Comprehensive, School-Based Preventive Dentistry: Program Details and Students' Unmet Dental Needs

Muath A. Aldosari; Omair M. Bukhari; Ryan Richard Ruff; Joseph N. Palmisano; Helen Nguyen; Chester W. Douglass; Richard Niederman; Jacqueline R. Starr

doi:10.1111/josh.13063

Comprehensive, School-Based Preventive Dentistry: Program Details and Students' Unmet Dental Needs

Muath A. Aldosari, Omair M. Bukhari, Ryan Richard Ruff, Joseph N. Palmisano, Helen Nguyen, Chester W. Douglass, Richard Niederman, Jacqueline R. Starr

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: In this paper, we describe the design, program details, and baseline demographics and oral health of participants in ForsythKids, a regional, comprehensive, school-based mobile caries prevention program. METHODS: We solicited all Massachusetts elementary schools with greater than 50% of students receiving free or reduced-price meals. Six schools initially elected to participate, ultimately followed by over 50 schools. Interventions were based on systematic reviews and randomized controlled caries prevention trials. Participating students received semiannual dental examinations, followed by comprehensive preventive care. Summary statistics regarding oral health indicators were derived from individual tooth- and surface-level data. RESULTS: Over a 6-year period, data were collected on 6927 children. The number of students per school ranged from 58 to 681. The overall participation rate was 15%, ranging from 10% to 29%. Overall, 57% of the children were younger than 8 years at baseline. Approximately, 54% of children experienced dental decay on any tooth at baseline; 32% had untreated decay on any tooth, 29% had untreated decay on primary teeth, and 10% untreated decay on permanent teeth. CONCLUSIONS: Untreated dental decay was double the national average, even in schools within several blocks of community dental clinics. These data demonstrate the need for caries prevention beyond the traditional dental practice.

Original language	English (US)
Pages (from-to)	761-770
Number of pages	10
Journal	Journal of School Health
Volume	91
Issue number	9
DOIs	https://doi.org/10.1111/josh.13063
State	Published - Sep 2021

Keywords

dental caries
dental health
preventive care
program planning
school health services
school-based clinics

ASJC Scopus subject areas

Education
Philosophy
Public Health, Environmental and Occupational Health

Access to Document

10.1111/josh.13063

Cite this

@article{1d3d659d1a1e453ca00374d7b6ad5883,

title = "Comprehensive, School-Based Preventive Dentistry: Program Details and Students' Unmet Dental Needs",

abstract = "BACKGROUND: In this paper, we describe the design, program details, and baseline demographics and oral health of participants in ForsythKids, a regional, comprehensive, school-based mobile caries prevention program. METHODS: We solicited all Massachusetts elementary schools with greater than 50% of students receiving free or reduced-price meals. Six schools initially elected to participate, ultimately followed by over 50 schools. Interventions were based on systematic reviews and randomized controlled caries prevention trials. Participating students received semiannual dental examinations, followed by comprehensive preventive care. Summary statistics regarding oral health indicators were derived from individual tooth- and surface-level data. RESULTS: Over a 6-year period, data were collected on 6927 children. The number of students per school ranged from 58 to 681. The overall participation rate was 15%, ranging from 10% to 29%. Overall, 57% of the children were younger than 8 years at baseline. Approximately, 54% of children experienced dental decay on any tooth at baseline; 32% had untreated decay on any tooth, 29% had untreated decay on primary teeth, and 10% untreated decay on permanent teeth. CONCLUSIONS: Untreated dental decay was double the national average, even in schools within several blocks of community dental clinics. These data demonstrate the need for caries prevention beyond the traditional dental practice.",

keywords = "dental caries, dental health, preventive care, program planning, school health services, school-based clinics",

author = "Aldosari, {Muath A.} and Bukhari, {Omair M.} and Ruff, {Ryan Richard} and Palmisano, {Joseph N.} and Helen Nguyen and Douglass, {Chester W.} and Richard Niederman and Starr, {Jacqueline R.}",

