Dental Public Health Activities & Practices

Dental Public Health Activities & Practices Practice Number: 33018 Submitted By: New Jersey Department of Health and Senior Services Submission Date: November 2009 Last Updated: November 2009 Name of the Practice: SECTION I: PRACTICE OVERVIEW New Jersey Children s Oral Health Program Public Health Functions: Assessment - Acquiring and Use of Data Policy Development Collaboration and Partnership for Planning and Integration Assurance Population-based Interventions Assurance Oral Health Communications Assurance Building Linkages and Partnerships for Interventions Assurance Building Community Capacity for Interventions HP 2010 Objectives: 21-1 Reduce dental caries experience in children. 21-2 Reduce untreated dental decay in children and adults. 21-8 Increase use of sealants in first and second molars. 21-10 Increase utilization of oral health system. 21-12 Increase preventive dental services for poor children. State: New Jersey Region: Northeast Region II Key Words: Oral health education, dental education, prevention, school program, classroom education Abstract: The New Jersey Department of Health and Senior Services established the New Jersey Children s Oral Health Program in 1981. The Program provides a variety of oral health education activities for children in grades pre-k through 12. The Program is regionally implemented in all twenty-one counties of the State. Each region has a Regional Oral Health Coordinator and other program personnel that implement program activities. Educational activities are age-appropriate and cover a variety of oral health issues including, but not limited to, oral hygiene, fluoride as a preventive measure for tooth decay, dental sealants, nutrition, periodontal disease, tobacco cessation, and the prevention of oral trauma. Classroom presentations include discussion, audio-visual materials, and extensive student participation. Health fair exhibits address areas of oral health appropriate for the participants. Puppet shows are used to teach the importance of proper oral hygiene, fluoride, a healthy diet and regular dental visits. All Children s Oral Health Program activities can be adapted for an audience of children with special needs. Educational presentations are also provided to parents and pregnant women. Furthermore, the program staff provides in-service or workshop programs to non-dental professionals, including school nurses, public health nurses, teachers, WIC Coordinators, and social workers. Data on regional program activities is compiled on a quarterly basis and submitted to the New Jersey Department of Health and Senior Services. During the 2008-2009 school year, over 80,000 individuals participated in formal oral health education programs provided by the Regional Oral Health Coordinators and their staff. Contact Persons for Inquiries: Beverly A. Kupiec-Sce, Ph.D., R.N., Coordinator, New Jersey Children's Oral Health Program, New Jersey Department of Health and Senior Services, P.O. Box 364, Trenton, NJ 08625, Phone: 609-943-5749, Email: Beverly.Kupiec@doh.state.nj.us Practice # 33011 New Jersey Children s Oral Health Program 1

SECTION II: PRACTICE DESCRIPTION History of the Practice: The New Jersey Department of Health and Senior Services initiated the Children s Oral Health Program in 1981 to provide age-appropriate oral health education to children in the State. Initially, education programs targeted primarily children in grades of K- 6 and focused on oral hygiene and the importance of regular dental visits. Over time, the educational programs were revised to reflect knowledge and research on other preventive oral health practices and to a target population that included younger and older children (grades Pre-k through 12). Education covers a wide variety of oral health issues including, but not limited to, good oral hygiene practices, fluoride as a preventive measure, dental sealants, good nutrition, periodontal disease, smoke and spit tobacco prevention and cessation, oral cancer awareness, prevention of oral trauma, oral piercing, oral implications of substance abuse, and the oral complications of diabetes. With additional program funding and increased efforts to raise oral health awareness statewide, the Children s Oral Health Program expanded to serve all counties through three regional programs, which are strategically located in the north, central and southern parts of the State. Justification of the Practice: Oral health education has a major role in promoting good health for children. Optimal oral health established early in life is essential to general overall health and well-being. Education that takes place in schools prepares students to take personal responsibility for their own health and to engage in personal care that will maintain and improve health over the course of their lifetime. The Children s Oral Health Program directs its efforts to improve the oral health of school-age children based on research and national recommendations. Through oral health education, the Program promotes good oral health practices to reduce future problems related to oral disease. The ideal oral/dental health education curriculum is a blending of a variety of programs and