SCHOOL DENTAL HEALTH PROGRAMS

CONTENT

● Introduction
● Historical background
● PLANNING of a school dental program
1) Improving school-community relations

2) Situation analysis

3) Supportive school policies/ practices

4) Conducting dental inspections

5) Conducting dental health education

6) Performing specific programs

● MODELS for school dental programs
● SCHOOL DENTAL PROGRAMS
❖ Save our smiles
❖ "Learning about your oral health" - a prevention oriented school program.
❖ "Tattletooth program"- texas statewide preventive dentistry program.
❖ “Askov dental demonstration”.
❖ “North carolina statewide preventive dental health program”.
❖ “Head start - pre-school dental health program”
❖ “School health additional referral programme (SHARP)”.
❖ Teenage health education teaching assistants program (THETA program).
❖ Love Teeth day - China
● Oral health programmes in India

○ Young India” bright smiles, bright futures

○ Chacha Nehru Sehat Yojna-School Health scheme-government of Delhi

○ NEEV-School oral health program Run by Government of NCT of Delhi

○ Intensive Dental Health Care Program

○ Trinity Care Foundation

● Conclusion

● Reference
 INTRODUCTION

➔ Oral health is fundamental to general health and well-being.

➔ Children who suffer from poor oral health are 12 times more likely to
have restricted-activity days than those who do not.

➔ More than 5 lakh school hours are lost annually because of oral health
problems which affect children's performance at school and success later
life.

National School Oral Health Programme [Internet]. [cited 2022 Jun 16]. Available from:
http://school.nohp.org.in/#/schoolacc
● Oral diseases (Tooth decay and gum disease )- lead to pain and tooth loss -
affects the appearance , quality of life, nutritional intake and consequently
the growth and development of children.

● Oral trauma - common at the age of 5 years.

● Tobacco-containing products - marketed directly at children and adolescents

● School dental program is an economical and powerful means of raising

community health in future generations.

National School Oral Health Programme [Internet]. [cited 2022 Jun 16]. Available from:
http://school.nohp.org.in/#/schoolacc
HISTORICAL BACKGROUND
● William Fisher
● 1909 Baroda city- India
● The Bhore Committee in 1946
● 1953 – Seconday education committee – emphazised the
need for nutrition programs
● 1960 – GOI – School health commitee
● January 1982 –GOI – Task force committee - propose
intensive school service project – report – 14 states
showed progress in their own health budget – also
highlighted reasons for poor state of oral health
programs.
● July 19th, 2001- Tokyo declaration – 1st asian conference (OHP for
school children)

● The declaration stated that this conference would be held on a

regular basis with the aim of exchanging information, building a
cooperative system , improving oral health among children, and
contributing to the wellbeing of mankind and the development of
each country and region based on mutual cooperation
● February 23rd, 2003 – Ayutthaya declaration – 2nd Asian
conference ((OHP for school children), Ayutthaya Thailand

● The declaration called upon national authorities in health

and education to ensure the implementation of systemic
school health programs for promoting oral health and
general health in children based on the WHO’s health
promoting school initiative.
● January 28th, 2005 – Bangalore declaration – WHO
workshop on prevention and promotion of oral
health program

● It called upon national authorities in health and

education to ensure the implementation of school
based oral health programs
 DEFINITION
School Health Services are defined as the "procedures established
➔ 1. to appraise the health status of pupils and school personnel
➔ 2. to counsel pupils, parents, and others concerning appraisal findings
➔ 3. to encourage the correction of remediable defects
➔ 4. to assist in the identification and education of handicapped children
➔ 5. to help prevent and control disease
➔ 6. to provide emergency service for injury or sudden sickness".

Dunning -PRINICIPLES OF DENTAL PUBLIC HEALTH ( The Committee on Terminology of the American Association for Health,
Physical Education, and Recreation 1951)
ASPECTS OF SCHOOL HEALTH
SERVICE

● HEALTH APPRAISAL

It is defined as "the process of determining

the total health status of the child through such
means as health histories, teacher and nurse
observations, screening test; and medical, dental
and psychological examinations".
● HEALTH COUNSELLING

“The procedure by which nurse, teachers,

physicians, guidance personnel, and others
interpret to pupils and parents, the nature and
significance of the health problem and aid
them in formulating a plan of action which will
lead to solution of the problem”.
● EMERGENCY CARE AND FIRST AID

Teachers - first to realize any emergency in a school - should be

trained in handling simple emergencies (traumatic injuries-
contact sports).
● SCHOOL HEALTH EDUCATION:

● Process of providing learning experiences

for the purpose of influencing knowledge,
attitudes, or conduct relating to individual
or community health.

● It should cover the aspects of personal

hygiene, environmental health and family
life.
● MAINTENANCE OF SCHOOL HEALTH RECORDS:

● Analyzing and evaluating school health programs

● Useful link between the home, the school and the community.

● CURATIVE SERVICES:

● They include regular dental check ups and prompt treatment

wherever possible and referral for special problems.
PLANNING A SCHOOL DENTAL
HEALTH PROGRAM
 18

PLANNING A SCHOOL DENTAL

HEALTH PROGRAM

1) Improving school-community relations

2) Situation analysis
3) Supportive school policies/ practices
4) Conducting dental inspections
5) Conducting dental health education
6) Performing specific programs
1) IMPROVING SCHOOL-COMMUNITY RELATIONS: 19

⮚ First step - formation of an advisory committee.

