SL.

N CONTENTS

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1. Introduction
2. History of school health
3. Definition of school health services
4. Models of school health
5. Aspects of school health service
6. Objectives
7. Ideal requirements
8. Advantages
9. Ideal requirements
10. Elements/components
11. School dental health programmes in India
12. Challenges and future recommendations
13. Conclusion
14. References

INTRODUCTION

Schools have proven to be a powerful setting for secondary socialization. An individual has a
greater receptivity toward shaping the behavior during childhood. School has been considered as
a foundation to address a child’s health and social issues due to their ability to reach children and
their families simultaneously. School oral health education programs have produced affirmative
results in improving the overall health of the child. Studies have revealed an overall decrease in
dental caries prevalence among children in several high-income countries. Such decline may be
attributed to the combination of factors ranging from better lifestyle, oral hygiene practices,

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positive oral health behavior, and school oral health interventions. However, in the case of low-
income countries, disparities were observed in dental caries status. As far as the experience is
concerned, Indians of all age group experience high caries; however, a huge burden of untreated
decay and negligible filled teeth also exist among children. The efforts for school oral health
promotion in India seem to be in nascent stages; however, attempts are being made toward oral
health education and promotion, prevention, and dental check-up/treatment camps at
National/State and Dental Institute levels

HISTORY

The concept of school health dates back to the 20th century when Benjamin Franklin advocated a
“healthful situation” and promoted physical exercise as one of the primary subjects in the
schools. However, prior to the mid-1800s, efforts to introduce health into the schools were
isolated and sparse. It was not until 1840 that Rhode Island passed the first legislation to make
health education mandatory, and other states soon adopted this concept.

In 1850, the Sanitary Commission of Massachusetts, headed by Lemuel Shattuck, produced a

report that has become a classic in the field of public health and had a significant influence on
school health. Shattuck served as a teacher in Detroit and member of the school committee in
Concord, Massachusetts, where he helped reorganize the public school system of the town. This
background led to school programs receiving major attention as a means to promote public
health and prevent disease. The report states that good health is the basis for wealth, happiness,
and long life and that all children should be taught that preserving their health and the health of
others is one of their most important duties. Knowledge leads to good health, while ignorance
leads to poor health and disease.

World War I (1914–1918) marked an important turning point in the history of school health
program with changing focus from inspections, hygiene, and didactic messages to broader health
promotion philosophies and movements. “Tokyo Declaration - 2001” (1st Asian declaration)
followed by Ayutthaya Declaration (2003) and Bangalore Declaration (2005) also stressed on
oral health promotion among school children.

India

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  1909 - School health service in India was first started in 1909, when the school children
were medically examined in Baroda (Vadodara), India. However, Bhore committee in
1946 reported that school health services in India were underdeveloped and in infant
stages.
 1957 - Child Education -Nutrition Education Committee and WHO assisted School
Health Education project was set up
 1960 the Ministry of Health, Government of India, set up a School Health Committee
under the chairmanship of Smt. Renuka Ray, the then member of parliament to assess the
standard of Health and Nutrition of school children and also to suggest ways and means
of improving these.
 1977 - Centrally Sponsored National School Health Scheme was started
 1979 - National School Health scheme was handed over to State Governments.
 1981 - Task Force was established by the Government of India, Ministry of Health and
Family Welfare to study the progress of School Health programme functioning in various
states of the country
 1984-85 - Delhi had its own comprehensive school Health Scheme which is continuing
 1988 - proposal for the comprehensive school health service.
 1989 - Central Health Education Bureau, Directorate General of Health Services, had
launched an intensive School Health Education Project.At present "child to child” and
"Youth to child” approaches.

Over the past 70 years, the school health has evolved from the narrower past concept of medical
examination to a broader concept of comprehensive care.

DEFINITION

School Health Services

are defined as the "procedures established

a) to appraise the health status of pupils and school personnel

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b) to counsel pupils, parents, and others concerning appraisal findings

c) to encourage the correction of remediable defects

d) to assist in the identification and education of handicapped children

e) to help prevent and control disease and

f) 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)

ASPECTS OF SCHOOL HEALTH SERVICE

1) 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. Periodic dental examination should be encouraged by the school through
a program of education for the parents and the child.The program should be based on prevention
and long term oral hygiene practices The school curriculum should be planned to give dental
health instruction, the time proportionate to its importance.

2) Health counseling:

Following appraisal counseling, which is procedure by which physicians, guidance comes health
defined as "the nurse, teachers, 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". Schools should be strongly encouraged to eliminate sales of
candy and sweetened beverages in school.

