School health programmes (DENTAL)

Dr.preyas joshi
3rd Year postgraduate student
Deptt. Of Public Health Dentistry
Rajasthan Dental College & Hospital

Contents
 Introduction
 Basic considerations
 Historical background
 School health
 Integrating oral health within various components of a school
health programme
 School based programs
 Specific programs
 Conclusions
 References

HEALTH
• Health is a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity.
(WHO 1948)
• Amplified to include the ability to lead a “socially and
economically productive life”
(WHO 1978)

ORAL HEALTH
• A standard of health of the oral and related tissues which
enables an individual to eat, speak and socialize without active
disease, discomfort, or embarrassment and which contributes
to general well-being.
(UK Department of health, 1994)

What is a Health Promoting School(HPS)?
• A health promoting school is one that constantly
strengthens its capacity as a healthy setting for living,
learning and working.
(World Health Organization)

• A health promoting school:
 Fosters health and learning with all the measures at its
disposal.
 Engages health and education officials, teachers, teachers'
unions, students, parents, health providers and community
leaders in efforts to make the school a healthy place.

 Strives to provide a healthy environment, school health
education, and school health services along with
school/community projects and outreach, health promotion
programmes for staff, nutrition and food safety programmes,
opportunities for physical education and recreation, and
programmes for counselling, social support and mental health
promotion.

 Implements policies and practices that respect an individual's
well being and dignity, provide multiple opportunities for
success, and acknowledge good efforts and intentions as well
as personal achievements.
 Strives to improve the health of school personnel, families and
community members as well as pupils; and works with
community leaders to help them understand how the
community contributes to, or undermines, health and
education.

School Health Program
• A comprehensive SCHOOL HEALTH PROGRAM is an
integrated set of planned, sequential, school-affiliated
strategies, activities, and services designed to promote the
optimal physical, emotional, social, and educational
development of students. The program involves and is
supportive of families and is determined by the local
community, based on community needs, resources, standards,
and requirements. It is coordinated by multidisciplinary team
and is accountable to the community for program quality and
effectiveness.1
1. Allensworth, D., Lawson, E., Nicholson, L., and Wyche. J. (Eds.). (1997). School & Health: Our Nation’s Investment (p. 2). Washington, D.C.:
National Academy Press.

Models
• There are a variety of models that have been used to describe
the components of a school health program.

1. The Three-Component Model: Originating in the early
1900s and evolving through the 1980s, the three-component
model is considered the traditional model of a school health
program, consisting of the following basic components:
• Health education
• Health services, and
• A healthful environment.

2. The Eight-Component Model: In the 1980s, the three-component
model was expanded into an eight-component model—
traditionally referred to as a “comprehensive school health
program”—consisting of the following components:
• Health education
• Health services
• Healthy school environment
• physical education
• nutrition services
• health promotion for school staff
• counseling, psychological, and social services
• parent and community involvement.

3. Full-Service Schools: In recent years, additional models,
definitions, and descriptions have emerged that build on
previous models, including the full-service school model. In
addition to quality education, a full-service school model
involves a one-stop, seamless institution, where the school is
the center for providing a wide range of health, mental health,
social, and/or family services.2
2. Diane D. Allensworth et al. The Comprehensive School Health Program: Exploring an Expanded Concept. Journal of School Health
1987;57(10):409-12.

School Health Through the Early Twentieth Century
• During the colonial period, only limited attention was paid to
any aspect of school health.
• Benjamin Franklin advocated a "healthful situation" and
promoted physical exercise as one of the primary subjects in
the schools that were developing during his time.

• Samuel Moody, headmaster of the Dummer Grammar School,
which opened in 1763 as the first private boarding school,
taught the value of exercise and participated in it himself.

• Prior to the mid-1800s, however, public education was still in
a formative stage and efforts to introduce health into the
schools were isolated and sparse.
• School health professionals often state that the ''modern school
health era" began in 1850.
• In that year, the Sanitary Commission of Massachusetts,
headed by Lemuel Shattuck, produced a report that had a
significant impact on school health.

Lemuel Shattuck: Architect of American Public Health
• On the 100th anniversary of Lemuel Shattuck's 1850s Report
of the Sanitary Commission of Massachusetts, Winslow
praised the Report as “the most outstanding single ‘Book of
Prophesy’ in the history of public health.”
• Most of the recommendations of the Shattuck Report are now
standard components of American public health practice.
Shattuck was not just a “prophet” of American public health,
but its most influential architect.

• The report states the following:
Every child should be taught early in life, that, to preserve his own life
and his own health and the lives and health of others, is one of the most
important and constantly abiding duties. By obeying certain laws or
performing certain acts, his life and health may be preserved; by
disobedience, or performing certain other acts, they will both be
destroyed. By knowing and avoiding the causes of disease, disease itself
will be avoided, and he may enjoy health and live; by ignorance of these
causes and exposure to them, he may contract disease, ruin his health,
and die. Everything connected with wealth, happiness and long life
depends upon health; and even the great duties of morals and religion
are performed more acceptably in a healthy than a sickly condition.

• When New York City was faced with an outbreak of smallpox
in the 1860s, no mechanism was in place to provide free
vaccinations to those who needed them, so the Board of Health
turned to the schools. Education officials agreed to permit
inspection of school children to determine whether or not they
had been vaccinated, and in 1870, smallpox vaccination
became a prerequisite to school attendance

• In 1902,
 New York City provided for the routine inspection of all
students to detect contagious eye and skin diseases, and
employed school nurses to help the students' families seek and
follow through with treatment.
 Lillian Wald demonstrated in New York City that nurses
working in schools could reduce absenteeism due to
contagious diseases by 50 percent in a matter of weeks.

• In 1906, Massachusetts made medical inspection compulsory
in all public schools, a step that ushered in broad-based
programs of medical inspections in which school nurses and
physicians participated.
• By 1911, there were 102 cities employing cadres of school
nurses.
• In 1913, New York City alone had 176 school nurses.

• As late as 1914, school inspectors were not allowed to touch
children, and inspections were done with children fully
clothed.
• In 1915, the New York Board of Education introduced a new
requirement that all children entering school must undergo a
physical examination without clothing. This requirement met
some resistance, with critics declaring it immoral to strip
children for medical purposes.

• The prevalence of tuberculosis in the United States had a
significant impact on school health during the early part of the
century. Particularly notable was the development and spread
of "open-air classrooms“ — wide open to the outside air,
even in the middle of winter — in all major cities, under the
supervision of both medical and education personnel.

• In 1915, the National Tuberculosis Association enlisted school
children in the Christmas Seal drive. A child who bought or
sold 10 cents worth of seals was enrolled as a "Modern
Health Crusader" and received a certificate with four "health
rules."

