|Year : 2016 | Volume
| Issue : 2 | Page : 70-77
Promoting oral hygiene and health through school
Preetika Parmar, G Radha, R Rekha, SK Pallavi, SR Nagashree
Deparment of Public Health Dentistry, VS Dental College and Hospital, Bengaluru, Karnataka, India
|Date of Web Publication||13-Feb-2017|
VS Dental College and Hospital, Bengaluru - 560 004, Karnataka
Source of Support: None, Conflict of Interest: None
A combined education, promotion, and preventive program in the school would greatly reduce the amount of classroom time lost in traveling to a treatment facility. Comprehensive school programs also would obviate the loss of study time due to pain and apprehension before and after treatment. Today, there is a need for research and evaluation on the best approaches to promoting oral health in schools with a focus on school-based clinics. Data from original scientific papers published in PubMed, PubMed Central, and Google Scholar were taken for review. Articles published in English are only included. The review concluded that the primary objective of school oral health promotion programs must focus on the 3 M's – manpower, money, and material, plus the amount of classroom time it will take from conventional classroom education.
Keywords: Oral health promotion, school children, school health programs, teachers
|How to cite this article:|
Parmar P, Radha G, Rekha R, Pallavi S K, Nagashree S R. Promoting oral hygiene and health through school. Int J Oral Health Sci 2016;6:70-7
| Introduction|| |
Oral health is fundamental to general health and well-being, significantly impacts on quality of life. Oral health means more than healthy teeth such as gums, oral soft tissues, chewing muscles, the palate, tongue, lips, and salivary glands. A healthy mouth enables an individual to speak, eat, and socialize without experiencing active disease, discomfort, or embarrassment.
The most prevalent diseases of childhood are dental caries, gingivitis, trauma, malocclusion, asthma, diabetes, and obesity. In India, the prevalence of dental caries was 32.6% and 42.2% at 12 and 15 years, gingivitis was 84.37%, and malocclusion was 36.42%.
The prevalence of other oral disorders such as dental erosion and enamel defects is rising. Many of them are under the age of 5 years. Children who suffer from poor oral health are 12 times more likely to have restricted activity days than those who do not and were 2.3 times more likely to affect in academics. More than 50 million school hours are lost annually because of oral health problems.
Many oral health problems are preventable and reversible at their early onset [Figure 1]. However, in several countries, a considerable number of children, their parents, and teachers have limited knowledge of the causes and prevention of oral disease.
The school provides an ideal setting for promoting oral health. At the global level, approximately 80% of children attend primary schools and 60% complete at least 4 years of education, with wide variations between countries and gender. In some countries, more than 50% of children aged 7–14 years are out of school and <20% complete the first grade due to the exploitation of child labor. Still, schools remain an efficient and effective way to reach over 1 billion children worldwide and, through them, families and community members.
A through literature review was made which engaged most of the articles published in peer review journals relating school oral health promotion. The review began with the medical subject heading (MeSH) like school health, oral health promotion in various search engine including PubMed, PubMed Central, and Google Scholar. Articles published in the English language are only included in the literature review. Finally, of 453 citations, 27 studies met study criteria and were reviewed.
| Dental Caries Prevention|| |
The most common oral diseases among children are gingivitis and dental caries, the latter affecting 60%–90% of children globally. In India, the prevalence of dental caries was 32.6% and 42.2% at 12 and 15 years, respectively. Dental caries is the most prevalent chronic disease condition that can cause a child to suffer a significant degree of pain, and if left untreated, the disease may lead to further complications including sepsis.
Dental caries can be prevented through:
- Pit and fissure sealants
- Diet and nutrition.
| Fluoride|| |
Fluoride is the foundation for preventing tooth decay. There are number of fluoridation measures which can be implemented in schools. School water fluoridationhas reduced dental caries among school children by about 40%. The goal of water fluoridation is to prevent a chronic disease whose burden particularly fall on children and the poor in communities with no central water supply or fluoride-deficient water supply.