3) Emergency care and first aid:

Since teachers are the first to realize any emergency in a school, they should be trained in
handling simple emergencies such as traumatic injuries to teeth during contact sports. The dental
and the school administration should work out policies dealing with dental emergencies arising
in or during extra curricular activities.
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4) School health education:

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

5) Maintenance of school health records:

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

6) Curative services:

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

OBJECTIVES

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

2. To help every school child appreciate the relationship of dental health to general health
and appearance.
3. To encourage the observance of dental health practices, including personal care,
professional care, proper diet, and oral habits.
4. To enlist the aid of all groups and agencies interested in the promotion of school health.
5. To correlate dental health activities with the total school health program.
6. To stimulate the development of resources to make dental care available to all children
and youth.
7. To stimulate dentists to perform adequate health services for children.

IDEAL REQUIREMENTS

A school dental health program should

1. Be administratively sound
2. Be available to all children

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 3. Provide the facts about dentistry and dental care, especially about self-care preventive
procedures
4. Aid in the development of favorable attitudes toward dental health
5. Provide the environment for the development of psychomotor skills necessary for tooth
brushing and flossing
6. Include primary preventive dentistry programs-prophylaxis, fluoride programs, and use
of pit-and- fissure sealants
7. Provide screening methods for the early identification and referral of pathology
8. Ensure that all discerned pathology is expeditiously treated

ADVANTAGES

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. Students can be accessed during their formative years, from childhood to adolescence.
These are important stages in people's lives when lifelong oral health related behavior as
well as beliefs and attitudes are being developed.
3. School clinics are less threatening than private offices since the children are in familiar
surroundings.
4. The children's daily contact with the dental personnel in other roles, such as joining with
the teachers in a variety of school activities, may have a lasting effect in their attitudes
towards dentistry in general.
5. 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.
6. A regular dental attendance pattern in early life will be continued after school age.
7. School dental health programs when associated with general health programs, can
facilitate valuable consultation on medico - dental problems.
8. The expenses involved and the time used in transportation to private dental office can be
saved if the child gets dental care in the school itself.

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 9. If parents have to escort children to a private dental office, he/she will lose income for
that day. This can be overcome by school dental health programs.
10. Utilizing dental auxiliaries can further reduce the cost.
11. The health of school staff, families and community members can be enhanced by
programs based in schools.

ELEMENTS/ COMPONENTS of school dental health program

1) Improving school-community relations:

One of the first steps in organizing a dental health program is the formation of an advisory
committee. It should include broad representation from parents, teachers, school administrators,
dental professionals, health officers and community leaders.

The task of these committees is

• To appraise and publicize the dental needs of the school children

• To address the school administration's concern in the promotion of oral health.
• To make people realize the importance of dental health

2) Conducting dental inspections:

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
favor of dental inspections.

Benefits of school dental inspections:

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

 Every child unless proved otherwise is considered to be free from dental disease,the
positive findings, on such children will provide greater motivation towards dental
health.
 It builds a positive attitude in the child toward the dentist and dental care.
 The child and the parent are motivated to seek adequate professional care.

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  Teachers, students, and dentists concerned with dental health may use the dental
inspection as a fact-finding experience.
 Baseline and cumulative data for evaluation of the school dental health program are
made available.
 Provides information as to the status of dental needs to plan a sound dental health
program.

Limitations:

• 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.
• Sometimes the school inspections may tend to discourage rather than promote the
development of the habit of visiting the dentist at an early age.
• It is desirable for parents to be present during dental examinations. This procedure is
not always feasible in school inspections.

3) Conducting dental health education:

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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 proper attitudes and
personal dental health practices by the teacher which can be passed on to the classroom.
Selfcontained dental health kit for teacher education and presentation of basic dental health
concepts should be made available to every school.

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4) Performing specific programs:

A) Tooth brushing programs:

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 imaginary dirt from between the cuticle and the thumb nail. The
mastery of the 45° angulations and the short vibratory strokes can then be repeated on an
oversize dentoform model. Emphasis should be placed on the need to follow a definite brushing
sequence to ensure that all the surfaces are brushed. 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 neighbors 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.
During the entire process appropriate corrections and reinforcement of brushing technique
should be emphasized.

B) Classroom-based fluoride programs:

Two effective fluoride programs are:

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 rinse dispenser, 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.

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 • 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. Aside from the United
States, 7 other nations- Denmark, Finland, New Zealand, Netherlands, Norway,
Thailand and Sweden - support major mouth rinse programs.

