Toolkit

Innovative Trainings

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Part I

School Nurse Start Up

Oral Health in Your School

The School-Based Oral Health Initiative, developed by the Pennsylvania Chapter of the American Academy of Pediatrics (PA AAP), is a comprehensive training program that equips school nurses with the knowledge and skills to integrate preventive oral health services into their daily practice. This course covers essential topics including dental caries prevention, fluoride varnish application, and…

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Documents

School Name 

School Address 

School Number 

Subject:   School-Based Oral Health Initiative 

Attention: Principal of [insert school name]  

Dear [Principal’s Name], 

I am pleased to inform you about an exciting new initiative from the PA Chapter of the American Academy of Pediatrics that aims at improving the oral health of Pennsylvania students. One of your school nurses, _________________, has expressed interest in participating in our program. Your school nurse will receive specialized training in providing preventive oral health services, including student education such as toothbrushing, flossing, proper nutrition, and resources to help families find care for oral health needs.  

This initiative supplies school nurses with a toolkit to refer to for support in caring for students’ oral health needs as well as information to supply to students and caregivers for oral health education and resources. In addition to resources, school nurses have the option to obtain a certification to apply topical fluoride varnish, if your school decides to implement a fluoride varnish program within your mandated dental program. This initiative is designed to benefit not only our students but also caregivers, families, and stakeholders within our school community. 

Cavities are the most common chronic disease of childhood and are preventable. On average, 34 million school hours are lost each year due to unplanned dental care. (Center for Disease Control and Prevention, 2024). With cavities and toothaches, children are more likely to have difficulty concentrating and performing well academically (Seirawan, Faust, & Mulligan, 2012). PA AAP has involved a local champion, such as a school nurse, who understands the value of the program and is trusted by both parents and school personnel to increase school acceptance and student participation, to help improve dental health of children throughout the Commonwealth. (Dudovitz et al. 2018)  

We believe that this initiative will significantly enhance the overall well-being of our students and foster a healthier school environment. Your support and cooperation are essential for the successful implementation of this program. Please feel free to reach out if you have any questions or need further information. 

Thank you for your attention and commitment to our students’ health. 

 

Warm Regards,  

Jacqueline Pugliese 

Jacqueline Pugliese, RDH, MPH 

PA AAP – Oral Health Project Manager  

[email protected] 

School District 

School Address 

School Phone number 

Subject:   School-Based Oral Health Initiative  

Attention: Superintendent  

Dear Superintendent [NAME], 

A School-based Oral Health Initiative was developed by the Pennsylvania Chapter of the American Academy of Pediatrics (PA AAP) to address the pressing oral health needs of school-aged children by integrating preventive care into the school environment.  We are pleased to inform you that one of your school nurses, _____________________, has expressed interest in participating in our program for [insert school name]. We are requesting your permission for their participation.  Your school nurse will be provided with the support and resources needed to follow all necessary steps to ensure the success of the program and that all school and HIPAA rules and regulations will be followed.  

This initiative will not only improve the oral health of students but also contribute to their overall well-being and academic success. We appreciate your support and collaboration in this effort. 

Below is an overview of the program for your information containing a request for your approval of participation of the above nurse. Please signify your approval no later than [insert date] by signing in the space provided at the end of this document and return to the participating school nurse. Should you have any questions or require further details about the program, please do not hesitate to contact me. 

Program Overview 

PA AAP is launching a pilot program that will equip school nurses with the necessary training and resources to provide education to students on the importance of oral health as they pass through the health room, as well as applying topical fluoride varnish if the school decides to participate in a fluoride varnish application program within their mandated dental program. Fluoride varnish is a proven method to reduce the incidence of dental caries (cavities) by strengthening tooth enamel and reversing early signs of decay. Prevention of dental caries is essential for students to avoid pain and illness and maximize learning.  

The training will encompass: 

Comprehensive Education on dental caries, the importance of oral health, and application of topical fluoride varnish: 

Information for students on ways to prevent tooth decay and other oral disease 

Understanding the benefits and safety of fluoride varnish. 

Step-by-step application instructions and hands-on training. 

Parental Engagement: 

Strategies to obtain informed parental consent. 

Clear communication about the benefits and safety of fluoride varnish. 

Integration into School Routine: 

Scheduling and application procedures to minimize disruption to the school day. 

Record-keeping protocols to ensure compliance with state and federal regulations. 

Health Equity and Access: 

Emphasizing the importance of meeting children where they are to ensure all students receive the necessary healthcare. 

Addressing health disparities by providing essential oral health services within the school environment. 