activities that encourage and challenge students to think about the relationship between knowledge, choice, behavior, and good oral health. For students to acquire the necessary knowledge, they need to develop the skills to incorporate healthy behaviors into their lives. These behaviors promote oral health and prevent dental disease, including toothbrushing with fluoridated toothpaste, reducing or eliminating sugar-rich foods from the child s diet, and emphasizing the importance of not using tobacco products. Curricula should be age-appropriate for both children's cognitive abilities and the health risks they face at each stage of life development. The Children s Oral Health Program addresses the beginning of the life cycle and oral health through education for women during pregnancy, emphasizing the infectious nature of tooth decay, transmission of bacteria from mother to infant, importance of visits to the dentist, and need for oral hygiene and dental care for optimal oral health. For children, the Program s oral health curriculum supports learning that will frame experiences and builds on their prior knowledge. In educating children in pre-k, emphasis is placed on the importance on brushing the teeth with a fluoridated toothpaste twice a day and developing a positive attitude about visiting the dentist. For children in early school years, through formal programs such as Cavity Free Kids or general oral hygiene instruction programs, children learn plaque removal to to protect their teeth. Adolescents are given lessons to help make decisions regarding self-care, dietary practices, tobacoo cessation/oral cancer, problems associated with oral piercings, and oral injury. Inputs, Activities, Outputs and Outcomes of the Practice: Administration The Children s Oral Health Program is administered by the New Jersey Department of Health and Senior Services. The Program is directed at the State level by the Program Coordinator, who has a Ph.D. Through a Memorandum of Agreement with the State s dental school, the University of Medicine and Dentistry of New Jersey, a dentist is available to provide consultation to the Program. The Oral Health Program is organized into three regional programs (north, central and southern) and covers all twenty-one counties of the State. Program services are targeted to high-need/high- Practice # 33011 New Jersey Children s Oral Health Program 2

risk areas with non-fluoridated community water and to schools with a high proportion of students enrolled in free-and reduced lunch programs (children from low-income families). The northern regional program covers the counties of Morris, Passaic, Sussex, and Warren. The central regional program covers the counties of Bergen, Essex, Hudson, Hunterdon, Middlesex, Monmouth, Ocean, Somerset, and Union. The southern regional program covers the counties of Atlantic, Burlington, Cape May, Camden, Cumberland, Gloucester, Mercer, and Salem. All three regional programs have similar scope of services and the programs provide the same types of activities. Regional Staffing The New Jersey Children's Oral Health Program is implemented by two full-time and one part-time Regional Oral Health Coordinators (ROHCs). Each ROHC is strategically located in the northern, central and southern parts of the State. Two of the ROHC positions are filled by registered dental hygienists with master degrees. The third ROHC position is filled by a health educator with a M.P.H. and has expertise in program evaluation. Each ROHC has staff support and implements program activities in the counties of their regional areas. The regional programs employ additional registered dental hygienists to deliver education in their catchment areas. In particular, two agencies in the central and southern parts of the State receive grant funds from the Children s Oral Health Program to hire dental hygienists and implement activities. These agencies include a federally-qualified health center and a maternal child health consortium. With additional staff, the Program has reached more younger and older children. This long standing program staff, with almost no staff turnover, has maintained strong collaborative relationships with school nurses statewide. School nurses regularly contact program staff for assistance and to implementation oral health educational activities. Regional program staff provide phone consultation and on-site school visits. Partnerships and Collaborations As of 2009, with a 28-year history, the Children s Oral Health Program has established collaborative partnerships with community-based agencies, local health departments, WIC programs, and State and local education agencies. Examples of partnerships and collaborations include: Program staff are featured speakers at child health conferences sponsored by local health departments and presents at school nurse conferences. Program staff provides oral health education programs for WIC clients and staff. The train the trainer approach provides WIC staff with the knowledge and resources to impart oral health education messages to their clients. The Children s Oral Health Program in collaboration with the New Jersey Dental Hygienists Association established the Homeless Shelter Initiative