Back to school

July 1, 2007
School-based dental hygiene clinics are a passion truly near to my heart. I think the time has finally come for the profession to be the forerunners in this necessary movement.

by Christine Nathe, RDH, MS

School-based dental hygiene clinics are a passion truly near to my heart. I think the time has finally come for the profession to be the forerunners in this necessary movement. In fact, given a Maryland boy’s recent death due to untreated dental decay, it is imperative that we work collaboratively with others to provide effective solutions to the pronounced dental care issues we face today. School-based health clinics have been gaining support in recent years. I feel that the momentum is building, politically, and it is time to help “carry” this school-based dental clinic paradigm to the next level.

As always, we begin with the historical significance of the concept. When Dr. Fones initiated the dental hygiene movement, he thought the dental hygienist would be best utilized by providing education and patient care in the school systems. He was a practicing dentist during the era before dental insurance, before Americans could count on sick leave or time off during working hours. He was a dentist when most people visiting the dentist needed extractions or prosthetic appliances. He thought a dental hygienist could be best utilized working in collaboration with teachers and nurses in the school.

In fact, Fones wrote that what is “universally conceded is that the most conspicuous physical defect of the school child is the unhygienic condition of his or her mouth. The reports of the medical inspectors in the public schools who made a glancing examination of the mouths of school children showed that decayed teeth outrank all other physical defects combined.”

Sound familiar? He further stated that in Bridgeport, Conn., “a plan to demonstrate what might be accomplished by applying the known means of prevention of dental caries to large groups of children was inaugurated in 1914. This was the inspiration for the original training course for dental hygienists - to provide a corps to carry out the first dental service in the public schools along educational and preventive lines.”

An RDH in all schools

We do have some dental services provided in schools via “mobile” dental care around the United States. I think this is fabulous and do not think it should cease. But my dream is for all schools in the nation to have their own dental hygienists, just as most schools have their own dedicated school nurses. Children from low-income families are known to experience higher rates of dental disease, have a higher percentage of unmet dental needs, and have significantly lower rates of dental care utilization than children not living in poverty.

Access to care remains an important issue for the children of this population. Realizing that many of these children are

attending school and that they have difficulty accessing dental care, school dental hygienists should be available to all children in school. School-based clinics need dental hygienists who manage dental care on a continuous basis, who are part of their communities, and who make dental care “safe” for children, just as dental hygienists do in private practice.

When a school has its own dental hygienist, every child in that school knows that there is a person there to help them with their dental problems and needs. Sometimes parents do not understand the significance of dental infection and pain, and other times parents just need help figuring out a dental care system.

Our experience in New Mexico in only one school has made a positive impact to many children by decreasing disease. Interestingly, it has made a tremendous impact to a few children. Unfortunately, these children were in constant, debilitating pain. They had no real options to deal with that pain until the school dental hygienist made sure that they received the care they needed to alleviate the pain by alleviating the infection. Basically, she helped the parents help their children.

I believe every child in the United States deserves to have necessary dental care. This includes dental hygiene care, which is not a luxury, nor is it elective health care. Prevention ensures that children are free from infection and subsequent pain. School-based dental clinics, managed by dental hygienists, is the direction we need to go in as a preventive profession.


Fones quotes: Fones, AC. Mouth Hygiene. 4th edition. Philadelphia: Lea & Febiger. 1934.

Children and oral health

  • Oral health is an essential and leading part in children’s overall health, functional capacity, and social welfare.
  • Dental care is an indispensable health service for children as dental caries and untreated dental disease can have significant consequences for a child’s health and well-being.
  • Dental care has been identified as the most prevalent unmet health need in U.S. children.
  • Millions of children continue to suffer needlessly from preventable oral diseases as a result of extensive disparities existing in oral health and access to care.
  • Dental caries remains the preeminent oral disease of childhood.
  • Children can experience pain, infection, dysfunction, poor appearance, and low self-esteem as well as drastic alterations to their ability to eat, communicate, sleep, and play.
  • Dental caries and untreated dental disease provide a reservoir of infection for systemic spread and have been associated with low social functioning and failure to thrive.
  • U.S. children experience an estimated 52 million hours lost from school each year to dental-related illness, in addition to problems with schoolwork completion and deterioration of school performance.
  • Children also experience many costly emergency room visits, and hospital-based medical and surgical treatments because of pain or dental problems.