⮚ Advisory committee - parents, teachers, school administrators,

dental professionals, health officers, PTA representatives, food

service providers, and health care providers, community leaders.

The task of these committees :

✔ To appraise and publicize the dental needs of the school

children.

✔ To address the school administration's concern in the

promotion of oral health.

✔ To make people realize the importance of dental health.

✔ Management, coordination and monitoring of health promotion
policies and action plans, and for establishing links with district
education personnel, or ministry-level staff.

✔ It also provides leadership, communication and support to

school staff and community members, and arranges training
where necessary.
 22

PLANNING A SCHOOL DENTAL

HEALTH PROGRAM

1) Improving school-community relations

2) Situation analysis
3) Supportive school policies/ practices
4) Conducting dental inspections
5) Conducting dental health education
6) Performing specific programs
2) SITUATION ANALYSIS 23

Assess the needs, resources and conditions that are

relevant to the planning and development of a health
promoting school.
The information needed include:
⮚ Current health/ oral health status of children and
adolescents.
⮚ Behaviors & other key factors related to oral health
and disease.
⮚ Oral health beliefs, knowledge, attitudes and
behaviours.
⮚ Other socio environmental factors that have an impact
on oral health.
⮚ Existing programmes and activities in school and the
local community, as well as those delivered by the
health service providers.
⮚ Available resources in school and the community.
 26

PLANNING A SCHOOL DENTAL

HEALTH PROGRAM

1) Improving school-community relations

2) Situation analysis
3) Supportive school policies/ practices
4) Conducting dental inspections
5) Conducting dental health education
6) Performing specific programs
 27
3) SUPPORTIVE SCHOOL POLICIES/
PRACTICES

⮚ Policies should be brief and simple documents that

provide a supportive framework detailing the rationale,
objectives and guidelines for the development,
implementation and evaluation of oral health promotion
activities in schools made available.
 28

PLANNING A SCHOOL DENTAL

HEALTH PROGRAM

1) Improving school-community relations

2) Situation analysis
3) Supportive school policies/ practices
4) Conducting dental inspections
5) Conducting dental health education
6) Performing specific programs
 29
4) CONDUCTING DENTAL
INSPECTIONS:

• Extent of dental diseases > 95% or more, Dental inspection-

matter of debate.
• A few are of opinion that it would be a mere waste of resources
(money, manpower, material and time) to examine for a disease
which occurs almost universally and which demands treatment.
 Benefits of school dental
30
inspections:
• It serves as a basis for school dental health instruction.
• Every child unless proved otherwise is considered to be free from
dental disease, the positive findings, on such children will provide
greater motivation towards dental health.
• It builds a positive attitude in the child toward the dentist and
dental care.
• The child and the parent are motivated to seek adequate
professional care.
 31

• Teachers, students, and dentists concerned with dental health

may use the dental inspection as a fact-finding experience.
• Baseline and cumulative data for evaluation of the school
dental health program are made available.
• Provides information as to the status of dental needs to plan a
sound dental health program.
 Limitations: 32

• Parents depend entirely upon the dental inspections rather than a

complete dental examination by the family dentist.

• Sometimes the school inspections may tend to discourage rather

than promote the habit of visiting the dentist at an early age.

• It is desirable for parents to be present during dental examinations-

not always feasible in school inspections.
 33

PLANNING A SCHOOL DENTAL

HEALTH PROGRAM

1) Improving school-community relations

2) Situation analysis
3) Supportive school policies/ practices
4) Conducting dental inspections
5) Conducting dental health education
6) Performing specific programs
 5) CONDUCTING DENTAL HEALTH
EDUCATION: 34

• Dentist - expert resource person to strengthen the teacher's

classroom instruction program.
• He should give each teacher sincere proper attitudes and personal
dental health practices by the teacher which can be passed on to
the classroom.
• Self contained dental health kit for teacher education and
presentation of basic dental health concepts should be made
available to every school.
35
 36

PLANNING A SCHOOL DENTAL

HEALTH PROGRAM

1) Improving school-community relations

2) Situation analysis
3) Supportive school policies/ practices
4) Conducting dental inspections
5) Conducting dental health education
6) Performing specific programs
 6) PERFORMING 37
SPECIFIC
PROGRAMS:

1) Tooth Brushing Programs

⮚ In the classroom, 6-8 children can be taught as a group.

⮚ A cup, a napkin, and a kit containing a disclosing tablet, a

toothbrush, and a tube of fluoride dentifrice.
⮚ The mastery of the 45° angulations and the short vibratory
strokes -repeated on oversize dento-form model.
 38

⮚ Emphasis - Definite brushing sequence to ensure that all

tooth surfaces are brushed.
⮚ Next, the children are asked to chew a disclosing tablet and
to swish it around the mouth for 3o seconds.
⮚ They are then encouraged to look at each other's teeth with
appropriate emphasis on the fact that the red stain colors
the plaque in which the bacteria live.
● Magnifying mirror is passed around

● Guided brushing can then begin

● At the end the mirror is again passed to see the

progress.
● During the entire process appropriate
corrections and reinforcement of brushing
technique are made
 40

2) CLASSROOM-BASED FLUORIDE
PROGRAMS

Two effective fluoride programs are:

1. Fluoride 'mouth - rinse' program
2. Fluoride tablet program
 FLUORIDE 'MOUTH - RINSE' PROGRAM 41

⮚ Once-a-week mouth rinse expected to result in

20% to 40% reduction in dental caries.

