School dental programs include screening students for dental needs, sealant programs to protect students’ permanent molars, fluoride treatment, and other preventive dental care. Services can be provided by dental professionals, often those employed by Federally Qualified Health Centers (FHQCs), via mobile vans parked at schools, or stationary or portable equipment within schools; services may be provided only in schools or students may be linked to clinics for additional care. Programs often serve school districts with high proportions of low income children and districts in rural areas1, 2.
Expected Beneficial Outcomes (Rated)
Other Potential Beneficial Outcomes
Increased access to oral health care
Evidence of Effectiveness
Sealant programs substantially reduce cavity formation in sound, pitted, and fissured teeth1, 7, especially for children in low income families1, 8. Effects are strongest when programs seal the newly erupted molars of second and sixth graders3, treat children with the highest risk of cavity development, and perform services directly in schools rather than at local clinics1. Sealants appear to stay on teeth longer when programs use two-person teams to apply them3, though additional personnel costs may reduce the number of students a program can serve9.
Fluoride supplements10, toothpastes, mouth rinses, gels, or varnishes also prevent cavities, though students may be most likely to use toothpaste11; sealants appear to be more effective than fluoride varnishes12. Fluoride treatments may increase the risk of fluorosis for children under age six13, 14; additional research is needed regarding potential adverse effects of swallowing fluoride gels11, 15.
School-based dental programs may reduce costs by performing screenings and applying sealants during the same visit1, and programs serving larger schools can reduce costs by employing an extra assistant and chair so that dentists and hygienists can move from one sterilized station to the next. Reducing supervision requirements for dental hygienists can also reduce the cost of sealant programs in many states9; school dental programs that employ dental hygienists to assess oral health and apply sealants cost less than programs with dentists in these roles1, 16.
The CDC considers preventively sealing all low income children’s molars a cost-effective strategy3; sealant programs are most cost-effective when focused on children with high risk of cavities7. Overall, school-based sealant programs appear to become cost saving within two years1. In Connecticut, Federally Qualified Health Centers (FQHCs) appear to have saved 50% per dental patient by treating children in their schools rather than in clinics17.
Services delivered via school partnerships with mobile dental clinics appear to reduce cavities among underserved children in rural areas18.
Impact on Disparities
Sixteen states support mobile preventive care, 25 states support restorative care, and 60% of state oral health programs sponsor fluoride varnishes for young children. As of 2010, 78% of states had dental sealant programs2.
School dental programs may be supported by a variety of private and public entities. Boston University, for example, runs five city-wide preventive dental programs, providing dental screenings, fluoride and sealant applications, and oral health education in 61 schools19. St. David’s Foundation in Central Texas provides dental care across six school districts via one of the largest mobile dental fleets in the country20. Multnomah County, OR and Dupage County, IL have programs tailored to serve children from families with low incomes21, 22.
ASTDD-Isman 2011 - Isman B. Mobile and portable dental services in preschool and school settings: Complex issues. Sparks: Association of State and Territorial Dental Directors (ASTDD); 2011: Issue Brief.
Mobile-Portable dental manual - Hill L, Jackson M, Teutsch M, et al. Mobile-portable dental manual. Washington, DC: Association of State and Territorial Dental Directors (ASTDD), National Maternal & Child Oral Health Resource Center (OHRC), Georgetown University.
Big Smiles Dental - Big Smiles Dental. Dental care right outside your classrooms.
* Journal subscription may be required for access.
1 CG-Oral health - The Guide to Community Preventive Services (The Community Guide). Oral health.
2 ASTDD-Isman 2011 - Isman B. Mobile and portable dental services in preschool and school settings: Complex issues. Sparks: Association of State and Territorial Dental Directors (ASTDD); 2011: Issue Brief.
3 CDC-Gooch 2009 - Gooch BF, Griffin SO, Gray SK, et al. Preventing dental caries through school-based sealant programs: Updated recommendations and reviews of evidence. Journal of the American Dental Association. 2009;140(11):1356–65.