11 daily “health chores” for Modern Health Crusaders
1. Wash hands before each meal; clean fingernails.
2. Brush teeth after breakfast and the evening meal.
3. Carry handkerchief and use it to protect others when
coughing or sneezing.
4. Avoid accidents; look both ways when crossing the street.
5. Drink four glasses of water, but no tea, coffee, or any harmful
drink.
6. Eat three wholesome meals; drink milk.

7. Eat some cereal or bread, green (watery) vegetable and fruit,
but no candy or "sweets" unless at the end of the meal.
8. Go to the toilet at regular times.
9. Sit and stand straight.
10. Spend 11 hours in bed, with windows open.
11. Have a complete bath and rub yourself dry.

School Health from World War I(1914) to the 1960s
• World War I marked a turning point in the history of school
health programs. Prior to this period, programs had a narrow
focus emphasizing inspection, hygiene, negative messages,
and didactic instruction about anatomy and physiology.

• However, the advent of the war made the problems of poverty
more visible: malnutrition, poor physical condition, and the
abysmal state of the health and welfare of many of the
country's children.
• New health promotion philosophies and movements began
to spring up to replace the outmoded methods; these new
approaches were based on using motivational psychology and
an understanding of behavior.

• The Child Health Organization was one of the most active
groups devoted to the health of children, and the organization
conducted a nationwide campaign to raise the health standard
of the American School Child.
• In 1922, in collaboration with the U.S. Department of the
Interior and the Bureau of Education, the organization
published and widely distributed…..
”The Rules of the Health Game”

• In the 1920s, more than 73 percent of the surveyed schools
taught health directly under the name of "health" or "hygiene,''
while 108 cities reported correlating content in their health
curriculum to such other subjects as language, civics, reading,
physical education, general science, and art.
• During the following decades, the health education curriculum
included topics such as nutrition, personal health habits,
diseases, exercise, alcohol and tobacco, family health, and sex
education.

• In 1936, New York City Board of Education set aside a day as
Health Day, during which teachers checked children's height,
weight, vision, hearing, and teeth. Teachers then had the
responsibility for trying to get any defects corrected.
• The 1948 National School Health Bill, which was designed to
provide federal aid to school health, was defeated partly
because of the opposition of the medical profession whose
members feared that funds would be provided for services to
students who would otherwise have paid private practitioners.

National School Lunch Act
• When many World War II draftees were found to suffer from
nutritional deficiencies, the federal government in 1946 passed
the National School Lunch Act to provide funds and surplus
agricultural commodities to assist schools in serving nutritious
hot lunches to school children. It was not until 1966, however,
that a pilot school breakfast program was established, and the
program was not made permanent until 1975.3
3. The National Academies Press website: http://www.nap.edu/read/5153/chapter/4
Accessed on 03/01/2016

“In the long view, no nation is healthier than its children, or more prosperous than its farmers.”
– Harry Truman
President of the United States of America
(On signing the 1946 NSLA)

India
• In ancient India, schools were in the form of Gurukuls.
Gurukuls were traditional Hindu residential schools of
learning; typically the teacher's house or a monastery.
• During the Mughal rule, Madrasa’s were introduced in India
to educate the children of Muslim parents.

• Under the British rule in India, Christian missionaries from
England, USA and other countries established missionary and
boarding schools throughout the country. Later as these
schools gained in popularity, more were started and some
gained prestige. These schools marked the beginning of
modern schooling in India and the syllabus and calendar they
followed became the benchmark for schools in modern India.
Today most of the schools follow the missionary school model
in terms of tutoring, subject / syllabus, governance etc.with
minor changes.

1875, Amritsar
Sikh girls enrolled in a school run by the Church Missionary School

• School health is an important branch of community health.
• An Economical and powerful means of raising community
health.4
• Developed over past 70 years.......
Narrower concept of medical examination
Broader concept of comprehensive care
4. Park K. Textbook of Preventive and Social Medicine. 22nd Ed. Jabalpur; M/s Banarsidas Bhanot Publishers. 2013

Historical Development (The Indian Context)
• The beginning of school health services in India dates back to
1909, when for the first time medical examination of the
school children was carried out in Baroda(Vadodara) city.

• The Bhore committee (1946) reported that school health
services were practically non-existent in INDIA, and where
they existed, they were in an under-developed state.4
Sir Joseph William Bhore
1878 - 1960
J.W. Bhore, Chairmanship of the Health Survey and Development Committee
Established in 1943 by the British colonial government

• 1953 – the secondary education committee emphasized the
need for medical examination of pupils and school feeding
programmes.
• 1960 – The government of India constituted a School Health
Committee to assess the standards of health and nutrition of
school children and suggest ways and means to improve them.
• 1961 – The committee submitted its report, which contains
many useful recommendations.4

The 1st Asian Declaration on
Oral Health Promotion for School Children
July 19, 2001 - “Tokyo Declaration”
• Declaration stated that this conference will be held on a
regular basis.
 To exchange information
 To Build a cooperative system
 Improve oral health among children
 Contribute to the well-being of mankind5
5. World Health Organization website: http://www.who.int/oral_health/events
Accessed on 03/01/2016,2016

The 2nd Asian conference of
oral health promotion for school children
- February 21-23, 2003
• Theme: "Prospectus for our Future Generation"
• Took place in Ayutthaya, Thailand.
• Participants from South East Asia (SEARO) and Western
Pacific (WPRO) regions discussed how to share experiences
related to continuous implementation of school oral health
programmes within the framework of the WHO Global School
Health Initiative.

• “Ayutthaya Declaration”: Oral health is an integral part of
general health and essential for quality of life for children.
• Called upon national authorities in health and education to
ensure the implementation of systematic school health
programmes for promoting oral health and general health in
children.

Bangalore Declaration
• Global workshop on "Prevention and promotion of oral
health through schools“.
• Took place on 27-28th January, 2005 in Bangalore.
• Called upon national authorities in health and education to
ensure implementation of school-based oral health
programmes for children.

• Established school health programmes should be strengthened.
• Emphasis to risk factors common to oral disease and chronic
diseases and health promotion.

Health Problems of The School Child4
(1) Malnutrition
(2) Infectious diseases
(3) Intestinal parasites
(4) Diseases of skin, eye and ear; and
(5) Dental caries

Objectives of School Health Services4
1. Promotion of positive health
2. Prevention of diseases
3. Early diagnosis, treatment and follow-up of defects
4. Awakening health consciousness in children
5. Provision of healthful environment.

