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.
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
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”.
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
SCHOOL HEALTH EDUCATION:
It is the process of providing learning experiences
for the purpose of influencing knowledge,
attitude, or conduct relating to individual or
It should cover the aspects of:-
•Environmental health and
MAINTENANCE OF SCHOOL
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.
They include regular dental checkups and promote
treatment wherever possible and referral for special
To help every school child appreciate the importance of a healthy
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
To stimulate the development of resources
to make dental care available to all children
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
•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
•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
•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.
•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
•Utilizing dental auxiliaries can further reduce
•The health of school staff, families and
community members can be enhanced by
programs based in schools.
ELEMENTS/COMPONENTOF SCHOOL DENTAL HEALTH
IMPROVING SCHOOL -
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.
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
• 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
• 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
• Provide information as to the status of dental needs to
plan a sound dental health program.
• 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
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
• 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.
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
• The rinse should be non-sweetened and non-flavored to
• Rinsing programs are advised for grades 1 to 12 but not
• 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.
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.
School water fluoridation
• 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.
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.
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.
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
• The placement of pit-and-fissure sealants is ideally suited for a
• 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
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.
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.
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.
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
This needs a good follow up system.
The dental hygienist is the logical person to conduct such follow-up
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
SOME SCHOOL DENTAL
1.“LEARNING ABOUT YOUR ORAL HEALTH”-A PREVENTION ORIENTED SCHOOL
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
“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.
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.
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.
•Three videotapes were produced as part of the teacher-training
•The first videotape familiarizes the teacher with the lesson format
•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.
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
• 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
• 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.
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
• 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.
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
• 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.
•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
• 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.
4.NORTH CAROLINA STATEWIDE PREVENTIVE DENTAL HEALTH
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
• funding through grants awarded by Kate. B. Reynolds Health care
• 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
• The fluoridation of water supplies of 130 rural schools,
• Weekly fluoride mouth rinse for more than 416,000 students in
• Dental health education was presented to 361,000 children and
• Screening and referral for more than 339,000 children.
• More than 33,000 dental sealants were applied.
• 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
• 86% reduction in dental caries after 4 years of sealant use on
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.
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.
established better rapport between school and home.
7.TEENAGE HEALTH EDUCATION TEACHING ASSISTANTS PROGRAM
Developed by the National Foundation for the prevention of oral
disease for the US Department of Health and welfare, Division of
Dental personnel train high school children to teach preventive
dentistry to elementary school children.
•To give knowledge & skills to young children
•Allows high school children to develop understanding of young
•Introduces them to career opportunities
“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.