School Oral Health Playbook
- WHY we need increased oral health services for all our children
- HOW to start a program or improve on existing efforts
- WHAT programs exist and what lessons can we learn from their successes and challenges.
- Oral health education
- Oral health screenings with referrals for care
- School-based dental sealant/varnish programs
- School-based dental hygiene program
- School-based hygiene and restorative treatment programs.
- Fixed dental centers located in schools (most often associated with school-based health centers)
- Portable equipment carried into schools and located in temporary spaces (the most common delivery model)
- Teledentistry-emerging models including integration with school-based primary care or school nurses
- Mobile vans parked on school property
- Mixed delivery models.
- Fixed site—Fixed dental centers are often part of school-based health centers (SBHCs) located in school buildings or on school grounds, or may be permanent dental centers operated by an outside agency. In general, fixed sites occupy a dedicated, permanent space in the school building but may use some portable equipment.
- Portable equipment—Portable dental equipment is relatively easy to move and is used to bring dental services to schools. The equipment occupies a fairly small space and can set up in empty classrooms, all-purpose rooms, unused offices, or in other available spaces.
- Teledentistry models—Teledentistry models aim to improve oral health using telehealth-connected teams and virtual dental homes. This relatively new operational model will continue to grow in the future as a way to increase access to care and utilize technology to connect dentists offsite with team-based care delivered on-site.
- Mobile van—Mobile vans are recreational vehicle–style vans that health professionals use to bring health services to schools. The vans may be equipped with exam rooms and medical equipment or outfitted with a full dental operatory.
- Mixed delivery models—Mixed delivery models may include the use of portable equipment or teledentistry at one or more schools and a fixed site at another school. Mixed delivery models often adapt to the size of the student body at the individual schools and the oral health needs of students in each school.
Types of Programs
The following programs represent a cross-section of types of services and delivery models. The School-Based Health Alliance describes the main program types and most common delivery models in its white paper, School Oral Health: An Organizational Framework to Improve Outcomes for Children and Adolescents.
There are five main program types:
There are five common delivery models, including:
Described below are the various models:
School-Based Health Centers
Many School-Based Health Centers (SBHC) have added dental care to their comprehensive health services. SBHCs, defined in federal statute as health clinics that (i) locate in or near school facilities of school districts or boards or Indian tribes or tribal organizations; (ii) organize through school, community, and health professional relationships; (iii) administer by sponsoring facilities; (iv) use health professionals to provide primary care services to children per state and local laws, including laws relating to licensure and certification; and (v) satisfy such other requirements as states may establish for the operation of such clinics.
“Our relationship with the established School-Based Health Centers, and the relationship they already had with the school, helped to foster acceptance and trust of the School Dental Centers. The SBHCs paved the way for acceptance of the addition of dental services. The school was accustomed to First Health providing medical and behavioral health services in the school, so it was not a hard sell to add dental services. The SBHC nurse practitioners and school nurses make referrals to the dental center – the schools understand that the need for onsite dental care exists for these children.”
–Dena Hunt, Dental Assistant, First Health of the Carolinas
School-based dental programs can be oral health components of SBHCs. School-Based Health Centers that provide medical and behavioral health services may include oral health services in their comprehensive health approach. Services can range from oral health screenings to sealant programs to full hygiene and restorative treatment. The SBHC may develop a fixed site delivery model within the SBHC facility or in another location within the school. Students benefit from the cross-referral practices between medical and dental providers. Many fixed site models use portable dental equipment that remains in the SBHC location, but can be moved if necessary. SBHCs that utilize the services of dental hygienists and dentists can serve as the student’s dental home.
A variety of sponsoring organizations can provide support and oversight to school-based dental programs. Some of the most common sponsoring organization types include:
Federally Qualified Health Centers—Federally Qualified Health Centers (FQHC) are public or private not-for-profit organizations that provide preventive and primary health care to populations with limited access to health services. Students can benefit from the provision of dental services in school, with a linkage to a dental home in the FQHC. For additional information: http://www.nnoha.org/nnoha-content/uploads/2014/07/SBHC-Report-FINAL_2014-07-28.pdf
State Health Departments – Many state health departments disburse funds to implement statewide school-based dental sealant programs and provide guidelines and metrics to guide the implementation, promotion, data collection, and best practice approaches. For additional information on the CDC School Sealant Programs: https://www.cdc.gov/oralhealth/dental_sealant_program/school-sealant-programs.htm
Private Nonprofit Corporations – Nonprofit organizations may provide a variety of healthcare programs that may include school dental services, or may form solely to offer dental programs in schools.
Hospitals and Medical Centers – SBHCs sponsored by hospitals may be considered satellite locations or outpatient clinic sites affiliated with the hospital or medical center. Students may link to the primary locations for services outside the scope of the school-based dental program.
School Systems – Local boards of education may sponsor SBHCs and or school dental programs. Upon written consent, all children are eligible to receive services. Staff may be school employees, increasing coordination of care with other school programs and services.