Aspects of School Health Service4
1. Health appraisal of school children and school personnel
2. Remedial measures and follow-up
3. Prevention of communicable diseases
4. Healthful school environment
5. Nutritional services
6. First aid and emergency care

7. Mental health
8. Dental health
9. Eye health
10. Health education
11. Education of children with special needs.
12. Proper maintenance and use of school health records.

Ideal Requirements of a School Health Programme
• Be Administratively sound
• Available to all children
• Provide facts about Health and health care
• Aid in development of favorable attitude towards health
• Provide environment for development of psychomotor skills
• Include primary preventive programs
• Provide screening methods
• Ensure treatment

ADVANTAGES
1. Can bring comprehensive health care to school children
2. Students can be accessed during their formative years
3. School clinics are less threatening
4. Children’s daily contact with Health personnel
5. Makes it easy to maintain General health in adult life
6. Regular Healthcare attendance pattern can be instilled

7. Expenses and time involved in transportation to clinics can
be saved
8. Parents don’t have to lose the working day
9. Cost-effective
10. Health of school staff, families and community members can
be enhanced.

ARE SCHOOL-BASED ORAL HEALTH
PROGRAMMES EFFECTIVE ???
• School environments have a significant impact on sustainable
healthy behaviours.
• Without supportive environments, optimal oral health for
children cannot be realised.
• A well designed and implemented programme which links
curriculum with oral health promotion in school and
community is likely to produce health gains.

• Considerable evidence to support effectiveness of well-
conducted school-based oral health interventions worldwide.6
• In the regions of Americas, the US Surgeon General Report
(2000) documents that most school-based or community-wide
oral health prevention programmes are beneficial and cost-
effective.
6. WHO information series on school health. Oral Health Promotion: An Essential Element of a Health-Promoting School. Geneva: World
Health Organisation; 2003.

• Most school-based or school-linked fluoride and fissure sealant
programmes are effective. Particularly for children with high risk of
caries.
• Along with community-based and media-based activities, school-
based programmes are effective in preventing or delaying smoking
onset in 20-40% of adolescents.
• Schools that adopt and implement principles of a ‘Health-Promoting
School’ have lower proportion of children with dental caries and
dental trauma.6

• In India, oral health education has been integrated into school
curriculum
• Aims to provide dental knowledge and to empower children to
take control over their own health.
• Compared with the control groups, the test groups showed a
significant improvement in knowledge and oral hygiene.6

• There are three main divisions recognized in the field of
school health:
1. School health services
2. School health education
3. Healthful school living7
7. Dunning JM. Principles of dental public health. 4th edition. London: Harvard university press; 1986.

SCHOOL HEALTH SERVICES
School health services are procedures established to:
 Appraise health status of pupils and school personnel
 Counsel pupils, parents, and other concerning appraisal
findings.
 Encourage correction of remediable defects.
 Assist in identification and education of children with special
needs.

 Help prevent and control diseases.
 Provide emergency services for injury or sudden sickness.

SCHOOL HEALTH EDUCATION
• It is the process of providing learning experiences for the
purpose of influencing knowledge, attitudes, or conduct
relating to individual and community health.

HEALTHFUL SCHOOL LIVING
 Designates provision of a safe and healthful environment.
 Organization of a healthful school day.
 Establishment of interpersonal relationships favourable to
emotional, social and physical health.
 An addition to healthful school living has been school water
fluoridation at an increased concentration where public water
supplies are not available for community fluoridation.7

• Stanley B. Heifetz et al. (1983) conducted a study to determine
if fluoridating a school's water supply at seven times the
optimum amount (5 parts per million over a 12-year period )
recommended for community fluoridation produces greater
benefits than the currently recommended 4.5 times.
A caries reduction rate of 39% was observed.8
8. Stanley B. Heifetz et al. Effect of School Water Fluoridation on Dental Caries: Results in Seagrove, NC, After 12 Years. The Journal of the
American Dental Association 1983;106(3):334-37.

Health appraisal, Counselling & Follow through
• The starting point for school health services is.............
health appraisal, which has been defined as:
“The process of determining the total health status of the child
through such means as health histories, teacher and nurse
observations, screening tests, and medical, dental, and
psychological examinations.”

• Following appraisal comes health counselling and follow
through.
• Health counselling is defined as “the procedure by which
nurses, teachers, physicians, guidance personnel, and others
interpret to pupils and parents the nature and significance of
health problem and aid them in formulating a plan of action
which will lead to solution of the problem.”7

Planning the Intervention6
• The key steps to consider in planning oral health intervention
are:
 Establishing a School Health Team and a Community Advisory
Committee.
 Obtaining political, parental and community commitments.
 Establishing supportive school health policies.
 Setting goals and objectives.

School Health Team6
• Should comprise a balance of representatives including:
 Students
 Parents
 School administrators
 Teachers and school staff
 Members of teachers’ representative organisations
 PTA representatives
 Food service providers
 Health care providers

Policies that are Useful in School Oral Health
• Oral health education within school curriculum
• Oral hygiene
• Healthy eating policies including canteen, vending machines
• Violence and bullying
• Trauma and emergency care
• Fluorides
• Safe water and sanitation

• Infection control
• Safe environment
• Exercise
• Smoking and tobacco use
• Alcohol and substance abuse6

Community Commitment
• Development and maintenance of oral health interventions are
influenced by level of support from local community.
• Community participation is particularly important to ensure
the issues are addressed adequately and effectively.
• Creates a sense of community ownership.

• Dental health programmes succeed, not because they are
grafted onto a community by a group of experts, but because
community has come to want the programme.6

Parental Support & Commitment
• Parents influence their children’s oral health directly by
providing a home environment that is conducive to oral
health.
• Parents and other significant family members should be
educated about importance of oral health consequences of
oral diseases and preventive oral health practices.6

INTEGRATING ORAL HEALTH WITHIN VARIOUS
COMPONENTS OF A
SCHOOL HEALTH PROGRAMME

A comprehensive school programme should include:
• Healthy school environments
• School health education
• School health services
• Nutrition and food services
• Physical education and sports
• Mental health and well being
• Health promotion for school staff
• School and community relationships and collaboration6

HEALTHY SCHOOL ENVIRONMENT
• In health-promoting schools, emphasis is placed on supportive
school environment.
• Physical and Psychosocial
• Should be supportive to each other.

