The document provides an overview of school dental health education and school oral health programs. It discusses: - The importance of children's oral health and common oral diseases that affect children. - Models of school health programs, including the 3 component model, 8 component model, and health promoting schools model. - Components of school oral health programs, including dental inspections, health education, fluoride programs, nutrition programs, and referral for treatment. - The history and evolution of school health programs in India, from early medical examinations to more comprehensive care approaches.

1. 1
Good Morning!

2. School Dental Health Education
Kavisha Mahajan
MDS II
BVDUCH, Pune
2

3. Contents
• Introduction
• History
• Models of school health programs
• Aspects of school health services
• Objectives
• Ideal requirements
• Elements/components of School Oral Health Programs (SOHP)
• School oral health programs
• Conclusion
• References
3

4. Introduction
Oral health:
• ”A state of being free from mouth and facial pain, oral and throat cancer,
oral infection and sores, periodontal (gum) disease, tooth decay, tooth
loss, other diseases and disorders that limit an individual’s capacity in
biting, chewing, smiling, speaking, and psychosocial well being" – (WHO
2003).
4

5. Introduction
The Global Burden of Disease Study 2017 estimated that:
• Oral diseases affect close to 3.5 billion people worldwide
• Globally, it is estimated that 2.3 billion people suffer from caries of
permanent teeth and more than 530 million children suffer from caries of
primary teeth
5

6. Introduction
• The importance of children's oral health cannot be overestimated
(Manton 2018).
• Oral diseases, including dental caries, are progressive and cumulative.
• Largely preventable
• Most common oral diseases that affect children worldwide:
 Dental caries
 Gingival diseases
 Developmental defects of enamel
 Dental and facial trauma
 Malocclusion
6
Arora, Ankita; Khattri, Shivi; Ismail, Noorliza Mastura; Kumbargere Nagraj, Sumanth; Eachempati, Prashanti (2019). School
dental screening programmes for oral health. Cochrane Database of Systematic Reviews, (), –
.doi:10.1002/14651858.cd012595.pub3

7. Poor oral health
Untreated dental conditions
Decreased quality of life
Overall deterioration of health
7
Introduction

8. Majority of rural population
Children
Cannot avail dental facilities
8
Inaccessibility Financial
restraints
Stagnation of
public health services
Introduction

9. • Lack of education of the importance of oral health
• Lack of or insufficient dental insurance
• Limited income
• Lack of transportation
• Low dentist to patient ratio (geographic)
Availability of services does not always translate to use of services.
9
Barriers to Dental Treatment

10. School Dental Health Education
• Economical and powerful means
• Greater receptive attitude
• Children and their families
10

11. CDC, 2021:
• About 1 of 5 (20%) children aged 5 to 11 years have at least one untreated
decayed tooth.
• 1 of 7 (13%) adolescents aged 12 to 19 years have at least one untreated
decayed tooth.
• Children aged 5 to 19 years from low-income families are twice as likely
(25%) to have cavities, compared with children from higher-income
households (11%).
11
Introduction

12. Targeting school children is an attempt towards:
12
Oral
health
Education
Prevention
Promotion
Introduction

13. History
13

14. History
• William Fischer
 End of 19th century
 Dentist in England
• Benjamin Franklin
 20th century
 Advocated a ‘healthful situation’
 Promoted physical exercise
14

15. History
• World War I
 1914 - 1918
 Important turning point
15
Inspection, hygiene
& didactic
messages
Broader health
promotion
philosophies &
movements

16. History
16

17. History
17

18. History
18

19. History
19

20. History - India
1909 - School children medically examined in Vadodara
20

21. History - India
1946 - Bhore committee
 GOI appointed the Health Survey and Development Committee to
build the nations health, focus on preventive programs
 Chairperson: Sir Joseph Bhore
 Bhore Community
 Reports on school health services
21

22. History - India
1953 – Secondary education committee (need for school nutrition
program)
1960 – GOI constituted a school health committee
1982 – GOI constituted a task force to propose an intensive school
health service project
22

23. History - India
Over 70 years, SOHP (School Oral Health Programs) evolved
Narrower past concept of medical examination
Comprehensive care
23

24. Comprehensive Care
• Definition:
The meeting of accumulated dental needs at the time a population group is
taken into the program (initial care) and the detection and correction of new
increments of dental disease on a semi annual or other periodic basis
(maintenance care).
 Restorative
 Replacement
 Maintenance
 Preventive
• Dental care from womb to tomb
24

