Tooth decay is the most common pediatric chronic disease but is 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 school absenteeism and lower academic achievement. Effective strategies to reduce the incidence of childhood cavities include fluoridated drinking water, fluoride varnish and dental sealants.
School-based oral health services have the potential to overcome many of the logistical barriers for accessing primary preventive oral health services that disproportionately affect vulnerable populations. Schools also have the potential to link families to systems of care, and to impact the social norms regarding health behaviors. The Los Angeles Trust for Children’s Health, with our broad-based community-coalition, has developed an oral health initiative model in an attempt to harness schools to address oral health disparities through a 3-tiered program. It includes public health education, universal school-wide oral health screening and fluoride varnishing, and linkage to a dental home.
UCLA Research analysts Dr. Rebecca Dudovitz and Jacinta Elijah put together parent and school staff focus groups, which provided useful information on effectively reaching out to the community. From the eight key points presented, participants felt that the message, “Early care for your children’s teeth will protect their smile and their health,” would most likely help the community understand the importance of dental health. Both parents and school staff noted that parents needed guidance on the importance of caring for baby teeth, attending “well-baby visits,” and general information on healthy oral care habits. The parents noted that if children were taught in school about the importance of oral health, parents would feel more supported in enforcing proper hygiene at home. They also 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 programs necessary to get school and student participation. LAUSD requires active parental consent for all services, which engenders strong community and school commitment to the program. The District Oral Health Nurse introduced the program to school staff, parents and students at professional development meetings, parent groups, and student assemblies.
The consent form included information on student demographics, access to and use of dental care, and oral health behaviors. Screening exam results were collected using a standardized protocol, and they included the dental provider’s overall assessment of the child’s dental disease. 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 the day of the event, each school provided space on campus and custodial support. Parent volunteers worked with the Oral Health Nurse and provided assistance. Students who returned a signed consent form were escorted from class to a room where they received oral health education in a small group, a dental screening exam and fluoride varnish application. Each child receives a one-page report on their oral health status, recommended follow-up care, and a list of local low-cost dental providers who accept publicly insured and uninsured patients. Reimbursement for care provided to publicly insured children was submitted by the provider but all care was delivered at no cost to participating families.
Program costs and reimbursement data were 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 also estimated the potential dollars saved by both the health and school system, and compared it with the cost of the program. As we continue to adapt to challenges, this project demonstrated the potential for robust, broad-based school-community partnerships to address health disparities.
Parent volunteers commented on how fortunate the kids were to be a part of this program, and Nevin Principal Dr. Denise Pratt expressed her delight with the program’s success 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.