Physical Environment:
 Safe water and sanitation
 Health dietary practices
 Health supportive environment
 Outside vendor policy

Psychosocial Environment:
Refers to social and psychological conditions that strengthen
health education potential of the school community.
 Support for health promotion
 Teachers as role models
 Peer reinforcement

SCHOOL HEALTH EDUCATION6
The primary goals:
• Help children develop personal lifelong skills
• Raise health consciousness
• Improve understanding and healthy attitudes
• Promote healthy behaviours
• Reduce risks of oral diseases

Oral Health Education Curriculum6
Topics covered:
• Teeth and their functions
• Dental plaque and tooth decay
• Sugar and dental health
• Personal care of teeth and gums
• Fluorides
• Nutrition
• Dental visits

Educational Goals6
• Name the basic functions of teeth
• Explain why each function is important
• Give details of the two sets of teeth
• Describe number and the importance of primary teeth
• Explain why primary teeth are shed and replaced by permanent
teeth.

• Identify which permanent tooth erupts first and its importance
• Name healthy and unhealthy foods related to teeth
• Describe how to remove plaque

• Appreciate the importance of teeth and oral functions
• Demonstrate a positive attitude towards oral health
• Demonstrate a positive attitude towards dental team

• Practise proper oral hygiene care
• Restrict the amount and frequency of sugar intake
• Adopt a regular check-up routine
• Oral health education should be combined with efforts
addressing other health issues such as tobacco use, violence,
healthy nutrition etc.

SCHOOL HEALTH SERVICES
• School health services, help screen, prevent, control and
monitor oral diseases and conditions, as well as maintain good
oral health.
• Oral health teams work collaboratively with primary health
care team to provide accessible oral health services to students.

• Screening of teeth and mouth enables early detection, and
timely interventions
• Leads to substantial cost savings
• Important in planning and provision of school oral health
services as well as health services.
• Signs of some general health conditions can also be identified
through oral health screening.6

• Not necessarily performed by dentist or dental auxiliaries.
• Can be effectively carried out by trained school health nurses,
school teachers, or community workers.
• Can form part of oral and general health education and self
care programmes in school curriculum.6

Classification of screening examinations
(WHO, 1962)
Type 1, Complete dental examination with all aids
• This involves a very complete examination using mouth mirror
and explorer, good illumination, full mouth radiographs, and
lab investigations.
• Obviously unsuited to case finding in entire school populations
because of the expense and time involved.
• Moreover, dentist responsible for treatment will wish to make
his own final examination in order to construct a logical
treatment plan.

Type 2, Limited examination using mouth mirror and explorer,
bite-wing x-rays, and, if necessary, periapical x-rays
• Adapted to school dental health programs on a continuing
basis, but not for all children every year.
• May suffice (be enough or adequate) in mouths with
uncomplicated dental disease
• Seldom subject to danger of false negative findings which are
found in Types 3 and 4.

Type 3, Inspection using mouth mirror and explorer and
adequate illumination (epidemiological surveys)
• Lends itself very well to school procedures.
• Can be performed either by a dentist or by a dental hygienist.
• Identifies major dental needs in most instances.
• Can be vehicle for excellent individual health education.
• Can be performed on school premises with portable equipment
• Hygienist can combine it with dental prophylaxis or with
topical fluoride treatment.

Type 4, Screening using tongue depressor and available
illumination
• Dental case finding at its quickest.
• But lowest efficiency.
• Yet needed sometimes where dental personnel are not
available.
• Where school physicians or school nurses are called upon to
identify most serious cases of dental disease.

REFERRAL
• For services that cannot be offered in school, school oral
health services can provide referrals to other school services,
such as counselling and other general health issues and to local
health services, specialist care and other community agencies,
as appropriate.

Blanket Referral
• A program that has proved effective in many schools is
‘BLANKET REFERRAL’ of all children to their family
dentists.
• All children are given referral cards to take home and
subsequently to dentist, who signs the card upon completion of
examination, treatment or both. The signed cards are then
returned to the school nurse, or classroom teacher.

Excuses from School for Treatment
• The National Education Association recommends that children
should be excused to keep office appointments with the
physician or dentist during school hours.7
Abuses of the system can be
avoided by using excuse forms
with space for relevant details
to assure that appointment was
actually kept.

• Two good reasons for such an excuse:
1. First, child is a more cooperative patient when medical and
dental services are provided during early or middle part of
day.
2. Second, physicians and dentists can provide better service
when entire day is available for services to children and they
do not have to crowd their child patients into afterschool
hours and Saturdays/Holidays.7

Tooth Brushing Programs9
• In a classroom 6-8 children can be taught as a group.
9. Peter S. Essentials of preventive and community dentistry. 4th ed. New Delhi: Arya(Medi) Publishing House; 2010.

• Mastery of 450 angulations and short vibratory strokes can
then be repeated on an oversize dentoform model.

• Emphasis on the need to follow a definite brushing sequence
to ensure that all tooth surfaces are brushed.

• P.E. Petersen et al. (2015) conducted a two-year study to
assess the benefits of an enhanced oral health promotion
program combined with a closely supervised tooth brushing
program in 15 schools of southern Thailand. 3,706 pre-school
children were recruited: 8 schools with 1,766 children as
controls; 7 schools with 1,940 children in the intervention
groups. The DMFT and DMFS increments were 1.19 and 1.91
for the control group and 1.04 and 1.59 for the intervention
groups. These represent 12.6% and 16.8% reductions in caries
respectively.10
10. P.E. Petersen et al. School-based intervention for improving the oral health of children in southern Thailand. Community Dental Health
2015;32(1):44–50

• The Indian Association of Public Health Dentistry (IAPHD)
had decided to celebrate NATIONAL TOOTH BRUSHING
DAY on 7thNovember of each year and had requested each
college in India to adopt this day.

Fluoride Mouth-rinse Program
• In this program, rinsing with a 0.2 percent neutral NaF
solution once a week is performed under supervision in
classrooms.
• A 0.2 percent NaF solution is prepared by mixing 3 gm NaF
with 1,500 ml tap water.
• 10 ml that each child uses for weekly rinsing contains 9 mg
fluoride.11
11. Leske GS, Ripa LW. Guidelines for establishing a fluoride mouth-rinsing caries prevention program for school children. Public Health Rep.
1977;92(3):240-4.

• Premeasured packet of NaF powder is added to a pre-marked
container.

• Container is closed and shaken for 10 to 15 seconds to
dissolve all of powder.
• Cap is then replaced with a pump that is calibrated to deliver
10 ml of solution.

• Each child receives a disposable cup containing 10 ml of
fluoride solution and a paper napkin.
• Teacher times the rinse for 60 seconds.

• Children are reminded to swish the solution, to use cheek
pressure to force the fluid between the teeth, and not to
swallow the solution.

• After 60 seconds, children expectorate into paper cups, wipe
their mouths with napkins, and stuff them into the cups to
absorb the solution.
• Cups and napkins are then collected in a disposable bag that is
then tied and deposited in waste basket.