note = "Funding Information: The authors acknowledge the organizations in the community that facilitated care for the children in the greater Boston area school systems, as well as the Lynn and Harbor Community Health Centers. The organizations listed here provided partial support for this work: National Institute of Minorities and Health Disparities, DentaQuest, Bingham Trust, the Massachusetts State Legislature, the American Dental Trade Alliance, Bilezikian Family Foundation, Edward and Elza Kelly Foundation, The Camp Harborview Foundation, and Bank of America Perpetual Trust for Charitable Giving. In‐kind support included: glass ionomer provided by GC America and toothbrushes, fluoride toothpaste, and fluoride varnish provided by Colgate Palmolive. None of the preceding organizations or individuals working with or for them had any input into program design, children recruitment, clinical care, data collection, analysis, interpretation, report writing, or any aspect of the study. Funding Information: Consenting program participants received semiannual dental examinations by a dentist, with follow-on preventive care provided by a dental hygienist (Figure?1). During the period described here, services provided at each visit included: (1) Prophylaxis to clean the teeth first with a disposable rubber cup (Denticator, Earth City, Mo.) and chair-side oral hygiene instruction; (2) Placement of glass ionomer sealants on all eligible teeth with pits or fissures, with replacement if needed (Fuji IX, GC America, Alsip, Ill.); and (3) placement of interim therapeutic restorations (also called: therapeutic sealants, atraumatic restorative treatment, temporary fillings) on all accessible asymptomatic carious lesions (Fuji IX, GC America, Alsip, Ill.). The preventive sealants and interim therapeutic restorations used in the study were glass ionomer except in 2007, when sealants were light-cured resin based (Embrace, Pulpdent, Watertown, MA) and no therapeutic sealants were placed. This one-year change was made at the request of the Massachusetts Department of Health. Following placement of glass ionomer sealants and interim therapeutic restorations we (4) provided toothbrushes (Henry Schein, Melville, N.Y.) and toothpastes (Big Red, Colgate-Palmolive Company, New York City); and (5) applied fluoride varnish (Duraphat Colgate Pharmaceuticals, Canton, Mass., or Cavity Shield, OMNII Oral Pharmaceuticals, West Palm Beach, FL). In the presence of symptomatic teeth (mobility, swelling, pain, fistula, or exposed root canals), the program's patient advocate followed up with the parent/guardian by phone to ensure adequate care was received. Examination and care reports were prepared at the time of care and given to the school nurse and to children in English or Spanish, depending on parent language preference. Forms were translated by a professional licensed individual. Schools incurred no cost for the program or visits. If a child (or child's family) had Medicaid or dental insurance, Medicaid or the insurer were billed. If the child or family had no insurance, costs were absorbed by The Forsyth Institute rather than billed to patients or schools. Recommendations for treatment were also provided, and parents were given referrals to local dentists or health centers for further treatment. Although the risk of a medical emergency during care was very low as no anesthetic agent was administered during visits, ForythKids staff was trained to activate the emergency medical services (EMS) and provide supportive measures to maintain adequate airway, breathing, and circulation if an event were to occur. The incident would then be reported to the school nurse to follow the school's protocol in informing child's parent. At all times, there was one licensed dentist (DDS) and 2 registered dental hygienists (RDH) working for ForsythKids. Over the period between 2004 and 2010, the program has had 4 DDS and 5 RDH. All personnel were employed by The Forsyth Institute. To standardize examinations, dentists examined 10 students independently at baseline and discussed whether caries were present or not. Following this initial review, dentists were calibrated by examining another 10 students independently and comparing the results (kappa?=?0.75).35 Dental hygienists delivered all services other than clinical oral exams. To standardize the delivery of care, prior to participating in the program, dental hygienists were trained to use tooth-colored glass ionomer filling material (Fuji IX glass ionomer fillings in capsules, GC America, Alsip, Ill.).36 No tooth structure was removed when placing sealants or temporary fillings. For subsequent visits following baseline, dentists and hygienists were standardized but not calibrated. At all times, there was one licensed dentist (DDS) and 2 registered dental hygienists (RDH) working for ForsythKids. Over the period between 2004 and 2010, the program has had 4 DDS and 5 RDH. All personnel were employed by The Forsyth Institute. To standardize examinations, dentists examined 10 students independently at baseline and discussed whether caries were present or not. Following this initial review, dentists were calibrated by examining another 10 students independently and comparing the results (kappa?