Jordan Griffin
History of dental hygiene leading to school based dental programs
According to the American dental society, “Dental hygiene is defined as the science and practice of the recognition, treatment and prevention of oral diseases” (Bowen, 2013, p. 5). The history of dental hygiene dates back to 1000 CE when the first toothbrush was said to have been used in China (Sgan-Cohen, 2005). Dr. E.L. Pettibone gave the first oral hygiene in a public school in 1909 (University of Michigan Dentistry). In fact, Tennessee was reported to be home of one of the first school-based dental programs in the United States in the 1970s (National Maternal and Child Oral Health Resource Center, 2009). Understood as one of the most important aspects of a healthy life, dental hygiene continues to prove itself vital in overall human health, mainly because the oral cavity, or the mouth (PubMed Health), “is a portal of entry to the body as well as the site of disease for microbial infections that affects general health status” (National Institute of Dental and Craniofacial Research, 2014). For example, having less teeth in your mouth can eventually lead to coronary heart disease (Joshipura, Rimm, Douglass, Trichopoulos, Ascherio & Willett, 1996, p. 1631). There have been many improvements in developed countries over the last 30 years in oral health care. However, oral health care inequalities remain a major public health issue in the United States. As with many other public health challenges, lower income and socially disadvantaged groups have experienced a disproportionately high level of oral disease (Matichescu, 2016). Studies show that for families who have “incomes below 200% of the federal poverty level”, the children are “less likely to receive dental care and more likely to have unmet dental needs than children from higher income families” (Kenny, McFeeters, and Yee, 2005, p. 1360). Being such an important aspect of health, various community-based programs have been developed in attempt to address disparities within oral health care from a young age. Namely, school-based dental sealant programs stand out as just one efficient solution to make oral health more equitable in this country.
School-based dental programs
Dental sealants are a preventive service provided by many dentists that essentially function as a long-lasting seal for the tooth, preventing bits of food that can cause tooth decay from settling in hard to reach nooks and crannies that are often missed during regular brushing and flossing (Pediatric Dentistry of Florida, 2015). Sealants are ideal for children in disadvantaged communities or families because they are lower in cost than other procedures, quick, painless with few side effects, yet are still very effective in preventing dental caries over time.
School-based dental sealant programs (S-BSPs) provide services that aid in dental cavity prevention and other preventive oral hygiene care (Siegal and Detty, 2010). These programs are often publicly funded and operated, functioning with oversight by public agencies, non-profit organizations, and educational institution. Studies on the efficiency of S-BSPs break down targeted areas into two categories: high risk and low risk. Schools in these targeted areas are classified to be higher or lower risk by utilizing social determinants elicited from public questionnaires (e.g., free reduced priced meal programs (FRPMP) enrollment, method of payment for dental care, timing of recent dental visit). S-BSPs are proven to be of special importance for lower income children who may lack private dental insurance. “According to the CDC, using school-based programs to provide sealants to roughly 7 million low-income children who lack them could save up to $300 million in dental treatment costs. A 2016 study revealed that an SSP serving 1,000 children prevents the need for 485 dental fillings” (Jacob, 2017).
https://www.youtube.com/watch?v=EFM0JbXkeH8
This video provides a look at The Center for Oral Health, an organization with a mission to provide people worldwide with adequate dental services by starting with local programs like S-BSPs. The video focuses on San Bernardino county in southern California. In the video important statistics on tooth decay and oral healthcare in underprivileged children are given. For example, by their 5th birthday, 70% of children born in San Bernardino county were projected to have some degree of dental disease. Lack of knowledge and limited access to dental care are listed as the primary reasons for the disparity in dental health care statistics and services. However, 90% of doctors and nurses in the county would like to learn more about dental health care and diagnosing oral disease, demonstrating the support for programs like S-BSPs.
Who is at risk? Who is Targeted?
Dr. Mark Siegal stated that determining which children were at the highest at risk for dental caries depended on three conditions. The first condition was whether or not the child was enrolled in Free reduced meal plan programs (FRPMP). The second condition whether children reported to have Medicaid, a “Federal-State health insurance program for low-income and needy people”, as their payment source or reported to be uninsurance (Social Security Administration). And finally, the third condition was created by combining children in the first two groups into one, highlighting children who were both enrolled in FRPMP and were on Medicaid or were uninsured (Siegal and Detty, 2010).
This table shows that kids at higher risk schools, no matter how many of them are enrolled in FRPMP, “are significantly more likely to have dental caries and untreated caries” (Siegal and Detty, 2009). Also noted was when the threshold of those on the lunch program doubled from 30% to 60%, payment for dental care was significantly more likely to be through Medicaid rather than private insurance or no insurance.
