In the US, 29% of school-age children have untreated dental caries, which can have long term consequences for health and learning. A comprehensive school-based oral health program serves children in Chelsea, Massachusetts, the population of which is predominantly minority, immigrant, and low income, with high rates of dental caries and limited access to care. Oral health education, dental screening, dental sealants, fluoride varnish, and a full service dental clinic are offered. This evaluation covers six years of program operation, from 2001 to 2007 with three broad aims; to determine program effectiveness, utilization and impact of the dental clinic, and the influence of the program upon the oral health of students in Chelsea compared to students statewide.
Oral health and demographic data were available for nearly 7,500 students. Outcomes include untreated decay, severity of treatment needed, and dental sealants. Comparisons were made to 6,200 participants of the 2007 Massachusetts Oral Health Survey (MOHS). Analysis consisted of bivariate analysis of demographic characteristics and oral health outcomes using chi-squares and stratified by year or student grade level.
Logistic regression was also employed with adjustment for student characteristics and potential covariates.
Results indicated that the program lead to improved oral health outcomes. Students' oral health status improved with each additional year of participation. Participation in the dental sealant program during second grade led to higher rates of dental sealants that persisted until sixth grade. Students most likely to attend the dental clinic following dental screening were non-Hispanic Black students, student in first and second grades, and those with severe dental treatment needs. There was no difference in oral health outcomes for the entire population before and after the dental clinic opened, after adjustment for potential confounders. Chelsea students had higher decay rates than students statewide during 2007. However, third graders had equal rates of severe treatment needs and significantly more dental sealants. The school-based program in Chelsea successfully reduced income disparities in dental sealant rates.
In addition to revealing the benefits of a comprehensive school based health program on oral health outcomes, this evaluation also revealed challenges and areas for potential improvement.