in 2008 to provide oral health education to homeless families at shelters. The Children s Oral Health Program has established a partnership with a local faith-based, four-county community to train parish/congregational health nurses in oral health assessment and education. The New Jersey Coordinated School Health Demonstration Project Improving Health and Educational Outcomes of Young People is a CDC funded State project that builds State education and State health agency partnerships. The primary objectives are physical activity, tobacco prevention and nutrition. Eight schools throughout the State have received grant funds. Staff from the Children s Oral Health Program provides consultation and technical assistance. Program Activities The Children s Oral Health Program provides education activities for children, parents/caregivers, school staff, and health/childcare providers in school and community settings. 1. School-Based Oral Health Education Activities Classroom Oral Health Education Classroom oral health activities include the Cavity Free Kids Program. This program targets children ages 3-5 (preschool and pre-k children). This program includes daily tooth brushing with fluoridated toothpaste, oral hygiene education, parent education, Practice # 33011 New Jersey Children s Oral Health Program 3

dental screening referral, and follow-up. Sample lesson plans are provided. Program dental hygienists are innovative and creative with their presentations. Oral health education programs are provided upon request to schools. Each regional program has dental hygienists prepared and well equipped to provide education to all grade levels (pre-k to 12). Oral Health Teaching Kits Franny Flossisaurus and Mr. Gross Mouth The Children s Oral Health Program introduces two teaching kits to educate children and promote good oral health practices. Franny Flossisaurus is a puppet teaching tool for grades pre-k through three. It features a large magenta-colored dinosaur and a variety of teaching materials including a complete series of the American Dental Association s animated Dudley DVDs and respective teaching guides, two Charlie Brown DVDs, four videotapes with teacher guides, three books, a large demonstration toothbrush, puzzle, and toy model dental office. Mr. Gross Mouth, a teaching model, targets students in grades four through eight and addresses tobacco use, periodontal disease and mouth guards. The centerpiece of the teaching kit is a model showing the effects of tobacco on tissues of the mouth. Both kits are loaned to pre-schools, schools, day camps, after-school programs, and faith-based organizations and are used by teachers, school nurses, and allied health professionals. The kits are kept at each regional program location and mailed directly to the requesting school for a two-week period. Schools assume the responsibility for the return of the kits and to replace any damaged materials. 2. Oral Health and Nutrition Resource Guide The New Jersey Department of Health and Senior Services in collaboration with the ROHCs developed the Oral Health and Nutrition Resource Guide, a comprehensive compilation of oral health and nutrition materials, resources, and references. It was a one time effort to compile a comprehensive resource of oral health and nutrition related resources. The guide consisted of five sections of information for professionals and consumers: Oral Health Materials, Education, Products and Vendors, Web Resources, and Literature. The guide was produced for the use of school nurses, public health nurses, health and social service coordinators, and health educators in a various settings. Approximately 400 copies were printed and distributed statewide to county child care health consultant coordinators, child health nurses (who work in local health departments, childcare centers and clinics), county school nurse association presidents, and the health and social service coordinators. School nurses reproduced sections of the guide, and conducted their own Train the Trainer sessions. After the first distribution, it was decided that with the vast amount information on nutrition and oral health resource materials can be made available on the Web; it was not necessary to update and reprint the manual. When regional program staff provide consultation to school nurses, the Nutrition and Resource Guide is discussed and nurses are encouraged to update sections of the Guide as appropriate for their specific needs. 3. The Miles of Smiles Annual School Newsletter In the fall of 1991, the first issue of the newsletter Miles of Smiles was developed and distributed. The goal of the oral health newsletter is to increase the awareness of the statewide Children s Oral Health Program and to provide oral health education information for school personnel, parents and students. The newsletter has evolved from a two-sided, 1-page issue to a four-page booklet that on occasion included additional inserts (such as the Maternal and Child Oral Health Resource Center s fact sheets Oral Health and Learning, Preventing Tooth Decay, and Saving Teeth with Dental Sealants). Currently, the "Miles of Smiles" newsletter is an annual publication that is distributed to schools, and local health departments. The print cost is approximately $1 per newsletter. Topics that have been featured in the newsletter included: smoke and spit tobacco cessation, sports and soft drink effects on teeth, marijuana use and periodontal health, dental emergencies, tongue cleaning, fluoride varnish, HPV and oral cancer, grills, oral manifestations of eating disorders, xylitol, sealants, asthma medications and tooth decay, xerostomia, importance of Practice # 33011 New Jersey Children s Oral Health Program 4