School water fluoridation is not a satisfactory equivalent alternative to community water fluoridation. The major disadvantages with it are children do not receive benefits until they begin school; it should have independent water supply; installation cost of equipment is high; workers must be trained to operate, monitor, and maintain the fluoridation unit.
The school-based fluoride mouth rinse programis an important tool to reduce tooth decay among school-aged children. Fluoride mouth rinse programs are one of the most widely used caries-preventive public health methods and are targeted primarily to schools without enough fluoride in the water as well as to those in very low-income areas.
Fluoride mouth rinse prevents tooth decay by 20%–40% when used consistently in a school-based program [Table 1]. The most convenient schedule for school-based public programs is weekly administration to an entire class of children after obtaining parental consent. Caries reductions from daily rinsing are only slightly greater than those from weekly rinsing. The slight differences do not compensate for the greater practicality and lower cost of weekly rinsing in a school-based program. Fluoride mouth rinse programs are not recommended for children <6 years of age.
Another method for administrating systemic fluoride in school settings is the daily use of dietary fluoride supplements in the form of tablets.
| Pit and Fissure Sealants|| |
The dental sealant is an efficient and safe means of preventing pit and fissure caries in newly erupted teeth. Dental sealants applicationhas also been tested as an effective feasible measure in schools [Table 2]. Sealants are helpful for individuals at high risk for tooth decay such as those with medical conditions associated with higher caries rates, children who have experienced extensive caries in their primary teeth, and children who already have incipient caries in a permanent molar tooth.
School-based sealant programs are especially important for reaching children from low-income families who are less likely to receive private dental care. In a long-term evaluation of school health program found reduced decayed missing and filled surface (DMFS) which indicated that dental sealants, when used in combination with fluoride mouth rinse, were particularly effective in lowering the prevalence of dental caries.
The surgeon general's report on oral health indicates that sealants can reduce decay in school children by more than 70%.
Sealants are more cost effective:
- When they are placed in caries-prone children
- When used as therapy for carious lesions limited to enamel
- When completely retained
- When all of the patient's sealants are placed in one visit
- When another procedure (such as topical fluoride) is applied at the same visit
- When placed by auxiliaries.
| Diet and Nutrition|| |
Healthy nutrition takes many forms and is understood differently in different countries and among different cultures. In general, healthy nutrition should be an integral part of daily life that contributes to the physiological, mental, and social well-being of individuals. It is the combined effect of food, health, and care. Nutritional well-being is determined by consuming safe food as part of an appropriate and balanced diet that contains an adequate amount of nutrients in relation to bodily requirements.
The health and lifestyle of an individual influence the extent to which food contributes to good social, mental, and physical well-being. Care is shown by providing time, attention, and support in the household and the community to meet the food and health needs of the child and other family members.
Oral health activities can be included in the assessment and monitoring of nutritional status such as a school height census. While school food services are often managed by the public or private sectors through the ministry of education, it is important for schools, teachers, students, and school oral health services to collaborate closely with them to support healthy eating initiatives in schools.
Furthermore, schools also provide a setting to introduce nutrition information and technologies to the community and can lead the community in advocating policies and services that promote good nutrition. No other setting than schools offers these opportunities on as equal a basis [Table 3].
| Prevention of Periodontal Disease|| |
Chronic gingivitis is the most common oral health problem worldwide in both adults and children. While the disease is largely reversible in nature, it can develop in susceptible hosts into periodontitis, which is characterized by irreversible loss of periodontal attachment.
Periodontitis common in adults, but is still seen in children either as a rare but severely destructive form called aggressive periodontitis or a more common milder form called chronic periodontitis. In fact, the high prevalence of these types of periodontitis in children has been reported from some parts of the world. Therefore, early intervention to improve oral hygiene and reduce gingivitis is probably an important approach to prevent periodontitis in children as is the case with adults. We can prevent gingivitis and periodontal diseases among school children through programs such as classroom toothbrushing.
