WHAT programs exist and what lessons can we learn from their successes and challenges.

Communities across the country have developed school-based oral health programs to increase children’s access to oral health services. School-based programs can integrate oral health into the fabric of the learning environment, and provide opportunities to assess the oral health of all children in a school. In schools with School-Based Health Centers, the sponsoring organization, or community programs can partner with existing medical and behavioral health services to offer integrated dental services to students onsite.

SBHCs already have a presence and well-established relationships within the school, have a defined health facility for existing services, understand the needs of the student population, and understand how to work within the school environment.  The SBHC can serve as a dental home if they offer comprehensive dental services, or can partner with community dental providers to ensure that students have an established dental home – a critical component of continuity of care.

“We wanted to add dental services to our SBHC program.  We visited a well-established school dental program in a community similar to ours. Armed with data from their program, our dental team screened students in 5 schools with SBHCs in the first year to gather community-specific data, screening 95% of students in each school.  We provided hygiene services to students in need, and then shared aggregate data with the principals to demonstrate rates of decay and the ongoing need for dental services in the schools”.
Sue Peters, MPH, APRN, RN, Director of School Health Programs, New Haven Public Schools.

Many factors affect the planning and implementation of a program, including the community oral health environment, existing infrastructures, cultural influences, resource availability, the extent of oral disease, equitable access to services, and political considerations at the local and state level. Community needs, partnerships, regulations, state practice laws, and resources greatly influence the services and delivery models offered by various school-based dental programs.

Advantages of school-based oral health program and services:

  • Conduct screening and education programs in a variety of settings with minimal supplies
  • Conduct school-based dental sealant programs on a specified, limited schedule and require some supplies
  • Mobile vans and programs using portable dental equipment operate on a specific schedule and tend to be set up at the school temporarily. Once all enrolled students receive services, the equipment or van moves to another school location. These programs provide hygiene services and may provide restorative services for children requiring treatment for dental caries. Mobile and portable programs require equipment and supplies to provide direct care; portable programs may utilize temporarily assigned space in the school buildings
  • Fixed-site programs have a specified, permanent location in school buildings or on school grounds and may use portable or fixed equipment.

Common considerations for school-based oral health programs:

  • Identifying a healthcare sponsor for the school-based dental program
  • Developing a referral source or network to accept students needing restorative treatment outside the school setting
  • Providing in-school services or community services for students without dental insurance
  • Decreasing numbers of providers that accept Medicaid insurance in some states or communities
  • Identifying funds for initial equipment purchases and ongoing need for disposable supplies
  • Ensuring adequate utilization of the program to sustain the services
  • Expect a slow first year for new programs, as generally year two is when programs become cost-effective
  • Obtain a reliable process for data collection and processing to ensure data is not lost; develop a tracking mechanism to demonstrate the cost-effectiveness of the in-school dental program
  • Adopting best practices and innovative approaches to improve consent form return rates, which can be a primary barrier in the successful functioning of school-based programs.

“School based dental programs are a long game. Every advance that you achieve places you one step closer to your vision for the oral health of the children. You must have patience and perseverance, try new things, and adapt and evolve as things change.  You need to recognize and care for your team, and nurture them so they feel valued”.
Terri Chandler, RDH, Future Smiles Founder and Executive Director