Content

1. Questions and Answers on School Oral Health ProgramsPresented by the ASTDD, School and Adolescent Oral Health Committee in conjunction with the National Association of School Nurses

2. Content This webinar will focus on: • Access to oral health care • Delivery of dental services • Emergency care • Oral health resources The questions featured in this webinar were provided by school nurses from across the country and will be answered by professionals with knowledge and experience in the delivery of dental services in the school setting.

3. Presenters • Jill Moore, RDH, BSDH, MHA – Oral Health Coordinator Michigan Dept. of Community Health • Martha Bergren, DNS, RN, NCSN, FNASN, FASHA NASN Special Projects and faculty, UIC College of Nursing • Nicole Breton, BS, RDH – Public Health Educator Maine Centers for Disease Control, Oral Health Program • Rudy Blea, BA - Director Office of Oral Health, New Mexico Department of Health

4. Access to Oral Health CareJill Moore

5. Access to Oral Health Care • Oral Health is included in Healthy People 2020 and is a Leading Health Indicator • All children should have access to the oral health care system • Multiple barriers Photo courtesy of: Jill Moore

6. I spend a lot of time on the phone trying to find dental care for the students in my school. Is there a published list of dental professionals and clinics that accept Medicaid or a website I might go to?

7. Access to dental care can be challenging for every school nurse, in some areas of the country, such as rural areas it may be even more challenging. • Why are only certain grades targeted by a school-based program, for instance 2nd and 3rd grade or 6th and 7th grade? • Financial assistance to pay for dental care for children without insurance seems very limited or non-existent. How can I learn about the resources in my community?

8. Oral Health Education Access to Dental Care Injury Prevention Mouthguard Use As a school nurse, I understand why oral health is important. What is the best way to address this with my school’s administrators and teachers to help them understand why the dental needs of our students’ needs to be addressed and why oral health needs to be part of our school’s curriculum? Oral Health Promotion for School Staff School-based Dental Services School Environment Promoting Oral Health Nutrition Services Social Services & Relationship w/ Oral Health Improving Children’s Oral Health Through Coordinated School Health Programs www.astdd.org/docs/BPASchoolCSHP.pdf

9. Resources and Access www.mchoralhealth.org www.michigan.gov/oralhealth

10. I would like to coordinate a program in my community that helps parents and students receive dental care. Are there any communities that have worked collaboratively to create successful programs like this? Where would I find out more information about these programs?

11. Delivery of Dental Services Martha Dewey Bergren

12. Oral Health Education Where can school nurses get more education about oral health and how to deliver oral health care in school? Visit NASN’s Oral Health Connections, an interactive website for quick and easy school oral health links. Funded by the DentaQuest Foundation, this site includes: • Oral health knowledge interactive self assessment • Links to NYU’s Smiles for Life Oral Health Curriculum and other curricula for health providers • NASN Radio Program: Nurse's Guide to Student Oral Health • Online Continuing Education: Oral Health 101 for School Nurses • Annual Conference information offering oral health educational sessions

13. What does the delivery of oral health care look like in a school setting? There are many different options available for the delivery of oral healthcare in a school. It can range from screening to actual restorative treatment. Although some school nurses do administer screenings and fluoride rinses in schools, most partner with regional and community agencies to provide care. The first resource to tap into is your state’s oral health program: www.astdd.org/state-programs/ For school nurses who want to start an oral health initiative in their school: www.astdd.org/school-and-adolescent-oral-health-committee/ • Oral Health Education for Students/Parents • Prevention Services: Fluoride Rinses, Cleanings, Sealants, Varnish • Comprehensive Restorative Services

14. Consent for Oral Health Care Receiving parent/guardian consent is difficult for so many types of health care in school settings. What are some of the recommended models for getting written consents for oral health care in schools? School nurses and oral health champions across the country are experimenting with models aimed at collecting written parent/guardian consent for the delivery of oral health care. Some of the strategies reported by members of NASN and ASTDD’s School and Adolescent Health Committee are: • Include the forms in the “back to school” packets with all of the paperwork that parents return to school at the beginning of the year. • Provide downloadable consent forms on the School District’s Health or School Nurse’s webpage. • Be present at Back-to-School Nights, Parent/Teacher Conferences, PTA/PTO meetings to promote the OH program and distribute forms.

15. Consent Form’s cont’d • Provide oral health education programming for parents prior to the date the school oral health program is scheduled to provide services at the school. • Provide in class oral health programming for students prior to the scheduled school oral health program start-date. • Request that ALL forms be returned, allowing parents to check a YES or NO if their child is participating. Create student AND teacher incentives (gift cards, electric toothbrush, etc.) for classes who return 100% of forms. Do you know an innovative and successful model for the return of signed consent forms for any health purpose in schools? If so, please email mbergren@nasn.org

16. Dental Emergencies Nicole Breton

17. What is a dental emergency? A dental emergency can be easily described as: • Any abnormal oral condition that causes pain or concern; • An abscess (infection) toothache can cause pain, swelling or fever; or • An injury to the teeth, gums or other oral structures.