saliva, obesity, periodontal disease and tooth decay, meth mouth, burning mouth syndrome, oral piercing, dentinal hypersensitivity, environmental tobacco smoke and tooth decay. 4. Oral Health Education for Parents/Caregivers Recognizing that early prevention is necessary for optimal oral health and that pregnancy is an ideal time to educate women about good oral health practices for themselves and their babies, the regional program staff have developed and implemented a number of initiatives. Protecting Oral Health from Pregnancy to Puberty OB Collaborative The Protecting Oral Health from Pregnancy to Puberty OB (Obstetrics) Collaborative is a pilot project established by the New Jersey Department of Health and Senior Services and the Southern Jersey Family Medical Centers, Inc. (SJFMC). The Children s Oral Health Program and the OB Department and Nutrition Services at SJFMC are implementing the pilot (started in July 2009) with the aim to improve the oral health of pregnant women and to promote good oral hygiene practices for their babies. Activities include: Training for the OB Coordinators on the importance of good oral health care practices during pregnancy and to ensure incorporation of oral health into education visits for pregnant women. Working with OB Coordinators and Nutritionists to facilitate referrals of patients to SJFMC dentists for dental care. Providing dental resource materials to the OB Coordinators and Nutritionists including the Access to Oral Health Care during the Perinatal Period and Oral Health Care During Pregnancy A Summary of Practice Guidelines and the Dental Clinic Directory Dial a Smile. Developing new educational materials including a fact sheet called Oral Health Recommendations for Health Care Professionals for OB Coordinators and an instruction sheet called Dental Do s From Birth to 1 Year! for new mothers. Distributing oral hygiene materials such as xylitol tooth wipes for babies and toothbrushes for pregnant women. Women Infant Children Program The ROHCs and regional program staff provide oral health education to pregnant women and parent/caregivers participating in the Women, Infants, and Children Supplemental Food Program (WIC). The WIC Education Coordinators also provide oral health education to pregnant women and parents on topics such as early childhood caries, fluoride supplements, oral hygiene for infants and toddlers, dental visits by age one, oral hygiene during pregnancy, dental visits for pregnant women, and the link between periodontal disease and pre-term birth. The ROHCs and program staff develop and distribute an annual oral health newsletter to all WIC agencies in the State. WIC Coordinators use the information from the newsletter to educate clients on topics of interest. Past issues have provided information on fluoride varnish, obesity, xylitol, and the effects of soda on oral health. Parent Education in Communities Parent education in local communities focuses on teen and adult parent groups. Parents are reached through workshops or community baby showers. For example, when community groups, such as Healthy Mothers/Healthy Babies Coalitions, host community baby showers, education on good oral health practices are provided to pregnant women and first time parents. These presentations take place at sites that include schools and community agencies. Health Fairs/Wellness Days Displays at health fairs are provided by regional staff in high-need/high-risk community settings as requested. Regional staff also participate in school wellness days. During community or school events, topics of interest on oral health are presented and resource materials on oral health and hygiene are distributed. Practice # 33011 New Jersey Children s Oral Health Program 5

5. Oral Health Training for School Staff/Personnel School-based dental programs such as Cavity Free Kids (an early childhood program for daily toothbrushing) and Save Our Smiles (a fluoride mouth rinse program) require training the school staff/personnel. Regional program staff provide the training. In the Cavity Free Kids program, school staff are trained on sanitary/hygienic storage of toothbrushes and proper management of the classroom toothbrushing activity. In the fluoride mouth rinse program, school staff are trained on proper storage and disposal of fluoride supplies, distribution methods of fluoride dosages, and program administration processes. 