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  2. 2. DEFINITION School health services are defined as the “procedures established to appraise the health status of pupils and school personnel, to counsel pupils, parents, and others concerning appraisal findings, to encourage the correction of remediable defects, to assist in the identification education of handicapped children, to help prevent and control disease and to provide emergency service for injury or sudden sickness.
  4. 4. HEALTH APPRAISAL It is defined as “the process of determining the total health status of child through such means as health histories, teacher and nurse observations, screening test; and medical, dental and psychological examinations”.
  5. 5. HEALTH COUNSELING Following appraisal comes health counseling, which is defined as “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”.
  6. 6. EMERGENCY CARE AND FIRST AID: Since teachers are the first to realize any emergency in school, they should be trained in handling simple emergencies such as traumatic injuries to teeth during contact sports.
  7. 7. SCHOOL HEALTH EDUCATION: It is the process of providing learning experiences for the purpose of influencing knowledge, attitude, or conduct relating to individual or community health.
  8. 8. It should cover the aspects of:- •Personal hygiene •Environmental health and •Family life.
  9. 9. MAINTENANCE OF SCHOOL HEALTH RECORDS These records are useful in analyzing and evaluating school health programs and to provide a useful link between the home, the school and the community.
  10. 10. CURATIVE SERVICES They include regular dental checkups and promote treatment wherever possible and referral for special problems
  11. 11. OBJECTIVES To help every school child appreciate the importance of a healthy mouth. To help every school child appreciate the relationship of dental health to general health and appearance. To encourage the observance of dental health practices, including personal care, professional care, proper diet, and oral habits. To correlate dental health activities with the total school health program.
  12. 12. To stimulate the development of resources to make dental care available to all children and youth. To stimulate dentists to perform adequate health services for children. A school dental health program should •Be administratively sound •Be available to all children •Provide the fact about dentistry and dental care, especially about IDEAL REQUIREMENTS
  13. 13. •self-care preventive procedures •Aid in the development of favorable attitudes dental health •Provide the environment for the development of psychomotor skills necessary for tooth brushing and flossing •Include primary preventive dentistry programs-prophylaxis, fluoride program and use of pit and fissure sealants •Provide screening methods for the early identification and referral to pathology
  14. 14. ADVANTAGES •Programs can bring comprehensive dental The school based dental health care including preventive measures to school children where they are gathered anyway for non-dental reasons in the largest possible numbers. •Students can be accessed during their formative year from childhood to adolescence. These are important stages in people’s lives when lifelong oral health related behavior as well as beliefs and attitudes are being developed. •School clinics are less threatening than privet offices since the children are in familiar surroundings.
  15. 15. •The children’s daily contact with the dental personnel in other roles, such as joining with the teachers in a variety of school activities, may have a lasting effect in their attitudes towards dentistry in general. •If the children can be maintain in a state of good dental health it will be relatively easy to maintain their dental health in adult life. •A regular dental attendance pattern in early life will be continued after the school age. CONT…..
  16. 16. •health programs can facilitate valuable consultation on medico-dental problems. •The expenses involved and the time used in transportation to private dental office can be saved if the child gets dental care in the school itself. •Utilizing dental auxiliaries can further reduce the cost. •The health of school staff, families and community members can be enhanced by programs based in schools. CONT……
  18. 18. IMPROVING SCHOOL - COMMUNITY RELATION One of the first steps in organizing a dental health program is the formation of advisory committee. It should include broad representation from parents, teachers, school administrators, dental professionals, health officers and community leaders.
  19. 19. The task of these committees is •To appriase 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.
  20. 20. CONDUCTING DENTAL INSPECTIONS • It serves as a basis for school dental health instruction. • Every child unless provide 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 towards the dentist and dental care.
  21. 21. • The child and the parent are motivated to seek adequate professional care • Teacher, students and dentists concerned with dental health may use the dental inspection as a fact-finding experience. • Provide information as to the status of dental needs to plan a sound dental health program.