=?0.75).35 Dental hygienists delivered all services other than clinical oral exams. To standardize the delivery of care, prior to participating in the program, dental hygienists were trained to use tooth-colored glass ionomer filling material (Fuji IX glass ionomer fillings in capsules, GC America, Alsip, Ill.).36 No tooth structure was removed when placing sealants or temporary fillings. For subsequent visits following baseline, dentists and hygienists were standardized but not calibrated. Dentists clinically examined children following guidelines provided by the National Institute of Dental and Craniofacial Research.37 All care was provided with mobile equipment that was set up in empty classrooms, school stages, hallways, nurses' office?anywhere in a school deemed appropriate and available by the school nurse. The examining dentist dried tooth surfaces with gauze squares and performed clinical visual-tactile full-mouth oral examinations with the aid of halogen lights, disposable mirrors, and explorers. Full-mouth examinations included: examination of all teeth and surfaces for decayed, missing, filled, or sound teeth, and teeth with exposed root canals. The exam also included an assessment of pain, swelling, infection, abscess, bite classification, or oral pathology. Data from clinical exams were recorded on electronically readable paper forms, which were scanned and uploaded to the data coordinating center. In 2003, the Massachusetts Department of Health contacted all superintendents and principals from Massachusetts Title 1 elementary schools to invite their participation in ForsythKids. School leaders were contacted directly by email; they were then met in person; and then the school nurse became the primary point-of-contact for the program. In these schools over half the students qualify to receive free or reduced meals. In the spring of 2004, 4 elementary schools began participating, 2 in suburban (Essex county) and 2 in rural (Barnstable county). Then, 2 elementary schools in urban (Suffolk county) joined the program in the following year. During the years following initiation, the school boards of the suburban and rural areas requested that we provide care to children in all of their elementary schools. By 2007, the program served children from 30 schools in eastern Massachusetts and, by 2008-2009, more than 50 schools. At the same time that schools were enrolled, we identified local community health centers and dentists interested in collaborating to provide continuing care. In the first year of the program, children were examined and treated only in grades K-3. In subsequent years, all children in participating elementary schools between kindergarten to 5th or 6th grades were eligible to enroll, providing guardian informed consent. The informed consent forms were created at an eighth-grade reading level and provided to students in multiple languages, as requested by schools. The sequence of distribution was from the investigators to school nurses to schoolteachers, to children, to parents, to teachers, to nurses, and finally back to the investigators. In all but the first year of the program, consent forms were distributed to parents with all other school forms at the beginning of the academic year. Schools or individual children could drop out of the clinical program at any time. At all times, there was one licensed dentist (DDS) and 2 registered dental hygienists (RDH) working for ForsythKids. Over the period between 2004 and 2010, the program has had 4 DDS and 5 RDH. All personnel were employed by The Forsyth Institute. To standardize examinations, dentists examined 10 students independently at baseline and discussed whether caries were present or not. Following this initial review, dentists were calibrated by examining another 10 students independently and comparing the results (kappa?