⮚ Kit - fluoride rinse dispenser, cups, napkins and

plastic disposal bags.

⮚ The dispenser is graduated so that 2.0 gm of

packaged sodium fluoride powder can be placed

in the jug and water added to the 1ooo-ml mark.

 42

⮚ The rinse should be non-sweetened and non-flavoured.

⮚ Rinsing programs are advised for grades 1 to 12 but not below.

⮚ Five ml rinse – rinse for 1 minute - spit carefully into the cup.

⮚ Napkins –wipe – forced into the bottom of the cup to absorb all

fluid.

⮚ Official recognition of safety from FDA -1974 and by the

Council on Dental Therapeutics of the ADA in 1975.

FLUORIDE TABLET PROGRAM 43

⮚ One tablet each student.

⮚ The student then chews and swishes the 2.2 mg sodium fluoride (1
mg fluoride) tablet in the mouth for a minute and then swallows.
⮚ The swish-and-swallow technique topical & systemic benefits
during the period of tooth development and maturation.
⮚ The daily tablet is more effective than the weekly rinse.
 3) SCHOOL WATER FLUORIDATION PROGRAMS 44

⮚ This procedure makes the fluoride available to

children, for whom dental caries is a primary
problem, as compared to older age groups.

⮚ The amount of fluoride added to school drinking

water must be greater than that used in
communal water supplies, i.e., 4.5 times the
optimum concentration(1ppm)
 45

⮚ Shown Systemic effects on developing teeth & topical effects

on erupted teeth.

⮚ Studies have shown a reduction in dental caries prevalence by

about 40% among children attending schools that support
school water fluoride programs.

⮚ Disadvantage - do not receive benefits until they begin school.

4) NUTRITION : AS A PART OF SCHOOL PREVENTIVE
46
DENTISTRY PROGRAMS

⮚ School lunch programs designed to

provide the child with an intake of
nutrients that approximate one third of the
daily intake of essential carbohydrates,
proteins, fat, minerals, and vitamins.
⮚ Sugar discipline - school dietician, dental
hygienist or teacher.
⮚ Emphasis cannot be on a total restriction of sugars.

⮚ Instead, it should focus on reducing the frequency of

intake and selecting sugar products that are rapidly
cleared from the mouth.
 MID DAY MEAL PROGRAM OF GOVERNMENT OF INDIA
48

⮚ The program of providing hot cooked

meal was introduced in 7 north eastern
districts of the state during 2002-03.
⮚ This scheme - extended to the remaining
areas under the title Akshara Dasoha
during 2003-04.
⮚ The scheme consisted of providing free food grains
at 3 Kilograms per child / per month to children of
class 1 to 5 of Government schools on the basis of
80% of attendance in a month.
⮚ The scheme was extended to classes 1 to 8 in
Government aided schools from 1-9-2004.
 50

❖ In 2008-09, scheme renamed - 'National Programme of Mid-Day

Meal in Schools', popularly known as Mid-Day Meal Scheme covers
all school children studying in I - VIII classes in Government and
Government-aided school.

OBJECTIVES:
⮚ To improve enrolment and attendance.

⮚ To reduce school drop-outs.

⮚ To improve child health by increasing nutrition level.

⮚ To improve learning levels of children.

History of Tamil Nadu’s mid-day meal scheme

Rationale behind the move:

•P. Theagaraya Chetty, the then President of the Corporation (the modern-day
equivalent of which is Mayor) said the boys studying at the school were poor,
which affected the strength of the institution ‘greatly’.

•At the time, there were only 165 students in the school.

•With the subsequent inclusion of four more schools into the scheme, the
enrolment in all five schools showed dramatic improvement — from a
combined strength of 811 in 1922-23 to 1,671 in 1924-25.
•British government disallowed the expenditure on the supply of mid-day
meals to students from the Elementary Education Fund, the scheme came to an
end on April 1, 1925.

•Revived two years later, benefitting around 1,000 poor students in 25 schools.

•In 1956, then Chief Minister K. Kamaraj decided to extend the free meals
scheme to poor children in all primary schools across the State.

•Chief Minister M. G. Ramachandran, - Extended its coverage to children in

the age group of 2-5 years in Anganwadis and those aged 5-9 years in primary
schools in rural areas in July 1982.
•M. Karunanidhi, as Chief Minister during the short-lived DMK Ministry
(1989-91), introduced the provision of boiled eggs, starting June 1989.

•The scheme was modified by Jayalalithaa in 2013, with the inclusion of

variety meals along with masala eggs as per the children’s choice.

•According to the Budget document for 2020-21, the Puratchi Thalaivar

MGR – Nutritious Meal Programme is being implemented in 43,243
noon meal centres, with 48.57 lakh students being fed every day.
 5) SEALANT PLACEMENT 54

⮚ First, second, 6th and 7th standards

⮚ Sealant placement, when coupled with a

follow-up application of fluoride, in
addition to the classroom fluoride
mouthrinse or fluoride tablet program,
helps provide a continuous protection of
the whole tooth.
 6) REFERRAL FOR DENTAL CARE 55

⮚ Few schools - dental care provided at the school itself.