6. The New Jersey Dental Clinic Directory The New Jersey Dial A Smile Dental Clinic Directory is a central source of information on safety-net dental clinic services in New Jersey. These dental clinic services are primarily provided by local health departments, hospitals and Federally Qualified Health Centers (FQHCs). Information contained in the directory is obtained from organizations that respond to a "Survey of Dental Health Services sent whenever the Directory needs an update. The New Jersey Dental Clinic Directory is used to assist people who have difficulty accessing appropriate dental care due to insurance or financial constraints. The directory is available online at http://www.state.nj.us/health/fhs/newborn/documents/dental_directory.pdf. The New Jersey Dental Clinic Directory is also printed by the New Jersey Department of Health and Senior Services and distributed to school nurses, child health conference coordinators, WIC agencies, NJ Dental Association, local health departments, hospital emergency departments, and the ROHCs. For each updated edition, approximately 4,000 copies are printed for distribution. The latest updated Directory was distributed in 2008; another update is anticipated in 2010. 7. Oral Health Education for Children with Special Needs All of the Children s Oral Health Program activities can be adapted for children with special needs. Program activities include: Classroom presentations which include a discussion, use of audio-visual materials, and extensive student participation. Puppet shows that feature six large colorful characters to teach the importance of proper oral hygiene, use of fluoride as a preventive measure, a healthy diet, and regular dental visits. In-service or workshop programs for non-dental professionals including school nurses, public health nurses, teachers, and social workers. In 2008, a newsletter with information addressing the oral health needs of children with special health care needs was prepared and distributed to all special needs school districts in the State. 8. Injury Prevention Education The regional program staff promote the use of mouthguards for protection from oral injury in school and community based education programs. In addition, education on the importance of seatbelts and other protection to avoid accidental trauma are emphasized. At the present time, there is no mechanism for the Program to provide direct referrals to dentists for student athletes needing mouthguards. 9. Fluoride Mouth Rinse Program The Children's Oral Health Program administers the school-based voluntary weekly Save Our Smiles fluoride mouth rinse (FMR) program. The 32-week program represents an active intervention in the Children s Oral Health Program to reduce tooth decay in elementary school children. The FMR program target schools in communities with nonfluoridated community water and having fluoride levels below optimal levels to prevent tooth decay. At the present time, the program provides fluoride using either a mix and pump method or a unit dose system. For schools that choose the less costly mix and pump method, the program is provided free of charge. For schools using the unit dose system, the school pays the cost difference between the mix and pump and unit dose method. Practice # 33011 New Jersey Children s Oral Health Program 6

When a FMR program is implemented at a school, typically the school nurse is the coordinator. Regional program dental hygienists conduct an in-service program to orient the school nurses on the policies and procedures of the program. A FMR program manual is provided outlining the necessary steps to ensure successful classroom activities. Program data forms are reviewed with the school nurses. These forms capture data that are used for reporting program participation/activities to the State central office and the regional programs. At the end of the school year, school nurses complete an order form for mouth rinse program supplies that will be used for the subsequent school year. Mouth rinse supplies are delivered directly to the school. School personnel are instructed to store the supplies in a locked and secure environment. All school children participating in the voluntary mouth rinse program receive education on the importance of good oral hygiene practices. Each participating school receives a yearly in-person visit by regional staff or an in-depth telephone consultation. 10. Homeless Shelter Oral Health Education Project In 2008, the Children s Oral Health Program in collaboration with the New Jersey Dental Hygienists Association (NJDHA) established the Homeless Shelter Initiative. This initiative set up an oral health education project for families and individuals in homeless shelters. The NJDHA has five component areas covering the State; one homeless shelter from each area was targeted for education. Volunteer dental hygienists recruited through the NJDHA provided the oral health education to homeless shelter residents. The Children s Oral Health Program developed a guidance template for the volunteer hygienists to develop their oral health education. The guidance template provided uniform oral health education content for all five shelters. The Children s Oral Health Program also provided DVDs to the volunteer dental hygienists to help educate young children. Personal care hygiene bags were assembled with donations from NJDHA members and distributed at each site. The New Jersey Department of Health and Senior Services donated oral health care bags that included a tooth brush, dental floss, baby tender tooth wipe, and oral health educational materials. Two copies of the Dial a Smile Dental Clinic Directory were provided for the case managers at all homeless shelters. The education project was repeated in 2009. 