Universal Screening and Fluoride Varnish Program
Tooth decay is the most common pediatric chronic disease, nearly 100% preventable and disproportionately affects low-income, minority children. Economic disadvantage is the single most significant predictor of tooth decay in U.S. children. Aside from impacting a student’s ability to eat, speak, and sleep, untreated cavities and dental pain are associated with more school absenteeism and lower academic achievement. Effective strategies to reduce the incidence of childhood caries include fluoridated drinking water, fluoride varnish and dental sealants.
School-based oral health services have the potential to overcome many of the logistical barriers to accessing primary preventive oral health services that disproportionately affect vulnerable populations. In addition, schools have the potential to link families to systems of care and to impact the social norms regarding health behaviors. The L.A. Trust, along with a broad-based community-coalition, has developed an oral health initiative model to attempt to harness schools to address oral health disparities through a 3-tiered program including public health education, universal school-wide oral health screening and fluoride varnishing and linkage to a dental home.
In preparation for the program, UCLA Research analysts Dr. Rebecca Dudovitz and Jacinta Elijah put together parent and school staff focus groups, which provided useful information on how to reach the community. Of eight key messages presented, participants felt, “Early care for your children’s teeth will protect their smile and their health,” was best to help the community understand the importance of dental health. Both parents and school staff mentioned that parents need guidance on the importance of baby teeth, attending well-baby visits, and general information on healthy oral care habits. Parents specifically mentioned that if children receive messages in school about the importance of oral health, then parents would feel more supported to enforce proper hygiene at home. Parents said the best ways to inform other parents about oral health and new programs was through assemblies and demonstrations.
Interviews with parents, school staff and community providers helped to identify oral health access barriers, successful strategies for community engagement and program elements necessary to achieve school and student participation. LAUSD requires active parental consent for all services, which necessitates strong community and school commitment to the program. The program was introduced to school staff, parents and students through presentations by the District Oral Health Nurse at professional development meetings, parent groups, and student assemblies where form return was encouraged.
The consent form includes items regarding student demographics, access to and utilization of dental care, and oral health behaviors. Screening exam results were collected using a standardized protocol including an overall assessment of the child’s dental disease as determined by the dental provider. For those with severe disease requiring emergent dental care, direct case management from the Oral Health Nurse ensured the child received follow-up care.
On event day, schools provide space on campus and custodial support. Parent volunteers work with the Oral Health Nurse to support the event. Students who returned a signed consent form are escorted from class to the event room where they receive oral health education in a small group, a dental screening exam and fluoride varnish application. Each child receives a 1-page report on their oral health status, recommended follow-up care, and a list of local low-cost dental providers who accept publically insured and uninsured patients. Reimbursement for care provided to publically insured children was submitted by the provider but all care was delivered at no cost to participating families.
Program costs and reimbursement data was collected from the school district and dental provider. All baseline and follow-up screening exam results, demographics, and oral health behaviors were collected and evaluated. We estimated the potential dollars saved by both the health and school system and compared this with program costs. As we continue to adapt to challenges, this project demonstrates the potential for robust, broad-based school-community partnerships to address health disparities.
Parent volunteers commented on how fortunate the kids were to receive this program, and Nevin Principal Dr. Denise Pratt expressed her delight with the success of the program and how important it is for her students to be in good health so they can be ready to learn.
“I’m very positive about the program,” one parent said. “I think it’s great. I think it’s long overdue. I think the more dental health you can provide to low income students, the better.”
These programs were supported by funding from the DentaQuest Foundation, Oral Health America, Dignity Health and the Los Angeles Trust for Children’s Health. They would not have been successful without the help and support of our provider network, the willing and motivated principals, school nurses, parent volunteers, District Nursing Services and Student Medical Services.