School Dental Health Programme | Oral Hygiene | Dentistry


Dept. of Pedodontics and Preventive Dentistry Christian Dental College

Wednesday, 4th May, 2011 09.00am

Harsimran Singh Sethi Final Year P.G. Resident

Definition of School Health services The committee on Terminology of the American association for Health. parents. In 1953. to counsel pupils. In 1960. were in an underdeveloped state. It is an economical and powerful means of raising community health in future generations. To encourage the Health counseling School health education Emergency care and first aid Maintenance of school health records . History The beginning of School health service in India dates back to 1909. submitted its report. according to which only 14 states had some progress with their own health department budget. when for the first time medical examination of children was carried out in Baroda city. School Dentists Society was formed in London. British dental Association appointed a committee to investigate child dental health. and others concerning appraisal findings. The Bhore committee in 1946 reported that School Health Service were practically non-existent in India. to encourage the correction of remedial defects. the task force constituted by the Government of India to accomplish the School Health Survey.The school based oral health program provides an opportunity to reach the largest number of children during early stages of development when habit patterns can be more easily modified. Aspects of a School health Service Health appraisal Curative Services Objectives To help every school child appreciate the importance of a healthy mouth. Physical Education and recreation (1951) has defined school Health services as the procedures established to appraise the health status of pupils and school personnel. to help prevent and control disease and to provide emergency service for injury or sudden sickness. On July 23rd 1898. the government of India constituted a School Health committee and submitted its report in 1961. The subsequent reports were an important step towards the initiation and development of a School dental Service. to assist in identification and education of handicapped children. In 1885. To help every school child appreciate the relationship of dental health to general health & appearance. The school setting also provides an environment conducive to learning and reinforcement for a considerable period of time and allows the teacher to use various strategies for inducing children to participate in appropriate preventive oral health actions. In Jan 1982. William Fisher published a paper entitled “Compulsory Attention to the Teeth of School Children”. Following this. the secondary Education committee emphasized the need for school nutritional programs. School health is an important branch of community health. and where they existed.

The third and final level of preventive dentistry sophistication is the identification and referral for early treatment of pathology. professional care. . Include primary preventive dentistry program. To enlist the aid of all groups & agencies interested in the promotion of school health. To stimulate the development of resources to make dental care available to all children & youth. These Levels of Care are: The first level program involves only participation by the existing staff and superimposes on additional time commitment other than that expected within the present school curriculum. money and material and should produce observable results. Provide screening methods. To correlate dental health activities with the total school health program. proper diet. Provide environment for development of psychomotor skills necessary for tooth brushing. The dental service supplements the nursing services by helping to provide total health care for school children. School Clinics are less threatening than private offices. Advantages of a school based program Dunning has pointed out the advantages as: The children are available for preventive or treatment procedures.One of the first steps in organising a school dental health program is the formation of a community dental health council or advisory community. A school primary preventive dentistry program should not impose an excess or unusual teaching burden on teachers and should be cost effective in manpower. including personal care.observance of dental health practices. Be available to all school children. A school dental program facilitates central education on dental subjects. & oral habits. These guidelines can be met by considering three different levels of care. It should include broad representation from parents. Aid in development of favorable attitudes toward dental health. The dental hygienist/dental nurse are the key individual to the accomplishment of the next level of sophistication in this program. teachers. as the training focuses on the delivery of preventive procedures. ELEMENTS OF A SCHOOL DENTAL HEALTH PROGRAM Improving school-community relations: . health officers and community leaders. Ideal Requirements Be administratively sound. These communities are important in improving the school-community relations and make people realize the importance of dental health and the school administration’s concern in the promotion of dental health. To stimulate dentists to perform adequate health services for children. Provide the facts about dentistry & dental care.

Fluoride tablet program: . The child is motivated to seek adequate professional care. Conducting Dental health education: . The rinse should be non-sweetened and non-flavoured and are advised for grades 1-12 and not below. Positive findings on inspection serve as motivation for dental health measures. The dentist serves as the expert resource person to strengthen the teacher’s classroom instruction program. which is not always feasible in schools. The students chew.2 mg sodium fluoride around the mouth for a minute and then swallow.A school dental health Program should include a suggested formal approach to teaching dental health in the classrooms. The swish and swallow technique allows the benefit of a topical application.2% of the rinse is dispensed into a plastic cup and the children are instructed to rinse for a minute. Performing specific programs: Tooth brushing programs In school tooth brushing programs. The daily tablet is more effective than a weekly rinse. 40% reduction in dental caries is reported. Status of dental needs is ascertained. as compared to older age groups. it is necessary to distinguish between the mechanical action of tooth brushing and the desired objective of plaque removal. the children may be asked to chew a disclosing tablet. the instructor can teach guided brushing. Baseline and cumulative data is obtained.A once a week fluoride mouth rinse program can be instituted. .Conducting dental inspections: Dental inspections are necessary because: Dental inspection is an opportunity for individual health education. It is desirable for parents to be present for dental inspections. groups of 6-8 children can be taught brushing techniques and then. for whom dental caries is a major problem. Benefits of dental inspections: It serves as a basis of school dental health instructions.One tablet is given to each student. Dental inspection also provides baseline information upon which the treatment program can be built. In a classroom program. 5ml of a 0. then swish the 2. The amount of fluoride added to school drinking water must be greater than that used in communal water supplies since children are in school for shorter hours than at home. School water fluoridation programs School water fluoridation programs make fluoride available to children. Once plaque deposit areas are revealed. Limitations of dental inspections: School inspections may be treated as comprehensive treatment by parents and complete treatment by a family dentist may not take place. It builds a positive attitude in the child towards the dentist and the dental care. Classroom based fluoride programs Fluoride ‘Mouth rinse’ Program: .