FLUORIDE TABLET PROGRAM
• One tablet given to each student.
• Student chews and swishes 2.2 mg NaF (1 mg fluoride) tablet
for one minute and then swallows.

• Swish-and-swallow technique not only provides benefits of a
topical application but also provides systemic benefits.
• Daily tablet is more effective than weekly rinse.9
Half-Strength

SCHOOL WATER FLUORIDATION
• In areas lacking public water supplies and where fluoride is
not naturally present in the well water, school fluoridation
programs have been shown to be effective and safe.
• Reductions of up to 39% in the rate of dental decay have been
reported.12
12. Avery KT et al. School water fluoridation. J Sch Health. 1979;49(8):463-5.

• The amount of fluoride added to school water supply 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.
• A major disadvantage is that the children do not receive
benefits until they begin school.
optimal level of fluoride in community water systems/recommended ratio of
fluoride to water: 0.7 parts per million.

• Endemic fluorosis remains a challenging and extensively
studied national health problem in India.
• In 1991, 13 of India’s 32 states & territories were reported to have
naturally high concentrations of fluoride in water (Mangla,1991),
but this had risen to 17 by 1999 (UNICEF, 1999).13
13. J. Fawell et al. Fluoride in Drinking-water. World Health Organization 2006. IWA Publishing. London, UK

• The most seriously affected areas are Andhra Pradesh, Punjab,
Haryana, Rajasthan, Gujarat, Tamil Nadu and Uttar Pradesh
(Kumaran, et al., 1971; Teotia et al., 1984).
• The highest concentration observed to date in India is 48 mg/l
in Rewari District of Haryana (UNICEF, 1999).13
• In Rajasthan, fluoride concentrations have been found to vary
between 0.6 mg/l and 69.7 mg/l (Gupta, 1999).

• The prevalence of dental fluorosis has been investigated in
Rajasthan by Choubisa et al. (1997).
• Prevalence rates were observed in 15 tribal villages with
fluoride concentrations of 0.3–10.8 mg/l.
• At mean fluoride concentrations of 1.4 and 6 mg/l, dental
fluorosis was seen in 25.6 per cent and 84.4 per cent of school
children (< 16 years) and 23.9 per cent and 96.9 per cent of
adults respectively.14
14. SL Choubisa. Endemic fluorosis in southern rajasthan, india. Fluoride 2001;34(1):61-70

• The studies made by Rajasthan Voluntary Health Association
in 1994 has showed that the total number of villages having
fluoride problem in Rajasthan is 2433 covering nearly 2.6
million population. Moreover, nearly 30,000 people are
drinking water with concentration of 10.0 mg/l of fluoride.15
• The permissible limit is 1.5 mg/l according to the Public
Health Engineering Department (CPHED), Government of
India and the World Health Organization.
15. Hussain J et al. fluoride in drinking water in Rajasthan and its ill effects on human health. Journal of Tissue Research 2004;4(2):263-73.

SCHOOL-BASED SEALANT PROGRAMS
• Sealants prevent tooth decay and also stop cavities from
growing.
• The Surgeon General’s report on oral health indicates that
sealants can reduce decay in school children by more than 70
percent.
• Especially important for reaching children from low-income
families who are less likely to receive private dental care.
16. http://www.cdc.gov/oralhealth/topics/dental_sealant_programs Accessed on 06/01/2016

• Findings from scientific studies clearly show that school dental
sealant programs work to stop tooth decay.

• Based on this evidence, the following recommendations are
provided for practitioners in school-based programs:
 Seal pit-and-fissure tooth surfaces that are sound or have early
decay, prioritizing first and second permanent molars.
 Use visual assessment to differentiate surfaces with the earliest
signs of tooth decay from more advanced lesions.

 X-rays are not needed solely for sealant placement.
 A toothbrush can be used to help clean the tooth surface before
acid etching.
 When resources allow, have an assistant help the dental
professional place sealants.
 Provide sealants to children even if follow-up examinations for
every child cannot be guaranteed.

A fissure sealant is defined as a material that is placed in
the pits and fissures of teeth in order to prevent or control
the development of dental caries.

LIST OF EQUIPMENT AND MATERIAL17
• Basic requirements for a school-based fissure sealant
programme:
• Equipment
 Portable cutting unit with oil-less compressor
 Oil-free 3-way syringe
 Vacuolyser and suction tips
 Light cure equipment (if using light cure resin)
 Portable chair
 Portable light
 Basic dental instruments

• Materials17
 Self-cure or light cure composite resin kit (Opaque/tinted) or
Glass Ionomer Cements
 Cotton rolls
 White stones for occlusal adjustment of sealant
 Articulating paper
 Petroleum Jelly / Vaseline (if using glass ionomer cement)
 Dentine conditioner (if using glass ionomer cement)
17. SCHOOL-BASED FISSURE SEALANT PROGRAMME. Second Edition. Ministry of Health, Malaysia. 2003

NUTRITION AS A PART OF
SCHOOL ORAL HEALTH PROGRAM
• The Mid Day Meal is the world’s largest school feeding
programme reaching out to about 12 crores children in over
12.65 lakh schools.18
18. http://mdm.nic.in/ Accessed on 6 january, 2016

• The Midday Meal Scheme is a school meal programme of the
government of India designed to improve the nutritional status
of school-age children nationwide.
• The central and state governments share the cost of the
Midday Meal Scheme, with the centre providing 75 percent
and the states 25 percent.

The nutritional guidelines for the minimum amount of food and
calorie content per child per day are:

• In 1925, a Mid Day Meal Programme was introduced for
disadvantaged children in Madras Municipal Corporation.
• By the mid 1980s three States viz. Gujarat, Kerala and Tamil
Nadu and the UT of Pondicherry had universalized a cooked
Mid Day Meal Programme with their own resources for
children studying at the primary stage
• By 1990-91 the number of States implementing the mid day
meal programme with their own resources on a universal or a
large scale had increased to twelve states.

• By the year 1997-98 the programme introduced in all blocks of
the country.
• It was further extended in 2002 to cover not only children in
classes I -V of Government, Government aided and local body
schools, but also children studying in EGS (Education
Guarantee Scheme).
• Central Assistance under the scheme consisted of free supply
of food grains @ 100 grams per child per school day, and
subsidy for transportation of food grains up to a maximum of
Rs 50 per quintal

Mid-Day Meal improves three areas:
1. School attendance
2. Reduced dropouts
3. A beneficial impact on children's nutrition.
• Meal should be a supplement and not substitute to home diet.
• Meal should supply at least 1/3 of total energy requirement,
and ½ of protein need.4

• Meal should be such that it can be easily prepared in schools,
not involving any complicated cooking process.
• Locally available food should be used.
• Menu frequently changes to avoid monotony.
• Food grains at rate of 3 Kgs minimum per child are provided
per month (300 k cal and 8-12 grams of protein per day).
• Central Government supplies full requirement of food grains
for programme free of cost.4

SPECIFIC PROGRAMMES
“Learning about Your Oral Health”
A prevention-oriented school program

• Development:
 “Learning about Your Oral Health” was developed by
ADA and its consultants in response to a request from 1971
ADA house of delegates.
 Comprehensive program.
 Materials for preschool, primary and secondary schools
have been developed for educators to facilitate inclusion of
preventive dentistry into school health curricula.19
19. Jong AW. Community dental health. 3rd edition. Missouri: Mosby Inc.; 1993.

Primary goal :
• To develop knowledge, skills, and attitudes for prevention of
dental diseases.
• First priority of program was to develop effective plaque
control knowledge and skills.
• Next consideration is given to increasing knowledge
regarding diet and dental health.
• Emphasis on understanding role of sugar and starch.

Other areas:
• Significance of fluoride
• Oral safety
• Consumer health concepts
• Role of dental professionals
• Oral health in relationship to total health
• Community dental programs

• Program format is divided into five levels with specific content
defined for each level.
• The levels are divided by grades:
 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)

• Core material for each of five levels is self-contained in a
teaching packet.
• Allows classroom teacher to adapt presentation to needs of the
students.

Each packet includes:
1. A teacher's self-contained guide on "dental health facts"
with a section on children with special needs.
2. A glossary of dental health terms.
3. A curriculum guide featuring content, goals, behavioural
objectives, and suggested activities for other classes.
4. Five lesson plans for preschool level and seven or more
lesson plans for each of the other levels.

5. Four overhead transparencies
6. 12 spirit masters (Blind tasting competitions)
7. Methods and activities for parental involvement
• Supplementary printed material and films coordinated with
each level have also been developed.

• In addition, ADA, in cooperation with American Cancer
Society, has developed and produced a rock video on dangers
of using smokeless tobacco.
• Geared for junior and senior high students, as well as for adult
audiences.

Texas state-wide preventive dentistry program:
“Tattle tooth II, A New Generation”

DEVELOPMENT:
• The Tattletooth Program was developed in 1974-76.
• Cooperative effort between Texas dental health professional
organizations, the Texas education agency, and the Texas
Department of Health.

• In its original format this program was used by approximately
500,000 children in Texas per year before the new program
was completed in 1989.
• In 1989, the Bureau of Dental Health developed a mostly new
program, Tattletooth II, A New Generation for Grades K-6.
• So named because characters in the artwork for grades
kindergarten through second were from the old curriculum.

• New curriculum was modified to reflect recommendations
obtained from formative evaluator process.
• Separate lesson plans were developed for each grade.
• Three videotapes were produced as part of the teacher training
package.
• The first videotape familiarizes teachers with lesson format
and content.

• Second videotape “Brushing and Flossing,” was developed for
dual purpose:
 teacher training
 instructional unit to be used by teacher with students.
• Third videotape provides teachers with additional background
information as a means of preparing them to teach the lessons.

• In addition to the curriculum, a public relations plan was
formulated
• Materials were developed to aid in implementation of the
program.

• Two news releases were written:
1. One was targeted toward parents and designed for local
newspapers
2. Other was aimed at readership of professional education
journals.
• A letter to school principals and nurses was sent out as part of
a package distributed annually by the Bureau of Maternal and
Child Health.

PROGRAM PHILOSOPHYAND GOALS
Basic goal:
• to reduce dental disease and to develop positive dental habits
to last a lifetime.
• Major thrust of Tattletooth is to convince students that
preventing dental disease is important and that they can do it.

• Tattletooth II embraces the six elements of effective lesson
design:
1. anticipatory set,
2. setting the objective,
3. input modeling,
4. checking for understanding,
5. guided practice,
6. independent practice.

Program implementation:
• The Texas Department of Health is divided into eight public
health regions
• Employs 16 hygienists in regions who implement the
Tattletooth program.
• Hygienists instruct teachers using videotapes designed for
teacher training and provide them with a copy of the
curriculum.

• In some instances, hygienists train lead teachers who, in turn,
provide training for teachers in their schools.
• The bureau provides teachers with a unit overview and a
section on organizing dental health lessons.
• Health promotion activities are encouraged and publicized
within school community.
• Teachers are encouraged to invite a dental professional to
demonstrate brushing and flossing in classroom.

• A field trip to a dental office is strongly recommended for
kindergarten children.
• Each unit has a brief introduction that summarizes and gives a
theme to the unit.
• Topics covered in the curriculum include:
 correct brushing and flossing techniques
 awareness of the importance of safety
 factual information relating to dental disease, its causes, and
preventive techniques.

• The results of the Tattletooth II evaluation were positive, with
teachers praising teacher-student interaction that was present
as a result of format.
• Student responses to curriculum were positive or very positive.
• About half the teachers had used previous program, and half
the teachers were new to program.
• Approximately 94% of teachers felt that teaching oral health
can have a positive effect on children's dental health habits.

• Most teachers (90%) taught dental health once per year
• Average number of hours in which dental health was taught
was 4.2.
• The bureau states that given teaching requirements, the fact
that 88.7% of the teachers spent 45 minutes to 62 hours
teaching "Tattletooth II, A New Generation" is an indication
that the curriculum was well received.

North Carolina State-wide Preventive
Dental Health Program
In 1970 the North Carolina Dental Society passed resolutions
advocating a strong preventive dental disease program embracing:
 school and community fluoridation
 fluoride treatments for school children
 continuing education on prevention for dental professionals
 plaque-control education in schools and communities.

• In 1973 Frank E. Law prepared a report for North Carolina
Dental Society that defined extent of dental disease problem.
• Resulted in initiation of a 10-year program to reduce dental
disease.
• This was the first state-wide program of its magnitude.
• Still remains largest and most comprehensive of all state
public health dental programs.

• A unique public and private partnership dedicated to mission
of assuring optimal oral health conditions in North Carolina.
• Dental health is considered an important part of general health.
• Can be achieved through the coordinated efforts of individuals,
professionals, and community members.
• The Division of Dental Health's programs are based on
prevention and education.

• Organized to provide as many direct services to citizens of
North Carolina as possible.
• Primary prevention and education are considered to be the
most effective means of decreasing dental disease and
promoting dental health.
• All program activities include educational components to
modify behaviour patterns of individuals.

• To improve their oral health habits through dietary change,
tooth brushing, and flossing.
Objectives that will facilitate attainment of the goals of the
division include:
1. Appropriate use of fluoride
2. Health education in schools and communities
3. Availability of public health dental staff in all counties

• Program Implementation:
The fiscal year 1990 services delivered through the program
included:
 Fluoridation of the water supplies of 130 rural schools,
 Weekly fluoride mouth-rinse for more than 416,000 students in
1,051 schools
 Screening and referral for more than 339,000 children.

 Dental health education was presented to 361,000 children and
42000 adults.
 More than 33000 dental sealants were applied.
 To reach children, public health dental staff provides training
and consultation to those who work with preschool and
school-age children and maternal and child health programs.
 Teachers are believed to be the key in educational program.

 Received pre-service, in-service, and follow-up training to
cover dental health concepts, practice oral hygiene skills, and
integrate dental health into the curriculum.9

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 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.

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.
• Minnesota Department of Health supervised a school dental
health program (1949-1957).

• All recognized methods for preventing 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 over 10 yr period revealed,
 28% reduction in dental caries in deciduous teeth of children 3
to 5 years old
 34% reduction in caries in permanent teeth of children 6 to 12
years old
 14% reduction in children 13 to 17 years old.7

• “Dental Health Is a Family Affair” is a slide-tape education
program for parents.
• Coordinated by Texas Department of Health's dental hygienists
for use with groups such as school parent groups, local health
departments, and clinics.
• Covers dental disease problems and their prevention.
• Diet and a section describing characteristics of children's
dental development ranging from prenatal to late adolescence.

HEAD START – PRE-SCHOOL DENTAL HEALTH PROGRAM
• The Head Start Program is a program of the United States
Department of Health and Human Services that provides
comprehensive education, health, nutrition, and parent
involvement services to low-income children and their
families.

• The program's services and resources are designed to foster
stable family relationships, enhance children’s physical and
emotional well-being, and establish an environment to develop
strong skills.
First Lady Lady Bird Johnson (wife of the 36th President of the United States) visits a Head Start class in 1966

SCHOOL HEALTH ADDITIONAL REFERRAL PROGRAM
(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.
• Carried out by district nurses with cooperation of school
personnel.
• Nurses made daytime visits to families in which mothers were
at home.

• Working parents were contacted by phone.
• One-to-one basis of health guidance between parent and health
worker established better rapport between school and home.

COLGATE’S BRIGHT SMILES, BRIGHT FUTURES

• Colgate Bright Smiles, Bright Futures reaches children around the
world with free dental screenings and oral health education.
• It is among the most far-reaching, successful children's oral health
initiatives in the world.20
20. http://www.colgate.com/app/BrightSmilesBrightFutures/US/EN/Our-Commitment.cvsp Accessed on 10/01/2016

• With long-standing partnerships with governments, schools
and communities, Colgate Bright Smiles, Bright Futures has
reached more than half a billion children and their families
across 80 countries with free dental screenings and oral health
education.
• This program also encourages dental professionals, public
health officials, civic leaders and most importantly, parents and
educators to come together to emphasize the importance of
oral health.

• Under this program, children in primary schools 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-visual and printed
literature.
• Free dental health care packs are distributed to encourage good
oral hygiene.

• Education is imparted with the aid of audio-visual and printed
literature.
• Free dental health care packs are distributed to encourage good
oral hygiene.

WHO’s Global school health initiative
• WHO's Global School Health Initiative, launched in 1995,
seeks to mobilise and strengthen health promotion and
education activities at the local, national, regional and global
levels.
• Designed to improve the health of students, school personnel,
families and other members of the community through
schools.

• The goal is to increase the number of schools that can truly be
called "Health-Promoting Schools".
The general direction of WHO's Global School Health
Initiative is guided by the:
 Ottawa Charter for Health Promotion (1986);
 the Jakarta Declaration of the Fourth International Conference
on Health Promotion(1997);
 WHO's Expert Committee Recommendation on
Comprehensive School Health Education and Promotion
(1995)

Strategies:
1. Research to improve school health programmes:
Evaluation research and expert opinion is analyzed and
consolidated to describe nature and effectiveness of school
health programmes.
2. Building capacity to advocate for improved school health
programmes:
Technical documents are generated that consolidate research
and expert opinion about the nature, scope and effectiveness
of school health programmes.

3. Strengthening national capacities:
Collaboration between health and education agencies is
fostered and countries are helped to develop strategies and
programmes to improve health through schools.
4. Creating networks and alliances for the development of
health-promoting schools:
Regional Networks for the development of Health-Promoting
Schools have been initiated in Europe, Western Pacific and
Latin America.

• A global alliance has been formed to enable teachers'
representative organizations, worldwide, to improve health
through schools.
• The alliance includes Education International, Centers for
Disease Control and Prevention, Education Development
Center, UNESCO (United Nations Educational, Scientific and
Cultural Organization), and UNAIDS.

INCREMENTAL DENTAL CARE
• Periodic care so spaced that increments of dental disease 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.
• Treatment programs are "gotten off the ground” carrying the
youngest available group the first year & carrying it forward in
subsequent years as far as funds permit.

• Each year adding a new class of children at the next earliest
served to as high an age as available resources permit.
ADVANTAGES:
1. Prevent pulpal involvement and loss of teeth.
2. Economic.
3. Periodontal diseases identified at early age.
4. Preventive programs on periodic basis.
5. Confines dental diseases to small early increments, reducing
loss of teeth.
6. Habit of periodic return.

DISADVANTAGES:
1. Restorative dentistry is more time consuming on a piecemeal
basis than upon a wholesale basis.
2. Financial resources may be exhausted even before the
elementary school population has been cared for and the
permanent teeth might receive no care at all.
3. Increasing likelihood of interruption in children’s dental
health programs due to mobility along with their families and
also the segments of the population where systemic recall
habits will be difficult or impossible to induce.

SCHOOL HEALTH PROGRAMME
MINISTRY OF HEALTH AND FAMILY WELFARE
GOVERNMENT OF INDIA

School Health program is a program for school health service
under National Rural Health Mission, which has been
necessitated and launched in fulfilling the vision of NRHM to
provide effective health care to population throughout the
country.21
21. Ministry of Health and Family Welfare, Govt. of India’s website: http://mohfw.nic.in/WriteReadData/l892s/2099676248file5.pdf

It also focuses on effective integration of health concerns
through decentralized management at district with determinant
of health like sanitation, hygiene, nutrition, safe drinking
water, gender and social concern.21

The School Health Programme intends to cover
12,88,750 Government and private aided schools covering
around 22 Crore students all over India.21

Rationale for School Health Programme
• The School health programme is the only public sector
programme specifically focused on school age children.
• Its main focus is to address the health needs of children, both
physical and mental, and in addition, it provides for nutrition
interventions, yoga facilities and counseling.

• It responds to an increased need, increases the efficacy of other
investments in child development, ensures good current and
future health, better educational outcomes and improves social
equity and all the services are provided for in a cost
effective manner.21

School health programme Under the
State programme Implementation Plans (2008-09)

• Health education and improving the hygiene will be an
important component of the programme.
• Under the school health programme following services are
being provided to children from primary schools (including
Rajiv Gandhi schools):
 Health check-up (done twice a year, by the Auxiliary Nurse
Midwifery (ANM) and PHC Medical Officer)
 Provision of micronutrients to children (including IFA-
small, Vitamin-A, Tab. Albendazole - used for the treatment of
a variety of parasitic worm infestations).

• Activities:
 Identification of Schools and number of beneficiaries under
the programme.
 Revised guidelines, formats, supplies (Vision Charts, drugs) to
be sent to the PHC.
 Plan for school Health Check-up to be prepared at the PHC
level.
 Health check-up and provision of Micronutrients, as per plans.
 Monitoring and Supervisions.
 Data compilation and analysis.

Rapid Assessment and Action Planning Process
(RAAPP)22
• RAAPP is a cost-effective, evidence-based method to assess
and improve the capacity of school health programmes.
• The goal of the RAAPP is to strengthen countries' capacity to
support national, provincial, and local school health programs.
22. http://www.who.int/school_youth_health/assessment/raapp/get_started/en Accessed on 10/01/2016

• It equips ministries of education and health and other national
organizations to assess and improve their capacity to promote
health through schools.
• RAAPP is based on two concepts put forth by the World
Health Organization and its partners: Health-Promoting
Schools (HPS) and Focusing Resources on Effective School
Health (FRESH).

• Methods used for data collection during RAAPP typically
include:
 Key informant interviews
 Group discussions
 Secondary data collection
 Observations

• While preparing for and conducting the RAAPP, the in-
country core team will learn qualitative data gathering and
analysis techniques such as:
 Interviewing
 Facilitating
 Recording
 Coding, managing and analyzing data
 Strategic action planning

• The RAAPP is divided into three phases:
1. Planning
2. Training and data collection
3. Analysis and action planning

Barriers to School-Based Health Care Programs
• Although school-based health care programs (SBHCPs)
provide affordable and accessible health care to children and
adolescents and are known to improve school attendance, a
variety of barriers affect their development.23
23. Improving school health programmes: Barriers and Strategies. World Health Organization. Geneva 1996

• Three general, related, and common barriers that impede
local,National, and International efforts to Improve School
Health Programmes:
1. Inadequate Understanding and Acceptance
2. Inadequate Collaboration
3. Inadequate Vision and Strategic Planning

CONCLUSION
• In conclusion, there is a pressing need for oral health to be
promoted in schools worldwide.
• The potential for developing a health program using the Health
Promoting School approach is considerable.
• Commitment from central and local government, schools,
families and the community is critical.

• To ensure a healthy future for our children, school-based
nutrition education programs must become a national priority.
• These programs should be part of comprehensive school health
programs and reach students from preschool through
secondary school.
• School leaders, community leaders, and parents must commit
to implementing and sustaining nutrition education programs
within the schools.

• Such support is crucial to promoting healthy eating behaviors.
• Health promoting Schools can help ensure that all school-age
youths attain their full educational potential and good health.

References
1. Allensworth, D., Lawson, E., Nicholson, L., and Wyche. J. (Eds.). (1997). School & Health:
Our Nation’s Investment (p. 2). Washington, D.C.: National Academy Press.
2. Diane D. Allensworth et al. The Comprehensive School Health Program: Exploring an
Expanded Concept. Journal of School Health 1987;57(10):409-12.
3. The National Academies Press website: http://www.nap.edu/read/5153/chapter/4
4. Park K. Textbook of Preventive and Social Medicine. 22nd Ed. Jabalpur; M/s Banarsidas
Bhanot Publishers. 2013
5. World Health Organization website: http://www.who.int/oral_health/events
Accessed on 03/01/2016,2016
6. WHO information series on school health. Oral Health Promotion: An Essential Element of a
Health-Promoting School. Geneva: World Health Organisation; 2003.
7. Dunning JM. Principles of dental public health. 4th edition. London: Harvard university press;
1986.

8. Stanley B. Heifetz et al. Effect of School Water Fluoridation on Dental Caries: Results in
Seagrove, NC, After 12 Years. The Journal of the American Dental Association
1983;106(3):334-37.
9. Peter S. Essentials of preventive and community dentistry. 4th ed. New Delhi:
Arya(Medi) Publishing House; 2010.
10. P.E. Petersen et al. School-based intervention for improving the oral health of children in
southern Thailand. Community Dental Health 2015;32(1):44–50
11. Leske GS, Ripa LW. Guidelines for establishing a fluoride mouth-rinsing caries
prevention program for school children. Public Health Rep. 1977;92(3):240-4.
12. Avery KT et al. School water fluoridation. J Sch Health. 1979;49(8):463-5.
13. J. Fawell et al. Fluoride in Drinking-water. World Health Organization 2006. IWA
Publishing. London, UK
14. SL Choubisa. Endemic fluorosis in southern rajasthan, india. Fluoride 2001;34(1):61-70

15.Hussain J et al. fluoride in drinking water in Rajasthan and its ill effects on human
health. Journal of Tissue Research 2004;4(2):263-73.
16.http://www.cdc.gov/oralhealth/topics/dental_sealant_programs Accessed on 06/01/2016
17.SCHOOL-BASED FISSURE SEALANT PROGRAMME. Second Edition. Ministry of
Health, Malaysia. 2003
18.http://mdm.nic.in Accessed on 6 january, 2016
19.Jong AW. Community dental health. 3rd edition. Missouri: Mosby Inc.; 1993.
20.http://www.colgate.com/app/BrightSmilesBrightFutures/US/EN/Our-Commitment.cvsp
21.Ministry of Health and Family Welfare, Govt. of India’s website:
http://mohfw.nic.in/WriteReadData/l892s/2099676248file5.pdf

22. http://www.who.int/school_youth_health/assessment/raapp/get_started/en Accessed on
10/01/2016
23. Improving school health programmes: Barriers and Strategies. World Health Organization.
Geneva 1996

School health programmes (DENTAL)

School health programmes (DENTAL)

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School health programmes (DENTAL)