INTRODUCTION :

As individual dental care is not available and affordable by every

person community dental health programmes are essential in delivering oral
care to the public. The WHO oral health programme applies the philosophy
“think globally and act locally”. The development of such programmes
focus on
 Identification of health determinants, implement interventions that
promote oral health.
 Implementation of community based demonstration projects for oral
health promotion with special reference to poor and disadvantaged
population group.
 Building capacity in planning and evaluation of national programmes
for oral health promotion and evaluation of intervensions in
operation.
 Development of methods and tools to analyze the processes and
outcomes of oral health programmes.
 Establishment of networks and alliances to strengthen national and
international actions for oral health promotion.

SCHOOL PROGRAMMES :

School health services are procedures established

a. To appraise the health status of pupils and school personnels.
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.

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 School health services include more obvious procedures involving the
use of medical and dental personnel. The starting point for school health
service is health appraisal. Health appraisal has been defined as “The
process of determining the total health status of the child through is served
to children and excessive refined carbohydrates are eliminated both during
the meal and between meal snacks. School fluoridation of school water at an
increased concentration school water of an increased concentration where
public water supplies are not available for community fluoridation is also a
new programme under healthful school living.

School health care programmes may run either by the education

department or by the health department. In favour of the former system are
simpler administrative control and the fact that health services can more
readily be made educational in character. In favour of the latter are the facts
that medical services should be under medical supervision, school nursing
services can and should be coordinated with community health nursing
activities and that the health department will in any case have to service all
the private schools in the community.

SCHOOL HEALTH PROGRAMMES IN INDIA :

Dental health is part of general health in programmes run by certain

voluntary agencies in India like voluntary health association of India. Clubs
like Rotary, Lions also conduct various school dental health programmes.
Various programmes are :
1. Learning about your oral health (Prevention oriented school programe)

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DEVELOPMENT :

Learning about your oral health was developed by ADA. Bureau of

dental health education and its consultants in response to request from 1971
ADA house of delegates.

PROGRAMME GOALS :
a. Learning about your oral health is a comprehensive programme
covering current dental concepts.
b. The goal of the programme is to develop the knowledge skills,
attitudes needed for the prevention of dental disease.
c. The priority of the programme is to develop effective plaque control
knowledge and skills.

PROGRAMME IMPLIMENTATION :
a. The programme format is divided into 4 levels with specific content
for each level.
b. Level are Level I (Kindergarten std 3)
Level II (std 4-6)
Level III (std 7-9)
Level IV (std 10-12)
c. Supplementary printed material and 7 films that specifically
coordinated with each level has been developed.
d. A plaque control kit is made available.

PROGRAMME EVALUATION :

Should be done at regular intervals

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TOOTH KEEPER PRGRAMME :

DEVELOPMENT :

Originally sponsored by American Society of Preventive dentistry

and programme is from Kindergarten to std 6.

PROGRAMME GOALS :
a. Capitizers on reinforcement activities and helps children to develop
personal responsibilities for health care.
b. Primary goal of the programme is education rather than oral hygiene.

PROGRAMME IMPLEMENTATION :
a. Teachers are trained each year by dental health consultants.
b. All necessary infer nation and teaching resources are provided by this
system.
c. The teachers are requested to carry out the programme for 16
consecutive weeks.

EVALUATION :

The patients hygiene performance score (PHPS) Las been utilized to

evaluate plaque removal both prior and alter 16 weeks programme.

TATTLE TOOTH PROGRAMME :

DEVELOPMENT :

Developed as a co-operative efforts between Texas Dental Health

Professional Organizations, Texas Department of Health and Texas
Education Agency.

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PROGRAMME GOALS :
a. This programme is related to dental health of individuals and focuses
on a total person.
b. The goal of the programme is to reduce dental disease and develop
habits to last a life long.

PROGRAMME IMPLEMENTATION :
a. State wide implementation
b. Teachers are trained to present dental health information.

EVALUATION :
a. Field testing
b. State wide continuous monitoring

THETA PROGRAMME :

(Teenage Health Education Teaching Programme)

DEVELOPMENT :

Developed by US public health service.

PROGRAMME GOALS :

The programme goal is to give young children is to give the

knowledge and skills to start them with preventive dental practices.

IMPLEMENTATION :

Suggest guidelines and that a teachers manual to the interested party.

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EVALUATION :

No formal evaluation system for that a programme.

COMMUNITY WIDE PROGRAMMES :

Community wide programmes include preventive measures, dental

health education, case finding through dental inspection or other means and
referral to a source of treatment. These services are appropriate to a dental
public health programme because they involve prevention and team work.
Treatment services might or might not be a part of dental public health
programme, depending upon the claim of the population group.