. MID DAY MEAL PROGRAM OF GOVERNMENT OF INDIA: . 1st and 2nd grades (because the 1st molars are sufficiently erupted). fats. outlining possible dental projects and offering assistance of local dentists to help students develop projects. The school dietician. painting competitions. proteins. such schools have to refer children to a dentist for proper dental treatment. Nutrition as part of school dental policies School lunch programs/mid-day meals are designed to provide the child with an intake of nutrients that approximate one third of the daily intake of essential carbohydrates. by the U. Sealant placement. minerals and vitamins. Despite various studies documenting the effectiveness of school water fluoridation. Literature should be provided for students.It is to provide free food grains at 3kg/child/month to children of class 1st to 5th of government schools. 6th and 7th grades (because 2nd molars are erupted) would be desirable grades to intervene to prevent pit and fissure lesions. Most schools also require the patients to be notified in writing of dental problems. One major disadvantage of school water fluoridation is also that children do not receive its benefits until they begin school. The school water was fluoridated slightly over 3 times the optimum indicated for the community water. a school water fluoridation pilot study was initiated at St Thomas V. it should be on reducing the frequency of intake and selecting sugar products that are rapidly cleared from the mouth. Objectives of the Program To improve enrolment & attendance To reduce school drop outs To improve child health by increasing nutrition level Sealant placement: The placement of pit and fissure sealants is ideally suited for a school dental health program. After 8 years.In 1954. dental hygienist. Emphasis cannot be on total restriction of sugars. or teacher can aid sugar discipline through counselling. best smile and teeth competitions where students can exhibit projects. it has not been widely implemented. Referral for dental care Many schools do not provide dental care within the school itself. Public Health Service division of dental health. students showed 22% less caries experience than children drinking non-fluoridated school water. helps provide a continuous protection of the whole tooth.S. Virgin Islands.S. followed by an application of fluoride. Such projects increase awareness among students and the community at large. Science fairs: Local and state dental associations can organise science fairs.

School dental health clinics also facilitate peer review. The signed cards are then returned to the school nurse. ADVANTAGES OF SCHOOL BASED DENTAL PROGRAMS School dental health programs can bring school children when they are gathered in school for non dental reasons. The dental hygienist is a good candidate to follow up dental examinations. all children are given referral cards to take home and subsequently to the dentist. medical problems of children can be addressed simultaneously. VARIOUS SCHOOL BASED DENTAL PROGRAMS TEXAS STATEWIDE PREVENTIVE DENTISTRY PROGRAM.In this program. through a grant from the Dept. A combination of education and health facilities is practical both ideologically and logistically. Follow-up of dental inspection Issuance of referral slips is of little importance to children if steps are not taken to follow up dental therapy. SCHOOL DENTAL CLINICS School dental health clinics are less threatening to children. When associated with medical clinics. low income groups are also able to afford dental care of a specialized nature when necessary. Higher utilization of dental care services has been obtained by this method than any other. Classroom teachers may also be allotted for this purpose. In addition.Blanket referral: . of Health and Human Services to the . who plays an important role in following up referrals. either at the informal level or formal level. The location of dental clinics in school premises favours dental health education. or the classroom teacher. b) One-chair dental clinics as seen in older school programs have proven insufficient to address the health needs of the entire school. DISADVANTAGES OF SCHOOL BASED DENTAL CLINICS a) Short school hours and frequent vacations make full time employment of dental personnel difficult and thus make availability of personnel a problem. the children’s daily contact with the dental personnel in other roles has a lasting effect on their attitudes towards dentistry in general.TATTLE-TOOTH PROGRAM Program Development The Tattle-tooth program was first developed in the 1970s as a cooperative effort between Texas oral health professional organizations. since they are in familiar surroundings. By providing certain basic dental services at govt expense. Members of the dental health team can engage in classroom teaching and also reinforce their message at the chair-side. who signs the cards upon completion of examination or treatment or both. It is also important that someone from school health services coordinate the work of various teachers.