Why Schools are the Ideal Setting 

Schools are an ideal setting for delivering healthcare services, especially prevention education and preventive care like fluoride varnish application. Providing these services within the school setting helps overcome barriers such as transportation issues, financial constraints, and lack of available services, ensuring that all children have access to necessary preventive care, regardless of their socio-economic background. 

Cavities are the most common chronic disease of childhood and are preventable. On average, 34 million school hours are lost each year due to unplanned dental care. (Center for Disease Control and Prevention, 2024). With cavities and toothaches, children are more likely to have difficulty concentrating and performing well academically (Seirawan, Faust, & Mulligan, 2012). PA AAP has involved a local champion, such as a school nurse, who understands the value of the program and is trusted by both parents and school personnel to increase school acceptance and student participation, to help improve dental health of children throughout the Commonwealth. (Dudovitz et al. 2018) 

Warm Regards,  

Jacqueline Pugliese 

Jacqueline Pugliese, RDH, MPH 

PA AAP – Oral Health Project Manager  

[email protected] 

 

Superintendent Consent  

I acknowledge receipt of this document. I approve of the topical fluoride varnish application program in our school during the [         ] school year. I understand that the designated school nurse will be appropriately trained and educated to competently and safely administer fluoride to the students who will have parent/guardian consent. 

 

________________________________________ 

Superintendent Print Name 

 

_________________________________________ __________________________ 

Superintendent  Signature Date 

 

________________________________________ 

School District  

 

________________________________________ 

Participating School Name                   

School District 

School Address 

School Phone number 

Subject:   School-Based Oral Health Initiative  

Attention: Physician and Dentist of Record 

Dear [Insert names], 

A School-based Oral Health Initiative was developed by the Pennsylvania Chapter of the American Academy of Pediatrics (PA AAP) to address the pressing oral health needs of our school-aged children by integrating preventive care into the school environment. We are pleased to inform you that your school nurse has expressed interest in participating in our pilot program at [insert school name]. 

Program Overview 

PA AAP is launching a pilot program that will equip school nurses with the necessary training and resources to provide education to students on the importance of oral health as they pass through the health room, as well as applying topical fluoride varnish if the school decides to participate in a fluoride varnish application program within their mandated dental program. Fluoride varnish is a proven method to reduce the incidence of dental caries (cavities) by strengthening tooth enamel and reversing early signs of decay. Prevention of dental caries is essential for students to avoid pain and illness and maximize learning.  

The training will encompass: 

Comprehensive Education on dental caries, the importance of oral health, and application of topical fluoride varnish: 

Information for students on ways to prevent tooth decay and other oral disease 

Understanding the benefits and safety of fluoride varnish. 

Step-by-step application instructions and hands-on training. 

Parental Engagement: 

Strategies to obtain informed parental consent. 

Clear communication about the benefits and safety of fluoride varnish. 

Integration into School Routine: 

Scheduling and application procedures to minimize disruption to the school day. 

Record-keeping protocols to ensure compliance with state and federal regulations. 

Health Equity and Access: 

Emphasizing the importance of meeting children where they are to ensure all students receive the necessary healthcare. 

Addressing health disparities by providing essential oral health services within the school environment. 

Why Schools are the Ideal Setting 

Schools are an ideal setting for delivering healthcare services, especially prevention education and preventive care like fluoride varnish application. Providing these services within the school setting helps overcome barriers such as transportation issues, financial constraints, and lack of available services, ensuring that all children have access to necessary preventive care, regardless of their socio-economic background. 

Cavities are the most common chronic disease of childhood and are preventable. On average, 34 million school hours are lost each year due to unplanned dental care. (Center for Disease Control and Prevention, 2024). With cavities and toothaches, children are more likely to have difficulty concentrating and performing well academically (Seirawan, Faust, & Mulligan, 2012). PA AAP has involved a local champion, such as a school nurse, who understands the value of the program and is trusted by both parents and school personnel to increase school acceptance and student participation, to help improve dental health of children throughout the Commonwealth. (Dudovitz et al. 2018) 

We believe this initiative will not only improve the oral health of our students but also contribute to their overall well-being and academic success. We appreciate your support and collaboration in this effort. Should you have any questions or require further details about the program, please do not hesitate to contact us. 

We ask that you ensure that fluoride varnish is appropriately signed off for a standing prescription, to confirm that the school nurses have the appropriate documentation to distribute to students.  