=?0.75).35 Dental hygienists delivered all services other than clinical oral exams. To standardize the delivery of care, prior to participating in the program, dental hygienists were trained to use tooth-colored glass ionomer filling material (Fuji IX glass ionomer fillings in capsules, GC America, Alsip, Ill.).36 No tooth structure was removed when placing sealants or temporary fillings. For subsequent visits following baseline, dentists and hygienists were standardized but not calibrated. Dentists clinically examined children following guidelines provided by the National Institute of Dental and Craniofacial Research.37 All care was provided with mobile equipment that was set up in empty classrooms, school stages, hallways, nurses' office?anywhere in a school deemed appropriate and available by the school nurse. The examining dentist dried tooth surfaces with gauze squares and performed clinical visual-tactile full-mouth oral examinations with the aid of halogen lights, disposable mirrors, and explorers. Full-mouth examinations included: examination of all teeth and surfaces for decayed, missing, filled, or sound teeth, and teeth with exposed root canals. The exam also included an assessment of pain, swelling, infection, abscess, bite classification, or oral pathology. Data from clinical exams were recorded on electronically readable paper forms, which were scanned and uploaded to the data coordinating center. Consenting program participants received semiannual dental examinations by a dentist, with follow-on preventive care provided by a dental hygienist (Figure?1). During the period described here, services provided at each visit included: (1) Prophylaxis to clean the teeth first with a disposable rubber cup (Denticator, Earth City, Mo.) and chair-side oral hygiene instruction; (2) Placement of glass ionomer sealants on all eligible teeth with pits or fissures, with replacement if needed (Fuji IX, GC America, Alsip, Ill.); and (3) placement of interim therapeutic restorations (also called: therapeutic sealants, atraumatic restorative treatment, temporary fillings) on all accessible asymptomatic carious lesions (Fuji IX, GC America, Alsip, Ill.). The preventive sealants and interim therapeutic restorations used in the study were glass ionomer except in 2007, when sealants were light-cured resin based (Embrace, Pulpdent, Watertown, MA) and no therapeutic sealants were placed. This one-year change was made at the request of the Massachusetts Department of Health. Following placement of glass ionomer sealants and interim therapeutic restorations we (4) provided toothbrushes (Henry Schein, Melville, N.Y.) and toothpastes (Big Red, Colgate-Palmolive Company, New York City); and (5) applied fluoride varnish (Duraphat Colgate Pharmaceuticals, Canton, Mass., or Cavity Shield, OMNII Oral Pharmaceuticals, West Palm Beach, FL). In the presence of symptomatic teeth (mobility, swelling, pain, fistula, or exposed root canals), the program's patient advocate followed up with the parent/guardian by phone to ensure adequate care was received. Examination and care reports were prepared at the time of care and given to the school nurse and to children in English or Spanish, depending on parent language preference. Forms were translated by a professional licensed individual. Schools incurred no cost for the program or visits. If a child (or child's family) had Medicaid or dental insurance, Medicaid or the insurer were billed. If the child or family had no insurance, costs were absorbed by The Forsyth Institute rather than billed to patients or schools. Recommendations for treatment were also provided, and parents were given referrals to local dentists or health centers for further treatment. Although the risk of a medical emergency during care was very low as no anesthetic agent was administered during visits, ForythKids staff was trained to activate the emergency medical services (EMS) and provide supportive measures to maintain adequate airway, breathing, and circulation if an event were to occur. The incident would then be reported to the school nurse to follow the school's protocol in informing child's parent. We used the baseline data extracted from the clinical records of ForsythKids participants since its inception in 2004 to December 2010. Analysis was restricted to children ages 5-12 years since this is the typical age range for the included grades. We excluded data from schools with fewer than 50 total students over this period to minimize variability due to small numbers. Oral health indicators were calculated and reported separately for permanent teeth, primary teeth, and both dentitions. These indicators included the proportion of children with (1) caries experience (ie, cavities or restorations), (2) untreated carious surfaces, (3) restored teeth, (4) fissure sealants in posterior teeth (as a proxy for previous preventive care), (5) either treated teeth or fissure sealants (a proxy for any previous dental care, whether preventive or otherwise). We also calculated (6) the mean number of DFS & dfs,38 and (7) the significant caries index (SiC), which is the mean DFS or dfs score for patients with scores in the highest tertile.39 We calculated descriptive statistics for demographics and oral health measures separately for participants in the first 6 and remaining schools and stratifying by the community water fluoridation (CWF) status of the school area. Publisher Copyright: {\textcopyright} 2021 American School Health Association.",