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. The daily
tablet is more effective than the weekly rinse.

School water fluoridation programs:

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 supply must be considered. In addition to the systemic
effects on developing teeth, school water fluoridation also imparts topical effects on erupted
teeth. Studies have shown a reduction in dental caries prevalence by about 40% among children
attending schools that support school water fluoride programs A major disadvantage is that
children do not receive benefits until they begin school.

Nutrition as a part of school preventive dentistry programs:

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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 products that are rapidly cleared from the
mouth.

Mid Day meal Program of Government of India

The program of providing hot cooked meal was introduced in 7 north eastern districts of the state
during 2002-03. This scheme was extended to the remaining areas under the title Akshara
Dasoha during 2003-04. The scheme consisted of providing free food grains at 3 Kilograms per
child / per month to children of class 1 to 5 of Government schools on the basis of 80% of
attendance in a month. The scheme was extended to classes 1 to 5 in Government aided schools
from 1-9-2004. The program was extended to VI and VII standards in Government / Government
Aided schools in the State from 01 -10-2004.

The objectives of the program

• To improve enrolment and attendance

• To reduce school drop outs.
• To improve child health by increasing nutrition level.
• To improve learning levels of children.

These objectives have been substantially attained, with dramatic impact on the enrollment and
retention of girl children in particular. Additionally it has provided employment to destitute
mothers who work as cooks in the various noon meal centres in the state. The hot cooked food
contains about 400 calories (Per child per day)

Sealant placement:

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. (1 st 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

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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.

Science fairs:

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 someday choose a career in dentistry. Local
and state dental associations can organize support for these fairs. Literature should be provided
for students, outlining possible dental projects and offering the assistance of local dentists to help
students develop projects. The student with the best dental project in regional science fairs
should be invited to represent their regions and local dental societies at the state science fair or
the state dental association meeting.

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.

Follow-up:

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

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from school for dental treatment are strongly recommended. That is, children should be excused
to keep office appointments with the physician or dentist during school hours. There are two
reasons for such concessions:

a) The child is a more co-operative patient when medical / dental services are provided
during early or middle part of the day.
b) Dentists can provide better services for children when they have time and do not have to
crowd their child patients into after school hours.

Abuse of the school excuse system can be avoided, by having printed forms duly signed by the
school officials, parents and the dentists to assure that the appointment was actually kept

MODELS OF SCHOOL HEALTH

Various Models of Schools health have been proposed

The Three Component Model (1900-1980s)

Originating in the early 1900s and evolving through the 1980s, the three component model is
considered the traditional “three-legged stool” of school Health, consisting of

1. Health education
2. Health services
3. A healthful environment

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The Eight Component Model/CDC (Center for Disease Control and Prevention) Model
(1980s)

In the 1980s, the three component model was extended into an eight component model referred
to as a “comprehensive school health program (CSHP)” – consisting of multiple domains called
Bubbles.

The following are working descriptions of the eight components of Coordinated School Health.

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Nutrition Services: schools should provide access to a variety of nutritious and appealing meals
that accommodate the health and nutrition needs of all students.  School nutrition programs
reflect the U.S. dietary Guidelines for Americans and other criteria to achieve nutrition integrity.
the school nutrition services offer students a learning laboratory for classroom nutrition and
health education, and serve as a resource for linkages with nutrition-related community services.
Qualified child nutrition professionals provide these services.

Physical Education: physical education is a school-based instructional opportunity for students

to gain the necessary skills and knowledge for lifelong participation in physical activity.
Physical education is characterized by a planned, sequential K - 12 curriculum's (course of study)
that provide cognitive content and learning experiences in a variety of activity areas.  Quality
physical education programs assist students in achieving the national standards for k - 12
physical education.  The outcome of a quality physical education program is a physically
educated person who has the knowledge, skills, and confidence to enjoy a lifetime of healthful
physical activity.  Qualified, trained teachers teach physical education.

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Health Education: health education provides students with opportunities to acquire the
knowledge, attitudes, and skills necessary for making health-promoting decisions, achieving
health literacy, adopting health-enhancing behaviors, and promoting the health of others.
Comprehensive school health education includes courses of study (curricula) for students in pre-
K through grade 12 that address a variety of topics such as alcohol and other drug use and abuse,
healthy eating/nutrition, mental and emotional health, personal health and wellness, physical
activity, safety and injury prevention, sexual health, tobacco use, and violence prevention.
Health education curricula should address the National Health Education Standards (NHES).
Health education assists students in living healthier lives.  Qualified, trained teachers teach
health education.

