SUBMITTED BY Nesheena v k 3rd yearPSM DENTALCOLLEGE

SCHOOL DENTAL HEALTH PROGRAMMES

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

CONTENTS

School health is an important aspect of any community health program. It is an economical and powerful means of raising community health in future generations.

Towards the end of the nineteenth century, William Fisher, a dentist of England was so concerned by the high caries experience and lack of treatment in the child population that he devoted much time campaigning for compulsory inspection and treatment of children in schools.

The beginning of school health service in India dates back to 1909, when for the first time medical examination of school children was carried out in Baroda city.

The Bhore Committee in 1946 reported that School Health Services were practically no existent in India, and where they existed, were in an underdeveloped state.

INTRODUCTION

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

DEFINITION

School Health Services

are defined as the "procedures established1. to appraise the health status of pupils and school personnel2. to counsel pupils, parents, and others concerning appraisal findings3. to encourage the correction of remediable defects4. to assist in the identification and education of handicapped children5. to help prevent and control disease and6. to provide emergency service for injury or sudden sickness".

(by The Committee on Terminology of the American Association for Health, Physical Education, and Recreation 1951)

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

ASPECTS OF SCHOOL HEALTH SERVICE 1)

2)

3)

School health education:

It is the process of providing learning experiences for the purpose of influencing knowledge, attitudes, or conduct relating to individual or community health. It should cover the aspects of (a) personal hygiene (b) environmental health and (c) family lifeMaintenance of school health records:

These records are useful in analyzing and evaluating school health programs and to provide a useful link between the home, the school and the community.Curative services:

They include regular dental check ups and prompt treatment wherever possible and referral for special problems.

4)

5)

6)

To help every school child appreciate the importance of a healthy mouth.

To help every school child appreciate the relationship of dental health to general health and appearance.

To encourage the observance of dental health practices, including personal care, professional care, proper diet, and oral habits. To enlist the aid of all groups and agencies interested in the promotion of school health.

To correlate dental health activities with the total school health program.

To stimulate the development of resources to make dental care available to all children and youth.

To stimulate dentists to perform adequate health services for children.

OBJECTIVES @

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A school oral health program should1). Be administratively sound2). Be available to all children3). Provide the facts about dentistry and dental care, especially about self- care preventive procedures4). Aid in the development of favourable attitudes toward dental health5). Provide the environment for the development of psychomotor skills necessary for tooth brushing and flossing6). Include primary preventive dentistry programs-prophylaxis, fluoride programs, and use of pit-and- fissure sealants7). Provide screening methods for the early identification and referral of

pathology8). Ensure that all discerned pathology is expeditiously treated

IDEAL REQUIREMENTS

1). The school based dental health programs can bring comprehensive dental care including preventive measures to schoolchildren where they are gathered anyway for non dental reasons in the largest possible numbers. This is particularly advantageous in dentist - deprived areas.

2). School clinics are less threatening than private offices since the children are in familiar surrounding

3). If the children can be maintained in a state of good dental health it will be relatively easy to maintain their dental health in adult life.

4). A regular dental attendance pattern in early life will be continued after school age.

5). Utilizing dental auxiliaries can further reduce the cost

ADVANTAGES

ELEMENTS/COMPONENTS of school oral health program

• Improving school- community relation• Conducting dental inspection• Conducting health education• Performing specific programmers'• Referral for dental care• Follow-up of dental inspection

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

1). Improving school-community relations:

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

2. Conducting dental inspections:

1. It serves as a basis for school dental health instruction.

2. It builds a positive attitude in the child toward the dentist and

dental care.

3. The child and the parent are motivated to seek adequate professional care,

4. Teachers, students, and dentists concerned with dental health may use the dental inspection as a fact-finding experience.

5. Baseline and cumulative data for evaluation of the school dental health program are made available.6. Provides information as to the status of dental needs to plan a sound dental health program.

Benefits of school dental inspections:

1. Parents and children frequently accept the inspections to be comprehensive and depend entirely upon it rather than a complete dental examination by the family dentist

2. Sometimes the school inspections may tend to discourage rather than promote the development of the habit of visiting the dentist at an early age.