year = "2021",

month = sep,

doi = "10.1111/josh.13063",

language = "English (US)",

volume = "91",

pages = "761--770",

journal = "Journal of School Health",

issn = "0022-4391",

publisher = "Wiley-Blackwell",

number = "9",

}

TY - JOUR

T1 - Comprehensive, School-Based Preventive Dentistry

T2 - Program Details and Students' Unmet Dental Needs

AU - Aldosari, Muath A.

AU - Bukhari, Omair M.

AU - Ruff, Ryan Richard

AU - Palmisano, Joseph N.

AU - Nguyen, Helen

AU - Douglass, Chester W.

AU - Niederman, Richard

AU - Starr, Jacqueline R.

N1 - Funding Information: The authors acknowledge the organizations in the community that facilitated care for the children in the greater Boston area school systems, as well as the Lynn and Harbor Community Health Centers. The organizations listed here provided partial support for this work: National Institute of Minorities and Health Disparities, DentaQuest, Bingham Trust, the Massachusetts State Legislature, the American Dental Trade Alliance, Bilezikian Family Foundation, Edward and Elza Kelly Foundation, The Camp Harborview Foundation, and Bank of America Perpetual Trust for Charitable Giving. In‐kind support included: glass ionomer provided by GC America and toothbrushes, fluoride toothpaste, and fluoride varnish provided by Colgate Palmolive. None of the preceding organizations or individuals working with or for them had any input into program design, children recruitment, clinical care, data collection, analysis, interpretation, report writing, or any aspect of the study. Funding Information: Consenting program participants received semiannual dental examinations by a dentist, with follow-on preventive care provided by a dental hygienist (Figure?1). During the period described here, services provided at each visit included: (1) Prophylaxis to clean the teeth first with a disposable rubber cup (Denticator, Earth City, Mo.) and chair-side oral hygiene instruction; (2) Placement of glass ionomer sealants on all eligible teeth with pits or fissures, with replacement if needed (Fuji IX, GC America, Alsip, Ill.); and (3) placement of interim therapeutic restorations (also called: therapeutic sealants, atraumatic restorative treatment, temporary fillings) on all accessible asymptomatic carious lesions (Fuji IX, GC America, Alsip, Ill.). The preventive sealants and interim therapeutic restorations used in the study were glass ionomer except in 2007, when sealants were light-cured resin based (Embrace, Pulpdent, Watertown, MA) and no therapeutic sealants were placed. This one-year change was made at the request of the Massachusetts Department of Health. Following placement of glass ionomer sealants and interim therapeutic restorations we (4) provided toothbrushes (Henry Schein, Melville, N.Y.) and toothpastes (Big Red, Colgate-Palmolive Company, New York City); and (5) applied fluoride varnish (Duraphat Colgate Pharmaceuticals, Canton, Mass., or Cavity Shield, OMNII Oral Pharmaceuticals, West Palm Beach, FL). In the presence of symptomatic teeth (mobility, swelling, pain, fistula, or exposed root canals), the program's patient advocate followed up with the parent/guardian by phone to ensure adequate care was received. Examination and care reports were prepared at the time of care and given to the school nurse and to children in English or Spanish, depending on parent language preference. Forms were translated by a professional licensed individual. Schools incurred no cost for the program or visits. If a child (or child's family) had Medicaid or dental insurance, Medicaid or the insurer were billed. If the child or family had no insurance, costs were absorbed by The Forsyth Institute rather than billed to patients or schools. Recommendations for treatment were also provided, and parents were given referrals to local dentists or health centers for further treatment. Although the risk of a medical emergency during care was very low as no anesthetic agent was administered during visits, ForythKids staff was trained to activate the emergency medical services (EMS) and provide supportive measures to maintain adequate airway, breathing, and circulation if an event were to occur. The incident would then be reported to the school nurse to follow the school's protocol in informing child's parent. At all times, there was one licensed dentist (DDS) and 2 registered dental hygienists (RDH) working for ForsythKids. Over the period between 2004 and 2010, the program has had 4 DDS and 5 RDH. All personnel were employed by The Forsyth Institute. To standardize examinations, dentists examined 10 students independently at baseline and discussed whether caries were present or not. Following this initial review, dentists were calibrated by examining another 10 students independently and comparing the results (kappa?