DENTAL CASE FINDING :

In areas where dental disease constitutes an important problem, it

becomes necessary to set up a programme of secreting, inspection or
examination which can be carried out year after year without undue strain
upon dental personnel involved and without the inhibition of other phases of
the dental programme. Dentists, dental hygienists or dental therapists should
be employed to do the secreting. Dental assistants or trained lay people
should be available as recorders. The type of examination or inspection to
be used will determine the personnel needed.

The ADA classifies IV types of examination.

Type I :

Complete dental examination with all aids. This is unsuited to case

finding in populations because of the expense and time involved.

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Type II :

Limited examination using mouth mirror and explorer, bitewing X-

ray and if necessary periapical x-rays. This is adapted to school dental
health programmes on a continuity basis but not for all children every year.

Type III :

Inspection using mouth mirror and explorer and adequate

illumination. This itself very well to school procedures and can be
performed either by a dentist or a dental hygienist. Type III inspection
identities major dental needs in most instances and can be made the vehicle
for excellent individual health education. It can be performed on school
premises with portable equipment and the hygienists can combine it with
dental prophylaxis or topical fluoride treatment.

Type IV :

Screening using tongue depressor and available illumination. It is

dental case finding at its quickest, but at its lowest efficiency. Yet the
procedures is needed sometimes where dental personnel are not available to
do and where school physicians or school nurses are called upon to identify
the dental diseases. But type IV screening should be avoided wherever
possible.

REFERRAL FOR DENTAL CARE :

At times where a public health programme cannot supply full dental

care to all school children, referral to private dentists is an important part of
school or neighborhood health center can link a public programmes without
local private offices in the matter of dental reference. These programmes

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require follow-up system 1 person should be in charge of this system in each
school. The dental hygienist is the logical person to conduct a follow up
system if she is a member of the school health team. Otherwise the dental
assistant or the school nurse can work effectively.

DENTAL HEALTH EDUCATION (as community dental health

programme) :

Dental health is an in expensive and important tool in community

dental health programme. It forms the backbone of an efficient community
endavear. Its use in community programmes is enhanced by the fact that the
dentist himself isn’t required to import it, and easily and efficiently done by
the other dental professionals such as the dental hygienist, dental nurse etc.
The following is a briefing about the various dental staff’s role in health
education.

DENTAL HYGIENE TEACHER :

Dental hygienists with additional training and experience in the field

of education can function extremely well as school dental health coordinator
and import health education. They have a powerful opportunity for the
referral of children to sources of dental particularly where they can perform
the screening individuals.

DENTAL HYGIENIST, DENTAL THERAPIST OR DENTAL

NURSE:

The professionally trained dental auxiliary without specialized

training in education can do a greater deal as a resources person and even as
a coordinator of dental programs. They may be much more successful in
“levelling” with the community patients than a graduate dentist would be.
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CLASSROOM TEACHER AND SCHOOL NURSE :

Authorities both in the field of education and in the field of health

agree that classroom teacher and in the field of health agree that classroom
teacher carries a major share of the task of dental health education in a
school setting. The teacher’s inters in securing dental corrections is a major
factor in developing pupil interest and action. Teachers properly instructed
in the principles of oral hygiene and gifted with enthusiasm and persistence
can stimulate children to seek dental service as effectively as dentists or
hygienists.

HEALTH EDUCATOR :

They have a specialists responsibility in all fields of health and are

usually found serving school districts rather than individual schools.

DENTIST :

In the field of dental health education the dentist has 2 functions, 1 st,
that of ultimate arbiter as to the quality and type of factual material
presented in the program and 2 nd, that of chair side teacher in the course of
any examination or treatment that is rendered.

The importance of dental health education as a part of community

programmes is because of the fact that it aids in providing a body of
information, among the public about the prevalence and occurrence of oral
diseases. Also they can be educated about the most salient clinical features
of the common oral diseases so as to aid in the awareness, early detection
and demand for early treatment procedures. Imparting information
pertaining to various available preventive approaches and early habits that

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prevent the onset of oral diseases is also essential as it checks the prevalence
of various preventable oral diseases.

COMMUNITY ORAL HEALTH PROGRAMME FOR OLDER

PEOPLE :

World wide reports have shown that use of professional dental health
services is law among older people. Research may be poor access to oral
health care because of less dental manpower, impaired mobility, financial
hardship and negative attitudes to oral health.

The WHO oral health programme encourages national oral health

planners to strengthen the implementation of systematic oral health
programmes oriented towards oral health of older people.

Several oral health programmes have been designed to improve the

oral health status of institutionalized elderly. For an example an oral health
care programme established for residents of nursing homes provided oral
examination, dental treatment oral prophylaxis and instructions to both
nursing staff and residents. The programme demonstrated a reduction in the
number of teeth with decayed and periodontal treatment need, reduced
prevalence at denture stomatitis and improved denture hygiene (Vigild M et
al and Buitz Jorgensen E et al).