  22. 22. CONDUCTING DENTAL HEALTH EDUCATION • The dentist serves as the expert resource person to strengthen the teacher’s classroom instruction program. • He should give each teacher sincere attention. • This is important in developing proper attitudes and personal dental health practices by the teacher which can be passed on to the classroom.
  24. 24. TOOTH BRUSHING PROGRAMS : • In the classroom, 6-8 children can be taught as a group. Each is given a cup, a napkin, and a kit containing a disclosing tablet, a toothbrush, and a tube of fluoride dentifrice. • The mastery of the 45 degree angulations and the short vibratory strokes can then be repeated on an oversized dent form model. • Next, the children are asked to chew a disclosing tablet and to swish it around the mouth for 30 seconds. They are then encouraged to look at each other’ teeth with appropriate emphasis on the fact that the red stain colors the plaque in which the bacteria live.
  25. 25. • Next a magnifying mirror is passed around so the participants can note that their teeth are no different from those of their neighbor i.e. all people have plaque. • Guided brushing can then begin, with the instructor establishing the sequence of teeth to be brushed. • At the end, the mirror is again passed around to show that progress has been made.
  26. 26. classroom-based fluoride programs: Two effective fluoride programs- Fluoride ‘mouth-rinse’ program: • A once-a-week mouth rinse can be expected to result in 20% to 40% reduction in dental caries. • The dispenser is graduated so that 2.0 gm. of packaged sodium fluoride powder can be placed in a jug and water is added to the 1000-ml mark. • The rinse should be non-sweetened and non-flavored to discourage swallowing.
  27. 27. • Rinsing programs are advised for grades 1 to 12 but not below. • Five ml of the rinse is dispensed in to each cup and all the children are instructed to rinse the solution in the mouth for 1 minute, after which they are to spit carefully in to the cup. • The napkin is used to wipe the mouth, after which it is forced into the bottom of the cup to absorb all fluid. • Fluoride mouth- rinse programs received official recognition of safety from the FDA in 1974 and by council on dental therapeutics of the ADA in 1975.
  28. 28. Fluoride tablet program: • One tablet is given to each student. The student then chews and swishes the 2.2mg sodium fluoride (1mg fluoride) tablet in the mouth for a minute and then swallows. The swish-and-swallow technique provides the optimum systemic benefit during the period of tooth development and maturation. • The daily tablet is more effective than the weekly rinse.
  29. 29. School water fluoridation programs • 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 since children are in school for shorter hours and less water is consumed during that time. • Study have shown a reduction in dentalcaries prevalence by about 40% among children attending school that support school water fluoride programs a major disadvantage is that children do not receive benefits until they begin school.
  30. 30. Nutrition as a part of school preventive dentistry programs: School lunch programs are 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.
  31. 31. Mid day meal program of Government of India • The program of providing hot cooked meal was introduced in 7 north eastern districts of the state during 2002-2003. • The scheme consisted of providing free food grains at 3 kg per child/per months 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 5 in Government aided schools from 1-9-2004.
  32. 32. The objectives of the program •To improve enrolment and attendance •To reduce school drop outs. •To improve child health by increasing nutrition level. •To improve learning levels of children. The hot cooked food contains about 400 calories (per child per day) Rice - 100 gms Pulses - 20 gms Oil - 03 gms Salt - 02 gms Vegetables - 50 gms
  33. 33. Sealant placement: • The placement of pit-and-fissure sealants is ideally suited for a school program. • 1st, 2nd, 6th and 7th standards would be desirable levels to selectively intervene to prevent pits-and-fissure lesions. • 1st and 2nd standards, because first permanent molars are sufficiently erupted to place the sealant. 6th and 7th standards-2nd permanent molars.
  34. 34. Science fairs Science fair not only helps in educating and motivating school children to improve their oral health but also provides an excellent opportunity for dentistry to contribute substantially to the building of a growing reservoir of students who may same day choose a career in dentistry.
