Increasing school-based health centers with an oral health component

by Carolina on December 15, 2009

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Author: Dr. Arana

“Dental caries is the single most common chronic disease of childhood, occurring five to eight times as frequently as asthma, the second most common chronic disease in children. Despite the reduction in cases of caries in recent years, more than half of all children have caries by the second grade, and, by the time students finish high school, about 80 percent have caries. Unless arrested early, caries is irreversible “(HP2010).

The HP2010 Oral Health overall goal is to prevent and control oral and craniofacial diseases, conditions, and injuries and improve access to related services. In order to reach that goal, oral health segment is divided in seventeen specific objectives from which I choose increasing school-based health centers with an oral health component.

In recent years, schools are considered appropriate settings for health promotion for children, since the school may provide an environment for improving health, self-esteem, behaviors and life skills. A model for health promotion in schools, known as Health Promoting Schools (HPS), was defined as ‘a school constantly strengthening its capacity as a healthy setting for living, learning and working’ (WHO, 1998). This definition improve the health status of the school’s community; health and education professionals, and the school’s community work all together to make the school a healthy place, provide a healthy environment, and implement policies and practices that will support school-based health centers incorporate oral health component.

Schools provide multiple opportunities for health; it is a setting that explicitly supports students’ physical, emotional and social wellbeing in addition to their academic achievement. For these reasons, implementing oral health education and services in the school environment will contribute familiarize not only students and education professionals but also parents, with the oral health field and provide information and promote strategies that will improve the oral health status of the community. At the same time, this oral health component includes oral care services and in some cases referrals. These alternatives of dental treatment and control, monitoring and follow ups are key elements for prevention and promotion in oral health. All those intervention will contribute to reduce prevalence of health conditions, chronic and infectious diseases caused by unhealthy oral conditions.

Promotion of oral health will increase awareness respect dental care in children and will reinforce the necessity to establish school-based health centers with an oral health component.

The School-Based Preventive Dental Programs created by the New Hampshire Department of Health & Human Services is focus on oral health prevention providing preventive dental care services.  Preventive dental care procedures are an important aspect to control and reduce undesired dental conditions within children and community. The school-based preventive dental programs are more oriented to reduce dental caries, untreated dental decay in children, and increase preventive services, such as sealants in 8 year old first molars. These programs work to extend dental services including dental treatments and screening to low-income children and adolescents.

It is known that dental disease is preventable; however, dental care is the most common unmet health treatment need in children. In the U.S., 9 million children lack health insurance, and more than twice that number lack access to oral health services (NCSL, 2009). Untreated dental caries can lead to pain, weight loss, missed school days, poor appearance, decreased self-esteem and even death.  For these reasons childhood tooth decay disproportionately affects low-income families and racial or ethnic minorities. The rate of untreated dental caries in children from families with incomes below the poverty level is double than of non-poor children.

According to the National Survey of Children’s Health in 2003, Hispanic children were the least likely racial/ethnic group to receive preventive dental care.  Increasing the proportion of school-based health centers with an oral health component, will contribute to increase preventive dental care to low-income children improving their oral health status, and at the same time will provide education and information about dental health conditions, risk factors, diagnosis, prevention and treatments. All this together will enhance the wellness of the community reaching a sensitive and vulnerable part of the community such as children and their parents.

The Center for Health and Health Care in Schools program is more concentrated on evaluation of school-based health centers in terms of delivery and quality of dental care services. Evaluation is a very important part of the planning and conducting interventions and it is a way to understand, control, monitor, and analyzed programs and outcomes getting valuable information for future and existing programs. Having this evaluation component we expect to get better results from the programs, and also implement new strategies or improve and avoid old ones. In this manner, the Center for Health and Health Care in Schools will contribute to achieve better health outcomes for children and adolescents through school-connected health programs and services, and will expand school-based health center services to include dental health and mental health care. Evaluation of school-based health centers will provide valuable information related to new strategies and better outcomes that might support the idea of increasing the proportion of school-based health centers with an oral health component. This is a more evidence-based way to prove and enforce this HP2010 oral health objective.

It is important to consider that dental disease is the most common chronic illness for children in the United States. According to the Centers for Disease Control and Prevention (CDC) more than one-quarter of children have tooth decay in baby teeth before entering kindergarten. By age 19, 68 percent of youth have experienced tooth decay in permanent teeth.  This information should call for an immediate implementation of preventive and promotion interventions to reduce the prevalence of dental disease the most common chronic illness for children in U. S.

The Boston University/Chelsea Partnership Dental Program is working in increasing preventive dental services including dental care screening and referrals, and providing access to dental services for low-income children, as well as, oral health education. The program is focus on oral health education, screening, and referral services. Sometimes patients need to be referred to a specialty dental service. This method is a different approach of dental disease. Increasing the proportion of school-based health centers with an oral health component will provide more opportunities not only to educate and promote oral health, but also to provide preventive dental services and treatments that will have a follow up and referral components necessary to control dental health status and maintain a stable health condition in children requiring specialty care. Through school-connected health programs and services, a dental health network will be created providing access to dental care to low-income children and families. This approach might give the opportunity to have a continuous access to dental care and maintain in control the dental health status of children, and in some cases of families.

Boston University/Chelsea Partnership Dental Program is a comprehensive program that tries to provide access to oral health care, and at the same time educate and inform children including their parents. The program increases awareness of dental health and enhances access to routine screenings and preventive and restorative care.

In conclusion, in order to reach one of the  HP2010 oral health objectives: Increase the proportion of school-based health centers with an oral health component; programs like the ones described above should contribute to the prevention, awareness, control, promotion, evaluation, and access to dental health care necessary to the wellness of the community specifically for children. Those programs should effectively prevent and decrease decay for children and adolescents improving the “health” of populations as well as the nation. The comprehensive model of those school-based health centers with an oral health component should focus on prevention, treatment and educational needs for children as they relate to oral health. In addition, it is important to consider that state legislators can play important roles in improving children’s oral health. This is related to aspects such as funding, availability of resources and cost-effectiveness analysis of the programs that should be considered by the time of planning and conducting any type of intervention.

Increasing the proportion of school-based health centers with an oral health component will contribute to promote and prevent one of the most common chronic disease in children in United States which is dental caries. Incorporate comprehensive oral health programs in schools will ensure a better approach to dental decay and other health conditions related to unhealthy oral stage. Overall, increasing  school-based health center with an oral component  will contribute to the key elements necessary to improve oral health status in children including promotion, prevention, awareness, and access to oral care.

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