=?0.75).35 Dental hygienists delivered all services other than clinical oral exams. To standardize the delivery of care, prior to participating in the program, dental hygienists were trained to use tooth-colored glass ionomer filling material (Fuji IX glass ionomer fillings in capsules, GC America, Alsip, Ill.).36 No tooth structure was removed when placing sealants or temporary fillings. For subsequent visits following baseline, dentists and hygienists were standardized but not calibrated. At all times, there was one licensed dentist (DDS) and 2 registered dental hygienists (RDH) working for ForsythKids. Over the period between 2004 and 2010, the program has had 4 DDS and 5 RDH. All personnel were employed by The Forsyth Institute. To standardize examinations, dentists examined 10 students independently at baseline and discussed whether caries were present or not. Following this initial review, dentists were calibrated by examining another 10 students independently and comparing the results (kappa?=?0.75).35 Dental hygienists delivered all services other than clinical oral exams. To standardize the delivery of care, prior to participating in the program, dental hygienists were trained to use tooth-colored glass ionomer filling material (Fuji IX glass ionomer fillings in capsules, GC America, Alsip, Ill.).36 No tooth structure was removed when placing sealants or temporary fillings. For subsequent visits following baseline, dentists and hygienists were standardized but not calibrated. Dentists clinically examined children following guidelines provided by the National Institute of Dental and Craniofacial Research.37 All care was provided with mobile equipment that was set up in empty classrooms, school stages, hallways, nurses' office?anywhere in a school deemed appropriate and available by the school nurse. The examining dentist dried tooth surfaces with gauze squares and performed clinical visual-tactile full-mouth oral examinations with the aid of halogen lights, disposable mirrors, and explorers. Full-mouth examinations included: examination of all teeth and surfaces for decayed, missing, filled, or sound teeth, and teeth with exposed root canals. The exam also included an assessment of pain, swelling, infection, abscess, bite classification, or oral pathology. Data from clinical exams were recorded on electronically readable paper forms, which were scanned and uploaded to the data coordinating center. In 2003, the Massachusetts Department of Health contacted all superintendents and principals from Massachusetts Title 1 elementary schools to invite their participation in ForsythKids. School leaders were contacted directly by email; they were then met in person; and then the school nurse became the primary point-of-contact for the program. In these schools over half the students qualify to receive free or reduced meals. In the spring of 2004, 4 elementary schools began participating, 2 in suburban (Essex county) and 2 in rural (Barnstable county). Then, 2 elementary schools in urban (Suffolk county) joined the program in the following year. During the years following initiation, the school boards of the suburban and rural areas requested that we provide care to children in all of their elementary schools. By 2007, the program served children from 30 schools in eastern Massachusetts and, by 2008-2009, more than 50 schools. At the same time that schools were enrolled, we identified local community health centers and dentists interested in collaborating to provide continuing care. In the first year of the program, children were examined and treated only in grades K-3. In subsequent years, all children in participating elementary schools between kindergarten to 5th or 6th grades were eligible to enroll, providing guardian informed consent. The informed consent forms were created at an eighth-grade reading level and provided to students in multiple languages, as requested by schools. The sequence of distribution was from the investigators to school nurses to schoolteachers, to children, to parents, to teachers, to nurses, and finally back to the investigators. In all but the first year of the program, consent forms were distributed to parents with all other school forms at the beginning of the academic year. Schools or individual children could drop out of the clinical program at any time. At all times, there was one licensed dentist (DDS) and 2 registered dental hygienists (RDH) working for ForsythKids. Over the period between 2004 and 2010, the program has had 4 DDS and 5 RDH. All personnel were employed by The Forsyth Institute. To standardize examinations, dentists examined 10 students independently at baseline and discussed whether caries were present or not. Following this initial review, dentists were calibrated by examining another 10 students independently and comparing the results (kappa?