  35. 35. Referral for dental care • In few schools dental care is provided at the school itself. However if only emergency treatment is provided, for e.g. the dental auxiliary places eugenol-soaked cotton in a child’s cavity to relieve the pain ,the 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 treatment.
  36. 36. “Blanket” referral A program that has proved to be effective in many schools is “blanket” referral of all children to their family dentists. 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.
  37. 37. FOLLOW –UP The mere insurance of referral slips to children will be of little value if steps are not taken to make it clear that the school is interested in defect correction. This needs a good follow up system. The dental hygienist is the logical person to conduct such follow-up examinations There are two reasons for such concessions: •The child is a more co-operative patient when medical/dental services are provided during early or middle part of the day. •Dentists can provide better services for children when they have time and do not have to crowd their child patients into after school hours.
  38. 38. SOME SCHOOL DENTAL HEALTH PROGRAMS: 1.“LEARNING ABOUT YOUR ORAL HEALTH”-A PREVENTION ORIENTED SCHOOL PROGRAM: This program was developed by the American dental association and there consultants inco-ordination with the 1971 ADA house of delegates and is presently available to school systems throughout the United States of America. “Learning about your oral health” is a comprehensive program covering current dental concepts THE PRIMARY GOAL OF THIS PROGRAM •Is to develop the knowledge, skills, and attitudes needed for prevention of dental diseases among school children.
  39. 39. Implementation of the program: • The program is divided in to five levels, each level having its own defined specific content. • Preschool (designed for children too young to read). Level I (kindergarten through grade 3). Level II (grades 4 through 6). Level III (grades 7 through 9). Level IV (grades 10 through 12). • A teacher’s self-contained guide on “dental health facts” with a section on handicapped children • Four overhead transparencies • Twelve spirit masters( for copying) • Methods and activities for parental involvement.
  40. 40. 2.“TATTLETOOTH PROGRAM”-TEXAS STATEWIDW PREVENTIVE DENTISTRY PROGRAM The Tattletooth program was developed in 1974-1976 as a cooperative effort between Texas DENTAL health professional organizations, the Texas Department of Health and the Texas Education Agency through a grant from the Department of Health and Human Services to the Bureau of Dental Health. The program was pilot tested in 1975 and field tested in spring 1976 in schools within the states of Texas. Separate lesson plans were developed for each grade and a systems approach was used to develop all educational material.
  41. 41. •Three videotapes were produced as part of the teacher-training package. •The first videotape familiarizes the teacher with the lesson format and content. •A second videotape, “Brushing & Flossing” was developed for the dual purpose of teacher training & as an educational unit to be used by the teacher with the students. •A third videotape provides teachers with additional background information as a means of preparing them to teach the lessons. •The materials that were developed to aid in the implementation of the program consisted of •A brochure that provides an overview of the program. •A school nurses brochure. A letter to school principals & nurses was sent out as part of a package distributed annually by the Bureau of Maternal & Child Health. A two hour training session using the materials in the new curriculum was televised to the schools via a video network.
  42. 42. Program Implementation: The Texas Department of health employs 16 hygienists in the eight public health regions to implement the Tattletooth program. • The hygienist instructs teachers using videotapes designed for teacher training & provide them with a copy of the curriculum. • Health promotion activities are encouraged & publicized within the school community. • Teachers are encouraged to invite a dental professional to demonstrate brushing & flossing in the classroom. • A field trip to a dental office is strongly recommended for kindergarten children. • Bulletin board suggestions, a book list, films & videotapes are available on a free loan for appropriate grade levels. • Other resources used are a list of companies providing supplementary classroom resources & a comprehensive glossary of vocabulary words written for the teacher in English that are used in all grades levels.