⮚ However if only emergency treatment is provided, parent does not see

the child in pain and might conclude that the school has taken care of the
dental problem.
⮚ Therefore the parent should be informed and made to understand that
such emergency treatment is not a cure and she will have to visit the
dentist of her choice for proper dental treatment.
 7) "BLANKET" REFERRAL 56

⮚ In this program, all children are given referral cards

to take home and subsequently to the dentist, who
sign the cards upon completion of examination,
treatment, or both.
⮚ The signed cards are then returned to the school
nurse, or classroom teacher, who plays an important
role in following up the referrals with the child and
parents.
 57
8) FOLLOW-UP

⮚ Referral slips will be of little value if not

followed up.
⮚ The dental hygienist is the logical person to
conduct follow up examinations.
⮚ Leave concessions are strongly
recommended.
 58

⮚ Two reasons for such concessions:

a) Child - more co-operative patient when

medical/ dental services - early or middle part
of the day.

b) Dentists provide better services for children

when they have time and do not have to
crowd their child patients into after school
hours.
Models of School Health Programs
The Three Component Model (1900-
1980s)

⮚
Traditional “Three legged stool”

of school Health.

⮚
Consists Health education,

Health services, and A healthful

environment.
The Eight Component Model/CDC (Center for
Disease Control and Prevention) Model (1980s)

● Three component model - extended -

“comprehensive school health program
(CSHP)” – multiple domains called
Bubbles.
● New Mexico Adapted
the eight components
model and represented
its components as
leaves of Yucca Plant.
● The eight component model or CSHP - Further explored by
Resnicow and Allensworth- emphasized the role of School
Health Coordinator as an essential component of the model.

● Three program elements; staff wellness, healthy

environment, and community/family involvement, are
incorporated within the coordinator’s role; thus, reducing
the number of program elements from eight to five.

Healthier Schools-New Mexico. Available from: https://www.nmhealth.org/ publication/view/guide/4317/

 Family-School-Community Model (1990)

● Nader (1990)

Nader PR, Emmel A, Charney E. The school health service: A new model. Pediatrics 1972;49:805-13.
● School is one locus of a broad range of health and
educational activities and emphasized that the school,
community, and family or friends are the three important
systems supporting children’s health status and
educational achievement.
● Further, the media–including educational, electronic, and
print media – play a prominent role in influencing health-
related behaviors.
 ACCESS (Administration, Community, Curricula,
Environment, School, and Services) Model (1990)

● ACCESS model regard the school as an institution that

is a microcosm of society, where students spend much
of their developmental years.
● This model focuses on the development of
administration and community keystones first and
remaining are added later on with optimal effect .

Stone EJ. ACCESS: Keystones for school health promotion. J School Health 1990;60:298-300.
Full-Service Schools (Dryfoos, 1994)

● Full-service school concept has been described as a “one-

stop center” for educational, physical, psychological, and
social requirements of students and their families.
● Such services vary and are delivered through
collaborative efforts of school, agencies, and the families,
thus addressing multiple factors impacting the student.

Dryfoos J. Full-service community schools: A strategy-not a program. New Dir Youth Dev 2005;107:7-14
 Health Promoting Schools (HPS) (1995)
➔ WHO school health initiative - launched in 1995.
Four key strategies :
➔ Building capacity to advocate for improved school health
programs
➔ Creating networks and alliances for the development of HPSs
➔ Strengthening national capacity
➔ Research to improve the effectiveness of school health programs.

World Health Organization. WHO’s Global School Health Initiative: Health Promoting Schools. Geneva,
Switzerland: World Health Organization; 1998
Complementary Ecological Model of the CSHP

● Lohrmann - Emphasized the role of ecology in health

behavior and combined concepts from multiple
ecological models with eight components to
formulate complementary ecological model of CSHP.

Lohrmann DK. A complementary ecological model of the coordinated school health program. Public Health Rep 2008;123:695-703
● The six components that
comprise programs and
services, provided to
students and school
employees, are located
in the center circle.
➔ Further, the six components are
surrounded by four concentric rings
➔ The healthy school environment
(inner ring)
➔ Essential governance structures of a
CSHP (second ring)
➔ Local school system infrastructure
within which a CSHP exists and
functions (Third ring)
➔ Family and community
involvement (outer ring).
➔ The “chutes” are meant to convey
coordination across all layers
PART II
SCHOOL DENTAL HEALTH
PROGRAMS
SOME SCHOOL DENTAL
HEALTH PROGRAMS
1. “Askov dental demonstration” 1949-57.

2. “Head start - pre-school dental health program” 1965

3. “North carolina statewide preventive dental health program”.1970

4. "Learning about your oral health" –a prevention oriented school program -
1971 – ADA
5. "Tattle tooth program" 1974-76
6. Save our smiles - 1981 – new jersey
7. Love teeth day - China 1989

8. “School health additional referral programme (SHARP)”

9. Teenage health education teaching assistants program (THETA program).

 1. ASKOV DENTAL DEMONSTRATION

⮚ Askov is a small farming community with a population mostly of

Danish extraction.

⮚ It showed very high dental caries in the initial surveys made in

1943 and 1946.

⮚ 1949 to 1957- the Section on Dental Health of the Minnesota

Department of Health supervised a demonstration school dental
health program in Askov, including caries prevention and control,
dental health education and dental care.
● Findings available through a 10 year period revealed

⮚ 28% reduction in dental caries in deciduous teeth of children aged

3 to 5 years.
⮚ 34% reduction in caries in the permanent teeth of children 6 to 12
years old.
⮚ 14% reduction in caries in permanent teeth of children 13 to 17
years old.
⮚ Improvements in filled-tooth ratios.
⮚ Dietary habits for the children to carry on to adult life.
 2. HEAD START - PRESCHOOL DENTAL
HEALTH PROGRAM

⮚ A program of the United States Department of Health and

Human Services initiated in 1965, focuses on assisting children
from low-income families.