Toothbrushing in schoolsis a valuable tool for reinforcing good oral hygiene. A classroom brushing program is an excellent way to help students learn and practice proper brushing techniques. The most important aspect of toothbrushing from an early age is to develop a regular toothbrushing habit and to provide topical application of fluoride through toothpaste to the teeth to reduce the chance of tooth decay in children. Studies have shown that children who participated in a school toothbrushing program believed effective toothbrushing were able to improve their oral hygiene [Table 4].
Improvements in the level of general dental health can only be realized if children receive good dental care from the time their first teeth erupt. Unfortunately, the oral health of children has long been neglected, despite widespread dental problems before age 3. Most schools have annual school health check-up which includes single lecture and demonstration.
Health education is given two objectives. One is to enable students to acquire the necessary skills to make free and responsible choices about health, and the other is to create conditions in which all students can succeed. This insistence on “all” students is related to the particular attention that is paid to those who are vulnerable because of disability, social situation, or health.
Schools have a particular responsibility, working closely with families, to watch over the health of the young people in their care and to enable them to develop their personalities to the fullest extent. They also take part in prevention and health promotion, providing students throughout their school life with health education that is closely tied to teaching, and which is appropriate for their expectations and needs, and that is well-adapted to current public health challenges. The aim is to enable them to acquire knowledge and to develop critical skills, and thereby to adopt behaviors that will support their future health, by improving their levels of autonomy and responsibility. For this reason, student health cannot only be the business of a few specialists but should involve the whole of the educational community.
Role of school teachers
Teachers are the cornerstones and can play a major role in imparting dental health education to children by playing a vital role in planning and implementing oral health preventive programs. Since children spend a considerable amount of time with teachers during their school education, it becomes the responsibility of the teachers, by virtue of their training to impart such knowledge to the children. Promoting knowledge about the causes and prevention of oral diseases has become an important responsibility of school teachers. The National Oral Health Care Program states that when teachers brush their teeth, students follow the suit and it becomes a daily exercise routine for them. This can encourage the link between education and healthy habits as it shapes the individual's way of life and personality. School teachers can provide dental health education and screening for any gross deposit of food and calculus. This proves to be a feasible and more effective way of imparting and educating children for good oral hygiene. In India, which is developing, programs can be organized to train teachers on a short-term basis. This can be incorporated as part of the curriculum which can bring about a change in oral hygiene behavior which in turn can bring about a change in lifestyle practices.
Role of government
The government should incorporate dental surgeons in school health programs to give lecture on oral health, oral hygiene, plaque control, oral and dental diseases, oral cancer or smokeless tobacco use and hazards counseling, and topical fluoride application. The government should incorporate oral and dental health-related topic in school curriculum. Compulsory fitness regarding oral and dental health should be made mandatory for class promotion.
Role of health professional
Dental surgeons working in public sector have an important role to play in school dental health program to reinstitute the oral and dental health. It is important to enhance the knowledge about good oral health in teachers and parents by caring out workshops and seminars on oral and dental health by dental surgeons working in public health sector. Dental surgeons working in public health sector should carry out oral screening to improve the future of oral health care.
Tobacco avoidance and cessation
Tobacco use is the number one preventable cause of death and disease. Most adults who use tobacco products started before the age of 18, so policies that help to keep youth from starting to use tobacco are vitally important in reducing tobacco use.
Children and youth spend most of their days at school. Tobacco-free school grounds support the message students receive in the classrooms, creating no conflict between what is taught and what is experienced in the rest of the school environment. Prohibiting tobacco use at all times on school grounds reinforces the norm that most people do not use tobacco products and do not want to breathe secondhand smoke.