11. Experiential Learning Education Project The Children s Oral Health Program, the Burlington County College Dental Hygiene Program and Southern Jersey Family Medical Centers, Inc. (SJFMC) collaborated to provide an oral health education learning experience in a dental public health setting for senior dental hygiene students. This experiential learning will place the students in a situation where they think, interact and learn in a real-world environment. Starting in January 2008, senior dental hygiene students provided oral health education at the SJFMC s New Lisbon dental clinic site (formerly Buttonwood Hospital). Each Friday during the Spring semester, two students provided a 15-minute oral health education program to patients at the dental clinic. The Children s Oral Health Program staff provided the students an Oral Health Points to Emphasize booklet, teaching kits, and videos as resources to develop their education program. A flyer was distributed to the clinic patients informing them of the oral health education programs every Friday. The education program focuses on school age children. Presentations developed by the students covered good oral hygiene practices, early childhood caries, dental check-ups, dental sealants, and oral health and childhood obesity. Participants are given oral hygiene supplies (e.g., toothbrush/toothpaste) provided by the Children s Oral Health Program. 12. Parish Nurse Oral Health Initiative In an effort to provide oral health education to all school age children statewide, a collaborative was formed that would utilize parish or congregational health nurses in faithbased communities to promote oral health. Through consultation with the Roman Catholic Diocese of Trenton, the Parish Nurse Oral Health Initiative was proposed. This Initiative would increase the awareness of oral health among parish nurses and enlist their support in oral health education activities. The Initiative will promote interdisciplinary training of nursing professionals to counsel patients in strategies to reduce risk factors for dental disease and encourage referral to dental professionals for oral health care. Practice # 33011 New Jersey Children s Oral Health Program 7

The counties of Mercer, Burlington, Ocean and Monmouth, which comprise the Diocese of Trenton, would be targeted for parish nurse training. Oral health training would be conducted in each of the four counties at a centrally located parish site. Parish nurses will receive training in oral hygiene, pregnancy and oral health, early childhood oral care, use of fluoride as a preventive measure, good nutrition practices, injury prevention (mouthguards), periodontal disease, oral cancer and tobacco cessation, substance abuse, and diabetes and oral health. Continuing education credits will be awarded for the parish nurse training. Each parish nurse will receive a guidance template that highlights all pertinent educational topics with content information and color pictures that can be used to teach the children and families across each parish. Program Output Data from regional program activities are compiled on a quarterly basis and submitted to the New Jersey Department of Health and Senior Services. During the 2008-2009 school year, the Children s Oral Health Program provided these services: More than 80,000 individuals (school-age children, parents, expectant women, school nurses, and professionals) participated in formal oral health education programs provided by the ROHCs and their staff. More than 3,320 students received oral health education using the teaching kits Franny Flossisaurus (toothbrushing and flossing) and Mr. Gross Mouth (tobacco cessation). Eleven workshops for teachers were conducted providing oral health education for the Cavity Free Kids Program. Approximately 2,225 students participated in the Cavity Free Kids Program Five fluoride mouth rinse program trainings were conducted for school staff. The voluntary Save Our Smiles fluoride mouth rinse program serves over 25,000 students per year in 122 high-risk schools in non-fluoridated areas of the State. More than 4,400 students participated in a variety of oral health activities at regional health fairs; students received oral health education, take home resource materials and toothbrushes. Additional oral health educational activities for the 2008-09 program year included: The annual "Miles of Smiles" newsletter was mailed to more than 3,200 public, non-public schools, and local health departments. Approximately 875 WIC clients received oral health education. Approximately 750 teens/adult parents were educated through workshops and community baby showers. More than 435 homeless families living in a shelter received dental education and oral health care bags. Program Evaluation In order to determine if programs and activities conducted by the Children s Oral Health Program are meeting the needs of school age children, the following program evaluation activities were conducted. 