Health Services: these services are designed to ensure access or referral to primary health care
services or both, foster appropriate use of primary health care services, prevent and control
communicable disease and other health problems, provide emergency care for illness or injury,
promote and provide optimum sanitary conditions for a safe school facility and school
environment, and provide educational and counseling opportunities for promoting and
maintaining individual, family, and community health.  Qualified professional such as
physicians, nurses, dentists, health educators, and other allied health personnel provide these
services.

Counseling & Support Services: these services are provided to improve students' mental,
emotional, and social health and include individual and group assessments, interventions, and
referrals.  Organizational assessment and consultation skills of counselors and psychologists
contribute not only to the health of students but also to the health of the school environment.
Professionals such as certified school counselors, psychologists, and social workers provide
these services.

Healthy and Safe School Environment: a healthy and safe school environment includes the
physical and aesthetic surroundings and the psychosocial climate and culture of the school.
Factors that influence the physical environment include the school building and the area
surrounding it, any biological or chemical agents that are detrimental to health, and physical
conditions such as temperature, noise, and lighting.  The psychosocial environment includes the
physical, emotional, and social conditions that affect the well-being of students and staff.

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Health Promotion for Staff: schools can provide opportunities for school staff members to
improve their health status through activities such as health assessments, health education, and
health-related fitness activities.  These opportunities encourage staff members to pursue a
healthy lifestyle that contributes to their improved health status, improved morale, and a greater
personal commitment to the school's coordinated health program.  This personal commitment
often transfers into greater commitment to the health of students and creates positive role
modeling.  Health promotion activities have improved productivity, decreased absenteeism, and
reduce health insurance costs.

Family/Community Involvement: an integrated school, parent, and community approach can

enhance the health and well-being of students.  School health advisory councils, coalitions, and
broadly based constituencies for school health can build support for school health program
efforts.  Schools actively solicit parent involvement and engage community resources and
services to respond more effectively to the health-related needs of students.

 The eight component model or CSHP has been further explored by Resnicow and Allensworth,
who emphasized the role of School Health Coordinator as an essential component of the model.
Three program elements; staff wellness, healthy environment, and community/family
involvement, are incorporated within the coordinator’s role; thus, reducing the number of
program elements from eight to five. New Mexico Adapted the eight components model and
represented its components as leaves of Yucca Plant (State Flower)

ACCESS (Administration, Community, Curricula, Environment, School, and Services)

Model (1990)

ACCESS model regard the school as an institution that is a microcosm of society, where students
spend much of their developmental years (Stone, 1990). This model focuses on the development
of administration and community keystones first and remaining are added later on with optimal
effect

Full-Service Schools (Dryfoos, 1994)

Full-service school concept has been described as a “one-stop center” for educational, physical,
psychological, and social requirements of students and their families. Such services vary and are
delivered through collaborative efforts of school, agencies, and the families, thus addressing

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multiple factors impacting the student.Health Promoting Schools (HPS) (1995)World Health
Organization (WHO) school health initiative was launched in 1995 with the objective to create
HPSs. Four key strategies under HPSs are: Building capacity to advocate for improved school
health programs; creating networks and alliances for the development of HPSs; strengthening
national capacity; and research to improve the effectiveness of school health programs
Complementary Ecological Model of the CSHP

Lohrmann emphasized the role of ecology in health behavior and combined concepts from
multiple ecological models with eight components to formulate complementary ecological model
of CSHP. In this new model, the six components that comprise programs and services, provided
to students and school employees, are located in the center circle. Further, the six components
are surrounded by four concentric rings - the healthy school environment (inner ring), essential
governance structures of a CSHP (second ring), local school system infrastructure within which a
CSHP exists and functions (third ring), and family and community involvement (outer ring). The
“chutes” are meant to convey coordination across all layers

The WHO Global School Health Initiative consists of four broad strategies:

• Building capacity to advocate for improved school health programs.

• Creating networks and alliances for the development of Health Promoting Schools.
• Strengthening national capacity.
• Research to improve school health programs, health and education of young people, and
individual documents in the series encourage schools to address one or more important
health issues

EXISTING SCHOOL ORAL HEALTH PROGRAMMES IN INDIA

Indian Dental Association (IDA) - Colgate’s “Young India” Bright Smiles, Bright Futures
School Dental Health Education Program

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A collaborative effort of IDA and Colgate - Palmolive started in 1976 to deliver oral health
education to children. One campaign for school oral health promotion was launched in Agra,
2001.