3. It is desirable for parents to be present during dental examinations. This procedure is not always feasible in school inspections.

Limitations:

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

3). CONDUCTING DENTAL HEALTH EDUCATION

4). Performing specific programs

1. Tooth brushing programmes2. Classroom-based fluoride programmes3. School water fluoridation programmes4. Nutrition as a part of school preventive

dentistry programmes5. Sealants placement6. Science fair

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

A. Brushing programs

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

B).Classroom-based fluoride programs:

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

• This procedure makes the fluoride available to children, for whom dental caries is a primary problem, as compared to older age groups.The amount of fluoride added to school drinking water must be greater than that used in communal water supplies, i.e.,4.5 times the optimum concentration since children are in school for shorter hours and less water is consumed during that time. For Individuals not served by a public water supply, alternative methods such as fluoridating the individual school water I supply must be considered.A major disadvantage is that children do not receive benefits until they begin school.

C). School water fluoridation programs

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

D). Nutrition as a part of school preventive dentistry programs:

The objectives of the program

1. To improve enrolment and attendance2. To reduce school drop outs.3. To improve child health by increasing nutrition level.4. To improve learning levels of children

The placement of pit-and-fissure sealants is ideally suited for a school program. First, second, 6th and 7th standards would be desirable levels to selectively intervene to prevent pit-and- fissure lesions. (1st and 2nd standards, because- First permanent molars are sufficiently erupted to place the sealant. 6th and 7th standards - 2nd permanent molars). Sealant placement, when coupled with a follow-up application of fluoride, in addition to the classroom fluoride mouth- rinse or fluoride tablet program, helps- provide a continuous protection of the whole tooth.

A science fair not only helps in educating and motivating school children to improve their oral health but also provides an excellent opportunity for dentistry to contribute substantially to the building of a growing reservoir of students who may some day choose a career in dentistry.

E) . Sealant placement:

F) . Science fairs:

5) Referral for dental care: In a few schools dental care is provided at the school itself. However if only emergency treatment is provided, for eg, If the dental auxiliary places eugenol - soaked cotton in a child's cavity to relieve the pain, the parent does not see the child in pain and might conclude that the school has taken care of the dental problem. Therefore the parent should be informed and made to understand that such emergency treatment is not a cure and she will have to visit the dentist of her choice for proper dental treatment.

"Blanket" referral: A program that has proved to be effective in many schools is 'blanket' referral of all children to their family dentists. In this program, all children are given referral cards to take home and subsequently to the dentist, who sign the cards upon completion of examination, treatment, or both. The signed cards are then returned to the school nurse, or classroom teacher, who plays an important role in following up the referrals with the child and parents.

The mere issuance of referral slips to children will be of little value if steps are not taken to make it clear that the school is interested in defect correction. This needs a good follow-up system. The dental hygienist is the logical person to conduct such follow-up examinations.Leave concessions from school for dental treatment are strongly recommended.

6) Follow-up:

SOME SCHOOL ORAL HEALTH PROGRAMS1. “Learning about your oral health” – prevention oriented

school programme2. “TATTLETOOTH PROGRAM" - TEXAS STATEWIDE PREVENTIVE

DENTISTRY PROGRAM3. ASKOV DENTAL DEMONSTRATION4. NORTH CAROLINA STATEWIDE PREVENTIVE DENTAL HEALTH PROGRAM5. SCHOOL HEALTH ADDITIONAL REFERRAL PROGRAMME (SHARP)6. TEENAGE HEALTH EDUCATION TEACHING ASSISTANTS PROGRAM

(THETA Program)7. WORLD HEALTH ORGANIZATION’S (WHO’S) GLOBAL SCHOOL HEALTH

INITIATIVE

:

This program was developed by the 'American Dental Association' (ADA) and their consultants in coordination with the 1971 ADA House of delegates and is presently available to school systems throughout the United States of America."Learning about Your Oral Health" is a comprehensive program covering current dental concepts.