79
⮚ It is the longest-running program for stopping the cycle of
poverty in the United States.
⮚ It provides comprehensive education, health nutrition, and
parent involvement services to low-income children and their
families.
 3.NORTH CAROLINA STATEWIDE PREVENTIVE
DENTAL HEALTH PROGRAM

❖ In 1970, the North Carolina Dental Society passed resolutions

advocating a strong preventive dental disease program
embracing,
⮚ School and community fluoridation
⮚ Fluoride treatments for school children
⮚ Plaque control education in schools
⮚ Communities and continuing education on prevention for
dental professionals.
• Continuation and expansion - incremental funding from
state legislature and funding through grants awarded by
Kate. B. Reynolds Health Care Trust.
• 19 videotapes for classroom teachers in teaching dental
health and conducting a state wide oral health survey of a
representative sample of North Carolina schoolchildren
from k-12 during the 1986-87 school year.
 Program philosophy and goals

⮚ This program is a unique public and private partnership

dedicated to the mission of assuring conditions in which
North Carolina citizens can achieve optimal oral health.
⮚ Program activities - preventive and educational components
to modify the behavior patterns of individuals to improve
their oral health habits through dietary changes, tooth
brushing and flossing.
⮚ Young children are the primary focus – greater potential for
positively affecting the child's attitudes, values and behavior.
⮚ Fluoride recognized - most effective public health measure
for dental caries.
❖ Objectives:

1. Appropriate use of fluoride.

2. Health education in schools and communities.

3. Availability of public health dental staff in all counties.

 Program Evaluation
⮚ 34% reduction in decayed, missing and filled permanent teeth
among children who had 8 years experience drinking
fluoridated water at school.
⮚ 53% reduction in decayed, missing and filled permanent teeth
among children who had 10 years experience drinking
fluoridated water
⮚ 86% reduction in dental caries after 4 years of sealant use on
permanent teeth.
4."LEARNING ABOUT YOUR ORAL HEALTH" - A prevention
oriented school program

⮚ Developed by 'American Dental

Association' (ADA) and their consultants
in coordination with the 1971 ADA House
of delegates .
⮚ A comprehensive program covering
current dental concepts.

86
 PRIMARY GOAL OF THIS PROGRAM

⮚ Develop knowledge, skills and attitudes needed for prevention

of dental diseases among school children.
⮚ Knowledge regarding diet and dental health, relationship of
sugar, starch and caries.
⮚ The other topics included in this program are the significance
of fluoride, oral safety, consumer health concepts, the role of
dental professionals, and the relationship of oral health with
total health. 87
 IMPLEMENTATION OF THE PROGRAM
The five different levels are:
⮚ Preschool (designed for children too young to read).
⮚ Level I (kindergarten through grade 3).
⮚ Level II (grades 4 through 6).
⮚ Level III (grades 7through 9).
⮚ Level lV (grades 10 through 12).
❖ The core material for each of the five levels is self-contained in a
teaching packet that allows the classroom teacher to adapt the
presentation to the needs of the students.

88
Each teaching packet includes :-
⮚ A teacher's self-contained guide on “Dental Health
Facts" with a section on handicapped children.
⮚ A glossary of dental health terms.
⮚ A curriculum guide featuring content, goals, behavioural
objectives and suggested activities for other classes.

89
⮚ Five lesson plans for the preschool level and seven or
more lesson plans for each of the other levels.
⮚ Four overhead transparencies
⮚ Methods and activities for parental involvement.
⮚ The ADA in collaboration with the American Cancer Society
developed materials - Hazards of tobacco usage.
⮚ This program was developed mainly for general use and can be
adapted in full or in part to complement other ongoing
programs.
91
5.TATTLE TOOTH I PROGRAM

The Tattle Tooth Program was developed in 1974 to 1976 as

a cooperative effort between Texas oral health professional
organizations, the Texas Education Agency and the Texas
department of health through a grant from the department of
health and human services to the Bureau of Dental Health.
⮚
The program involved teaching of students in the
classroom.
⮚
To care for their teeth through brushing flossing and
proper diet.
⮚
Classroom material for the Tattle tooth curriculum were
so developed.
Implementation
• It included more than 16000 students from
kindergarten through high school and approximately
540 teachers across Texas.
• Separate lesson plan were developed for each of the
nine grade levels; kindergarten, six elementary grades,
junior high school and senior high school.
Tattle Tooth Package :
Each package comprised of 10 lessons of
instructions, a package of information called as
‘People Facts and ‘Dental Facts’, which gave
instruction on brushing, flossing, nutrition and dental
health in general.
 TATTLE TOOTH II PROGRAM