The pre-school curriculum was designed for use with personnel in head start programs. a coalition of several agencies set up a committee that was responsible for developing a practical plan for a program in schools. A field trip to a dental office is strongly recommended for kindergarten children. Tattletooth II-A for grades kindergarten through six.year program to reduce dental disease. In 1993.bureau of dental health. public and private child care centres.directed activities that teachers do with children on large or small scale groups Program Philosophy and goals To reduce dental caries and develop positive dental habits to last a lifetime in participants. Program implementation Dental hygienists serve as technical consultants for school districts and promote dental education. In 1970. In the same year. To convince students at preventing dental diseases is important and can be done by them. fluoride treatment of school children. Children-directed activities that children do largely on their own 2. continuing education on prevention for dental professionals and plaque control education in schools and communities. In 1973. the Texas legislature mandated that the essential elements for comprehensive health education be incorporated in the curriculum state-wide. Teachers are trained to present dental health information for school-aged children. . The curriculum contains: 1. In 1985. NORTH CAROLINA STATEWIDE DENTAL PUBLIC HEALTH PROGRAM Program development The need for an oral health program was realised as early as 1918 in North Carolina and oral hygiene was added to the North Carolina Public Health Program. To focus on dental health as part of total health. public school programs and family day care homes. In 1989. the Oral Health section started the process of establishing new long range goals for the state that reinforce and expand on those started in 1973. Supported materials are available for teachers and program hygienists. Teacher. a report prepared for the North Carolina Dental Society defined the extent of dental disease problem and resulted in the initiation of a 10. With the North Carolina Oral Health Survey in 1986. They are also encouraged to invite a dental professional to demonstrate brushing and flossing in the classrooms. pre kindergarten. the North Carolina Dental Society passed resolutions advocating a strong preventive disease program embracing school and community fluoridation. a pre-school programme titled ‘Superbrush’ was completed by the Bureau of Dental Health. the Bureau of Dental Health developed a new program. This program was initially implemented with approx 50.000 children in Texas per year.

The curriculum encourages youngsters to go for regular dental check-ups and invites dental professionals to participate in classroom instruction. Proctor and Gamble (P&G) has been providing the curriculum resources to schools throughout America. professionals and community. a mobile van staffed by volunteer dental professionals provides dental attention on wheels. The purpose of the program was to motivate parents into initiating action for correction of defects in their children through effective utilization of community resources.Program philosophy and goals 1. School-age children are the primary focus. The program enhances children’s self esteem while giving them information about taking care of their oral health. fluoride mouth rinse programs and sealants. P&G also provides educational materials for professional and patient use. BRIGHT SMILES BRIGHT FUTURES (COLGATE) Colgate Oral Pharmaceuticals have developed an oral health educational program to teach children about caring for their teeth through proper oral hygiene. diet and physical activity. Program Implementation Teachers are trained to present dental health information for school-age population. Each year. . SCHOOL HEALTH ADDITIONAL DEVELOPMENT PROGRAM (SHARP) This program was developed in Philadelphia where the lowest rate for correction of physical defects prevailed. Materials are sent to participating schools each year in time for National Children’s Dental Health month (Feb). Public health dental staff provides training and consultative services to teachers. Primary prevention and education are considered to be the most effective means of decreasing dental disease and promoting oral health.000 classrooms. stickers. CREST’S FIRST GRADE ORAL HEALTH EDUCATION PROGRAM Since 1961. 2. guides and exhibits. Fluoride and sealants are recognised as the most effective public health measures for preventing dental caries. posters. 3. Available material includes books.videotapes. In several communities. charts and guides for teachers or professionals administering the program. Crest kits containing toothbrushes and toothpaste samples have been provided for children in more than 20. The North Carolina Oral Health Section’s goals are based on prevention and education. videos. parents. The priorities are community water fluoridation. Several teaching aids are used. screening children and providing referrals for additional needed treatment and aims to provide dental care and information to children at risk for dental problems.

