Oral Health in Schools

This information outlines the key components of effective school-based oral health practices and provides practical tips and resources to help schools and primary care providers improve oral health for students.

• Early childhood caries (ECC) are the most common chronic childhood disease in the United States. Left untreated, tooth decay (dental caries, cavities) can lead to infection and pain that inhibit a child’s ability to eat, sleep, speak, play and learn.
• Students miss an average of more than 34 million school hours each year because of acute/unplanned dental care.
• Dental disease is often accompanied by other chronic childhood comorbidities such as diabetes, heart disease and food insecurity/malnourishment.
• Persistent oral health disparities result from the same social determinants of health that drive other disparities affecting children, families, communities and the health care system. For more information about these impacts, see the Centers for Disease Control and Prevention (CDC) resource on Disparities in Oral Health.
• According to the most recent surveillance data from the National Health and Nutrition Examination Survey (2011-2016), 23% of children aged 2-5 and 52% of children aged 6-8 have cavities in their primary teeth. Additionally, 10% of tooth decay in children aged 2-5 and 16% of tooth decay in children aged 6-8 went untreated. In permanent teeth, 17% of children aged 6-11 had cavities, and 57% of adolescents aged 12-19 had cavities

School-based Oral Health Programs

School-based oral health programs are designed to address access barriers for high-risk children to prevent dental decay and improve overall health and academic success. Aligned with the CDC’s Whole School, Whole Community, Whole Child (WSCC) model, these programs can provide:

• Oral health education for students, parents, and school staff
• Promotion of healthy school nutrition
• Oral health screening including topical fluoride application and referral as needed
• Dental sealants
• Comprehensive dental care including preventive services as well as treatment for oral disease and dental injury
• Oral healthcare coordination and identification of a dental home

Programs are optimally coordinated through, or in partnership with, school nurses to insure integration with overall school health services. Services may be provided in school buildings through school nursing or school-based health centers, drop-in services - including mobile vans operating on school grounds or maybe school-linked but provided in the community.

The AAP oral health risk assessment tool (Spanish) can by incorporated to assist in screening, counseling, and referral of children to a dental home.

The Role for Pediatricians in Supporting School-Based Oral Health Programs

Pediatricians can promote child oral health through collaboration with schools and districts and with school nurses to advocate for evidence-based school oral health programs.

Existing AAP recommendations for pediatricians are:

• One full-time professional school nurse in every school with medical oversight from a school physician in every school district. School nurses are critical in coordinating school-based oral health services in the context of school health services and the WSCC model.
• Support school-based health centers (SBHCs) – SBHCs can provide oral healthcare coordination and/or direct oral health services as well as primary care, mental, and vision care.
• Coordinate care with school nurses and school-based health centers.
• Develop school health advisory councils or participate on established school health advisory councils.

Pediatricians can also:

• Learn about oral health programs in local schools and provide patients with information to support their access to critical oral health services.
• Advocate for comprehensive school-based oral health programs as described above.
• Support coordination between school-based programs and medical and dental homes, particularly through partnership with school nurses.

The Critical Role of School Nurses

Pediatricians have long recognized the important role school nurses play in the health and well-being of school-age children. According to the AAP policy Role of the School Nurse in Providing School Health Services, when pediatricians collaborate with, support, and promote school nurses in their communities, the health and safety of children and adolescents improve. The statement addresses the expanding role of school nurses and the importance of the relationship between pediatricians and school nurses to improve the health and academic achievement of students.

Helpful Resources:

AAP Oral Health Practice Tools
These tools help pediatricians integrate oral health into practice and learn how to perform an oral health risk assessment, provide anticipatory guidance and apply fluoride varnish as vital components of well-child exams.

AAP Oral Health and Education Training
These resources help pediatricians identify oral disease, provide caries prevention services and establish referral relationships with dental professionals.

Smiles for Life National Oral Health Curriculum
The Smiles For Life curriculum is made up of discrete modules to ensure the integration of oral health into primary care.  

The Partnership for Integrating Oral Health Care into Primary Care Project (PIOHCPC) 2019–2021: Final Report
This document discusses the importance of integrating oral health care into primary care. It also provides information about the implementation of the PIOHCPC project including project strategies, activities and findings.

The Community Preventive Services Task Force (CPSTF)- Improving Oral Health: School-Based Dental Sealant Delivery Programs Community Guide
This guide summarizes recommendations for school-based programs to deliver dental sealants and prevent dental caries (tooth decay) among children.

Oral Health in America: Advances and Challenges 2021
A culmination of 2 years of research and writing by over 400 contributors. As a follow up to the Surgeon General’s Report on Oral Health in America, this report explores the nation’s oral health over the last 20 years.

Promoting Oral Health Care in Schools: A Resource Guide (4^th Edition)
This resource guide is divided into two sections. The first section describes materials, such as brochures, fact sheets, guidelines, curricula, and reports. The materials listed in this section were published from 2015 to 2019. The second section lists federal agencies, national professional associations, resource centers, and national coalitions that may serve as resources.

Best Practice Approaches for State and Community Oral Health Programs (March 2017)
This report describes a public health strategy, assesses the strength of evidence on the effectiveness of the strategy, and uses practice examples to illustrate successful/innovative implementation.

Resources for Families:

Healthychildren.org Oral Health
This website provides information to families about various oral health issues, needs, and strategies throughout childhood.

American Academy of Pediatric Dentistry My Children’s Teeth
This website provides oral health information based on ages and stages as well as the special needs of children.

CDC Children’s Oral Health
This website provides prevention strategies for families to help improve oral health and hygiene as well as prevent caries.