25. Incremental Care
• Definition:
Periodic care so spaced that increments of dental diseases are treated at the
earliest time consistent with proper diagnosis and operating efficiency, in
such a way that there is no accumulation of dental needs beyond the
minimum
• 6 monthly visits
25

26. Definition
School Health Services are defined as the “procedures established:
 to appraise the health status of people and school personnel
 to counsel people, parents, and others concerning appraisal findings
 to encourage the correction of remediable defects
 to assist in the identification and education of handicapped children
 to help to prevent and control disease and
 to provide emergency service for injury or sudden sickness.”
(By The Committee on Terminology of The American Association for
Health, Physical Education, and Recreation 1951)
27

27. Models of School Health
Programs
28

28. Models of School Health Programs
29
Chahar P et al. Schools as opportunity for oral health promotion: Existing status in India. Indian J Child Health.
August 2018

29. The 3 Component Model
• 1990’s
• It is considered the traditional “three- legged stool” of school Health,
consisting of:
1. Health education,
2. Health services, and
3. A healthful environment
30

30. The 8 Component Model/CSHP
• 1980’s
• aka: CDC (Centre for Disease Control and Prevention) Model
• referred to as a “comprehensive school health program (CSHP)”
• Multiple domains : bubbles
31

31. The 8 Component Model
Goal:
• To establish a system of home, school, and community support
• To assure that students are provided with a planned sequential program
of study, appropriate services, and a nurturing environment that
promotes the development of healthy, well-educated, productive citizens.
32

32. Further explored by Resnicow and
Allensworth
• Role of School Health Coordinator
33

33. Family School Community Model
• Nader, 1990
• Important systems supporting children’s health and education:
1. School
2. Community
3. Friends/family
4. Others: educational, electronic & print media
34

34. ACCESS Model
• ACCESS - Administration, Community, Curricula, Environment, School,
and Services
• Stone, 1990
• School – microcosm of society
35

35. Full Service Schools
• Dryfoos, 1994
• “one-stop centre” for educational, physical, psychological, and social
requirements of students and their families.
• Collaborative efforts of school, agencies, and the families
36

36. Health Promoting Schools (HPS)
• WHO, 1995
• 4 key strategies:
37
Research to improve
school health
programs
Building capacity to
advocate for
improved school
health programs
Strengthening
national capacities
Creating networks
and alliances for the
development of
Health Promoting
Schools (HPS)
- Education International (EI)
- Centres for Disease Control (CDC)
- Education Development Centre
- UNESCO
- UNAIDS

37. Complementary Ecological Model Of
The CSHP
(comprehensive school health program)
38
Lohrmann, D. K. (2008). A Complementary Ecological Model of the Coordinated School Health Program. Public
Health Reports, 123(6), 695–703.doi:10.1177/003335490812300605
1. Healthy school environment
2. Essential governance structures
3. Local school system infrastructure
4. Family & community involvement

38. 39
Gargano L, Mason MK and Northridge ME (2019) Advancing Oral Health Equity Through School-Based Oral Health
Programs: An Ecological Model and Review. Front. Public Health 7:359. doi: 10.3389/fpubh.2019.00359
An Ecological Model to Advance Oral Health Equity. An ecological model of influences on health care access, skills-based
health education, and health and well-being brought about by school-based oral health programs, adapted from previous
work by the senior author, with key contributions from the World Health Organization concept of a health promoting
school

39. Aspects of School Health Service
40

40. Aspects of School Health Service
Maintenance
of records
Prompt
treatment &
referral
Health
education
41
Health
counselling
Emergency care
& first aid
Health
appraisal

41. Aspects of School Health Service
42
Health counselling:
• The procedure by which nurse, teachers, physicians, guidance personnel
and others interpret to pupils and parents, the nature and the significance
of the health program and aid them in formulating a plan of action which
will lead to solution of a problem

42. Objectives
• Appreciate importance of healthy mouth
• Relationship between general and dental health
• Encourage dental health practices
• Correlate dental health activities with total school health programs
• Stimulate development of resources
• Stimulate dentists to perform adequate services for children
43

43. Ideal Requirements
• Administratively sound
• Available to all children
• Provide facts about dentistry
• Develop favourable attitudes in children
• Provide proper environment
• Include primary preventive dentistry
• Provide screening for early identification and referral
• Ensure treatment
44