In addition to the health consequences, research shows that tobacco use affects student attendance and academic performance. Policies and procedures that provide positive support for remaining tobacco-free or that help students to quit actually help learning. Helping students with health-related needs, such as tobacco use, allows them to become better academic students [Table 5]. If they can be helped to solve non-academic problems, students will be in class more often, have fewer health problems, and feel more connected to their peers.
| Preventive Dentistry in Sports|| |
Unintentional injury is one of the leading causes of death in the world, with 1 in 5 deaths among children under the age of 15 years. In some developing countries, unintentional injuries account for 80% of all deaths in children. Sport- and playground-related injuries, as well as general and road traffic accidents, often affect the head, neck, and mouth. Throughout the world, the number of cases of head and face injuries is increasing in both urban and rural areas. With the increase in road traffic, poor lighting on the road and a lack of legislation regarding road safety, this is particularly significant in some developing countries.
The front teeth are most vulnerable. In some countries, over 50% of children have experienced oral trauma, with a quarter of cases being children under the age of 5 years While the most commonly sustained damage is fractures to tooth enamel, some injuries can lead to permanent tooth loss. The significance of intentional head and face injuries should not be overlooked. In addition to potential direct damage to the teeth and, possibly, other head and face structures, there may be signs of child abuse, a problem that could scar the child for life. Schools are the major public institutions in most communities. What schools define as important to the well-being of the students and school staff reflects out into the communities they serve. Schools that actively promote tobacco-free living make a strong statement that tobacco use is not acceptable [Table 6]. By setting this example, school and public health advocates collaborate to change environments and improve the health of all citizens.
| Discussion|| |
A large segment of children and adolescents are at risk for dropping out of school before completing high school as a result of a wide range of health, economic, and behavioral problems. Moreover, a large proportion of our school-age children do not have access to basic preventive and primary dental and medical care.
With the challenges posed by overwhelming need and limited resources, children deserve to receive information and education that enables them to make informed choices about their health. Furthermore, they deserve the opportunity to learn skills and develop attitudes that enable them to practice appropriate behaviors to enhance their oral and general health. Finally, they deserve to receive services that prevent and/or treat oral diseases.
We have the ability to essentially eliminate most oral diseases among children. Less obvious are the political and administrative means needed to make these cost-efficient measures available to the children. School-based oral health education and promotion programs give children and adolescents a chance to learn about their oral tissues in health and disease.
Protecting the oral health of future generations is a commitment that must be shared by parents, teachers, school administrators, and all health professionals. This shared responsibility is especially relevant now that national health objectives for total child health care are established.
To involve communities, families, or individuals in assuming responsibility for their own oral health, many ingredients are necessary. These include but are not limited to knowledge, skills, motivation, access to preventive agents and treatment services, and a safe, healthy environment.
Further, decision-makers and teachers must be willing to include health education and health promotion in schools. Finally, the policy is important. For example, smoke-free schools are a result of a policy that bans the use of tobacco products by all on school campuses.
| Conclusion|| |
School dental health programs are one aspect of total dental public health programs and should be allied to other programs of prevention and education as far as possible. If school children maintain good dental health, then it can be carried in adult life. Hence, regular dental attendance pattern in early life will be continued after the school age. Since children are often the most important victims of dental diseases, programs aimed at dental health of the school children are of great importance in promoting oral health of the community.
If oral health promotion is to be accomplished through the school systems, it must be integrated with the general medical health program. In order not to detract from the teaching of the classic academic curriculum, the school year must be lengthened proportionately to the increased time demands of promoting health, and the school system's budget must be increased to meet the requirements for additional facilities, workforce, and materials.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kwan SY, Petersen PE, Pine CM, Borutta A. Health-promoting schools: An opportunity for oral health promotion. Bull World Health Organ 2005;83:677-85.
Shailee F, Girish MS, Kapil RS, Nidhi P. Oral health status and treatment needs among 12- and 15-year-old government and private school children in Shimla city, Himachal Pradesh, India. J Int Soc Prev Community Dent 2013;3:44-50.
Al-Tamimi S, Petersen PE. Oral health situation of schoolchildren, mothers and schoolteachers in Saudi Arabia. Int Dent J 1998;48:180-6.
