Guest Editorial
February, 2010 edition

Integration of Oral Health into Coordinated School Health

By Kathy Voigt Geurink, RDH, BS, MA

As a dental hygiene educator for over 20 years, every February during National Children’s Dental Health Month (NCDHM), I receive numerous requests from schoolteachers and nurses for dental hygiene students or faculty to provide oral health presentations in their classrooms. Usually, the department of dental hygiene receives more requests than we can accommodate, so I seek additional help from the local component of ADHA or from former dental hygiene students to answer these requests. Everyone realizes that school settings are ideal places to reach children with the message that developing good habits at an early age, including routine visits to the dentist, will help them get a good start on a lifetime of healthy teeth and mouths. What’s more, the children spread the message to their families and to their communities.

Despite all the National Children’s Dental Health Months that have occurred during my professional lifetime and the provision of thousands of oral health presentations, statistics demonstrate the following oral health disparities and lack of progress:

• An estimated 51 million school hours per year are lost because of oral health problems.[1]
• Among children ages 2 through 5 from families with incomes at or below the federal poverty level, the amount of dental caries in the primary teeth remained unchanged from the early 1970s to the early 1990s.[2]
• Although more than 90 percent of general dentists provide care to children and adolescents, very few provide care to children under age 4, children and adolescents with high levels of dental caries, and children and adolescents covered by Medicaid.[3]
• Among children and adolescents from families with low incomes, nearly 80 percent of decayed primary teeth have not been restored in children ages 2 through 5, and almost 50 percent of decayed primary and permanent teeth have not been restored in children and adolescents ages 6 through 14.[4]

The knowledge exists to prevent dental caries in children, and that knowledge needs to be transferred to practices that will eliminate this chronic childhood disease. Since the 2000 Surgeon General’s Report, Oral Health in America, strategies have been developed and are being implemented that demonstrate movement in the right direction. Along with NCDHM activities in schools, many other oral health promotion and disease prevention efforts have been initiated for school-age children. Those with the most benefit are the evidence-based practices of sealants and fluorides.

• Direct delivery of dental sealants to children and adolescents in school-based settings reduces dental caries among children and adolescents by 60 percent.[5]
• Community water fluoridation decreases tooth decay by 29 percent to 51 percent in children and adolescents (ages 4 to 17).[5]
• Fluoride varnish has been found effective in preventing caries on permanent teeth and has been shown to prevent or reduce caries in the primary teeth of young children.[6]

One-time presentations will not be successful in changing behaviors.[7] Health education efforts such as oral health presentations during oral health observances need to be connected with evidence-based practice and incorporated into coordinated school health programs. Presently, models exist where services such as dental sealant programs and fluoride varnish are being provided in school-based settings along with oral health screenings/referrals and classroom education. The integration of oral health into coordinated school health is the pathway to transfer the knowledge of prevention into practice. The Centers for Disease Control and Prevention (CDC) has established a coordinated school health program model (CSHP) described as follows:

A coordinated school health program (CSHP) model consists of eight interactive components including health education, physical education, physical environment, family and community, health services, nutrition services, health promotion for staff and counseling services. Schools by themselves cannot—and should not be expected to—solve the nation’s most serious health and social problems. Families, health care workers, the media, religious organizations, community organizations that serve youth, and young people themselves also must be systematically involved. However, schools could provide a critical facility in which many agencies might work together to maintain the well-being of young people.[8]

The mission of our schools is to provide children and adolescents with the knowledge and skills to lead a healthy and productive life. Good oral health is an important part of that mission. The proposed Healthy People 2020 objective related to this mission is to increase the proportion of school-based health centers with an oral health component.[9]

The lead article in this issue of Access, “Improving Oral Care for At-Risk Children,” includes interviews with dental hygienists involved in implementing oral health programs that are integrated into coordinated school health at some level. The goal of these programs is to have full integration of oral health into all eight components of school health. The Association of State and Territorial Dental Directors’ (ASTDD) Committee on School and Adolescent Oral Health, with funding from the Health Resources and Services Administration Maternal and Child Health Bureau, has provided guidance and resources to states on integrating oral health into these eight school health components. ASTDD has also released a resolution in support of school-based programs.[10] The dental hygienists interviewed for the lead article are members of the ASTDD School and Adolescent Oral Health Committee and represent programs from four separate states.

February is a good time for all dental hygienists to review models of integrating oral health into coordinated school health so that your activities are not limited one-time efforts. The next time you receive a call for a school presentation, suggest a planning meeting on integrating oral into the school health curriculum. I believe our efforts will be best spent introducing the concept of integrated prevention measures into the school health curriculum and will bring us closer to the goal of preventing and even eliminating childhood caries in the future.

References

1. National Institute of Dental and Craniofacial Research/Centers for Disease Control and Prevention Dental, Oral and Craniofacial Data Resource Center. Oral health, US 2002 annual report. Available at http://drc.hhs.gov/report/17_1.htm.
2. Brown LJ, Wall TP, Lazar V. Trends in total caries experience: permanent and primary teeth. J Am Dent Assoc 2000; 131(2): 223-31.
3. Seale NS, Casamassimo PS. Access to dental care for children in the United States. A survey of general practitioners. J Am Dent Assoc 2003; 134(12): 1630-40.
4. Vargas CM, Crall JJ, Schneider DA. Sociodemographic distribution of pediatric dental caries: N HANESIII, 1988-1994. J Am Dent Assoc 1998; 129(9): 1229-38.
5. Task Force on Community Preventive Services. 2002 guide to community preventive services: oral health. Atlanta: Community Guide Branch, Centers for Disease Control and Prevention.
6. American Dental Association. Report of the Council on Scientific Affairs. Evidence-based clinical recommendations: professionally applied topical fluoride, May 2006. Available at http://www.ada.org/prof/resources/pubs/jada/reports/report_fluoride.pdf.
7. 7. Isman B. Health promotion and health communication. In Geurink KV: Community oral health practice for the dental hygienist, 2nd ed. St Louis: Elsevier; 2005.
8. Centers for Disease Control and Prevention. Healthy youth/coordinated school health program. Available at www.cdc.gov/healthyYouth/CSHP
9. U.S. Department of Health and Human Services: Healthy People 2020: Oral Health. Available at www.healthypeople.gov./HP2020/objectives/topicarea.
10. Association of State and Territorial Dental Directors. Integrating oral health into coordinated school health programs. Available at http://www.astdd.org.

Kathy Voigt Geurink, RDH, BS, MA, is clinical associate professor in the Department of Dental Hygiene, University of Texas Health Science Center. A consultant on the ASTDD School and Adolescent Oral Health Committee, she has received awards in dental hygiene and furthering its role in public health. Her textbook, Community Oral Health Practice, is used nationwide.