44. Elements/Components of School
Oral Health Programs (SOHP)
45

45. Components
1. Improving school-community relations
2. Conducting dental inspections
3. Conducting dental health education
4. Performing specific programs
5. Referral for dental care
6. Follow-up
46

46. Improving School-Community Relations
• Formation of an advisory committee representing:
 Parents
 Teachers
 School administrators
 Dental professionals
 Health officers
 Community leaders
• Task:
 Dental needs
 Administration
 Awareness
47

47. Conducting Dental Inspections
• Debatable
48
Advantages Disadvantages
Basis for dental health
instructions
Depend on it entirely rather
than a complete dental
examination
Builds a positive attitude Discouraging
Provides motivation Parents need to be present
Fact finding experience
Baseline and cumulative
data
Helps in planning health
programs

48. Conducting Dental Health Education
• Formal approach
• Dentist + teacher
• Self contained dental health kit for teacher education
49

49. Conducting Dental Health Education
50

50. Conducting Dental Health Education
51

51. Conducting Dental Health Education
52

52. Performing Specific Programs
1. Tooth brushing programs
2. Classroom based fluoride programs
3. School water fluoridation programs
4. Nutrition as a part of school preventive dentistry programs
5. Sealant program
6. Science fairs
53

53. 1. Tooth Brushing Programs
• Classroom – 6 to 8 children taught in a group
• Demonstration
• Disclosing tablet
• Magnifying mirror
• Guided brushing
• Mirror
• Appropriate corrections and reinforcement
54

54. 1. Tooth Brushing Programs
55
Damle S. Patil P, Jain S, Damle D, Chopal N. Effectiveness of supervised toothbrushing and oral health education in improving
oral hygiene status and practices of urban and rural school children: A comparative study. Journal of International Society of
Preventive and Community Dentistry. September-December 2014, Vol. 4, No. 3

55. 1. Tooth Brushing Programs
56
Damle S. Patil P, Jain S, Damle D, Chopal N. Effectiveness of supervised toothbrushing and oral health education in improving
oral hygiene status and practices of urban and rural school children: A comparative study. Journal of International Society of
Preventive and Community Dentistry. September-December 2014, Vol. 4, No. 3

56. 1. Tooth Brushing Programs
57
Damle S. Patil P, Jain S, Damle D, Chopal N. Effectiveness of supervised toothbrushing and oral health education in improving
oral hygiene status and practices of urban and rural school children: A comparative study. Journal of International Society of
Preventive and Community Dentistry. September-December 2014, Vol. 4, No. 3

57. 2. Classroom Based Fluoride Programs
a) Fluoride mouth rinse program
b) Fluoride tablet program
58

58. 2. a) Fluoride Mouth Rinse Program
• Once a week mouth rinse 20% - 40% reduction in dental caries
• Rinse should be non sweetened and non flavoured
• Grades 1 to 12
• 2 g packets of NaF powder + 1000 ml water
• 5 ml of rinse – for 1 minute
59

59. 2. a) Fluoride Mouth Rinse Program
• Official recognition of safety from:
 The FDA in 1974
 The Council on Dental Therapeutics of the ADA in 1975.
• Countries supporting major mouth rinse programs:
 United States
 Denmark
 Finland
 New Zealand
 Netherlands
 Thailand
 Sweden
60

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76. 77

77. 2. b) Fluoride Tablet Program
• 2.2 mg NaF for 1 min and then swallow
• Swish and swallow technique
 Daily tablet > weekly rinse
78
Topical
effects
Systemic
effects

78. 2. Classroom Based Fluoride Programs
79
Hossain A, Sampaio F, Fehr F, Arneberg P. Changes in plaque fluoride levels by school-based fluoride rinsing and tablet
programs in Bangladesh. Acta Odontol Scand 61 (2003).