The objective is to empower children to practice good oral care hygiene, by making them aware
of good oral care practices, to reduce prevalence of dental caries and to promote preventive
health care habits.

Since the inception of the program, the Company has been delivering oral health education to
children, in partnership with the Indian Dental Association (IDA) through their network of
committed dental professionals, by reaching out to influencers – like school teachers and the
Anganwadi workers in the community to promote preventive oral care education.

Children between the age group of 6 to 14 years, studying in primary schools, are taught good
oral hygiene habits, the right techniques of brushing with the use of a tooth model and a
toothbrush, the importance of night brushing through an interactive module where the
importance of a good mouth cleaning regimen is strongly instilled in them. At the end of the
program, each child is given a ‘Dental Health Pack’ consisting of a toothpaste and a basic
toothbrush, along with attractive charts depicting valuable oral care information in order to
encourage these children to brush twice a day and take care of their oral care hygiene. A chart
containing the oral care information is left in each classroom as a reminder to them, and for the
teachers to reiterate the oral care message.

School teachers are trained and provided with a ‘Teacher’s Guide’ to help them instill good oral
care habits on an on-going basis. The Teacher’s Guide is a detailed booklet that pictorially shares
details of a tooth’s anatomy, stages of decay, and the causes of gum diseases to help them
advocate the importance of healthy teeth.

Colgate Bright Smiles, Bright Futures® has so far touched the lives of 162 million plus school
children between the age of 6 – 14 years across schools in urban and rural India since the
inception of the program.

In the year 2018-19 alone, Colgate Bright Smiles, Bright Futures® reached 11.5 million children
across the country.

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Chacha Nehru Sehat Yojna School Health Scheme

Government of Delhi Directorate of Health Services, Government of Delhi, started SHS in 1979
with six school health clinics, initially, to provide comprehensive health-care services to the
school going children. The scheme was expanded during the 7th five-year plan, and 64 school
clinics were opened. The dental component of school health scheme is looked after by two
government hospitals, namely Maulana Azad Institute of Dental Sciences and DDU hospital
which conducts regular screening programs and also serves as referral centers

Neev - School Oral Health Program

Among the proposed programs, “Neev-SOHP” would be initiated across government schools run
by Government of NCT of Delhi, in Delhi state, as a pilot project. The Dental Team along with
the Mobile Dental Clinic would draw a district plan which would cover different schools round
the year.

The primary intention is to

 Promote oral health through Dental Health Education and organize dental check up/
Screening.

 Provide Primary and Secondary Dental care through Mobile Dental Clinic in the Schools.

 And make necessary referrals for advanced care available at Maulana Azad Institute of
Dental Sciences.

Target group: 

 The Program would be run for one year during which it would cover all the Public funded
schools in any one District, Delhi State (at least 50 schools) and include all children from
Class 6th to Class 10th. 

 Training and involving Teachers, School authorities and Parents as team members.

 Collaborating ultimately into the existing Health Care system at the school level.

Intensive Dental Health Care Program – Punjab

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To provide the best of the Dental Health Care Services to the people of the State, the Punjab
Govt. has launched Intensive Dental Health Care Programme for school children, school teachers
and general public, which is first of its kind in the country. To reach the far-flung areas of each
district one mobile Dental Clinic Van was provided to give interceptive  and curative treatment
to the people at their doorstep. To monitor and implement all the dental programmes it was
proposed to establish a post of District Dental Health Officer for all the districts of the State.

Aims and objective:

a. To bring down the incidence of oral and dental diseases to less than 40 %. 
b. To bring down the Decayed Missed Filled Teeth (D.M.F.T.) in School children of
6 – 12 years less than two. 
c. To achieve 25 % reduction in number of persons without teeth after the age of 60
Years. 
d. To provide one dental clinic to serve the population of 30,000 in the rural areas by
opening 354 new Dental Clinics by the end of five years plan. 
e. To provide total oral health coverage to all the school going children in the age
group of 6 - 12 years. 
f. To provide Dental Health Education Training to all the primary school teachers,
medical & paramedical personnel.
g. To organize special Dental Health Fortnights. 
h. To provide on the spot diagnostic preventive interceptive & curative Dental
Health Care Services to the people in the far – flung rural areas of the state and
the school children through fully equipped Mobile Dental Clinic Vans.

