MCHbest. NPM 13.2: Preventive Dental Visit: Childhood
Strategy. School-Based Dental Programs
Approach. Provide school oral health programs, School Based Health Centers (SBHCs), and Title V local grantees with technical assistance to enhance the quality of oral health services and increase oral health visits.
Source. Robert Wood Johnson Foundation's What Works for Health (WWFH) Database
Overview. School dental programs include screening students for dental needs, sealant programs to protect students’ permanent molars, fluoride treatment, and other preventive dental care. Services can be provided by dental professionals, often those employed by Federally Qualified Health Centers (FHQCs), via mobile vans parked at schools, or stationary or portable equipment within schools; services may be provided only in schools or students may be linked to clinics for additional care. Programs often serve school districts with high proportions of low income children and districts in rural areas (CG-Oral health, ASTDD-Isman 2011). Participants in Head Start had significantly higher average number of preventive dental visits than non-Head Start participants. There is also evidence showing effectiveness for school-based dental services such as screening and referral improving receipt of past year preventive dental visit for children.1
Evidence. Scientifically Rigorous. There is strong evidence that school dental programs prevent cavities, especially for low income children (CG-Oral health, CDC-Gooch 2009, Simmer-Beck 2015*, Carpino 2016*, Niederman 2008*). School-based dental programs may reduce costs by performing screenings and applying sealants during the same visit (CG-Oral health), and programs serving larger schools can reduce costs by employing an extra assistant and chair so that dentists and hygienists can move from one sterilized station to the next. Reducing supervision requirements for dental hygienists can also reduce the cost of sealant programs in many states (Scherrer 2007); school dental programs that employ dental hygienists to assess oral health and apply sealants cost less than programs with dentists in these roles (CG-Oral health, Neidell 2016*). The CDC considers preventively sealing all low income children’s molars a cost-effective strategy (CDC-Gooch 2009); sealant programs are most cost-effective when focused on children with high risk of cavities (Tinanoff 2015*). Overall, school-based sealant programs appear to become cost saving within two years (CG-Oral health). In Connecticut, Federally Qualified Health Centers (FQHCs) appear to have saved 50% per dental patient by treating children in their schools rather than in clinics (Bailit 2012a*). Services delivered via school partnerships with mobile dental clinics appear to reduce cavities among underserved children in rural areas (Enciso 2015*). Read more in the WWFH database report. Read more about WWFH's evidence ratings. (*Links to citations can be accessed through the WWFH database). You can also access the peer-reviewed evidence about school or preschool interventions from the MCH Digital Library. (Read more about understanding evidence ratings).
Target Audience. State.
Outcome. Percent of infants and children ages 1 to 17 with a past-year preventive dental visit. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.
Examples from the Field. Access descriptions of ESMs from across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.
Sample ESMs. Using the approach “Provide school oral health programs, School Based Health Centers (SBHCs), and Title V local grantees with technical assistance to enhance the quality of oral health services and increase oral health visits,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):
Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).
1 Martin AB, Hardin JW, Veschusio C, Kirby HA. Differences in dental service utilization by rural children with and without participation in Head Start. Pediatr Dent. 2012;34(5):107-111.