⮚ In 1989, the Bureau of Dental Health developed Tattletooth

II, a new generation for grades K-6, so named because the
characters in the artwork for grades kindergarten through
second were from the old curriculum.
Philosophy and Goals:
⮚ Reduce dental diseases and to develop positive dental habits
which would last a lifetime.
Program Implementation:
⮚ The Texas Department of Health employed hygienists to
implement the program.
⮚ The hygienists were asked to instruct the teachers using
videotapes designed for teachers training.
⮚ Topics covered were correct brushing and flossing techniques,
awareness of the importance of safety, factual information
relating to dental diseases, its causes and preventive technique.
Teacher’s Package:
⮚ Three videotapes were produced as a part of the teacher
training package.
⮚ Content : These contained teacher’s lesson format and
contents, brushing and flossing lessons and instructions,
and additional background information as a means of
preparing teachers to teach the lessons
Cost of Program :
⮚ The estimated cost per child was $ 0.60
Program Evaluation :
⮚ Tattletooth II underwent formative evaluation by teachers in
1988, where a 19-item questionnaire was developed.
⮚ In 1989 a statewide summative evaluation of the curriculum
was conducted.
 6. SAVE OUR SMILES
(SCREENING AND
SEALANT PROGRAM) – New
jersey - 1981
❖ School-based, preventive dental health program that
provides in-school education, screenings, and referrals.
❖ Weekly fluoride mouth rinsing and dental sealants are
also provided in specific geographic areas.
❖ The program is funded through the California Children’s
Dental Disease Prevention Program.
Services provided include:
• Dental health education for elementary students, including toothbrushing
instruction
• School dental health fairs
• Teacher and parent workshops
• Screenings at school sites and health fairs and referrals for treatment
• Sealants
• Weekly fluoride mouth rinsing for communities with suboptimal
fluoridation
• Toothbrushes, toothpaste, and floss for ongoing brushing
and flossing (both in-class and at-home).
 7. China - A campaign on "Love Teeth Day" celebrated
Nation-wide each year

➔ 20 September - Love Teeth Day (LTD) - since 1989.

➔ Aim: Encourage all Chinese people to conduct preventive oral
public health care and promote oral health education.
➔ The main activities were planned and conducted by the National
Committee for Oral Health and local committees at provincial,
county and municipal levels to support preventive oral care

Dai J, Hao Y, Li G, Hu D, Zhao Y. 'Love Teeth Day' campaign in China and its impact on oral public health - the twentieth
anniversary. Br Dent J. 2010 Nov 27;209(10):523-6. doi: 10.1038/sj.bdj.2010.1039. PMID: 21109809.
 8.THETA PROGRAM
The Teenage Health Education Teaching Assistants

(THETA) program was developed by the United States

Public Health service, division of dentistry.

Goals:

To give young children the knowledge and skills to start

them on the way to lifetime of preventive dentistry practice.

Implementation:

⮚ Qualified dental personnel - Train interested high

school children to teach preventive dentistry to
elementary students.

⮚ Suggested guidelines and a THETA teacher’s manual

was forwarded to the interested party.
⮚ All recognized methods for preventing dental caries were
used in the demonstration with the exception of communal
water fluoridation since until 1955 Askov had no communal
water supply.
⮚ Dental care was rendered by a group of five dentists from
nearby communities employed by the Minnesota Department
of Health.
⮚ These dentists also gave topical fluoride treatments.
 9.SCHOOL HEALTH ADDITIONAL REFERRAL
PROGRAMME (SHARP)

⮚ Motivation through home visit

⮚ This program was instituted in Philadelphia
⮚ Purpose - Motivating parents into initiating action
for correction of defects in their children through
effective utilization of community resources.

109
⮚ The project was carried out by district nurses with the
cooperation of school personnel.
⮚ The nurses made daytime visits to families in which the
mothers were at home.
⮚ Working parents were contacted by phone.
⮚ The one-to-one basis of health guidance between parent
and health worker established better rapport between
school and home.
 ORAL HEALTH
PROGRAMMES IN
INDIA
Indian Dental Association (IDA) - Colgate’s “Young India”
Bright Smiles, Bright Futures School Dental Health
Education Program

112
Colgate Bright Smile, Bright Future. Available from: https://www. colgatepalmolive.co.in/core-values/community-responsibility/brightsmiles-bright-futures
• A collaborative effort of IDA and Colgate - Palmolive started in 1976
to deliver oral health education to children.

• One campaign for school oral health promotion was launched in

Agra, 2001.

• Objective : Empower children to practice good oral care hygiene, by

making them aware of good oral care practices, to reduce prevalence
of dental caries and to promote preventive health care habits.
 • Children between the age group of 6 to 14 years, studying in
primary schools, are taught good oral hygiene habits, the right
techniques of brushing with the use of a tooth model and a
toothbrush, the importance of night brushing through an interactive
module where the importance of a good mouth cleaning regimen is
strongly instilled in them.

114
Colgate Bright Smile, Bright Future. Available from: https://www. colgatepalmolive.co.in/core-values/community-responsibility/brightsmiles-bright-futures
 • At the end of the program, each child is given a ‘Dental Health Pack’
consisting of a toothpaste and a basic toothbrush, along with
attractive charts depicting valuable oral care information in order to
encourage these children to brush twice a day and take care of their
oral care hygiene.

• A chart containing the oral care information is left in each classroom

as a reminder to them, and for the teachers to reiterate the oral care
message.

115
Colgate Bright Smile, Bright Future. Available from: https://www. colgatepalmolive.co.in/core-values/community-responsibility/brightsmiles-bright-futures
 • School teachers are trained and provided with a ‘Teacher’s
Guide’ to help them instill good oral care habits on an on-
going basis.

• Teacher’s Guide is a detailed booklet that pictorially shares

details of a tooth’s anatomy, stages of decay, and the causes
of gum diseases to help them advocate the importance of
healthy teeth.