Petersen PE, Zhou E. Dental caries and oral health behaviour situation of children, mothers and school teachers in Wuhan, people's Republic of China. Int Dent J 1998;48:210-6.
Marinho VC, Higgins JP, Logan S, Sheiham A. Systematic review of controlled trials on the effectiveness of fluoride gels for the prevention of dental caries in children. J Dent Educ 2003;67:448-58.
Pieterse S, de Jong N, de Vos N. Does fluoride rinsing have an effect on teeth status? Evaluation of preventive dental health activities for the youth of Woudenberg, the Netherlands. Int J Dent Hyg 2006;4:133-9.
Asl Aminabadi N, Balaei E, Pouralibaba F. The Effect of 0.2% sodium fluoride mouthwash in prevention of dental caries according to the DMFT index. J Dent Res Dent Clin Dent Prospects 2007;1:71-6.
Komiyama E, Kimoto K, Arakawa H. Relationship between duration of fluoride exposure in school-based fluoride mouthrinsing and effects on prevention and control of dental caries. ISRN Dent 2012;2012:183272.
Subramaniam P, Nandan N. Effect of xylitol, sodium fluoride and triclosan containing mouth rinse on streptococcus mutans. Contemp Clin Dent 2011;2:287-90.
Jauhari D, Srivastava N, Rana V, Chandna P. Comparative evaluation of the effects of fluoride mouthrinse, herbal mouthrinse and oil pulling on the caries activity and streptococcus mutans count using oratest and dentocult SM strip mutans kit. Int J Clin Pediatr Dent 2015;8:114-8.
U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institute of Health; 2000.
Gooch BF, Griffin SO, Gray SK, Kohn WG, Rozier RG, Siegal M, et al.
Preventing dental caries through school-based sealant programs: updated recommendations and reviews of evidence. J Am Dent Assoc 2009;140:1356-65.
Leskinen K. Fissure sealants in caries prevention. A practice-based study using survival analysis. Acta Univ. OULD; 2010. p. 1078.
Singh S. School-based dental sealant programme: Report and assessment. SADJ 2011;66:384, 386-8.
Gugnani N. Trial shows caries reductions at one year in school-based sealant programme. Evid Based Dent 2013;14:71.
Morgan AG, Madahar AK, Deery C. Acceptability of fissure sealants from the child's perspective. Br Dent J 2014;217:E2.
Kumar JV, Tavares V, Kandhari P, Moss M, Jolaoso IA. Changes in caries experience, untreated caries, sealant prevalence, and preventive behavior among third-graders in New York State, 2002-2004 and 2009-2012. Public Health Rep 2015;130:355-61.
World Health Organization. Diet, Nutrition and the Prevention of Chronic Diseases. WHO Technical Report Series 916. Geneva: World Health Organization; 2003.
Schmitz KH, Lytle LA, Phillips GA, Murray DM, Birnbaum AS, Kubik MY. Psychosocial correlates of physical activity and sedentary leisure habits in young adolescents: The Teens Eating for Energy and Nutrition at School study. Prev Med 2002;34:266-78.
Jamelli SR, Rodrigues CS, de Lira PI. Nutritional status and prevalence of dental caries among 12-year-old children at public schools: A case-control study. Oral Health Prev Dent 2010;8:77-84.
Thippeswamy HM, Kumar N, Acharya S, Pentapati KC. Relationship between body mass index and dental caries among adolescent children in South India. West Indian Med J 2011;60:581-6.
Zúñiga-Manríquez AG, Medina-Solís CE, Lara-Carrillo E, Márquez-Corona Mde L, Robles-Bermeo NL, Scougall-Vilchis RJ, et al.
Experience, prevalence and severity of dental caries and its association with nutritional status in Mexican infants 17-47 months. Rev Invest Clin 2013;65:228-36.
Panwar NK, Mohan A, Arora R, Gupta A, Marya CM, Dhingra S. Study on relationship between the nutritional status and dental caries in 8-12 year old children of Udaipur City, India. Kathmandu Univ Med J 2014;12:26-31.