=?0.75).35 Dental hygienists delivered all services other than clinical oral exams. To standardize the delivery of care, prior to participating in the program, dental hygienists were trained to use tooth-colored glass ionomer filling material (Fuji IX glass ionomer fillings in capsules, GC America, Alsip, Ill.).36 No tooth structure was removed when placing sealants or temporary fillings. For subsequent visits following baseline, dentists and hygienists were standardized but not calibrated. Dentists clinically examined children following guidelines provided by the National Institute of Dental and Craniofacial Research.37 All care was provided with mobile equipment that was set up in empty classrooms, school stages, hallways, nurses' office?anywhere in a school deemed appropriate and available by the school nurse. The examining dentist dried tooth surfaces with gauze squares and performed clinical visual-tactile full-mouth oral examinations with the aid of halogen lights, disposable mirrors, and explorers. Full-mouth examinations included: examination of all teeth and surfaces for decayed, missing, filled, or sound teeth, and teeth with exposed root canals. The exam also included an assessment of pain, swelling, infection, abscess, bite classification, or oral pathology. Data from clinical exams were recorded on electronically readable paper forms, which were scanned and uploaded to the data coordinating center. Consenting program participants received semiannual dental examinations by a dentist, with follow-on preventive care provided by a dental hygienist (Figure?1). During the period described here, services provided at each visit included: (1) Prophylaxis to clean the teeth first with a disposable rubber cup (Denticator, Earth City, Mo.) and chair-side oral hygiene instruction; (2) Placement of glass ionomer sealants on all eligible teeth with pits or fissures, with replacement if needed (Fuji IX, GC America, Alsip, Ill.); and (3) placement of interim therapeutic restorations (also called: therapeutic sealants, atraumatic restorative treatment, temporary fillings) on all accessible asymptomatic carious lesions (Fuji IX, GC America, Alsip, Ill.). The preventive sealants and interim therapeutic restorations used in the study were glass ionomer except in 2007, when sealants were light-cured resin based (Embrace, Pulpdent, Watertown, MA) and no therapeutic sealants were placed. This one-year change was made at the request of the Massachusetts Department of Health. Following placement of glass ionomer sealants and interim therapeutic restorations we (4) provided toothbrushes (Henry Schein, Melville, N.Y.) and toothpastes (Big Red, Colgate-Palmolive Company, New York City); and (5) applied fluoride varnish (Duraphat Colgate Pharmaceuticals, Canton, Mass., or Cavity Shield, OMNII Oral Pharmaceuticals, West Palm Beach, FL). In the presence of symptomatic teeth (mobility, swelling, pain, fistula, or exposed root canals), the program's patient advocate followed up with the parent/guardian by phone to ensure adequate care was received. Examination and care reports were prepared at the time of care and given to the school nurse and to children in English or Spanish, depending on parent language preference. Forms were translated by a professional licensed individual. Schools incurred no cost for the program or visits. If a child (or child's family) had Medicaid or dental insurance, Medicaid or the insurer were billed. If the child or family had no insurance, costs were absorbed by The Forsyth Institute rather than billed to patients or schools. Recommendations for treatment were also provided, and parents were given referrals to local dentists or health centers for further treatment. Although the risk of a medical emergency during care was very low as no anesthetic agent was administered during visits, ForythKids staff was trained to activate the emergency medical services (EMS) and provide supportive measures to maintain adequate airway, breathing, and circulation if an event were to occur. The incident would then be reported to the school nurse to follow the school's protocol in informing child's parent. We used the baseline data extracted from the clinical records of ForsythKids participants since its inception in 2004 to December 2010. Analysis was restricted to children ages 5-12 years since this is the typical age range for the included grades. We excluded data from schools with fewer than 50 total students over this period to minimize variability due to small numbers. Oral health indicators were calculated and reported separately for permanent teeth, primary teeth, and both dentitions. These indicators included the proportion of children with (1) caries experience (ie, cavities or restorations), (2) untreated carious surfaces, (3) restored teeth, (4) fissure sealants in posterior teeth (as a proxy for previous preventive care), (5) either treated teeth or fissure sealants (a proxy for any previous dental care, whether preventive or otherwise). We also calculated (6) the mean number of DFS & dfs,38 and (7) the significant caries index (SiC), which is the mean DFS or dfs score for patients with scores in the highest tertile.39 We calculated descriptive statistics for demographics and oral health measures separately for participants in the first 6 and remaining schools and stratifying by the community water fluoridation (CWF) status of the school area. Publisher Copyright: © 2021 American School Health Association.

