. checking for understanding,

5. guided practice,

6. independent practice.

Program implementation:

• The Texas Department of Health is divided into eight public

health regions

• Employs 16 hygienists in regions who implement the

Tattletooth program.

• Hygienists instruct teachers using videotapes designed for

teacher training and provide them with a copy of the

curriculum.

• In some instances, hygienists train lead teachers who, in turn,

provide training for teachers in their schools.

• The bureau provides teachers with a unit overview and a

section on organizing dental health lessons.

• Health promotion activities are encouraged and publicized

within school community.

• Teachers are encouraged to invite a dental professional to

demonstrate brushing and flossing in classroom.

• A field trip to a dental office is strongly recommended for

kindergarten children.

• Each unit has a brief introduction that summarizes and gives a

theme to the unit.

• Topics covered in the curriculum include:

correct brushing and flossing techniques

awareness of the importance of safety

factual information relating to dental disease, its causes, and

preventive techniques.

• The results of the Tattletooth II evaluation were positive, with

teachers praising teacher-student interaction that was present as

a result of format.

• Student responses to curriculum were positive or very positive.

• About half the teachers had used previous program, and half the

teachers were new to program.

• Approximately 94% of teachers felt that teaching oral health can

have a positive effect on children's dental health habits.

• Most teachers (90%) taught dental health once per year

• Average number of hours in which dental health was taught

was 4.2.

• The bureau states that given teaching requirements, the fact

that 88.7% of the teachers spent 45 minutes to 62 hours

teaching "Tattletooth II, A New Generation" is an indication

that the curriculum was well received.

North Carolina State-wide Preventive Dental Health Program

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

continuing education on prevention for dental professionals

plaque-control education in schools and communities.

• In 1973 Frank E. Law prepared a report for North Carolina

Dental Society that defined extent of dental disease problem.

• Resulted in initiation of a 10-year program to reduce dental

disease.

• This was the first state-wide program of its magnitude.

• Still remains largest and most comprehensive of all state

public health dental programs.

• A unique public and private partnership dedicated to mission

of assuring optimal oral health conditions in North Carolina.

• Dental health is considered an important part of general health.

• Can be achieved through the coordinated efforts of

individuals, professionals, and community members.

• The Division of Dental Health's programs are based on

prevention and education.

• Organized to provide as many direct services to citizens of

North Carolina as possible.

• Primary prevention and education are considered to be the

most effective means of decreasing dental disease and

promoting dental health.

• All program activities include educational components to

modify behaviour patterns of individuals.

• To improve their oral health habits through dietary change,

tooth brushing, and flossing.

Objectives that will facilitate attainment of the goals of the

division include:

1. Appropriate use of fluoride

2. Health education in schools and communities

3. Availability of public health dental staff in all counties

• Program Implementation:

The fiscal year 1990 services delivered through the program

included:

Fluoridation of the 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 339,000 children.

Dental health education was presented to 361,000 children and

42000 adults.

More than 33000 dental sealants were applied.

To reach children, public health dental staff provides training

and consultation to those who work with preschool and

school-age children and maternal and child health programs.

Teachers are believed to be the key in educational program.

Received pre-service, in-service, and follow-up training to

cover dental health concepts, practice oral hygiene skills, and

integrate dental health into the curriculum.9

Teenage Health Education Teaching Assistants Program

Developed by the “National Foundation for the prevention of

Oral Disease” for the US 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.

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.

• Minnesota Department of Health supervised a school dental

health program (1949-1957).

• 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.

• 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 over 10 yr period revealed,

28% reduction in dental caries in deciduous teeth of children

3 to 5 years old

34% reduction in caries in permanent teeth of children 6 to 12

years old

14% reduction in children 13 to 17 years old.7

PARENT PROGRAM

• “Dental Health Is a Family Affair” is a slide-tape education

program for parents.

• Coordinated by Texas Department of Health's dental

hygienists for use with groups such as school parent groups,

local health departments, and clinics.

• Covers dental disease problems and their prevention.

• Diet and a section describing characteristics of children's

dental development ranging from prenatal to late adolescence.

HEAD START – PRE-SCHOOL DENTAL HEALTH PROGRAM

• The Head Start Program is a program of the United States

Department of Health and Human Services that provides

comprehensive education, health, nutrition, and parent

involvement services to low-income children and their

families.

