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Dental Public Health Activities: Descriptive Summaries

Tacoma-Pierce County Health Department School-Based Oral Health Program

Practice Number: 54011
Submitted By: Tacoma-Pierce County Health Department, Oral Health Program
Submission Date: November 2017
Last Reviewed: November 2017
Last Updated: November 2017
Best Practice Approach Example -

Tacoma- Pierce County Health Department’s School-Based Oral Health Program (SBOHP) serves as an integral part of a robust, public health strategy in Pierce County, Washington. The SBOHP demonstrates effective, collaborative partnership of the local health department, schools, and oral health clinicians to reach children, increase access to dental services, and improve oral health. 

The Health Department oversees and coordinates the SBOHP countywide. Private dentists, dental assistants, and dental hygienists provide direct preventative oral health services to children and adolescents in a school setting, using Best Practices. Preventative services provided through the SBOHP include screenings, sealants, fluoride varnish applications, oral health education, and referral to a dental home. The SBOHP also provides referral to emergency dental treatment as appropriate.

The overall goal of the SBOHP is to increase the number of Pierce County children and adolescents in Kindergarten through 12th grade who receive comprehensive preventative dental care. 

Lessons Learned:

What we’ve learned from schools:

  • Schools are an important partner to provide accessible venues for oral health services to students during school hours. The commitment level of the school principal, school nurse, and teachers to the SBOHP is a strong indicator of Program success in a school. Health Departments can help educate school staff reluctant to participate that having a student away from class for approximately 30 minutes to receive preventative oral health services will help prevent longer absences from school for more extensive oral health treatment.
  • Schools benefit from SBOHP oversight and coordination provided by the Health Department to maintain Program fidelity and improve efficiency. Schools appreciate that Program participation will require minimal time commitment of their staff since the Health Department leads oversight, coordination, and scheduling. Schools are confident that providers assigned to their schools are already vetted for professional credentials, with signed MOU and quality assurance agreements, liability insurance, and background clearances to work with children.

What we’ve learned from students: 

  • SBOHP recruitment efforts are best prioritized in elementary and middle schools, since older students are often hesitant to participate, or not as interested to participate, in the SBOHP, particularly after 7th grade.
  • Recruitment efforts are also best prioritized in new schools. Providing services in schools new to the SBOHP tend to yield more student participation and more cost-effectiveness for providers than schools which already participate in the SBOHP.  A newly-participating school offers potential for un-tapped student participation, whereas an existing school draws from virtually the same cohort of students each school year, with students who may already participate in the SBOHP, or have had the opportunity to participate but do not. Parents who have declined to give participation permission in earlier grade levels may continue to decline permission as their child advances through different grades. 
  • Another reason why targeting new schools can help maximize participation is that many students in existing schools have already received dental sealants at appropriate intervals, (2nd and 6th grade, based on usual age of eruption for 1st and 2nd molars) so do not receive sealants each school year (but are eligible to receive the other preventative services each school year).

What we’ve learned from SBOHP providers:

  • Providers who participate in the SBOHP genuinely love children and providing service delivery in a school setting.
  • Mobile dental vans are expensive to purchase and operate, and few providers have capacity to do either. However, portable dental units (dental chair and mobile equipment) are feasible to purchase and transport. These can be set up inside a school in a limited space, such as a small classroom or the corner of a gym or stage.
  • Providers benefit from value-added services that the Health Department can offer them, such as fluoride varnish and other bulk supply purchases at our government rate, or the maintenance and repair costs of their equipment used in the SBOHP. Our independent hygienists have indicated that fluoride varnish, in particular, is especially expensive for them to purchase, so the option to purchase at the government rate is useful.

What we’ve learned as a Health Department from a Program administration perspective:

  • Return of parental permission forms is crucial to ensure student participation. The Health Department, providers, and schools need to work together to address barriers and implement participation strategies that appeal to students and their parents. (Barriers and strategies may vary according to school and student population).
  • Site visits to schools by Health Department SBOHP staff, and regular conversations to check-in with schools and providers initiated by the Health Department, are important to demonstrate Health Department support to providers and schools, monitor Program effectiveness, and address challenges.
  • Socio-economic status of children in Pierce County is not a predictable indicator of oral health status. We have learned that dental decay and dental neglect exist in children in our community across all income levels. Therefore, offering school-based oral services to all students, and not only those of lower income (based on Federal poverty levels, such as those who qualify for Medicaid and free or reduced lunch) can help improve oral health for children of any socio-economic status.
  • Extending SBOHP services to all students helps eliminate possible stigma within a school for students being singled out for services based on their family’s income.
  • Public-Private partnerships between the Health Department and private, community providers to offer fluoride varnishes and other oral health services in a school setting offer both health and economic benefits. Such partnerships provide long-term, sustainable solutions to provide access to oral health services to children without reliance on health department staff for delivery. This SBOHP partnership model operates successfully despite the potential for decreasing public funds or term-limited grants and limited Health Department staffing capacity.
  • The SBOHP partnerships help maintain Program integrity, sustain Program longevity, improve access to oral health services, and expand service levels to meet increasing community needs.


Contact Person(s) for Inquiries:

Michele Haymond, MBA, Health Promotion Coordinator III, Tacoma-Pierce County Health Department, Oral Health Program, Strengthening Families Division, 3629 South D Street, Tacoma, WA, 98419, Phone: 253-798-6500, Cell: 253-468-6373, Email:

Dawn Jacobs, School-Based Oral Health Program Coordinator, Strengthening Families Division, Tacoma-Pierce County Health Department, , 3629 South D Street, Tacoma, WA, 98419, Phone: 253-798-2945, Cell: 253-579-5695, Email: