Schools provide an important setting for oral health promotion, as they reach over a billion children worldwide. Through school children, the school staff, families and the community as a whole are benefited from the oral health programs carried out at schools. This presentation covers major oral health programs implemented in schools across Middle East and Asia

1. SCHOOL ORAL HEALTH PROGRAMS
(MIDDLE EAST AND ASIA)
AND EVIDENCES FOR JUSTIFICATION
1

2. CONTENTS
• Oral health programme – MALAYSIA
• DUBAI Smiles healthy
• JAPAN – fluoride mouth rinse program
• Fit for school program, PHILLIPINES
• KUWAIT-FORSYTH school health program
• UMN oral health program NEPAL
• School Health Program, PAKISTAN
• Status of school health programs in INDIA
• Evidences for justification of school oral health programmes
2

3. INTRODUCTION
• Schools provide an important setting for oral health promotion, as they
reach over a billion children worldwide. Through school children, the
school staff, families and the community as a whole are benefitted from
the oral health programs carried out at schools.
• The health and education of children are a public good that lies at the core
of government policies and programmes.
3

4. Tip
Don’t wait till the end of
the presentation to give
the bottom line.
Reveal your product or
idea (in this case a
translation app) up front.
Primary Oral Healthcare is delivered to the
population by target groups namely
• The toddlers
• Pre-school children
• Primary and secondary schoolchildren,
• Antenatal mothers
• Children with special needs
• Adults and the elderly.
4

5. Toddler Programme
• The EARLY CHILDHOOD ORAL HEALTHCARE PROGRAMME
• is an extension of the antenatal programme
• targets postnatal mothers and parents/carers of children aged 4 years and below who are seen
under the Child Health Services of the Ministry of Health (MOH).
• The main objective of the early childhood oral healthcare
programme is to promote and maintain good oral health of
toddlers towards achieving their optimum growth and development.
5

6. Pre-School Service
• The oral healthcare programme for PRESCHOOL CHILDREN
was launched in 1984 for kindergartens.
• This programme utilizes a friendly, non-invasive approach whereby dental nurses introduced
dentistry to children via promotional and preventive initiatives.
• These include tooth brushing sessions, puppet shows, role-play and other fun activities.
• In keeping with the non-invasive approach, Atraumatic Restorative Technique (ART) is
adopted to provide necessary restorative care for the children.
6

7. School Dental Service
• The main thrust of the public oral health services.
• Oral healthcare to primary and secondary school children is delivered through the
School Dental Service (SDS) which utilizes the Incremental Dental Care Approach,
• A systematic and comprehensive approach for delivery of care with the final objective that the children achieve an orally-
fit status.
• Care is delivered mainly at school dental clinics, dental clinics, mobile dental teams and complemented by mobile dental
clinics.
• The SDS has been successful at reducing the caries experience of school children. Expansion to reach almost 98.2% of
primary and 84.0% of secondary schoolchildren in 2009 has been largely through the outreach strategy implemented since
the early 1970s.
• These mobile teams utilizing portable equipment, have brought oral healthcare to even the most remote areas. Mobile
dental teams has increased about 37-fold from 13 in 1970 to 476 in 2008.
7

8. Service for Children With Special Needs
• The Oral Health Division has recognized children with special needs as one of the priority
groups.
• A programme for CHILDREN WITH SPECIAL NEEDS was launched in 1993 with
emphasis given to the disadvantaged group at outpatient clinics.
• The objective of this programme is to improve oral health of children with special needs
that will contribute to enhanced quality of life.
• Inculcating good oral health practices, increasing
awareness of carers of children with special needs and
improving skills of dental personnel are some of the activities carried out.
8

9. 1) MY SMILE” - Tooth brushing program for
school children in Dubai, UAE.
2) DUBAI SMILES HEALTHY- Reaching
children at their own schools and nurseries
9

10. MY SMILE – Tooth Brushing Programme
 Introduced by Dr Shiamaa AlMashhadani in 2017
 Introduced to 12 Government and Private schools in Dubai, covering 1500 students aged
4-6 years old.
 ORGANIZATIONS INVOLVED
The Ministry of Health and Prevention, The Knowledge and Human Development Authority
,School health and Educational Institute Unit, The private companies and Dental Services
Department, Dubai Health Authority
10

11.  Schoolchildren were provided with free
toothbrushes appropriate for their age,
fluoridated toothpaste and customized tooth
brushing charts to record their daily tooth
brushing
 A training workshop was conducted for the
oral health coordinators (school nurses) that
were assigned to supervise the daily tooth
brushing after meals and provide guidance
and support to the students. 11

12. The program involved two forms of tooth brushing based on the facilities in school.
Dry tooth brushing:
 Schools that did not have the facility for children to go
to washrooms to brush their teeth and spit excess
toothpaste were given instructions to brush in their
classrooms using appropriate amount of toothpaste and
spit in cups or paper towels and were disposed of
appropriately.
Wet tooth brushing:
 Schools that had enough washrooms that accommodated the students
were requested to take their tooth brushes with the proper amount of
tooth paste and brush their teeth on the sink, rinse their tooth brushes
and replace them back in the storages.
 Toothpaste was placed on paper plates to help in infection control and
enables the use of one toothpaste tube to be used for more than one
student 12

13.  A dental team of two dentists and two dental hygienists
visited each school and conducted dental check ups using
the visible plaque index (VPI) in a mobile dental van.
 Main concentration was to measure the plaque
accumulation on the teeth surfaces for the students aged
4-6 years, as they were the age group with the highest
caries prevalence based on the previous screening
conducted in Dubai.
Results were recorded for each student on oral hygiene forms and
were placed in the student’s medical file in the school with the
supervision of the school nurse.
13

14.  Parents were invited on the same day to have an introduction on the tooth brushing scheme and information
given on healthy diet and good oral hygiene habits and tooth brushing charts were distributed to help them
follow up on the brushing at home.
Follow up from the dental team with oral health coordinator was done on a weekly and
monthly basis. 14

15. DUBAI HEALTHY SMILES
• A national oral disease preventive program designed to improve the oral health of
children in Dubai.
It has three main components:
1) Dubai Smiles Healthy School Practice
2) Dubai Smiles Healthy Child Health
3) Dubai Smiles Healthy School Nurse Training
15

16. Dubai Smiles Healthy- School Practice- Reaching children at
their own schools and nurseries:
• In order to provide preventive dental care delivered in the
nursery and school setting, a dental team was set to visit
these schools with mobile dental vans.
• The dental team consisting of one dentist and 6 dental
hygienists who are all trained and calibrated periodically to
perform screening and oral preventive measures based on
the WHO standards.
Visits to these schools and nurseries twice yearly for preventive measures which include routine
dental check up of the teeth, filling referral forms for high risk patient sent to the guardians to
complete their dental treatments with their local dentist and placement of topical fluoride varnish.16

17. They also promote good oral health behaviour by emphasizing on four points:
1-Proper tooth brushing techniques and routine oral hygiene: Children get to have a hands on experience and
demonstrate their skills in tooth brushing and flossing in front of each other with the guidance of the dental hygienist
2-Dietary advice: what are cariogenic foods vs. healthy foods (foods that make teeth sad and happy) Children get to
sort out different kinds of food in to groups using models and pictures
3- Placement of fluoride varnish (making our teeth strong to fight cavities): Children get an application of fluoride
varnish placed on their teeth and learn why this is placed and how it helps prevent the acid attack of sugar bugs.
4- Why we have to visit the dentist and what to expect on a dental visit: Children see an educational video; have
hands on experience of a real dental clinic through the mobile dental van. They sit on the dental chair and are free to
touch and ask the hygienist about their doubt. The feeling of fear is tackled since the children have the dental clinic
within the school premises, which is a more comfortable and familiar setting.
17

18. Dubai Smiles Healthy- Child health session:
Each session includes the following:
• How to care for your child’s dentition
• Dietary advice and the healthy way to feed your child
• Avoiding bad habits from childhood (thumb sucking,
pacifiers, etc.…)
• Breast feeding verses bottle feeding
• Resources for families to look up at home
• Advise parents to talk to their children about dental
visits in a positive way.
 There are three sessions per week in the main large
health centres and once a week in the smaller
centres.
 Dental hygienists lead these sessions after they
undergo proper training and educational sessions.
A printed guide in a form of a flip chart
18

19. Dubai Smiles Healthy - School Nurse training
 Goal of this training is to create an educational
infrastructure for the school nursing profession
that advances’ nursing’s contribution to reducing
oral health problems across Dubai schools.
 In 2015, there were 290 nurses trained to conduct
simple oral check ups, oral health promotion
sessions
which included three basic points of a healthy
oral environment in their schools
 Maintaining routine oral hygiene
 Dietary advice
 Importance of routine visits to the dentist.
19

20. Tip
Don’t wait till the end of
the presentation to give
the bottom line.
Reveal your product or
idea (in this case a
translation app) up front.
Fluoride mouth rinse
programme
20

21. INTRODUCTION
• In Japan, the first trial of the school-based fluoride mouth rinse programme (FMR) was started in
1970 in Yahiko Primary School, Niigata. In 1978 in order to prevent the dental caries of
1st permanent molars erupting in preschool age, the FMR was also practiced in nursery schools.
• Since the number of schools carrying out this programme has gradually increased
• The Ministry of Health, Labour and Welfare in Japan released the guidelines in 2003,
recommending that the FMR be introduced from preschool age children.
• At present, about 500,000 children participate in the school-based FMR, at national level.
Limited to the nursery schools and preschools, the number of children accounted for about 30%
of all children practicing FMR. 21

22. Project outline
The procedure of school-based FMR is as follows:
• The school dentist writes prescriptions for fluoride rinsing solution, that is, amount of water
as a solvent and amount of fluoride medicine dissolved in the water according to number of
children in each school, to the school pharmacist, school director and principal.
• The pharmacist prepares the fluoride medicine according to the letter and delivers the
medicine to the school.
• In nursery school and preschool, the director or vice-director
makes fluoride solution enough for all children according to
the instructions and divides the solution among classes.
• The school nurse makes fluoride solution in primary
and junior high school.
22

23. • Preschool-aged children have practiced daily using 7 ml of 0.05% sodium fluoride (NaF)
solution for one minute under the supervision of schoolteachers.
Primary and junior high school children have practiced the weekly method using 10ml of 0.2
% NaF solution.
• Before starting practicing FMR, children are trained rinsing with tap water for a month.
• School-based FMR have been practiced since the age of 4-5 years when the permanent teeth
would begin to erupt and continued until graduating from junior high school when the
permanent dentition would be completed.
• In Japan the school-based FMR has been practiced as a health policy in municipality.
Accordingly, most municipalities supported the cost of the programme. 23

24. • In each classroom a schoolteacher
distributes a paper cup containing 7ml
(10ml) of fluoride solution to children.
• Hereafter children rinse together for a minute
• After a minute they spit the solution in
his/her paper cup. The cups of all
children were gathered and disposed by
burning. 24

25. 25

26. 26

27. OVERVIEW
• School children in the Phillipines suffer from a high burden of preventable diseases, with hygiene
deficiencies as a common cause, i.e. lack of basic personal hygiene and poor access to sanitation
• To address this The Essential Health Care Program (EHCP) was implemented by the Department of
Education
• The EHCP started on a limited scale with pilot programs in 2003, and received its formal launch in 2008 in
Phillipines.
• In 2011, commissioned by the German Federal Ministry for Economic Cooperation and Development, the
Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) and the South-East Asian Ministers of
Education Organization Regional Centre for Educational Innovation and Technology (SEAMEO INNOTECH)
partnered to expand the FIT approach to Cambodia, Indonesia and Lao PDR as the ‘Regional Fit for School
Programme’. 27

28. 28

29. Programme outline
The “Fit for School” programme intervenes and prevents diseases among children by institutionalising
healthy behaviours at school.
• Daily supervised hand washing with soap.
• Daily supervised tooth brushing with fluoridated toothpaste.
• De-worming children bi-annually by swallowing albendazole tablets.
The finance and procurement of needed consumables like soap,
toothpastes, toothbrushes and medication are provided by the
Health sector.
29

30. 30

31. • In all three countries, children in intervention schools had a lower prevalence of dental caries in the permanent
dentition at follow-up and a lower increment in DMFT between baseline and follow-up in comparison to
children in controls schools, although these were only statistically significant in the overall sample.
• The preventive fraction for DMFT was 23.9% in the overall sample, and 18.3%, 22.4%, 38.0% in Cambodia,
Indonesia and Lao PDR, respectively
31

32. KUWAIT
FORSYTH
SCHOOL DENTAL
HEALTH
PROGRAM
1982-2011 32

33. PROGRAM OUTLINE
• School Oral Health Program, Kuwait is a comprehensive school-based/linked program providing
Oral health Education, Prevention and Treatment to almost 270,000 Kuwaiti school children..
• This program is a joint venture between Ministry of Health, Kuwait and Forsyth Research
Institute, Boston, USA.
• This program was established in 1982-83 on pilot basis and expanded later. This is one of the
largest/long standing School Oral Health Program in the world and only one of its kinds in the
Gulf region where there is a great need for such programs.
33

34. Program History
34

35. KG Schools /
Students
Primary Schools /
Students
Intermediate Schools /
Students
Total Schools /
Students
196 246 175 617
40,564 128,744 90,663 259,971
Target Population
• In brief, this school-based program provides only Oral health promotion and Prevention to
Kindergarten children, Oral Health Promotion, Prevention and Treatment to all the children in
Primary and Intermediate schools.
• Hence this program covers all the school children in the age range of 4 to 15 years. All the
services are provided to children with positive consents.
35

36. Program Activities – Health education
1. All the students get at least two oral health education lessons with supervised tooth
brushing during every school year.
2. Oral health education sessions are organized for parents and pregnant mothers.
3. Dental health education programs are conducted for school teachers.
4. Participating in school activities.
5. Participating in the community activities in public places.
6. Each year around 4,000 hours are spent on health education.
7. Concentrated efforts to make health education need-based.
8. Health Education Teams work closely with Prevention Teams…..
9. Recently Department has come up with 10 new brochures and 6 posters.
10. Since 2008-2009, 80,000 emails and SMSs are being sent with important messages each
year…. 36

37. 37

38. Prevention
• Biannual application of Fluoride varnish and Pit and Fissure Sealants on newly erupted Permanent molars
and pre-molars are the forms of primary prevention performed under SOHP.
• Fluoride gel was replaced with Fluoride varnish since 2006.
• Today SOHP has 43 mobile teams for Sealants and around 30 teams for fluoride varnish application.
These teams cover schools that do not have
fixed dental clinics.
38

39. TREATMENT
• Treatment is provided to all the children in the age group of 6 to 16 years with positive consents.
• Treatment is performed in centre-based and school-based clinics.
• General Paediatric dentistry procedures are performed along with Root Canal Therapy.
• All the procedures performed are outlined in SOHP clinical protocol.
• Procedures are performed on quadrant basis in order to minimize the no. of appointments to the
child.
• Four-handed dentistry is practiced for all the procedures.
39

40. PROGRAM EVALUATION
• Staff evaluation: Both clinical and non-clinical staff are evaluated on annual basis.
• Outcome evaluation: Overall effectiveness evaluated once in 5-6 years. Based on
evaluating the oral health status of 4 to 16 year old children under the program.
• Evaluation of clinical and infection control procedures were performed.
• Evaluation for sealant retention :
• Short term retention checks
• One year Sealant retention checks
40

41. 41
ACHIEVEMENTS
• Today SOHP has become a trend setter in the field of school-based
oral health prevention and evaluation and hence a model for oral
health planners in gulf region.
• The SOHP made a major policy change to seal non cavitated caries
lesions which otherwise would have gone for restorations. .

42. UMN ORAL
HEALTH
PROGRAM
42

43. PROJECT OVERVIEW
• The project achieved health promotion outcomes including healthy corporate and public
policies and organisational practice and intermediate outcomes such as increased
availability and consumption of affordable fluoridated toothpaste.
• Prior to implementation of the advocacy project in 1997, availability and consumption of
fluoridated toothpaste was negligible.
• By March 2002 total market share of fluoridated
toothpaste was approximately 90%.
• This represents an annual tonnage of 900 tons of
fluoridated toothpaste.
43

44. SCHOOL
HEALTH
PROGRAM
44

45. Program overview
Basic components or pillars of SHP
SCHOOL HEALTH EDUCATION
Education of students on health and hygiene
issues, through integration of health and hygiene
information messages into the curriculum, and
training of teachers on following themes form part
of the School Health programmes.
45

46. SCHOOL HEALTH SERVICES
• Health screening (medical check up) of
students on regular basis.
• Referral of students with health problems to
medical centres for treatment or
rehabilitation.
SCHOOL NUTRITION PROGRAM
• Good supplements for malnourished children
• Food as incentive to enhance enrolment and
attendance
• Promotion of use of iodized salt
• School feeding or school lunch programme
for all students in schools
46

47. 47

48. 48
As of August 2018
Chahar P, Jain M, Sharma A, Yadav N, Mutneja P, Jain V. Schools as opportunity for oral health
promotion: Existing status in India. Indian Journal of Child Health. 2018:513-7.

49. National School Oral Health Programme
IDA has drafted National School Oral Health Program to address oral health issues in schools. The primary
objectives are to:
• Educate school authorities about the link between oral health and student learning and achievement
• Develop a policy framework that supports and offers solutions
• Share knowledge of best oral health practices in schools
• Encourage school-based oral health projects
IDA is dedicated to the vision of “oral health for all.” The association provides leadership in advocacy, education
and public policy development; promotes community-based prevention strategies; encourages the integration of
oral health into total health; and works to improve access to and the quality of oral health services. 49

50. A flagship initiative by the Company, it was created with an aim to spread
awareness among children about the correct oral health habits, basic hygiene and
diet, through use of engaging aids to ensure that the children retain their learning
about oral care.
Since the inception of the program in 1976, the Company has been delivering oral
health education to children, in partnership with the Indian Dental Association (IDA)
through their network of committed dental professionals, by reaching out to
influencers – like school teachers and the Anganwadi workers in the community to
promote preventive oral care education.
50

51. • Children between the age group of 6 to 14 years, studying in primary schools, are taught good oral
hygiene habits, the right techniques of brushing with the use of a tooth model and a toothbrush, the
importance of night brushing through an interactive module where the importance of a good mouth
cleaning regimen is strongly instilled in them.
• At the end of the program, each child is given a ‘Dental Health Pack’ consisting of a toothpaste and a
basic toothbrush, along with attractive charts depicting valuable oral care information in order to
encourage these children to brush twice a day and take care of their oral care hygiene.
• Colgate Bright Smiles, Bright Futures® has so far touched the lives of 145 plus million school children
between the age of 6 – 14 years across schools in urban and rural India till December, 2017.
• In the year 2016-17 alone, Colgate Bright Smiles, Bright Futures® reached 9.5 million children across the
country.
51

52. 52
Pit and Fissure Sealant Pilot Project - National Oral Health
Program (NOHP), AIIMS, New Delhi
• Under the central component of NOHP, the current pit and fissure sealant
project have been launched, for which training of representatives from 12
dental colleges was done on May 1, 2017.
• The project is in the execution stages by these dental colleges, who have
to seal 5000 molars per college.

53. 53

54. There is no record of an organized school dental health program on a national basis in India.
School programs are basically conducted by dental teaching institutions and other
professional organizations as a part of their community out reach programs.
Even though India has a school health program under National rural Health mission activities,
the oral health component is missing.
54

55. EVIDENCES FOR
JUSTIFICATION OF
SCHOOL ORAL HEALTH
PROGRAMMES
55

56. PAST EVIDENCE
No evidence to show
that DHE was effective
against dental caries
56

57. • Traditional oral health educational
actions were effective in reducing
plaque, but not gingivitis.
• There is no long-term evidence in
respect of the effectiveness of these
interventions in preventing plaque
accumulation, gingivitis and dental
caries in the school environment.
2017
57

58. Most studies evaluating behavioral and
periodontal outcomes have shown
significant improvements in favor of
interventions.
All studies evaluating caries have shown a
reduction in new lesions or cases of the
disease in the groups receiving the
interventions, although
only five of the eleven articles have found a
statistically significant difference
2018
58

59. 2013
59

60. • Couldn’t draw conclusion to traditional school
dental screening in improving dental
attendance due to low evidence.
• Criteria-based screening may improve dental
attendance when compared to no screening.
• Personalised or specific referral letters improve dental attendance when compared to
non-specific counterparts.
• Screening supplemented with motivation (oral health education and offer of free
treatment) improves dental attendance in comparison to screening alone
60

61. MEDICAID
The median annual economic benefit
was $6.29, suggesting that over 4 years
the SSP benefit ($23.37 at a 3% discount
rate) would exceed costs by $11.73 per
sealed tooth.
In addition, two of four economic models
and all three analyses of Medicaid claims
data found that SSP benefit to society
exceeded SSP cost.
61

62.  Application of fluoride gels,
either by professionals or self-
applied, is associated with a clear
reduction in caries increment.
 Strong evidence, established by
systematic review with meta-
analysis, setting the effectiveness
of topical fluoride use on cavity
prevention in children and
teenagers
62

63. Supervised tooth brushing, there is some
evidence on its efficacy and cost-
effectiveness
63

64. CONCLUSION
64
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.

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