116
Colgate Bright Smile, Bright Future. Available from: https://www. colgatepalmolive.co.in/core-values/community-responsibility/brightsmiles-bright-futures
 • Colgate Bright Smiles, Bright Futures® has so far

touched the lives of 162 million plus school children

between the age of 6 – 14 years across schools in urban

and rural India.

• In the year 2018-19 alone, Colgate Bright Smiles,

Bright Futures® reached 11.5 million children across

the country.

117
Colgate Bright Smile, Bright Future. Available from: https://www. colgatepalmolive.co.in/core-values/community-responsibility/brightsmiles-bright-futures
 Chacha Nehru SehatYojna School
Health Scheme

• Government of Delhi Directorate of Health Services, Government

of Delhi, started SHS in 1979 with six school health clinics,

initially, to provide comprehensive health-care services to the

school going children.

School Health scheme. Govt. of NCT of Delhi.

118
Major Achievements Of School Health Scheme (CNSY); 2014
• The scheme was expanded during the 7th five-year plan,

and 64 school clinics were opened.

• The dental component of school health scheme is looked

after by two government hospitals, namely Maulana Azad

Institute of Dental Sciences and DDU hospital which

conducts regular screening programs and also serves as

referral centers
School Health scheme. Govt. of NCT of Delhi.
Major Achievements Of School Health Scheme (CNSY); 2014
 Neev - School Oral Health Program

• “Neev-SOHP” would be initiated across government

schools run by Government of NCT (National capital
territory) of Delhi, in Delhi state, as a pilot project.
• The Dental Team along with the Mobile Dental Clinic
would draw a district plan which would cover different
schools round the year.

School Health scheme. Govt. of NCT of Delhi.

120
Major Achievements Of School Health Scheme (CNSY); 2014
• The primary intention is to

⮚ Promote oral health through Dental Health Education and

organize dental check up/ Screening.
⮚ Provide Primary and Secondary Dental care through Mobile
Dental Clinic in the Schools.
⮚ And make necessary referrals for advanced care available at
Maulana Azad Institute of Dental Sciences.

School Health scheme. Govt. of NCT of Delhi.

Major Achievements Of School Health Scheme (CNSY); 2014
• Target group:
⮚ The Program would be run for one year during which it would
cover all the Public funded schools in any one District, Delhi
State (at least 50 schools) and include all children from Class
6th to Class 10th.
⮚ Training and involving Teachers, School authorities and Parents
as team members.
⮚ Collaborating ultimately into the existing Health Care system at
the school level.

School Health scheme. Govt. of NCT of Delhi.

122
Major Achievements Of School Health Scheme (CNSY); 2014
Financial details:

The total expected annual expenditure for the program

is Rs. 2, 00, 00,000/-covering more than 80,000

School Children in the One District of the State.

Current status : ongoing

School Health scheme. Govt. of NCT of Delhi.

Major Achievements Of School Health Scheme (CNSY); 2014
Intensive Dental Health Care Program –
Punjab
• Punjab Govt. has launched Intensive Dental Health Care Programme for school
children, school teachers and general public.
• To reach the far-flung areas of each district of Punjab one mobile Dental Clinic
Van was provided to give interceptive and curative treatment to the people at
their doorstep.

• To monitor and implement all the dental programmes it was proposed to

establish a post of District Dental Health Officer for all the districts of the State.

Intensive Dental Health Care Program. Dept. of Health and Family welfare. Govt. of Punjab. 124
 Aims and objective:

⮚ Bring down the incidence of oral and dental diseases to less than 40 %.

⮚ Bring down the Decayed Missed Filled Teeth (D.M.F.T.) in School

children of 6 – 12 years less than two.

⮚ Achieve 25 % reduction in number of persons without teeth after the

age of 60 Years.

⮚ Provide one dental clinic to serve the population of 30,000 in the rural
areas by opening 354 new Dental Clinics by the end of five years plan.

Intensive Dental Health Care Program. Dept. of Health and Family welfare. Govt. of Punjab. 125
⮚ Provide total oral health coverage to all the school going children in the

age group of 6 - 12 years.

⮚ Provide Dental Health Education Training to all the primary school

teachers, medical & paramedical personnel.

⮚ Organize special Dental Health Fortnights.

⮚ Provide on the spot diagnostic preventive interceptive & curative Dental

Health Care Services to the people in the far Flung rural areas of the

state and the school children through fully equipped Mobile Dental

Clinic Vans. 126

Trinity Care Foundation – Bengaluru

Non-Profit Organization with main focus on enhancing the public programs

effectiveness and strengthening the community programs by reaching out to the
socially and economically underprivileged sections of the society both in rural and
urban India since 2007.
• It provides pre-screening of students for
height, weight, skin, eye, dental,
cardiac, caries, oral lesions, facial
deformities, etc.

• Also focuses on the training of teachers

and imparting awareness on health
issues, ill effects of tobacco and tooth
brushing techniques to students in
government schools.

School Health Programs. Trinity Care Foundation. Available from: http: //www.trinitycarefoundation.org/preventive 128
• The TCF team works in synergy with National Health Mission and
Government of Karnataka.

• Identifies children with facial deformities such as cleft palate, cleft

lip, tmj ankylosis, facial clefts, hemangioma and vascular
malformations.

