Access & Academics: Improving Oral Health Through Schools

Ensuring children have access to oral health care is a local challenge in many parts of the country. 

“Maine has reached a low in access to care like we’ve never seen,” says Courtney Vannah, IDPH, MS, MPH, senior program manager at MCD Global Health, a nonprofit dedicated to improving the health and well-being of people worldwide. “Children in Maine have long faced challenges in access to dental care within the traditional dental care delivery model.” 

It’s a national problem, too. 

Laura S. Larsson, PhD, MPH, RN, a professor at Montana State University, sees those same struggles in her state. “Among Montana’s indigenous and rural communities, these challenges are amplified and result in poor oral health status at early ages,” Larsson says. “For example, the untreated decay rate is twice as high among the indigenous preschool group in Montana (40.8%) than for kindergarten-aged students statewide.” 

The reasons for those barriers to access to care range from provider shortages to a limited number of dentist offices that accept Medicaid. To help, earlier this year, CareQuest Institute put out a call for proposals to find creative, innovative projects that drive systemic change in oral health and promote school-based or school-linked oral health programs. In all, the Institute selected 10 organizations to receive $125,000 each, for a total investment of $1.25 million. 

“Schools play a critical role in supporting positive health outcomes for children, particularly those from under-resourced communities,” says Trenae Simpson, director of grants and programs at CareQuest Institute. “Oral health programs at schools have the potential to increase student success, improve health outcomes for children, and reduce racial, ethnic, and economic disparities.” 

Funding New Collaboratives and Future Workforces 

In unique and novel ways, the organizations will use the funds to reduce racial, ethnic, and economic disparities, and, in turn, increase students’ chances to stay in school and achieve in life. 

Montana State University, one of the 10 grantees, will use its funds to advance a medical-dental integration model with nurses and nurse practitioners in a new school-based health center. 

“We hope to impact the success and sustainability of the clinic, improve health care access, reduce time to treatment, and excite teenage schoolchildren about health occupations careers,” Larsson says. “By developing a health career pipeline with Lame Deer Junior and Senior High Schools, we hope indigenous adolescents will be inspired by this project, pursue health careers, and ultimately return to serve their neighbors and community.” 

At MCD Global Health, the funding will train school nurses to apply silver diamine fluoride (SDF), a topical medication to treat and prevent dental caries. 

“We immediately recognized this as an opportunity to bring equity in access to care to children in all of Maine’s schools,” Vannah says. “By expanding the workforce providing oral health services beyond the traditional dental workforce, the increase in access to preventive and early intervention caries arrest services will be significant.”

Here’s how all 10 organizations plan to use the funds to improve the oral health and overall health of students.

• The American Academy of Pediatrics (AAP) in Illinois will adapt the Training, Education, Assistance, Mentorship, and Support (TEAMS) model, a pilot project that helped expand access to school health services. They will also develop an oral health micro-module for the AAP Health services Assessment Tool for Schools (HATS), a tool designed to help school districts and states assess the quality and comprehensiveness of school health services, the level of infrastructure to support those services, and the strength and implementation of school health services policies and protocols. 
• The Center for Oral Health in California will support the success of the Early Smiles Program to advocate for critical policy reforms at local and state levels in California. The program seeks to expand and enhance oral health services provided through its school-based program, which has demonstrated significant impact in Sacramento, Yolo, Alpine, and Trinity Counties in California. 
• EXCELth, Inc. in Louisiana will implement the Louisiana Smile Krewe School-Linked Initiative with the goal of increasing the number of children utilizing dental services. It will also promote widespread use of teledentistry to address barriers to oral health for rural communities. 
• MCD Global Health in Maine will integrate oral health with health, dental, and school partners, and increase access to care for Maine children. School nurses will provide screenings and preventive services. 
• Montana State University will launch the Youth Voice Project, which will conduct focus groups with students from seventh through twelfth grade to identify perceptions of oral health in their community. Montana State University will also pilot a same-day treatment protocol within its newly established Northern Cheyenne School-Based Health Center to disrupt the current model where students are referred to treatment more than 100 miles away in Billings. 
• More Smiles Wisconsin will expand oral health collaborations between schools, school-based prevention programs, and local dentists through the existing and recently established Hometown Smiles (HTS) program. Through HTS, each student served by existing school-based dental prevention programs will have a dentist who can identify dental needs and fix them before they become emergencies. 
• Nicklaus Children’s Hospital Foundation, in partnership with Borinquen Medical Center and eight elementary public schools in Miami-Dade County, will increase access to oral health care for recent immigrant children. School-based nurses will receive training to conduct oral disease assessments, increasing the application of preventive therapies and appropriate referrals. Additionally, a designated community dental health coordinator will help expand the safety net. 
• The Oral Health Unit (OHU) at the Colorado Department of Public Health and Environment, in collaboration with Youth Healthcare Alliance, will work with communities to design, test, and implement school-based oral health services. They will train school nurses, increase resources to support SBOH implementation, and present findings to the Colorado Oral Health Coalition for policy considerations. 
• Well Child Center in Illinois will form and convene a Community of Practice, a group of community members, to improve oral health in the second-largest school district in Illinois in the western suburbs of Chicago. Their pilot project will focus on increasing completion of dental exam school requirements before the first day of school for kindergarteners, second graders, and sixth graders.

For more information on CareQuest Institute’s grants, go to carequest.org/philanthropy.