79. 2. Classroom Based Fluoride Programs
80
Raymer R. Selwitz R, Kingman A. Driscoll W. The Prevalence of Dental Fluorosis in a School-based Program of Fluoride
Mouthrinsing, Fluoride Tablets, and Both Procedures Combined. [J Public Health Dent 1995;55(3):165-701. Vol. 55, No. 3,
Summer 1995

80. 3. School Water Fluoridation Programs
• School water supply – 4.5 ppm F
• Communal water supply – 1 ppm F
• Systemic and topical effects
• Approximately 40% reduction in dental caries
Disadvantages:
1. Children don’t receive the benefits until they begin school
2. Installation cost is high
3. Schools should have independent water supply
4. Workers must be trained to operate, monitor, and maintain the
fluoridation unit
81

81. Fluoride - Articles
82
Aravind A et al. Effect of fluoridated water on intelligence in 10-12-year-old school
children. Journal of International Society of Preventive and Community Dentistry. 2106

82. Fluoride - Articles
83
Aravind A et al. Effect of fluoridated water on intelligence in 10-12-year-old school
children. Journal of International Society of Preventive and Community Dentistry. 2106

83. Fluoride - Articles
84
Sebastian S. Soman R. Sunitha S. Prevalence of dental fluorosis among primary school children in association with different
water fluoride levels in Mysore district, Karnataka. Indian Journal of Dental Research. 2016

84. Fluoride - Articles
85
Unde MP, Patil RU, Dastoor PP. The untold story of fluoridation: Revisiting the changing perspectives.
Indian J Occup Environ Med 2018;22:121-7.

85. 4. Nutrition as a Part of Preventive
Dentistry Programs
Focus on:
Reduction of frequency of intake and selective sugar products instead of
total reduction of sugars
86

86. Mid Day Meal Program of GOI
87

87. Mid Day Meal Program of GOI
• Introduced in 7 north eastern districts in 2003-04
• Extended to remaining areas under the title “Akshara Dasoha”
during 2003-04
• Free food grains at 3kg/child/month
• Class 1-5 of govt schools
• On the basis of 80% attendance
• Extended to classes 6 and 7 from October, 2004
88

88. Mid Day Meal Program of GOI
89

89. Mid Day Meal Program of GOI
90

90. Mid Day Meal Program of GOI
91

91. Mid Day Meal Program of GOI
92

92. Mid Day Meal Program of GOI
93

93. Mid Day Meal Program of GOI
97

94. Mid Day Meal Program of GOI
98

95. 5. Sealant Placement Programs
• Grades 1 and 2 – first permanent molars
• Grades 6 and 7 – second permanent molars
• Sealant placement
+
follow up fluoride application
+
classroom fluoride programs
continuous protection of the teeth
99

96. 5. Sealant Placement Programs
100
Parmar P, Radha G, Rekha R, Pallavi SK, Nagashree SR. Promoting oral hygiene and health through school.
Int J Oral Health Sci 2016;6:70-7.

97. 5. Sealant Placement Programs
101
Bolla M et al. Trial shows caries reductions at one year in school-based sealant programme. Effectiveness of school-based
dental sealant programs among children from low-income backgrounds in France: a pragmatic randomized
clinical trial. Community Dent Oral Epidemiol 2013; 41: 232–241.

98. 5. Sealant Placement Programs
102
Gupta N, Rajpurohit L, Phansopkar S, Agarwal D, Kakodkar P, Hegde-Shetiya S. Effectiveness of prevention-
oriented school oral health program in a private school in Pimpri, Pune. J Dent Res Rev 2017;4:21-4.

99. 6. Science Fairs
• Educating & motivating
103

100. Components
1. Improving school-community relations
2. Conducting dental inspections
3. Conducting dental health education
4. Performing specific programs
5. Referral for dental care
6. Follow-up
104

101. Referral for Dental Care
• Parents informed – emergency care is not a cure
• Visit the dentist
105
Children are
given cards
Dentist
Complete
treatment
School
teacher/nurse
Follows up
with referral
Blanket
referral

102. Follow-up
• Issuing referral slips – not enough
• Dental hygienist needs to follow up
• Leave concessions from school recommended
106

103. 107
Ghaffari, M; Rakhshanderou, S; Ramezankhani, A; Noroozi, M; Armoon, B (2017). Oral Health Education and
Promotion Programmes: Meta-Analysis of 17-Year Intervention. International Journal of Dental Hygiene, (), –
.doi:10.1111/idh.12304

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110. 114

111. 115

112. 116
Parmar P, Radha G, Rekha R, Pallavi SK, Nagashree SR. Promoting oral hygiene and health through school.
Int J Oral Health Sci 2016;6:70-7.

113. 117
Parmar P, Radha G, Rekha R, Pallavi SK, Nagashree SR. Promoting oral hygiene and health through school.
Int J Oral Health Sci 2016;6:70-7.

114. 118
Parmar P, Radha G, Rekha R, Pallavi SK, Nagashree SR. Promoting oral hygiene and health through school.
Int J Oral Health Sci 2016;6:70-7.

115. 119
Parmar P, Radha G, Rekha R, Pallavi SK, Nagashree SR. Promoting oral hygiene and health through school.
Int J Oral Health Sci 2016;6:70-7.

116. References
• Dye BA, Xianfen L, Beltrán-Aguilar ED. Selected Oral Health Indicators in the
United States 2005–2008. NCHS Data Brief, no. 96. Hyattsville, MD: National
Center for Health Statistics, Centers for Disease Control and Prevention; 2012.
• Peter S. Essentials of Public Health Dentistry. 6th edition
120

117. 121

118. School Oral Health Programs
122

119. Learning About Your Oral Health
– A Preventive Oriented School
Program
123

120. • American Dental Association (ADA), 1970
• Comprehensive program covering current dental concepts
• Goal: to develop the knowledge , skills and attitude needed for prevention
of dental diseases among school children
• Relationship of diet and dental health (starch, sugars, caries)
• Importance of fluoride
• Consumer health concepts
• Role of dental professionals
• Relationship of oral health and total health
124

121. Implementation
• Level 1 – kindergarten to grade 3
• Level 2 – grades 4 to 6
• Level 3 – grades 7 to 9
• Level 4 – grades 10 to 12
• Core material for each level is in a teaching packet containing:
• A teacher’s self contained guide on “dental health facts” with a
section on handicapped children
• A glossary on dental health terms
• A curriculum guide with content, goals, behavioral objectives,
suggested activities.
• Lesson plans
• Activities for parental involvement
125

122. • ADA + American Cancer Society
 Developed materials to educate high school students about the
hazards of tobacco use
126

123. Evaluation
• Level 1 and 2 contain pre and post-tests
• Other levels – behavioral objectives are the basis for evaluation
• Dr. Oliver L. Ezell – 1974
• Found that the program was more beneficial than the traditional
approach to oral health education
127

124. Tattletooth Program – Texas
Statewide Preventive Dentistry
Program
128

125. • 1974-1976
• Cooperative effort between: Texas Dental health professional
organisations, the Texas Department of Health and the Texas Education
Agency
• Through a grant from the dept. of Health and Human Services to the
Bureau of Dental Health
• 1989: Tattletooth II – A New Generation for Grades K-6
129

126. Lesson Plan
• Teacher training package with 3 videotapes
 1st – lesson format and content
 2nd – brushing and flossing
 3rd – additional background information to help them teach the
lessons
• Goal : reduce dental disease and develop positive dental
habits to last a lifetime
130

127. Implementation
16 hygienists in 8 public health regions of Texas
• Instruct teachers using videos
• Encourage and publicise health promotion activities
• Teachers are encouraged to invite dental professionals to demonstrate
brushing and flossing in class
• Field trip to a dental clinic – recommended
• Bulletin board suggestions, a book list, videos are available
Topics covered:
1. Correct brushing and flossing techniques
2. Awareness of the importance of factual information about dental
diseases, its causes and preventive techniques
131

128. Evaluation
• Students of grades 3, 5, 7, 9, 11 were given the Texas Assessment of
Academic Skills (TAAS)
• Teacher evaluation – done annually by principals, supervisors using a 65
item checklist
• A major field test in 1975 and 1976 studying 18000 children in 18
educational service regions revealed:
Knowledge
Plaque levels
• Majority of the teachers couldn’t let students practice the brushing and
flossing techniques – program didn’t provide toothbrushes and floss
132

129. Askov Dental Demonstration
133

130. • Askov – small farming community of mostly Danish people
• Dental caries (1943-1946)
• 1949-1957: health dept. of Minnesota supervised a health program in
Askov
• All methods for dental caries prevention except community water
fluoridation until 1955 when they had no communal water supply
• 5 dentists provided treatment
• 3 dentists have topical fluoride application
134

131. Results after 10 years
• 28% dental caries in 3-5 year olds
• 34% dental caries in 6-12 year olds
• 14% dental caries in 13-17 year olds
• number of fillings
• Good health and diet habits
135

132. Limitations
• Program cost was higher and the reduction in caries was lower compared
to water fluoridation
• But water fluoridation is not a substitute for such a program
136