• The program's services and resources are designed to foster

stable family relationships, enhance children’s physical and

emotional well-being, and establish an environment to develop

strong skills.

First Lady Lady Bird Johnson (wife of the 36th President of the United States) visits a Head Start class in 1966

SCHOOL HEALTH ADDITIONAL REFERRAL PROGRAM (SHARP)

• 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.

• Carried out by district nurses with cooperation of school

personnel.

• Nurses made daytime visits to families in which mothers were

at home.

• Working parents were contacted by phone.

• One-to-one basis of health guidance between parent and health

worker established better rapport between school and home.

COLGATE’S BRIGHT SMILES, BRIGHT FUTURES

• Colgate Bright Smiles, Bright Futures reaches children around the

world with free dental screenings and oral health education.

• It is among the most far-reaching, successful children's oral health

initiatives in the world.20

20. http://www.colgate.com/app/BrightSmilesBrightFutures/US/EN/Our-Commitment.cvsp Accessed on 10/01/2016

• With long-standing partnerships with governments, schools

and communities, Colgate Bright Smiles, Bright Futures has

reached more than half a billion children and their families

across 80 countries with free dental screenings and oral health

education.

• 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.

• Under this program, children in primary schools receive

instructions in dental care from members of the dental

profession nominated by the Indian Dental Association.

• Education is imparted with the aid of audio-visual and printed

literature.

• Free dental health care packs are distributed to encourage

good oral hygiene.

• Education is imparted with the aid of audio-visual and printed

literature.

• Free dental health care packs are distributed to encourage

good oral hygiene.

WHO’s Global school health initiative

• WHO's Global School Health Initiative, launched in 1995,

seeks to mobilise and strengthen health promotion and

education activities at the local, national, regional and global

levels.

• Designed to improve the health of students, school personnel,

families and other members of the community through

schools.

• The goal is to increase the number of schools that can truly be

called "Health-Promoting Schools".

The general direction of WHO's Global School Health Initiative

is guided by the:

Ottawa Charter for Health Promotion (1986);

the Jakarta Declaration of the Fourth International Conference

on Health Promotion(1997);

WHO's Expert Committee Recommendation on Comprehensive

School Health Education and Promotion (1995)

Strategies:

1. Research to improve school health programmes:

Evaluation research and expert opinion is analyzed and

consolidated to describe nature and effectiveness of school

health programmes.

2. Building capacity to advocate for improved school health

programmes:

Technical documents are generated that consolidate research

and expert opinion about the nature, scope and effectiveness

of school health programmes.

3. Strengthening national capacities:

Collaboration between health and education agencies is

fostered and countries are helped to develop strategies and

programmes to improve health through schools.

4. Creating networks and alliances for the development of

health-promoting schools:

Regional Networks for the development of Health-Promoting

Schools have been initiated in Europe, Western Pacific and

Latin America.

• A global alliance has been formed to enable teachers'

representative organizations, worldwide, to improve health

through schools.

• The alliance includes Education International, Centers for

Disease Control and Prevention, Education Development

Center, UNESCO (United Nations Educational, Scientific and

Cultural Organization), and UNAIDS.

INCREMENTAL DENTAL CARE

• 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.

• Treatment programs are "gotten off the ground” carrying the

youngest available group the first year & carrying it forward in

subsequent years as far as funds permit.

• Each year adding a new class of children at the next earliest

served to as high an age as available resources permit.

ADVANTAGES:

1. Prevent pulpal involvement and loss of teeth.

2. Economic.

3. Periodontal diseases identified at early age.

4. Preventive programs on periodic basis.

5. Confines dental diseases to small early increments, reducing

loss of teeth.

6. Habit of periodic return.

DISADVANTAGES:

1. Restorative dentistry is more time consuming on a piecemeal

basis than upon a wholesale basis.

2. Financial resources may be exhausted even before the

elementary school population has been cared for and the

permanent teeth might receive no care at all.

3. Increasing likelihood of interruption in children’s dental health

programs due to mobility along with their families and also the

segments of the population where systemic recall habits will be

difficult or impossible to induce.