It was also noticed that the Dental Surgeon population ratio was 1: 30000 in the urban areas.F.4 % of the State's population was suffering from one or the other Dental diseases. To provide the best of the Dental Health Care Services to the people of the State. The educational agencies in these states partnered with their state health depts. 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. medical & paramedical personnel. interceptive and curative treatment available in the existing infrastructure of the Dental Health Care Services in the State. In 1998. To provide Dental Health Education Training to all the primary school teachers.COORDINATED SCHOOL HEALTH PROGRAMS One proven strategy for reaching low-income children most at risk for dental caries is through school based programs with supporting linkages with health care professionals and other dental partners in the community. has launched INTENSIVE DENTAL HEALTH CARE PROGRAMME for school children. the CDC’s division of Oral Health provided 3 year funding to four US states. the Punjab Govt.000 in the rural areas by opening 354 new Dental Clinics by the end of five years plan.12 years. integrating oral health into their existing Coordinated School Health Programs (CSHPs). To provide one dental clinic to serve the population of 30. These models serve as a foundation of a comprehensive integrated and sustainable approach to address oral health needs of school aged children DENTAL PROGRAMS IN PUNJAB A survey conducted by the Health Department during the year 1989-90 revealed that nearly 84.T. To achieve 25 % reduction in number of persons without teeth after the age of 60 Years.M. In 1999. To organize special Dental Health Fortnights. Division of Oral Health. To bring down the Decayed Missed Filled Teeth (D. AIMS AND OBJECTIVE: To bring down the incidence of oral and dental diseases to less than 40%. the National Centre for Chronic Disease Prevention and Health Promotion at CDC. to promote. provided funding support to state educational agencies. develop. . It was noticed that this alarming rise in the Dental diseases was mainly due to the lack of awareness among the people about the prophylactic. school teachers and general public. But the ratio in the rural areas is 1:1. 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. To provide total oral health coverage to all the school going children in the age group of 6 .) in School children of 6 – 12 years less than two. expand and evaluate school based models.19 lacs.

At present three Medical Officers (School Health Clinic-I.0 Lacs 3. Under this Programme one sub-division is selected and the schools are covered block – wise.C.Punjab is the only state in India which has launched Intensive Dental Health Care Programme in the year 1989-90. Medical Officers (Dental) – I) visits the schools as per the detailed programs circulated to them. For school Children: Targets and achievements are as under: Year Target Achievements Children found % age of children found suffering from various suffering from various Dental Diseases Dental Diseases 123905 127494 80215 36.INTENSIVE DENTAL HEALTH CARE PROGRAMME: . Imparting of Dental Health Education to School Teachers.H.6 37.5 Lacs 3. 07) 7500 . Intensive Dental Health Care Programme-I & P. After covering the whole Sub-division the next Sub-division is taken up. The Special feature of this Programme is that in addition to the imparting of Dental Health Education training to the School children & detailed Oral Health check up.2 31.7 2005-06 2006-07 2007-08(Upto Dec. each child is given a mouth rinse with the freshly prepared 2 % solution of sodium fluoride to arrest the initiation & progress of dental caries and this process is repeated after every six months. Medical and Paramedical Personnel: Year 2005-06 2006-07 Target Achievement 6500 7000 9505 10468 4771 2007-08 (upto Dec. 07) 2. One day dental health education training workshop/camps are being held for primary school teacher.25 Lacs 342213 403880 212891 The children suffering from Dental Diseases are provided necessary Dental treatment on the Mobile Dental Clinic Vans. Medical and Paramedical Personnel so as to update their knowledge about commonly prevailing Dental diseases among the School children and their preventive measures to be taken.

Iran.19(4):274-81 7. Shenoy RP. 2nd edition Peter S (2009). Vehkalahti MM et al. 3. 4th edition Yazdani R. it was decided to establish seventeen Mobile Dental Clinics in the State (one for each District) so as to provide curative and prophylactic Dental Health Care Services in the far-flung rural areas of the State and also to provide effective prophylaxis against Dental Caries to the children in the Schools. Dentistry. Dental Practice and Community. So. Int J Paediatr Dent.21(2):253-9. curative Dental Health Care Services and effective Prophylaxis against Dental Caries can only be provided on the Dental Chair. Effectiveness of a school dental education program in improving oral health knowledge and oral hygiene practices and status of 12. 5. Sequeira PS. School Health Program. Textbook of Preventive and Community Dentistry. 2009 Jul. Eklund SA (2005). .3rd edition Haag JH (1972). Essentials of Preventive and Community Dentistry. School-based education to improve oral cleanliness and gingival health in adolescents in Tehran. Indian J Dent Res 2010 Apr-Jun. Community Dental Health. 6th edition Jong AW (1994).to 13-year-old school children. 3rd edition Hiremath (2009). 6. of Patients examined by the Mobile Dental Van during the year 2005-06 to 2007-08 are as under Year 2005-06 2006-07 2007-08(upto Dec 07) Target 70000 80000 85000 Achievement 114287 90026 44601 REFERENCES Burt BA. 1. 4. No.Mobile Dental Clinic Van: Since the incidence of Dental Diseases is very high amongst the school children particularly in rural areas. 2.

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  °#¾  °f  f ¯° % %  9  f¾ ½ ¾ nf°f ¯f f¾ € ½€ ¾¾°f f°  ½f °¾  .



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f   n ¾    ½ ½ € f  9°©f  f¾f°n -@-I-@@.

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