18. What might a dental emergency look like? Facial Swelling Tooth Decay Abscess/Fistula

19. Fractured Tooth Gum Laceration Trauma from Piercing Avulsed Tooth

20. What might a school nurse have available if there is a dental emergency? • Contact Info for Local Dentist(s)/Dental Clinic(s) • Saline Solution • Dental Floss • Tweezers • Flashlight • Dental (Paraffin) Wax • Gauze Squares • Cold Compress/Popsicles • Small Containers w/ Lids/Coin Envelopes

21. http://www.deardoctor.com/dental-injuries/dental-injuries-guide1.pdfhttp://www.deardoctor.com/dental-injuries/dental-injuries-guide1.pdf

22. http://www.iadt-dentaltrauma.org/images/save_your_tooth.jpg Downloadable in Seven Languages other than English

23. Oral Health Resources Rudy Blea

24. There are so many other issues that teachers deal with during the day besides oral health. What resources can guide us in this process? Your school’s health manual could provide some direction and information. It’s important for school administrators to support your efforts. A well child will learn without difficulties and stay in school. Additional resources are: • ASTDD’s School Health Policy: www.astdd.org/docs/Coordinated_School_Oral_Health_Policy_April_5_2011.pdf • A study published by the University of Southern California School of Dentistry linking how a child performs in school when they are well or ill. http://dentistry.usc.edu/2012/08/10/poor-oral-health-can-mean-missed-school-lower-grades

25. What are the best oral health prevention strategies for children and adolescents? 1. Dental sealants, fluorides and fluoridation, and education and nutrition are key prevention strategies. School-linked or a school-based prevention programs are the first line of defense for the prevention of tooth decay in the school setting, as well as securing a “dental home”. • Oral health education is important to teach students how and why hygiene practices are important. • Nutrition is important, this includes limiting the consumption of sugar and drinking fluoridated water. • Developing a school oral health policy is important as well as having the policy adopted and enforced throughout all school activities and curriculum. • Including dental professionals on your school’s Wellness Committee.

26. Water fluoridation has been a topic in the news and also discussed at community meetings in my town. As a school nurse, I want to understand the truth about fluoridation and why it’s important for preventing tooth decay. Are there water fluoridation resources available that are credible and easy to understand? There are many resources available on the internet and that can be a problem. A word of caution… many of the websites don’t offer credible information about fluoridation and will print anything to sway your opinion against its benefits. Most of that research is unscientific and has been conducted in other countries where the fluoride levels are ten times higher than they are in the US.

27. Community Water Fluoridation Resources • Centers for Disease Control and Prevention: http://www.cdc.gov/fluoridation/index.htm. • American Dental Association: http://www.ada.org/fluoride.aspx. • American Academy of Pediatrics: http://www2.aap.org/oralhealth • I Like My Teeth: www.ilikemyteeth.org • The Community Guide – Oral Health - Preventing Dental Caries: http://www.thecommunityguide.org/about/task-force-members.html

28. Where can a school nurse find resources about oral health programs, the importance of school sealant programs, how to do a dental screening, and other related topics? Where can I find out what oral health programs and resources are available in my community and/or in my state?

29. Oral Health Resources • Association of State and Territorial Dental Directors www.astdd.org • Division of Oral Health, US Centers for Disease Control and Prevention www.cdc.gov/OralHealth/ • Maternal and Child Oral Health Resource Center: (202) 784-9551 or www.mchoralhealth.org • Maternal and Child Oral Health Resources for Head Start Programs www.mchoralhealth.org/HeadStart/index.html • American Dental Association’s “Mouth Healthy” Resources www.mouthhealthy.org

30. Oral Health Resources • Bright Futures Oral Health Pocket Guide (AAP): http://brightfutures.aap.org/materials.html • Child Oral Health Resources for Primary Care Providers (Center for Health Care Strategies): www.chcs.org/publications3960/publications_show.htm?doc_id=1200397 • Reaching New Heights in Health with School Based Oral Health Programs (Massachusetts Coalition for Oral Health): http://www.masscoalitionfororalhealth.org/files/2009/06/9134_White- Paper_r5aPROOF.pdf • Medline Plus: www.nlm.nih.gov/medlineplus/childdentalhealth.html

31. Community Water Fluoridation Resources • Centers for Disease Control and Prevention: http://www.cdc.gov/fluoridation/index.htm. • American Dental Association: http://www.ada.org/fluoride.aspx. • American Academy of Pediatrics: http://www2.aap.org/oralhealth • I Like My Teeth: www.ilikemyteeth.org • The Community Guide – Oral Health - Preventing Dental Caries: http://www.thecommunityguide.org/about/task-force-members.html

32. Dental Emergency Resources Manuals • Dental First Aid Emergencies (Colorado Dept. of Public Health and Environment): scha-mi.org/emergencydentalflipchart.pdf • School Nurses’s Guide to Oral Health (Georgia Oral Health Prevention Program): http://health.state.ga.us/pdfs/familyhealth/oral/ohscreeningmanual_Revised0612.pdf Webinar • Managing and Preventing Dental Emergencies in the School Setting (Massachusetts School Health Institute): www.neushi.org/show-program.pl?type=online&id=493 Poster • Dental Emergency Guide (New Jersey Dept. of Health and Senior Services): www.nj.gov/health/fhs/oral/documents/dental_emergency_guide.pdf

33. Resources from NASN “ORAL HEALTH CONNECTIONS”: www.oralhealthconnections.org • Oral health knowledge interactive self assessment www.oralhealthconnections.org/Home/SelfAssessment • NYU’s Smiles for Life Oral Health Curriculum and other curricula for health providers http://smilesforlifeoralhealth.org/default.aspx?tut=555&pagekey=62948&s1=2127993 • NASN Radio Program: Nurse's Guide to Student Oral Health www.jackstreet.com/jackstreet/WNASN.HayesZacharski.cfm • Online Continuing Education: Oral Health 101 for School Nurseswww.nasn.org/ContinuingEducation/OnlineContinuingEducation • NASN’s Annual Conference offers oral health educational sessions www.nasn.org

34. Thank you for joining usQuestions and Answers on School Oral Health ProgramsPresented by the ASTDD School and Adolescent Oral Health Committee in conjunction with the National Association of School Nurses