  43. 43. Program Evaluation: The students in grades 3,5,7,9 and 11 were given the Taxes Assessment of Academic Skills (TAAS) by the Taxes Education agency, to satisfy the legislative requirement that student performance be assessed. • Dental health knowledge was significantly increased at all grades levels. • Plaque levels were decreased by approximately 15% in a randomly selected sample of 2,142 children. • Over 80%of the teachers judged the program to be helpful and effective, but evaluation questions suggested that they felt a need for additional technical help in brushing and flossing.
  44. 44. 4.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.Department of health supervised a demonstration school dental health program in a Askov, including caries prevention and control, dental health education and dental care. • All recognized methods for prevention dental caries were used in the demonstration with the exception of communal water fluoridation since until 1955 Askov had no communal water supply.
  45. 45. •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. 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 permanent teeth of children 13 to 17 year old. • Improvements in filled-tooth ratios. The cost of the program was greater and the caries reduction smaller when compared with fluoridation. However fluoridation is by no means a substitute for such a program. Good health habits are valuable even for persons with resistant teeth and dental care for the indigent is still needed in fluoridated areas.
  46. 46. 4.NORTH CAROLINA STATEWIDE PREVENTIVE DENTAL HEALTH PROGRAM: In 1970, the North Carolina Dental Society passed resolution advocating a strong preventive dental disease program embracing school and community fluoridation, fluoride treatments for school children, plaque control education in schools and communities and continuing education on prevention for dental professionals. •A steering committee developed a practical plan for a program in the schools. This was the first statewide program of its magnitude. Continuation and expansion of the North Carolina Preventive Dentistry program for Children (NCPDPC) has been made possible through incremental
  47. 47. • funding through grants awarded by Kate. B. Reynolds Health care Trust. • These projects include producing 19 videotapes for classroom teachers in teaching dental health and conducting a representative sample of North Carolina schoolchildren from kindergarten through grade 12 during the 1986-87 school years. Objectives that will facilitate attainment of the goals include: • Appropriate use of fluoride • Health education in schools and communities • Availability of public health dental staff in all counties Program implementation: • The fluoridation of water supplies of 130 rural schools, • Weekly fluoride mouth rinse for more than 416,000 students in 1,051 schools • Dental health education was presented to 361,000 children and 42,000 adults. • Screening and referral for more than 339,000 children. • More than 33,000 dental sealants were applied.
  48. 48. 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.
  49. 49. 5.HEAD START –PRE-SCHOOL DENTAL HEALTH PROGRAM: Head start is a program of the United states Department of Health and Human Services initiated in 1965 that focuses on assisting children from law-income families. It is the longest-running program for stopping the cycle of poverty in United States. It provides comprehensive education, health, nutrition, and parent involvement services to low-income children and their families.
  50. 50. 6.SCHOOL HEALTH ADDITIONAL REFERRAL PROGRAMME (SHARP): This program was instituted in Philadelphia with the purpose of motivating parents into initiating action for correction of defects in their children through effective utilization of community resources. The project was carried out by district nurses with the co-operation of school personnel. The nurses’ mode daytime visits to families in which the mother 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.
  51. 51. established better rapport between school and home. 7.TEENAGE HEALTH EDUCATION TEACHING ASSISTANTS PROGRAM (THETA Program) Developed by the National Foundation for the prevention of oral disease for the US Department of Health and welfare, Division of Dental Health. Philosophy Dental personnel train high school children to teach preventive dentistry to elementary school children. Goals •To give knowledge & skills to young children •Allows high school children to develop understanding of young children •Introduces them to career opportunities
  53. 53. “The Colgate Bright Smiles, Bright Futures” 0ral health educational program worldwide was developed to teach children positive oral health habits of basic hygiene, diet & physical activity. This program also encourages dental professionals, public health officials, civil leaders & most importantly, parents & educators to come together to emphasize the importance of oral health as part of a child’s overall physical & emotional development. Under this program, children in primary school receive instructions in dental care from members of the dental profession nominated by the Indian Dental Association Education is imparted with the aid of audio visuals and printed literature. Free dental health care packs are distributed to encourage good oral hygiene.
  54. 54. Thank you!