School-Based Oral Health Initiative


Tooth decay is the most common chronic disease among children. In North Carolina, almost 50 percent of schoolchildren have tooth decay, according to the North Carolina Department of Health and Human Services. Complicating this issue is the fact that access to quality, affordable preventative oral health care is especially difficult for children, in particular those living in rural communities across the state.

Creating access to oral health care in a setting where children spend much of their time - schools - has the potential to address many barriers to oral health access.

Since 2019, our foundation has been working in partnership with The Duke Endowment on an initiative to increase the number of school-based oral health care programs that deliver preventive services and address restorative treatment needs for children across the state, part of a larger $35 million joint commitment that also includes the BlueCross BlueShield of South Carolina Foundation.

What Are School-Based Oral Health Programs?

School-based dental programs provide a range of oral health care services directly to students, generally during the school day.  Some utilize fixed equipment in schools, while others bring in portable chairs and equipment or mobile clinics parked on school property. Depending on the model, services can include:

  • Oral screenings and risk assessments
  • Fluoride varnish applications
  • Dental sealant applications
  • Oral prophylaxes
  • Radiographs
  • Oral hygiene instruction
  • Nutrition and/or tobacco counseling


This video, produced by our partners at The Duke Endowment, shows a school-based oral health program in action. See how Kinston Community Health Center chief dental officer Dr. Francisco Rios and his team bring smiles to the students at Moss Hill in Lenoir County.

How Do the Programs Work? 

While school-based dental programs vary to meet communities’ needs, the model our foundations are supporting ensure that kids seen in schools have a dental home and that treatment needs are addressed, either by a dentist in the school or a fixed site. Partnerships between the school system, administrators, clinic staff, navigators, school nurses, teachers, families, and kids are essential to making these models work. While each implementation is slightly different based on local conditions and assets, the programs emphasize evidence-based services such as dental sealants and silver-diamine fluoride as part of their comprehensive care models, as well as engage multi-sector leadership to promote both dental access and program sustainability.

Grantees in these cohorts receive peer-support from each other and technical assistance from teams at the Medical University of South Carolina and East Carolina University School of Dental Medicine. Technical assistance covers a range of topics including: site selection, service scope, electronic records, staffing models, partnership development, billing, consent, and case management and navigation.

How is the Initiative Progressing?

The number of program sites across the state has continued to grow, despite the challenges presented by COVID-19.

  • 2018:     7 clinic sites added, providing service in 10 counties*
  • 2019:   10 clinic sites added, providing service in 23 counties
  • 2020:     7 clinic sites added, expected to serve 14 counties
  • 2021:     3 clinic sites added,  expected to serve 3 counties
  • 2022:     Cohort 5 recruitment planned for Fall/Winter 2022

*Supported solely by The Duke Endowment

Since the initiative launched in 2018, 24 dental clinics have received support, providing much needed oral health care to students in 250 North Carolina schools.

What's the Bigger Picture?

Increasing access to preventive oral health services for children has been a priority in our grantmaking for several years. Our approach – grounded in the recommendations of a 2014 Institute of Medicine Taskforce Children’s Preventive Oral Health Services – has included several small-scale investments in school-based dental programs as well as support for advocacy organizations that advance changes that increase access to affordable, quality, oral health care.

The majority of the school-based sites that are part of this initiative are utilizing public health exceptions that allow indirect supervision of hygienists, a practice advocated by the Taskforce. Other sites are implementing teledentistry. The proliferation of new programs using different models in communities across our state not only creates new access points, but also contributes to a shared understanding with families, advocates, oral health professionals, and others about the practices and policies that reduce barriers to care and supports developing systems and policy-level strategies to improve oral health access.