1. Oral Health Survey The 2008-2009 Oral Health Survey (a survey conducted every two years) collected data through a parent/guardian recall survey questionnaire that was administered to a random sample of third grade students statewide. The survey questions and results are as follows: Does Your Child Have a Dental Sealant on a Back Tooth? The Oral Health Survey estimated that 46% of third graders had at least one dental sealant on a permanent molar. Compared to the previous survey (two years ago), there is a 2% increase. Has Your Child Ever Had a Cavity? The survey showed that 51% of third grade students have/had dental caries. The rate of caries experience is similar to the two previous surveys. Has Your Child Had a Dental Check-up Within the Past Year? The survey showed that 91% of third grade students had a dental check-up within the past year. An increase of 4% compared to the previous survey. Has Your Child Ever Had A Toothache? Practice # 33011 New Jersey Children s Oral Health Program 8

The survey showed that 22% of third grade students did at some point in time have a toothache. More children in the high-need/high-risk areas had a toothache (33%). Do You Ever Feel Afraid or Nervous About Visiting the Dentist? The survey showed that 22% of parents/guardians reported feeling afraid or nervous about visiting the dentist. This may influence a child s response to a dental visit. 2. Oral Health Teaching Kit Evaluation Evaluation forms are included in the Oral Health Teaching Kits (Franny Flossisaurus and Mr. Gross Mouth). The forms are to be completed by the school or agency that borrowed and used the kits. Evaluations have been positive. Respondents indicate that the teaching materials, lesson plans, audio-visuals and handouts are very good to excellent. End-users report that the kits contain useful oral health education materials, instructions are clear and understandable, and education lessons were appropriate and engaging for the students. 3. Oral Health and Nutrition Resource Guide Evaluation A survey conducted by the regional program staff evaluated the Oral Health and Nutrition Resource Guide. Data revealed a positive response from public health nurses and health educators in local health departments. Respondents also suggested a periodic update of the resource guide. The Program determined that it would not be cost-effective to print future editions of the Guide since information can be accessed on the Web. 4. Miles of Smiles Newsletter Evaluation A survey of school nurses to determine the reception of the first issue of the Miles of Smiles newsletter had overwhelmingly positive responses. The school nurses reported that oral health was part of the curriculum in their schools (82%). The oral health education programs are primarily included in grades K-5 and are delivered in the majority of the schools by the school nurse or classroom teacher. Another survey was included in the recent distribution of the Miles of Smiles newsletter mailed to school nurses in September 2009. Program Outcome The Children s Oral Health Program has contributed to the following outcomes: State, regional and local oral health infrastructure have been expanded through the Program. Linkages have been established, resources have been pooled, and people have been mobilized to support oral health. The Program is contributing efforts to achieve Healthy People 2010 to increase the proportion of children receiving at least one dental sealant on their permanent molar teeth. The Program is integrating oral health into systems that include schools, homeless shelters, faith-based organizations, WIC programs, and OB services. Budget Estimates and Formulas of the Practice: The annual budget for the Children s Oral Health Program (covering the three regional programs) is approximately $400,000. The budget covers the salary/compensation costs of the Regional Oral Health Coordinators, staff dental hygienists and program support staff. In addition, the budget covers expenses related to local travel, training, program supplies, and educational materials. Lessons Learned and/or Plans for Improvement: The Children s Oral Health Program has been in existence for 28 years addressing oral health education needs for school age children. Given the successful history of the Program, there are no plans at the present time to make major program changes. Over the past five years, collaborative partnerships have been established to increase and enhance oral health education for school age children. Though many of the Initiatives are focused on school age children, children are able to take home the message learned and share it with parents and siblings. Practice # 33011 New Jersey Children s Oral Health Program 9

