School-based caries prevention and the impact on acute and chronic student absenteeism

Ryan Richard Ruff, Rami Habib, Tamarinda Barry Godín, Richard Niederman

Research output: Contribution to journalArticlepeer-review


Background: Poor oral health is significantly associated with absenteeism, contributing to millions of lost school hours per year. The effect of school-based dental programs that address oral health care inequities on student attendance has not yet been explored. Methods: CariedAway was a longitudinal, cluster-randomized, noninferiority trial of minimally invasive medicines for caries used in a school-based program. We extracted data on school absenteeism and chronically absent students from publicly available data sets for years before, during, and after program onset (2016-2021). Total absences and the proportion of chronically absent students were modeled using multilevel mixed-effects linear and 2-limit tobit regression, respectively. Results: In years in which treatment was provided through a school-based caries prevention program, schools recorded approximately 944 fewer absences than in nontreatment years (95% CI, –1,739 to –149). Averaged across all study years, schools receiving either treatment had 1,500 fewer absences than comparator schools, but this was not statistically significant. In contrast, chronic absenteeism was found to significantly decrease in later years of the program (b, –.037; 95% CI, –.062 to –.011). Excluding data for years affected by COVID-19 removed significant associations. Conclusions: Although originally designed to obviate access barriers to critical oral health care, early integration of school-based dental programs may positively affect school attendance. However, the observed effects may be due to poor reliability of attendance records resulting from the closing of school facilities in response to COVID-19, and further study is needed. Practical Implications: School-based caries prevention may also improve educational outcomes, in addition to providing critical oral health care. This clinical trial was registered at The registration number is NCT03442309.

Original languageEnglish (US)
Pages (from-to)753-759
Number of pages7
JournalJournal of the American Dental Association
Issue number8
StatePublished - Aug 2023


  • Oral health
  • absenteeism
  • academic performance
  • caries prevention
  • education

ASJC Scopus subject areas

  • General Dentistry


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