4 Simmer-Beck 2015* - Simmer-Beck M, Walker M, Gadbury-Amyot C, et al. Effectiveness of an alternative dental workforce model on the oral health of low-income children in a school-based setting. American Journal of Public Health. 2015;105(9):1763–1769.
5 Carpino 2016* - Carpino R, Walker MP, Liu Y, Simmer-Beck M. Assessing the effectiveness of a school-based dental clinic on the oral health of children who lack access to dental care: A program evaluation. The Journal of School Nursing. 2016:1-8.
6 Niederman 2008* - Niederman R, Gould E, Soncini J, et al. A model for extending the reach of the traditional dental practice: The ForsythKids program. The Journal of the American Dental Association. 2008;139(8):1040-1050.
7 Tinanoff 2015* - Tinanoff N, Coll JA, Dhar V, et al. Evidence-based update of pediatric dental restorative procedures: Preventive strategies. Journal of Clinical Pediatric Dentistry. 2015;39(3):193–197.
8 CDC MMWR-Griffin 2016 - Griffin SO, Wei L, Gooch BF, Weno K, Espinoza L. Vital signs: Dental sealant use and untreated tooth decay among US school-aged children. Morbidity and Mortality Weekly Report (MMWR). 2016;65(41):1141-1145.
9 Scherrer 2007 - Scherrer CR, Griffin PM, Swann JL. Public health sealant delivery programs: Optimal delivery and the cost of practice acts. Medical Decision Making. 2007;27(6):762–71.
10 Cochrane-Tubert 2011* - Tubert-Jeannin S, Auclair C, Amsallem E, et al. Fluoride supplements (tablets, drops, lozenges or chewing gums) for preventing dental caries in children. Cochrane Database of Systematic Reviews. 2011;(12):CD007592.
11 Cochrane-Marinho 2015* - Marinho VCC, Worthington HV, Walsh T, Chong LY. Fluoride gels for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews. 2015;(6):CD002280.
12 Cochrane-Ahovuo-Saloranta 2016* - Ahovuo-Saloranta A, Forss H, Hiiri A, Nordblad A, Mäkelä M. Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents (Review). Cochrane Database of Systematic Reviews. 2016;(1):CD003067.
13 Pizzo 2007* - Pizzo G, Piscopo MR, Pizzo I, Giuliana G. Community water fluoridation and caries prevention: A critical review. Clinical Oral Investigations. 2007;11(3):189–93.
14 Prystupa 2011* - Prystupa J. Fluorine - A current literature review. An NRC and ATSDR based review of safety standards for exposure to fluorine and fluorides. Toxicology Mechanisms and Methods. 2011;21(2):103–70.
15 Ammari 2007 - Ammari JB, Baqain ZH, Ashley PF. Effects of programs for prevention of early childhood caries: A systematic review. Medical Principles and Practice. 2007;16(6):437–42.
16 Neidell 2016* - Neidell M, Shearer B, Lamster IB. Cost-effectiveness analysis of dental sealants versus fluoride varnish in a school-based setting. Caries Research. 2016;50(Suppl 1):78–82.
17 Bailit 2012a* - Bailit HL, Beazoglou TJ, DeVitto J, McGowan T, Myne-Joslin V. Impact of dental therapists on productivity and finances: III. FQHC-Run, school-based dental care programs in Connecticut. Journal of Dental Education. 2012;76(8):1077-81.
18 Enciso 2015* - Enciso R, Sundaresan S, Yekikian M, Mulligan R. Oral health status of children attending a mobile dental clinic—A comparative study. Journal of Health Care for the Poor and Underserved. 2015;26(4):1418–1427.
19 Boston School-based dental - Boston University, Henry M. Goldman School of Dental Medicine. School-based oral health programs: 5 city wide prevention programs operating in 61 Boston schools.
20 St. David’s Dental Program - St. David’s Foundation. St. David’s Dental Program: Bringing mobile dental clinics to high needs schools and social service agencies in Central Texas.
21 Multnomah-School oral health - Multnomah County, OR. School and community oral health: A field-based program that promotes oral health, disease prevention, and access to dental care for children.
22 Dupage County-Dental health - Dupage County Health Department, IL. Dental Health Program.
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