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Rural Health Information Hub

School-Based Model

In school-based models, oral health programs provide evidence-based oral healthcare services like screening, fluoride varnish, and dental sealants to children. Dentists, dental hygienists, and community health workers deliver preventive dental services within schools.

School-based programs offer an opportunity to introduce dental hygiene students to the needs of rural populations, and can increase the rural oral health workforce in the long-term (see Workforce Models). For example, a rural oral health program in South Dakota uses dental hygiene students to perform screenings, fluoride varnish, dental sealants, oral health education to students, and if needed, refer patients to local dentists that have agreed to treat more complex cases. Dental hygiene students and their professors travel to rural school sites to deliver services.

Another program in rural Montana utilizes a community health advisor to apply fluoride varnishes for school children during dental screenings. Also, a program in rural Louisiana is educating medical and allied health professionals about how to apply fluoride varnish in schools.

The Northeast Oral Health Project in Sterling, Colorado promotes the health of school children by employing a school-based dental sealant program, providing dental screenings and oral health education on proper brushing and hygiene.

For an example of a school-based model, see School-Based Health Center Dental Outreach in the Rural Health Models and Innovations section.

Implementation Considerations

There is strong evidence that school-based oral health programs prevent cavities, particularly among children from families with lower incomes. School-based programs improve access to oral healthcare and are cost-effective since they may combine several services in one visit (for example, performing a screening and applying varnish in the same visit). In addition, the use of dental hygienists instead of dentists can reduce the cost of services.

Oral health programs implementing school-based models must create consent forms to obtain the appropriate permissions from parents and school administrators to work with school-aged children. A school nurse or school counselor may serve as an outreach coordinator that can assist the dentist in coordinating the program. Rural oral health programs implementing school-based models may have support from community partners, such as the health department, state office of rural health, universities, and state dental and dental hygienists associations.

Resources to Learn More

Dental Caries (Cavities): School-Based Dental Sealant Delivery Programs
Promotes school-based and school-linked dental sealant delivery programs as recommended by the federal government's Community Preventive Services Task Force (CPSTF) and based on evidence of effectiveness in preventing or reducing tooth decay among children.
Organization(s): Community Preventive Services Task Force
Date: 4/2013

Fluoride Varnishes for Preventing Dental Caries in Children and Adolescents
Presents the findings from 22 trials where 12,455 children and adolescents were treated with fluoride varnish or a placebo/no treatment to determine if fluoride varnish can effectively reduce tooth decay in both primary and permanent teeth.
Authors(s): Marinho, V., Worthington, H., Walsh, T., & Clarkson, J.
Citation: Cochrane Database of Systematic Reviews, 13,(7)
Date: 7/2013

Seal America: The Prevention Intervention, Third Edition
A step-by-step curriculum for health professionals when developing and implementing sustainable school-based dental sealant programs for the prevention of dental caries in children and adolescents.
Author(s): Carter, N. & Lowe, E.
Organization(s): National Maternal and Child Oral Health Resource Center
Date: 2016

Survey of School-Based Oral Health Programs Operated by Health Centers: Descriptive Findings
Presents the results of a national online survey of 62 School-Based Health Centers (SBHC) in 29 states, conducted in 2013, to obtain information about their school-based oral health programs.
Organization(s): National Network for Oral Health Access (NNOHA)
Date: 7/2014