The Children s Oral Health Program is in the process of planning further evaluation of its education services for program improvement. Assessment will determine whether children and adults gain accurate knowledge from the education programs and at community baby showers (pre-test and post-test). A series of evaluative sessions will be piloted. The parents and/or expectant women participating will be asked to answer questions based on key messages that will be provided in the education session. These evaluation efforts could then be expanded to the Program s WIC presentations, tobacco cessation presentations, non-dental professionals education, and school nurse trainings. Future efforts will evaluate the program s impact on children s oral health status. Available Information Resources: The following resources developed by the Children s Oral Health Program can be requested for reference. Lesson plans related to oral hygiene, brushing and flossing, tobacco cessation, and oral cancer awareness List of audio-visual materials for teaching children good oral health practices List of education material vendors Practice # 33011 New Jersey Children s Oral Health Program 10

SECTION III: PRACTICE EVALUATION INFORMATION Impact/Effectiveness How has the practice demonstrated impact, applicability, and benefits to the oral health care and well-being of certain populations or communities (i.e., reference scientific evidence, outcomes of the practice and/or evaluation results)? In a typical school year, the Children s Oral Health Program provides extensive oral health activities that include more than 80,000 individuals participating in formal oral health education programs and more than 25,000 students (in high-risk communities without optimal fluoride in their community drinking water) participating in a school fluoride mouth rinse program. The Children s Oral Health Program has increased partnerships and collaborations with State and local stakeholders, expanded local infrastructure to promote oral health, and increased oral health knowledge of children, parents and school personnel. Efficiency How has the practice demonstrated cost and resource efficiency where expenses are appropriate to benefits? How has the practice demonstrated realistic and reasonable staffing and time requirements? Provide unit cost analysis or cost-benefit analysis if appropriate. The Children s Oral Health Program educates children on preventive oral health care and good health practices to avert tooth decay and costly treatment. The Program is implemented in three regions educating children and families in all 21 counties of the State. This improves efficiency by leveraging local resources through collaboration with schools and community-based agencies to enhance program activities. Program efforts are directed to the high-need school districts in areas where the public water supply is not optimally fluoridated, targeting services to vulnerable children. Demonstrated Sustainability How has the practice showed sustainable benefits and/or how has the practice been sustainable within populations/communities and between states/territories? What mechanisms have been built into the practice to assure sustainability? The Children s Oral Health Program has a long-standing history of 28 years and is administered by the New Jersey Department of Health and Senior Services. Support of the Program is provided through Federal and State Maternal and Child Health Block Grant funds. Sustainability is also demonstrated by the Program s continued growth over the years to the current status of serving children statewide. Collaboration/Integration How has the practice built effective partnerships/collaborations among various organizations and integrated oral health with other health projects and issues? What are the traditional, nontraditional, public and private partnerships/collaborations established by the practice for integration, effectiveness, efficiency and sustainability? The Children s Oral Health Program has built effective partnerships with State, local, community, and faith-based agencies. These partnerships have been strengthened due to the stability of program personnel, good rapport with school nurses statewide, and regional coordination of program services. Partners include state agencies (such as Departments of Education, Human Services, and Environmental Protection), University of Medicine and Dentistry of NJ - NJ Dental School, local health departments, federally qualified health centers, public and parochial elementary/middle/high schools, NJ State Board of Dentistry, NJ Dental Hygiene Association, NJ Dental Association, NJ State School Nurses Association, and Burlington County College. Objectives/Rationale How has the practice addressed HP 2010 objectives, met the National Call to Action to Promote Oral Health, and/or built basic infrastructure and capacity for state/territorial/community oral health programs? Practice # 33011 New Jersey Children s Oral Health Program 11

The Children s Oral Health Program supports efforts to address the additional following Healthy People 2010 Objectives: Reduce untreated dental decay in children and adults. Increase adults with teeth who have never lost a tooth. Reduce adults who have lost all their teeth. Reduce gingivitis among adults. Reduce periodontal disease among adults. Increase utilization of oral health system. Extent of Use Among States Describe the extent of the practice or aspects of the practice used in other states. The Association of State and Territorial Dental Directors 2009 Synopses of State Dental Public Health Programs showed that 45 states reported having programs for oral health education/promotion. Practice # 33011 New Jersey Children s Oral Health Program 12