Chlapowska J, Rataj-Kulmacz A, Krzyzaniak A, Borysewicz-Lewicka M. Association between dental caries and nutritional status of 7-and 12-years-old children. Dev Period Med 2014;18:349-55.
Yazdani R, Vehkalahti MM, Nouri M, Murtomaa H. School-based education to improve oral cleanliness and gingival health in adolescents in Tehran, Iran. Int J Paediatr Dent 2009;19:274-81.
Gauba A, Bal IS, Jain A, Mittal HC. School based oral health promotional intervention: Effect on knowledge, practices and clinical oral health related parameters. Contemp Clin Dent 2013;4:493-9.
Damle SG, Patil A, Jain S, Damle D, Chopal N. Effectiveness of supervised toothbrushing and oral health education in improving oral hygiene status and practices of urban and rural school children: A comparative study. J Int Soc Prev Community Dent 2014;4:175-81.
Agaku IT, Adisa AO, Omaduvie UT, Vardavas CI. The relationship between proximity of tobacco retail outlets to schools and tobacco use among school personnel in Sub-Saharan Africa. Prev Med 2014;69:21-7.
Neff LJ, Arrazola RA, Caraballo RS, Corey CG, Cox S, King BA, et al.
Frequency of tobacco use among middle and high school students – United States, 2014. MMWR Morb Mortal Wkly Rep 2015;64:1061-5.
Mistry R, Pednekar M, Pimple S, Gupta PC, McCarthy WJ, Raute LJ, et al.
Banning tobacco sales and advertisements near educational institutions may reduce students' tobacco use risk: Evidence from Mumbai, India. Tob Control 2015;24:e100-7.
School Health Check Up Program Guideline for teachers national rural health mission School Health Unit, Health Education Bureau, Commissioner, Health, Medical Services, And Medical Education, Gandhinagar. Available from: http://shp.guj.nic.in/Downloads/Guideline%20for%20Teachers.pdf
. [Last accessed on 2016 Apr 22].
Karande N, Shah P, Bhatia M, Lakade L, Bijle MN, Arora N, et al.
Assessment of awareness amongst school teachers regarding prevention and emergency management of dentoalveolar traumatic injuries in school children in Pune city, before and 3 months after dental educational program. J Contemp Dent Pract 2012;13:873-7.
Murthy AK, Mallaiah P, Sanga R. Prevalence and associated factors of traumatic dental injuries among 5- to 16-year-old schoolchildren in Bangalore City, India. Oral Health Prev Dent 2014;12:37-43.
Singh G, Garg S, Damle SG, Dhindsa A, Kaur A, Singla S. A study of sports related occurrence of traumatic orodental injuries and associated risk factors in high school students in North India. Asian J Sports Med 2014;5:e22766.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
|This article has been cited by|
||Effect combined learning on oral health self-efficacy and self-care behaviors of students: a randomized controlled trial
| ||Zahra Sadat Hashemi,Mahboobeh Khorsandi,Mohsen Shamsi,Rahmatollah Moradzadeh |
| ||BMC Oral Health. 2021; 21(1) |
|[Pubmed] | [DOI]|
||Oral health knowledge, attitude, and practice among nursing students in the North-Eastern part of Rajasthan, India
| ||OmPrakash Yadav,Akbar Khan,Sabana Khan,Shubhi Gupta,Ravi Gupta,Rahul Gupta |
| ||Iranian Journal of Nursing and Midwifery Research. 2019; 24(5): 394 |
|[Pubmed] | [DOI]|
||The Effects of Gamification and Oral Self-care on Oral Hygiene in Children: a Systematic Review of mHealth Apps (Preprint)
| ||Nino Fijacko,Lucija Gosak,Leona Cilar,Alenka Novšak,Ruth Masterson Creber,Pavel Skok,Gregor Štiglic |
| ||JMIR mHealth and uHealth. 2019; |
|[Pubmed] | [DOI]|