1. Methods: Program Description Among Repeat Participants
Evaluation of a School-Based Solution to Improve Oral Health for High Risk Children
R. Dudovitz, MD, MS1, M.J. Puffer, BSN, MPA2, D. Romo, DDS3, G. Espinosa, RN, BSN, MEd4, R. Villanueva, RN,CPNP, MSN, Med4, J. Valiente, BS1, P.J. Chung, MD, MS1,5
1 Department of Pediatrics and the Children’s Discovery & Innovations Institute, UCLA; 2LA Trust for Children’s health; 3Eisner Pediatric Dentistry;
4 Los Angeles Unified School District; 5RAND and Department of Health Policy & Management, UCLA
Introduction
Methods: Evaluation
Results
Data Collection & Analysis
Demographics, insurance, access to and use of dental care and beverage consumption were gathered from consent forms.
Screening exam results, including indications for emergent dental care were recorded during the screening day.
Program costs (personnel, supplies) and reimbursement data was collected from LAUSD and the dental provider.
Data was entered into Excel and analyzed using STATA.
T-tests were used to compare means and proportions across groups.
Preparation
Schools were chosen for their interest and capacity to host the program and need for services.
At San Pedro ES, Eisner Pediatric Dentistry was providing regular comprehensive services; at Nevin ES there were no established school-based dental services.
District Oral Health Nurse attended school meetings with students, parents, and teachers to describe the program and provide oral health education.
Consent forms were distributed to all students in school. Children returning a signed parental consent form were eligible to participate.
Although dental decay is nearly 100% preventable, it remains the most common pediatric chronic disease , disproportionately affecting low-income, minority children.
Aside from impacting a student's ability to eat, speak, and sleep, untreated cavities and related dental pain are associated with more school absenteeism and lower grades.
Access to dental care, poor oral health behaviors, low health literacy, and limited use of fluoridated water drive this disparity.
To address this disparity, the Los Angeles Trust for Children’s Health piloted a universal school-based oral health screening and fluoride varnishing program in two public elementary schools serving low-income children.
Results
570 students participated in year 1 and 744 in year 2
28% of year 1 students (289) participated again in year 2
Objectives
To assess the school-based universal screening and fluoride varnishing program’s effectiveness and financial sustainability.
We sought to determine:
Whether the program reduced the burden of untreated dental disease
Whether participants had improved oral health behaviors over time
Whether the program appears sustainable and scalable
Table 1. Year 1Descriptive Statistics by School
Nevin ES (N=266)
San Pedro ES (N=304)
P-Value
Percent/mean
Male
47%
0.92
Age
8.1 ( )
8.0 ( )
0.25
Has a Dentist
78%
0.99
Dental Visit in Last 6 months
55%
65%
0.01
Dental Problem
18%
22%
0.2
Insurance 
Medi-Caid
67%
73%
0.15
Private
11% 7%
0.16
No Insurance 9%
0.69
Unknown 4%
0.84
Beverage Consumption in Last 7 Days
Tap Water
32%
0.97
Bottled Water
87%
0.94
Juice
79%
80%
Soda
44%
52%
0.06
Any Sugar-Sweetened Bev.
86%
89%
0.30
Emergent issues included dental abscesses, other infections, broken teeth, rampant decay and severe pain.
Methods: Program Description
There were no significant changes in oral health behaviors at follow-up.
Overall program costs:
Year Year 2
$2511/screening day $2603/screening day
$8.87/child $7.71/child
On average care to 44% (range 40%-49%) of students was reimbursable through Medi-Caid, although 70% reported having Medi-Caid insurance.
The program was 100% financially sustainable with a dental provider that is part of a federally qualified health center. However reimbursement rates for other types of providers would not sustain the program.
Screening Day
Students received a toothbrush, brief oral health education and completed a 2-minute supervised dry-brush
Underwent dental screening by a single pediatric dentist and fluoride varnishing by dental assistants
Received oral health care educational packages prior to returning to class.
Compared to students who participated in year 1 only, at baseline, students participating both years :
Were significantly older (mean age 8.3 vs.8.0, p<0.001)
Reported more dental problems (22% vs. 17%, p=0.04)
Were less likely to have active dental disease (37% vs. 45%, p=0.02)
Were less likely to need emergent care (2% vs. 7%, p=0.006)
Among Repeat Participants
Conclusions
A school-based universal screening and fluoride varnishing program can successfully improve access to preventative oral health care for low-income, at-risk children.
Students served by LAUSD have a high burden of dental disease and unmet oral health needs. 
Dissemination of the program throughout the district depends on funding for un-reimbursed care and developing capacity among additional oral health providers.
At Nevin, the average number of caries fell from 1.5 per student at baseline to 0.6 per student at follow-up (p<0.001).
There was no difference in average caries at San Pedro (0.4 vs. 0.6 per student).
Follow-Up
A letter was sent home indicating each child’s screening results and community resources for follow-up dental care.
Parents of students with urgent dental needs were contacted directly by the school nurse to ensure appropriate linkage to follow-up care.
ACKNOWLEDGMENTS: We would like to thank the parents, students and school staff for their support of this project; and the DentaQuest Foundation for funding this work.