Spotlight: School-Based Oral Health
Good oral health matters. It improves health outcomes related to major chronic conditions, lowers health care costs, supports confidence and self-assurance, and most importantly, improves lives.
However, there is the lack of access and opportunities to oral health care for rural and under-resourced communities nationally, including in communities across North Carolina. Kids and families have difficulty accessing regular oral health care due to the type of insurance they have, lack of providers in their communities, language barriers, or challenges getting out of work or school during the hours providers are open - all of which contributes to kids not being able to access adequate preventive care, and even treatment for tooth decay when they need it.
As a result, oral health is one of the top drivers for school absences in low resourced communities, and tooth decay is the most common chronic disease among children. On average, children with poor oral health status are about three times more likely to miss school because of dental pain, absences that are associated with lowered school performance. Poor dental health can also lead to negative consequences for the mental health and confidence of children - who can face bullying along with other detrimental social effects.
The development and expansion of school-based oral health is one tool that schools and oral health providers are partnering on to expand access. The increase in implementation of the model creates some hope that future generations will be better positioned to achieve and maintain good oral health.
What is School-Based Oral Health
School-based oral health (SBOH) programs provide a range of preventive oral health services for children where they spend a majority of their time. By hosting clinics in schools, parents don’t have to miss work to get kids to dental appointments, which in some places can be the next county over. School-based clinics in regions without accessible care for children nearby also keep kids in class instead of in long car rides to dental appointments during school hours.
According to the NC Oral Health Collaborative, while the extent of services offered varies, every school-based dental program brings care out into the community. This care can include:
- Oral screenings and risk assessments
- Fluoride varnish applications
- Dental sealant applications
- Oral hygiene instruction
- Nutrition and/or tobacco counseling
Because SBOH happens in a variety of school settings, it can look any number of ways. Take for example Kinston’s SBOH program at Rochelle Middle School, recently visited by Blue Cross NC Foundation’s Daijah Davis. The SBOH team from the Kinston Community Health Center consists of a dentist, two hygienists, their dental unit manager, and a patient navigator who is also a dental assistant. The team provides dental services two days a week at school, ranging from pre-k through 8th grade, where they bring portable equipment to set up shop within the school. They pride themselves on collaboration - the very mindset that has led to recent success from the organizations committed to this work.
“SBOH programs allow schools, community clinics, health departments, and families to partner in a very logical way, for the sake of the child’s health. Everyone benefits – clinics can see more children outside of their offices, which can free up space to see other patients, sometimes adults, who can have even fewer access points than children depending on the region.”
“SBOH programs allow schools, community clinics, health departments, and families to partner in a very logical way, for the sake of the child’s health, said Davis. “Everyone benefits – clinics can see more children outside of their offices, which can free up space to see other patients, sometimes adults, who can have even fewer access points than children depending on the region. Schools are supporting children in getting preventive, sometimes restorative care, which helps improve their oral health status and keeps them in the classroom, and parents have a task, which can be a lot more difficult for some, taken off their plate.”
Growing School-Based Oral Health in North Carolina, and Beyond
Recognizing the potential impact of these programs, in 2019, Blue Cross NC Foundation joined The Duke Endowment and the BlueCross BlueShield of South Carolina Foundation on a $35 million dollar commitment to launch the School-Based Oral Health Expansion Initiative, to spread SBOH across the Carolinas and support action that leads to better oral health care outcomes for all kids, no matter where they are.
The goal is to grow SBOH programs by supplying the resources and training for interested dental clinics to work with each other to develop new or expand existing SBOH to ensure that children from rural and low resourced communities have access to essential dental care. The two Blues foundations funded the readiness phases to make sure clinics have an advanced clinical care plan, a viable business plan, and adequate financial and clinical data reporting capabilities for the North Carolina and South Carolina sites, respectively.
The impact of the SBOH Initiative is being felt, especially in rural and under-resourced communities.
- 30 grantees are already serving more than 300 North Carolina schools.
- Five new grantee clinics are working to develop new programs.
- Schools in 48 of the state’s 100 counties are served by a grantee supported in this initiative.
- Technical assistance implementation teams have developed a robust SBOH training resource that is being shared nationally to help other clinics implement similar programs.
However, sustainable improvement in oral health will ultimately depend on changes at the policy and systems level that support broader impact. A great example of this was the passage of NC Senate Bill 146 in 2021, which formalized the practice of exam by teledentistry and streamlined rules for public health hygienists.
These regulatory updates made operation of SBOH programs significantly more sustainable for many clinics. Kintegra, for example, has shifted their workflow over the years to increase efficiency – namely the number of children they are able to provide preventive services to through the school-based program.
Looking ahead, the success of SBOH can serve as a model for different types of community-based collaboration with the potential to address the need for care for adults as well as younger children.
Learn more about the Foundation's focus on oral health.