Successful community based oral health programmes for older people

have been provided. A dental health proportion programme based on the
concept of predisposing, Reinforcing and establishing courses in
Educational Diagnosis and Evaluation (PRECEDE), resulted in significant
improvements in the oral health status of a voluntary group of healthy
elderly patients. Furthermore, oral health promotion programmes addressing

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self monitoring approaches improved oral health behaviour, attitudes and
health status among elderly patients.

Modification in oral health care systems by elimination of financial

barriers and establishment of outreach situations has been shown to improve
the oral health of older people. A public health programme providing free,
comprehensive dental care to old age persons resulted in the improvement
of their oral health status and also quality of life (Peterson PE et al) the
programme aimed at empowerment attitude, knowledge and oral hygiene
practice in addition to the use of dental health services.

Clinical studies suggest that oral health education for elderly patients
is effective (Schoul et al) a randomized clinical trial for older periodontal
patients revealed that group based behavior modification intervention
helped patient improve their self care skills such as brushing and flossing
and reduced gingival bleeding.

Public health programmes should apply the appropriate strategies to

older people. This group includes the physically and economically
vulnerable, home bound, institutionalized as well as active elderly people.
Where active older people are concerned, outreact activities may target
social environment such as clubs, recreational centers, libraries, and health
care centers. Such programmes must focus on enhancing awareness of the
importance of oral health and help to translate oral health knowledge into
practice. As concerned to institutionalized and home bound, involvement of
care givers play important role in oral hygiene diet and nutrition.

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PRE-SCHOOL PROGRAMMES :

In providing preventing oral health care at the real beginning pre-

school programmes play a vital role. Pre-school children can be reached
through department of health in baby clinics, nursery schools, day care
centers and kindergarden classes. Administration of a pre-school
programme is more centered in the health department than in the school
department.

ORAL HEALTH CARE IN STRESS AREAS :

There are same communities who cannot offered dental care in

accordance with their needs and with the recommendations which are made
to them. It is usual for such communities to make some effort to provide
dental care for disadvantaged children whether through a school dental
clinic, a health center or perhaps some other clinic maintained by a
voluntary organization. Communities may equally logically arrange for
dental care in private dental offices either at state or federal expenses
(Medicaid where available) or at local expenses.

EVALUATION OF COMMUNITY DENTAL HEALTH

PROGRAMMES :

Many of the benefits of dental health programmes will be intangible

from the start. Other benefits may appear only offer measurements.
Measurement can be made it careful initial surveying of dental caries and
other characteristics is matched by subsequent evaluation over a period of
years.

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 An example of such surveying and evaluation is available from the
ASKOV dental demonstration in Minnesota. ASKOV is a small forming
community with a population mostly of Danish people. It showed very high
dental caries in the initial survey made in 1943 and 1946.

Providing the period from January 1949-Sept 1957 the section on

dental health of the Minnesota department of health supervised a
demonstration school dental health programme in ASKOV including caries
prevention, dental health education and dental care. All recognized methods
for preventing dental caries were used in the demonstration except
communal water fluoridation, since until 1955 ASKOV had no communal
water supply. Dental care was rendered by a group of 5 dentists and they
also gave topical fluoride treatment.

Dental findings are available through a 10 year period. They include

28% reduction in dental caries in deciduous dentition of children 3-5 year
old, a 34% reduction in caries in the permanent teeth of children 6-12 year
old and 14% reduction in caries in children 13-17yr old. Beyond these are
improvement in filled tooth ratio and many intangible benefits such as good
health and dietary habits for the children to carry on to adult life.

Some of the clearest benefits of school dental health programmes in a

high caries area are seen in a country like New Zealand, where almost the
entire school age population has received comprehensive dental care over a
considerable number of years.

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REFERENCES :

1. Principles of Dental Public Health: James Morse Dunning 4 th edn:

1986.

2. Improving Oral Health of older people; Approach of WHO global

oral health programmes CDOE:2005:33(2) 81-92.

3. The global oral health report: CDOE 2003:31(1) 3-23.

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 CONTENTS

 Introduction

 School programmes

 Community wide programmes

 Dental case finding

 Referral for dental care

 Dental health education

 Oral health programme for older people

 Pre-school programmes

 Oral health care in stress areas

 Evaluation of community dental health programmes

 Reference

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 DEPARTMENT OF
PREVENTIVE AND COMMUNITY DENTISTRY

COLLEGE OF DENTAL SCIENCES

DAVANGERE

SEMINAR ON

COMMUNITY DENTAL
HEALTH PROGRAMMS

Presented by

Dr.
Dr PRASHANT. G.M.

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