PY - 2021/9

Y1 - 2021/9

N2 - BACKGROUND: In this paper, we describe the design, program details, and baseline demographics and oral health of participants in ForsythKids, a regional, comprehensive, school-based mobile caries prevention program. METHODS: We solicited all Massachusetts elementary schools with greater than 50% of students receiving free or reduced-price meals. Six schools initially elected to participate, ultimately followed by over 50 schools. Interventions were based on systematic reviews and randomized controlled caries prevention trials. Participating students received semiannual dental examinations, followed by comprehensive preventive care. Summary statistics regarding oral health indicators were derived from individual tooth- and surface-level data. RESULTS: Over a 6-year period, data were collected on 6927 children. The number of students per school ranged from 58 to 681. The overall participation rate was 15%, ranging from 10% to 29%. Overall, 57% of the children were younger than 8 years at baseline. Approximately, 54% of children experienced dental decay on any tooth at baseline; 32% had untreated decay on any tooth, 29% had untreated decay on primary teeth, and 10% untreated decay on permanent teeth. CONCLUSIONS: Untreated dental decay was double the national average, even in schools within several blocks of community dental clinics. These data demonstrate the need for caries prevention beyond the traditional dental practice.

AB - BACKGROUND: In this paper, we describe the design, program details, and baseline demographics and oral health of participants in ForsythKids, a regional, comprehensive, school-based mobile caries prevention program. METHODS: We solicited all Massachusetts elementary schools with greater than 50% of students receiving free or reduced-price meals. Six schools initially elected to participate, ultimately followed by over 50 schools. Interventions were based on systematic reviews and randomized controlled caries prevention trials. Participating students received semiannual dental examinations, followed by comprehensive preventive care. Summary statistics regarding oral health indicators were derived from individual tooth- and surface-level data. RESULTS: Over a 6-year period, data were collected on 6927 children. The number of students per school ranged from 58 to 681. The overall participation rate was 15%, ranging from 10% to 29%. Overall, 57% of the children were younger than 8 years at baseline. Approximately, 54% of children experienced dental decay on any tooth at baseline; 32% had untreated decay on any tooth, 29% had untreated decay on primary teeth, and 10% untreated decay on permanent teeth. CONCLUSIONS: Untreated dental decay was double the national average, even in schools within several blocks of community dental clinics. These data demonstrate the need for caries prevention beyond the traditional dental practice.

KW - dental caries

KW - dental health

KW - preventive care

KW - program planning

KW - school health services

KW - school-based clinics

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DO - 10.1111/josh.13063

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JO - Journal of School Health

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Comprehensive, School-Based Preventive Dentistry: Program Details and Students' Unmet Dental Needs

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