How Schools Can Support Oral Health in Children
Schools should implement comprehensive oral health programs that include universal screening and fluoride varnish application, oral health education integrated into the curriculum, and coordination with dental providers to establish dental homes for all children. 1, 2
School-Based Screening and Preventive Services
Schools must establish universal oral health screening programs with fluoride varnish application performed by trained personnel, as this approach has demonstrated significant reduction in dental caries among high-risk children. 1
Implement biannual fluoride varnish programs starting with first tooth eruption, delivered by dental hygienists, school nurses, or trained lay workers in school settings. 3
Conduct systematic oral health screenings to identify children with active dental disease, visible tooth decay, or emergent care needs, with documented evidence showing 56% of children had fewer or no visible caries after two consecutive years of school-based intervention. 1
Apply dental sealants on primary molars as part of school-based preventive protocols to prevent caries and reduce the need for operative repair. 3
Utilize silver diamine fluoride (SDF) in school settings to arrest caries progression and reduce reliance on general anesthesia for operative repair. 3
Oral Health Education and Curriculum Integration
Schools should integrate sequential, coordinated oral health education throughout all grade levels, as children are highly receptive to learning dental hygiene practices during school hours. 3, 4
Teach basic oral sciences and dental hygiene through interactive lectures delivered by dental professionals, covering dental anatomy, pathology (cavities, halitosis), and proper use of hygiene tools (brushes, floss, mouthwash, tongue scrapers). 4
Provide age-specific oral hygiene instruction starting from preschool through 12th grade, as dietary factors and oral health behaviors established in childhood influence lifelong health outcomes. 3
Emphasize reduction of sugar consumption through education about limiting sugar-containing drinks and sugary snacks, as poor dietary habits are directly associated with caries development in children. 3
Promote supervised twice-daily brushing with fluoridated toothpaste (rice grain-sized portion for children under 36 months, pea-sized portion for children 36 months and older). 3
School Policy and Environmental Support
Schools must establish formal oral health policies and create health-promoting environments that reinforce healthy behaviors through three interrelated components: curriculum strengthening, supportive environments, and community resource linkages. 3, 2
Designate a school-based oral health coordinator (such as a District Oral Health Nurse) to coordinate services, manage referrals, and serve as the liaison between schools, families, and dental providers. 1
Integrate school food service with nutrition education to ensure consistent messaging about dietary choices that affect both general and oral health. 3
Ensure community water fluoridation and educate school communities about the fluoridation level of their water supply. 3
Family and Community Engagement
Schools should actively engage parents as community oral health volunteers and provide them with oral health education, as mothers are the primary source of children's dental knowledge and parental education directly impacts children's oral health outcomes. 3, 1
Recruit and train parent volunteers to serve as community oral health champions who can promote oral health education and help navigate barriers within their communities. 5, 1
Conduct face-to-face interactions at schools and community events to build trust and address historical mistrust of healthcare systems, particularly in underserved populations. 5
Provide culturally sensitive materials in multiple languages and accessible formats (video, text, phone, in-person, social media) using plain language that avoids scientific jargon. 5
Establishing Dental Homes and Referral Systems
Schools must coordinate referrals to establish dental homes for all children by 12 months of age, though transitioning children from school-based preventive care to restorative dental care remains a significant challenge requiring systematic solutions. 3, 6
Partner with multiple dental provider groups to ensure adequate capacity for referrals, as school-based programs alone cannot provide comprehensive restorative care. 1, 6
Utilize teledentistry to facilitate remote consultations and improve access to dental specialists for children in underserved areas. 6
Engage primary care providers (pediatricians, nurse practitioners, community health nurses) to provide oral health screening, fluoride varnish application, and coordinate referrals during well-child visits. 3, 5
Deploy midlevel dental providers such as dental therapists and expanded-function dental hygienists who can provide preventive and basic restorative services under dentist supervision, particularly in areas with dental workforce shortages. 5
Critical Implementation Considerations
The most significant pitfall is that only 11% of children successfully transitioned to receive restorative care after school-based screening and referral, highlighting the need for integrated service delivery models rather than referral-only approaches. 6
Recognize that "two is too late" for preventive interventions in high-risk populations, as children in underserved communities acquire caries-causing bacteria earlier and develop severe disease before traditional intervention ages. 3
Address financial barriers by accepting Medicaid and public insurance, offering flexible scheduling including evening and weekend appointments, and providing nondiscriminatory care regardless of socioeconomic status. 5
Avoid guideline dissemination without implementation support, as guideline awareness alone does not change practice behavior—schools need concrete resources, training, and ongoing support. 5