• Screens and treats them with a team of specialized doctors and

surgeons in reputed hospitals in Bengaluru and Hyderabad, India

• The treated children will be followed up for prognosis and other

need based treatments such as speech therapy and Dental
129
Treatments.
Pit and Fissure Sealant Pilot Project - National Oral
Health Program (NOHP), AIIMS, New Delhi

Under the central component of NOHP, the current pit and fissure sealant project
have been launched, for which training of representatives from 12 dental colleges
was done on May 1, 2017 with a target to seal 53,750 permanent molars in
children 6-14 years of age to prevent dental caries.
ORAL HEALTH SELF CARE PROJECT
(OHSEC) in 1986:
• A health promotion programme covering 7,5o,ooo children from over
16oo primary schools (nursery to class V ) in rural and urban Delhi.
Aims:
▪ To improve health of municipal primary school children in Delhi
through an education programme.
▪ Teaching modules and manuals: 3 modules for class 3rd , 4th & 5th.
▪ Results (1995):
▪ Teachers:
▪ High level of satisfaction with programme.
▪ Increase in knowledge and confidence in teaching health
related topics.
▪ Parents:
▪ Increased awareness.
▪ Children:
▪ Significant reduction in dental plaque and gingivitis.
▪ Increase in knowledge and attitude especially towards self-
care.
 CHALLENGES AND FUTURE
RECOMMENDATIONS

Some of the anticipated challenges may include:

• Regular follow-up care

• Changing cultural norms

• Cultivating a relationship with schools

• Sharing and tracking data.

133
Recommendations

• SOHP need to take a multifaceted approach considering

that the dental care is provided in varied health-care
settings in the community.
• However, the amount and type of contribution that each
stakeholder can give are different.

134
 Conclusion

● Promoting oral health services in schools is hard work but

the rewards are immense.
● Messages about achieving and maintaining good oral
health can be reinforced regularly throughout the school
years.
● IDA recognizes that good physical and mental health is
critical to a student's ability to learn and believes that all
students should have access to comprehensive health
services.
● IDA believes that health education should foster the
knowledge, skills, and attitudes that students need in order
to lead healthy lives and avoid high-risk behaviors.
SCHOOL ORAL HEALTH PROGRAM IN INDIA

PROGRAMS DESCRIPTION STATUS

Young India” bright smiles, A collaborative effort of IDA and Colgate- Running
bright futures Palmolive started in 1976 to deliver oral health
education to children

Chacha Nehru Sehat Yojna- The dental component of school health scheme Running
School Health scheme- is looked after by two government hospitals,
government of Delhi namely.Maulana Azad Institute Of Dental
Sciences and DDUhospital which conducts
regular screening programs and also serves as
referral centers.
 contd
PROGRAM DESCRIPTION STATUS
NEEV-School oral health program Run In Delhi state as a Pilot Project Mobile ONGOING
by Government of NCT of Delhi Dental Van would be utilized after
drafting a district plan, and public
schools will be covered round the year

Intensive Dental Health Care Program Punjab Imparting of Dental Education to Unknown
the school children and detailed Oral
Health ceck-up,each child is given
fluoride mouth rinses to arrest the
initiation and progress of dental caries
and this process is repeated after every 6
months
contd
PROGRAM DESCRIPTION STATUS

Trinity Care Foundation Bengaluru Conducts Outreach Programs Running

and school health programs in Bengaluru
and nearby areas. It harbors the vision of
Health Promoting Schools and provide
pre-screening of students for
height,weight,skin,eye,dental,cardiac,carie
s,oral lesions ,facial deformities,etc

National Oral Health Program AIIMS Pit and Fissure Sealant Pilot Running
Project
 REFERENCES
● Dunning JM, Principles of dental public health, Harward university
press, 1986.
● Soben Peter, Essential of preventive and community dentistry, 2 nd
edition.
● CM Marya, A textbook of public health dentistry, jaypee
publications.
● S S Hiremath, A textbook of preventive and community dentistry,
Elsevier publications.

140
● National oral health program
● Dai J, Hao Y, Li G, Hu D, Zhao Y. 'Love Teeth Day' campaign in China and
its impact on oral public health - the twentieth anniversary. Br Dent J. 2010
Nov 27;209(10):523-6. doi: 10.1038/sj.bdj.2010.1039. PMID: 21109809.s
● Nader PR, Emmel A, Charney E. The school health service: A new model.
Pediatrics 1972;49:805-13.
● Stone EJ. ACCESS: Keystones for school health promotion. J School
Health
● Dryfoos J. Full-service community schools: A strategy-not a program. New
Dir Youth Dev 2005;107:7-14.
● World Health Organization. WHO’s Global School Health Initiative: Health
Promoting Schools. Geneva, Switzerland: World Health Organization; 1998.
● Lohrmann DK. A complementary ecological model of the coordinated school
health program. Public Health Rep 2008;123:695-703.
● Colgate Bright Smile, Bright Future. Available from:
https://www.colgatepalmolive.co.in/core-values/community-responsibility/brights
miles-
bright-futures.
● School Health scheme. Govt. of NCT of Delhi. Major Achievements Of School
Health Scheme (CNSY); 2014.
● Neev School Oral Health Program. Available from: http://www.gcdfund -
india.org/projects/neev-school-oral-health-program.
● Intensive Dental Health Care Program. Dept. of Health and Family
welfare. Govt. of Punjab. Available from:
http://www.pbhealth.gov.in/major9.htm.
● School Health Programs. Trinity Care Foundation. Available from:
http: //www.trinitycarefoundation.org/preventive.
● Pit And Fissure Sealant Training Workshop For Dental Professionals.
● National Oral Health Programme.