Table 1. Comparison of Higher Risk and Lower Risk Ohio Schools According to Dental Caries Prevalence, and Access-Related Factors (Insurance Coverage and Utilization of Dental Care) of Third Grade Students; and FRPMP-Based School-Level Higher Risk Standard, 2004-2005
Note. Reprinted [adapted] from “Targeting school-based dental sealant programs: who is at “higher risk?”, by M.D. Siegal and A.M.R. Detty, 2009, Journal of public health dentistry, 70(2), 140-147. Copyright 2009 by American Association of Public Health Dentistry.
Relation to Public Health
One can find a correlation between S-BSPs and Jill A. Fisher’s article “Ready to recruit, ready to consent” In the article, Fisher speaks on how pharmaceutical companies target a specific group of people for clinical trials who may have limited income or see that as the best option available for health care (Fisher, 2007, p. 1). Similarly, S-BSPs are normally targeted towards what they call higher risk schools and children. While the pharmaceutical industry has a different motive than S-BSPs, both have to go through a “recruiting process.” While pharmaceutical companies target those looking to make money, and who are looking for hope in a potential cure, S-BSPs are targeting dental health problems in kids in lower income areas. Both industries offer gain and reward for both sides. The pharmaceutical industry offers a monetary reward for participants or an opportunity at medication, though not 100% guaranteed, while still being able to test the effectiveness of newer drugs. S-BSPs provide low income children at risk for dental caries an opportunity at dental care they normally would not have received, while still providing jobs to men and women working in this system. This small but important difference differentiates the community-based, and therefore public health-based focus of S-BSPs from the more capitalistic interests of pharmaceutical companies.
Perspective
School based dental programs provide low-income students an opportunity at dental care. However this is very expensive; Klein et al. (1985, p. 389) found providing sealants through programs like S-BSPs costs on average approximately $23 each year. Contrastingly, the cost of restoring the surfaces that decay without sealants provided by these programs costs an average of $20 per year. This $3 difference may not seem like much, but for an entire school district or county, the cost of preventive oral health care can quickly add up.
References
Bowen, D. M. (2013). History of dental hygiene research. American Dental Hygienists Association, 87(suppl 1), 5-22.
Fisher, J. A. (2007). “Ready-to-recruit” or “ready-to-consent” populations? Informed consent and the limits of subject autonomy. Qualitative Inquiry, 13(6), 875-894.
Jacob, Matt. (2017). School-Based Dental Sealant Programs: Recommendations. Retrieved from https://www.cdhp.org/resources/334-school-based-dental-sealant-programs-recommendations
Joshipura, K. J., Rimm, E. B., Douglass, C. W., Trichopoulos, D., Ascherio, A., & Willett, W. C. (1996). Poor oral health and coronary heart disease. Journal of dental research, 75(9), 1631-1636.
Kenney, G. M., McFeeters, J. R., & Yee, J. Y. (2005). Preventive dental care and unmet dental needs among low-income children. American Journal of Public Health, 95(8), 1360-1366.
Klein, S. P., Bohannan, H. M., Bell, R. M., Disney, J. A., Foch, C. B., & Graves, R. C. (1985). The cost and effectiveness of school-based preventive dental care. American Journal of Public Health, 75(4), 382-391.
Matichescu, A., Marius, L. M., Alexandru, S. O., LUCA, M. M., & ROSU, S. (2016). Oral hygiene behaviour. case study of primary school children from timis county. Revista De Cercetare Si Interventie Sociala, 54, 142-155. Retrieved from http://login.proxy.library.vanderbilt.edu/login?url=https://search-proquest-com.proxy.library.vanderbilt.edu/docview/1923728466?accountid=14816
National Institute of Dental and Craniofacial Research. (2014). Chapter 5: Linkages with General Health. Retrieved from https://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/sgr/chap5.htm
National Maternal and Child Oral Health Resource Center. (2009). School-Based Dental Sealant Programs. Retrieved from https://www.ohiodentalclinics.com/curricula/sealant/mod1_1_2.html
Pediatric Dentistry of Florida. (2015). What are Dental Sealants and Does My Child Need Them? Retrieved from http://drverwest.com/what-are-dental-sealants-and-does-my-child-need-them/
PubMed Health. (n.a.). Oral Cavity: Mouth. Retrieved from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024366/
Sgan‐Cohen, H. D. (2005). Oral hygiene: past history and future recommendations. International journal of dental hygiene, 3(2), 54-58.
Siegal, M. D., & Detty, A. M. R. (2010). Do school‐based dental sealant programs reach higher risk children?. Journal of public health dentistry, 70(3), 181-187.
Social Security Administration. (n.a.). Medicaid Information. Retrieved from https://www.ssa.gov/disabilityresearch/wi/medicaid.htm
The University of Michigan Dentistry. (n.a.) Timeline of Dental Hygiene. Retrieved from
http://dent.umich.edu/about-school/sindecuse-museum/timeline-dental-hygiene
« Back to Glossary Index