“LEARNING ABOUT YOUR ORAL HEALTH” – A PREVENTION ORIENTED SCHOOL PROGRAM

The primary goal of this programis to develop the knowledge, skills and attitudes needed for prevention of dental diseases among school children.Implementation of the program:The program fs divided into five levels, each level having its own defined specific content The five different levels are:

The core material for each of the five levels is self-contained in a teaching packet that allows the classroom teacher to adapt the presentation to the needs of the students. Each teaching packet includes.A teacher's self-contained guide on "dental health facts" with a section on handicapped childrenA glossary of dental health termsA curriculum guide featuring content, goals, behavioral objectives and suggested activities for other classesFive lesson plans for the preschool level and seven or more lesson plans for each of the other levelsFour overhead transparenciesTwelve spirit masters (for copying)Methods and activities for parental involvement

* Preschool (designed for children too young to read).* Level I (kindergarten through grade 3).* Level II (grades 4 through 6).* Level III (grades 7 through 9).* Level IV (grades 10 through 12).

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

“TATTLETOOTH PROGRAM" - TEXAS STATEWIDE PREVENTIVE DENTISTRY PROGRAM

The program embraces the six elements of effective lesson design; anticipatory set, setting the objective, input modelling, checking for understanding, guided practice and independent practice.

The basic goal of the program is to reduce dental disease and develop positive dental habits to last a lifetime. The major thrust of Tattle tooth is to convince students that preventing dental disease is important and that they can do it.

Program philosophy and goals:

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

Program implementation:

Program evaluation:

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

ASKOV DENTAL DEMONSTRATION

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

Dental care was rendered by a group of five dentists from nearby communities employed by the Minnesota Department of Health. These dentists also gave topical fluoride treatments.

Findings available through a 10 year period revealed28% reduction in dental caries in deciduous teeth of children aged 3 to 5 years34% reduction in caries in the permanent teeth of children 6 to 12 years old14% reduction in permanent teeth of children 13 to 17 years old.Improvements in filled-tooth ratiosThe cost of the program was greater and the caries reductions smaller when compared with water fluoridation.

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

NORTH CAROLINA STATEWIDE PREVENTIVE DENTAL HEALTH PROGRAM

Program philosophy and goals:

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

Objectives that will facilitate attainment of the goals include:Appropriate use of fluorideHealth education in schools and communitiesAvailability of public health dental staff in all counties

Program implementation:This program is unique in that, it is designed to reach several segments of the population: young children, parents, teachers, dental professionals and community leaders.In the year 1990, services delivered through the program includedThe fluoridation of water supplies of 130 rural schools,Weekly fluoride mouth rinse for more than 416,000 students in 1,051 schools.Screening and referral for more than children.Dental health education was presented to 361,000 children and adults.More than 33,000 dental sealants were applied.Teachers are believe to be the key in the educational program. Program evaluationEvaluation is a necessary ongoing process to measure the effectiveness of the dental health program.

SCHOOL HEALTH ADDITIONAL REFERRAL PROGRAMME (SHARP)

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

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

COLGATE’S BRIGHT SMILES, BRIGHT FUTURES

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

WHO's Global School Health Initiative, launched in 1995, seeks to mobilize and strengthen health promotion and education activities at the local, national, regional and global levels. The Initiative is designed to improve the health of students, school personnel, families and other members of the community through schools.

WORLD HEALTH ORGANIZATION’S (WHO’S) GLOBAL SCHOOL HEALTH INITIATIVE

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

INCREMENTAL CARE

Advantages:Lesions of dental caries are treated before there has been a chance for pulpal involvement.Periodontal disease is intercepted at or near the beginning.Topical and other preventive measures are maintained on a periodic basis.

Bills for dental services are equalized and regularly spaced.The program avoids the high expenditure of late dental care

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

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

CONCLUSION

A school oral health program should not impose an excess or unusual teaching burden on the teachers, it should be cost effective in manpower,

money, and material and it should produce observable results.Since children are often the most important victims of dental diseases,

programs aimed at dental health of the school children are of great importance in promoting oral health of the community.

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