Trinity Care Foundation – Bengaluru

Trinity Care Foundation is a registered public charitable trust under the Indian Trusts Act which
conducts outreach programs and school health programs in Bengaluru and nearby areas. It
harbors the vision of HPS and provides pre-screening of students for height, weight, skin, eye,
dental, cardiac, caries, oral lesions, facial deformities, etc. Along with this, it also focuses on the
training of teachers and imparting awareness on health issues, ill effects of tobacco and tooth
brushing techniques to students in government schools

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The TCF team works in synergy with National Health Mission and Government of Karnataka.

1. Identifies children with facial deformities such as cleft palate, cleft lip, tmj ankylosis,
facial clefts, hemangioma and vascular malformations

2. Screens and treats them with a team of specialized doctors and surgeons in reputed
hospitals in Bengaluru and Hyderabad, India

3. The treated children will be followed up for prognosis and other need based treatments
such as speech therapy and Dental Treatments.

Pit and Fissure Sealant Pilot Project - National Oral Health Program (NOHP), AIIMS,
New Delhi

Under the central component of NOHP, the current pit and fissure sealant project have been
launched, for which training of representatives from 12 dental colleges was done on May 1, 2017
with a target to seal 53,750 permanent molars in children 6-14 years of age to prevent dental
caries.

Dr. Harsh Priya, Asst Professor, Division of Public Health Dentistry, CDER, AIIMS, New Delhi
was designated to do the Monitoring of School Based Pit and Fissure Sealant Programme, an
initiative of MoHFW at GDC Chennai on 24th October 2018. She conducted the monitoring of
the School Based Pit and Fissure Sealant Programme, in a primary school (Tamil Nadu
Government Adhidravida Nagarthurai) at Periyapalayam, Thiruvallur District. The Interns from
GDC Chennai were performing the Pit and Fissure Sealant which was evaluated. Also the
register maintained regarding the treatment was checked.

CHALLENGES AND FUTURE RECOMMENDATIONS

The current review revealed that serious efforts are being made to improve the oral health at
school levels ranging from NOHP, Govt./Private Dental Institutes, NGOs, etc. However, it is
required to implement the efforts at National/State level with maximum coverage. Some of the
anticipated challenges may include regular follow-up care, changing cultural norms, cultivating a
relationship with schools and sharing and tracking data.

Recommendations

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SOHP need to take a multifaceted approach considering that the dental care is provided in varied
health-care settings in the community. However, the amount and type of contribution that each
stakeholder can give are different.

Governmental Sector

Primary health care is the grass root level health-care tier of Indian governmental health-care
sector. There are multiple projects running under NHM such as Rashtriya Bal Swasthya
Karyakram, Janani Shishu Suraksha Karyakarm (JSSK), New Born health, and Adolescent
Health which presents an opportunity for horizontal integration without the economic burden of
starting a separate program. It is the responsibility of Government to develop evidence-based
guidelines (e.g., targeted approach - providing primary care services to 20% of most deprived
areas for implementation of SOHP. Along with this, regular monitoring, data maintenance, and
evaluation (formative/summative) are must to predict success of the SOHP.

Non-Governmental and Private Sector

Exploring the concept of Private Public Partnership (PPP) should be the priority of government
organization. Exploring the front of joint collaborations by international organization (e.g.,
SOHP, Kuwaitis a joint venture of Ministry of Health, Kuwait and Forsyth Institute, Cambridge
can solve the barrier of adequate funding. Involving the dental practices of that area for curative
dental component at some capitation payment/child. Adapting a multi-sectoral approach and
involving other sectors such as nutrition, community and voluntary sector, and hospital dental
services for wider action.

REFERENCES

1. Somaraj V. School Dental Health Programs–A Way to Meet the Unmet Oral Health
Needs. Journal of Dental Treatment and Oral Care. 2017 Oct 27;1(1).
2. Shamim T. Future recommendations for school dental health program in India. Iranian
journal of public health. 2015 Oct 11;44(6):881-2.
3. Peter S (2013) Essentials of Public Health Dentistry. (5th edn), Arya Medi Publishing
House, New Delhi, India

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4. Hiremath SS. Textbook of preventive and community dentistry. Elsevier India; 2011 Aug
15.
5. Marya CM. A textbook of public health dentistry. JP Medical Ltd; 2011 Mar 14.
6. Gambhir RS, Sohi RK, Nanda T, Sawhney GS, Setia S. Impact of school based oral
health education programmes in India: a systematic review. Journal of clinical and
diagnostic research: JCDR. 2013 Dec;7(12):3107.

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