133. North Carolina Statewide
Preventive Dental Health
Program
137

134. • 1970, by the North Carolina Dental Society
Objectives:
1. Appropriate use of fluoride
2. Health education in schools and communities
3. Availability of public health dental professionals
138

135. • 1973 – Frank E. Law prepared a report that defined the extent of the
dental disease problem initiation of a 10 year program to reduce
dental disease
• Steering committee developed a practical plan
• Funding through grants awarded by Kate B. Reynolds Health Care Trust
• Project included – 19 videos for class teachers
139

136. • Unique public and private partnership
• Activities to improve behavior patterns of individuals through diet
changes, toothbrushing and flossing
• Young children – primary focus (earlier a child is reached, greater is
the potential for positively affecting their attitudes, values and
behavious)
• Fluoride – recognized as the most effective public health measure
for dental caries
140
Young
children
Parents
Teachers
Dental
professionals
Community
leaders
designed to
reach

137. Implementation
141
Activities carries out in 1990:
1. Water fluoridation in 130 rural schools
2. Weekly fluoride mouth rinse for > 416,000 students in 1051 school
3. Screening and referral for > 339,000 children
4. Dental health education for 361,000 children and 42,000 adults
5. > 33,000 dental sealants
• Teachers – key role
• Receive pre-service, in-service and follow up training and consultation to
cover dental health concepts, practice oral hygiene skills and integrate
dental health into the curriculum

138. Framework/Curriculum
142
• Videos and guides to help teachers be more effective
• Additional teaching aids – leaflets, worksheets, handouts on nutrition,
fluoride, plaque control, routine dental visits, injury prevention and
smokeless tobacco
• Films and videos

139. Evaluation
143
• 34% DMFT among children who had 8 years experience of drinking
fluoridated school water.
• 53% DMFT among children who had 10 years experience of drinking
fluoridated school water
• 86% DMFT after 4 years of sealant use

140. Head Start – Pre-School Dental
Health Program
144

141. 145
• United States Department of Health Services, 1975
• Assist children from low-income families
• Longest running program for stopping the cycle of poverty in the US
• Provides comprehensive education, health, nutrition and parent
involvement services to low income children and their families

142. School Health Additional Referral
Program (SHARP)
146

143. 147
• Philadelphia
• Motivation of parents to improve children’s’ oral health through home
visits
• District nurses – daytime visits to families in which mothers were at
home
• Working parents contacted by phone
• 1 to 1 basis of guidance established better rapport between school and
home

144. Teenage Health Education
Teaching Assistants Program
(THETA)
148

145. 149
• National foundation for the prevention of oral diseases for the US
Department of Health and Welfare, Division of Dental Health
High school children
Receive training
Teach elementary school children
• Give knowledge and skills to young children
• Help high school children to develop understanding of young children
• Career opportunities

146. Colgate’s Bright Smiles, Bright
Futures
150

147. 151
• Teach children positive oral health habits of basic hygiene, diet and
physical activity.
• Encourages dental professionals, public health officials, civic leaders,
parents and educators to emphasise on a child’s overall physical and
emotional development.
• Children receive dental care instructions from dental professionals
nominated by the Indian Dental Association.
• Free dental health care packs, audio visual aids, printed literature

148. World Health Organisation
(WHO’s) Global School Health
Initiative
152

149. 153
• 1995
• To improve the health of students, school personnel, families and other
members of the community through school
• Strategies:
• Goal: increase the number of schools that can truly be called HPS
Research to improve
school health
programs
Building capacity to
advocate for
improved school
health programs
Strengthening
national capacities
Creating networks
and alliances for the
development of
Health Promoting
Schools (HPS)
- Education International (EI)
- Centres for Disease Control (CDC)
- Education Development Centre
- UNESCO
- UNAIDS

150. Health Promoting Schools (HPS)
154

151. Conclusion
155
• Shouldn’t impose an excessive or unusual teaching burden on the
teachers
• Cost effective
• Produce observable results
• If children can be maintained in a state of good oral health, it will be
easier to maintain their oral health as adults.

152. References
• Dye BA, Xianfen L, Beltrán-Aguilar ED. Selected Oral Health Indicators in the
United States 2005–2008. NCHS Data Brief, no. 96. Hyattsville, MD: National
Center for Health Statistics, Centers for Disease Control and Prevention; 2012.
• Peter S. Essentials of Public Health Dentistry. 6th edition
156

153. 157