SCHOOL HEALTH PROGRAMME

MINISTRY OF HEALTH AND FAMILY WELFAREGOVERNMENT OF INDIA

School Health program is a program for school health service

under National Rural Health Mission, which has been

necessitated and launched in fulfilling the vision of NRHM to

provide effective health care to population throughout the

country.21

21. Ministry of Health and Family Welfare, Govt. of India’s website: http://mohfw.nic.in/WriteReadData/l892s/2099676248file5.pdfAccessed on 02/01/2016

It also focuses on effective integration of health concerns

through decentralized management at district with determinant

of health like sanitation, hygiene, nutrition, safe drinking

water, gender and social concern.21

The School Health Programme intends to cover

12,88,750 Government and private aided schools covering

around 22 Crore students all over India.21

Rationale for School Health Programme

• The School health programme is the only public sector

programme specifically focused on school age children.

• Its main focus is to address the health needs of children, both

physical and mental, and in addition, it provides for nutrition

interventions, yoga facilities and counseling.

• It responds to an increased need, increases the efficacy of

other investments in child development, ensures good current

and future health, better educational outcomes and improves

social equity and all the services are provided for in a cost

effective manner.21

School health programme Under the

State programme Implementation Plans (2008-09)

• Health education and improving the hygiene will be an

important component of the programme.

• Under the school health programme following services are being

provided to children from primary schools (including Rajiv

Gandhi schools):

Health check-up (done twice a year, by the Auxiliary Nurse

Midwifery (ANM) and PHC Medical Officer)

Provision of micronutrients to children (including IFA-small,

Vitamin-A, Tab. Albendazole - used for the treatment of a

variety of parasitic worm infestations).

• Activities:

Identification of Schools and number of beneficiaries under

the programme.

Revised guidelines, formats, supplies (Vision Charts, drugs) to

be sent to the PHC.

Plan for school Health Check-up to be prepared at the PHC

level.

Health check-up and provision of Micronutrients, as per plans.

Monitoring and Supervisions.

Data compilation and analysis.

Rapid Assessment and Action Planning Process(RAAPP)22

• RAAPP is a cost-effective, evidence-based method to assess

and improve the capacity of school health programmes.

• The goal of the RAAPP is to strengthen countries' capacity to

support national, provincial, and local school health programs.

22. http://www.who.int/school_youth_health/assessment/raapp/get_started/en Accessed on 10/01/2016

• It equips ministries of education and health and other national

organizations to assess and improve their capacity to promote

health through schools. 

• RAAPP is based on two concepts put forth by the World

Health Organization and its partners: Health-Promoting

Schools (HPS) and Focusing Resources on Effective School

Health (FRESH).

• Methods used for data collection during RAAPP typically

include:

Key informant interviews

Group discussions

Secondary data collection

Observations

• While preparing for and conducting the RAAPP, the in-

country core team will learn qualitative data gathering and

analysis techniques such as:

Interviewing

Facilitating

Recording

Coding, managing and analyzing data

Strategic action planning

• The RAAPP is divided into three phases:

1. Planning

2. Training and data collection

3. Analysis and action planning

Barriers to School-Based Health Care Programs

• Although school-based health care programs (SBHCPs)

provide affordable and accessible health care to children and

adolescents and are known to improve school attendance, a

variety of barriers affect their development.23

23. Improving school health programmes: Barriers and Strategies. World Health Organization. Geneva 1996

• Three general, related, and common barriers that impede

local,National, and International efforts to Improve School

Health Programmes:

1. Inadequate Understanding and Acceptance

2. Inadequate Collaboration

3. Inadequate Vision and Strategic Planning

CONCLUSION

• In conclusion, there is a pressing need for oral health to be

promoted in schools worldwide.

• The potential for developing a health program using the

Health Promoting School approach is considerable.

• Commitment from central and local government, schools,

families and the community is critical.

• To ensure a healthy future for our children, school-based

nutrition education programs must become a national priority.

• These programs should be part of comprehensive school

health programs and reach students from preschool through

secondary school.

• School leaders, community leaders, and parents must commit

to implementing and sustaining nutrition education programs

within the schools.

• Such support is crucial to promoting healthy eating behaviors.

• Health promoting Schools can help ensure that all school-age

youths attain their full educational potential and good health.

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16.http://www.cdc.gov/oralhealth/topics/dental_sealant_programs Accessed on 06/01/2016

17.SCHOOL-BASED FISSURE SEALANT PROGRAMME. Second Edition. Ministry of

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18.http://mdm.nic.in Accessed on 6 january, 2016

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20.http://www.colgate.com/app/BrightSmilesBrightFutures/US/EN/Our-Commitment.cvsp

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