Warm Regards,  

[School Nurse Name]  

[Participating school name] 

[School nurse contact info] 

And 

Jacqueline Pugliese 

Jacqueline Pugliese, RDH, MPH 

PA AAP – Oral Health Project Manager  

[email protected] 

 

Dentist and Physician Consent 

I acknowledge receipt of this document. I approve of the topical fluoride varnish application program in our school for the [         ] school year. I understand that the designated school nurse will be appropriately trained and educated to competently and safely administer fluoride to the students who will have parent/guardian consent. 

 

__________________________________________ 

Physician of Record Print Name 

__________________________________________ ______________________ 

Physician of Record Signature Date 

_________________________________________ 

School Name  

 

Fluoride has been properly documented for a standing order for distribution (to be completed by the dentist of record or physician of record if there is no dentist of record)  

 

_______________________________________ 

Dentist of Record Print Name 

 

________________________________________ ______________________  

Dentist of Record Signature Date 

Resources

Oral Health in Your Schools Summary

Materials Required:

  • Topical Fluoride Varnish
  • Gloves
  • Manufacture post-op instructions

Workflow responsibilities:

  • Supply ordering 
  • Schedule application days
  • Notify/educate parents
  • Obtain consents
  • Parent/Student oral health education
  • Documentation
  • School records and SHARRs

Application Positions:

  • Standing
  • Sitting (Chair or table)
  • Supine

Steps:

  • Open packaging
  • Mix contents with application brush
  • Apply a small amount on brush
  • Wipe enough on to lightly coat all surfaces of teeth
  • Provide post-application instructions and review verbally

Oral Health Education:

  • Brush twice daily with pea size amount of fluoride toothpaste
  • Floss daily
  • Drink more water (no added sugar, juice or flavoring)
  • Less sticky, sugary foods, healthy diet
  • See dentist regularly (2x a year)
  • Provide list of clinics

Content coming soon…

What is Fluoride?

Fluoride is a naturally occurring mineral that can help prevent tooth decay. The element fluorine is abundant in the earth’s crust as a naturally occurring fluoride compound found in rocks and soil. As ground water moves through the earth, it passes over rock formations and dissolves the fluoride minerals that are present, releasing fluoride ions that are naturally occurring fluoride in the rocks. This increases the fluoride content of the water. Fluoride is present at varied concentrations in all water sources including rainwater and the oceans. (ADA 2018)

“CDC named fluoridation of drinking water one of 10 great public health interventions of the 20th century because of the dramatic decline in cavities since community water fluoridation started in 1945” (CDC, 2024). Community water fluoridation is recognized as one of the most cost-effective, equitable, and safe measures communities can take to prevent cavities and improve oral health. Pennsylvania American Water states that Pennsylvania’s groundwater has naturally occurring fluoride levels up to about 0.2milligrams per liter (mg/L). Compared to the Environmental Protection Agency maximum levels of 4.0mg/L, Pennsylvania’s maximum levels are not to exceed 2.0mg/L.  

Please check to see if your community fluoridates their water on the CDC website.  

https://nccd.cdc.gov/DOH_MWF/Default/CountyList.aspx

For more facts on fluoride visit:

Fluoride Fast Facts

American Dental Association. (2018). Fluoridation facts. American Dental Association.

Content coming soon…

  • Video or live in person demonstration
  • Post op – rip offs per manufacturer
  • How long are the benefits

Part II

Parent/Guardian

FAQs

Topical Fluoride Varnish FAQs for Parents
In case you had concerns, here are some frequently asked questions and answers to clear things up.

Fluoride varnish is a protective coating that is applied to teeth to help prevent cavities. Fluoride varnish is made with fluoride, a naturally occuring mineral that can be found in many foods and water and strengthen tooth enamel (outer coating on teeth).

Cavities can cause pain and infections, which can lead to problems eating, speaking, playing, and learning. Fluoride varnish makes teeth stronger, stops cavities from getting worse and helps prevent new cavities from forming.

Yes, fluoride varnish is safe to apply at any age. Only a small amount is used, and hardly any fluoride is swallowed. It is quickly applied and hardens.

Fluoride varnish is painted on teeth with a brush. The process is quick and easy and does not cause pain. The varnish sticks to the teeth and may leave a thin, temporary coating. This is normal and will go away when teeth are brushed.

Fluoride varnish protects teeth for several months. It works best when reapplied every three to six months.

Eating and drinking after application is ok. If possible to avoid hot, hard or sticky foods for 4-6 hours.

Feel free to contact school nurse for further oral health questions.

Memos & Forms

Parent/Caregiver/Guardian Memo 

Subject: Important Update: Topical Fluoride Varnish Application Program 

Dear Parents and Guardians, 

We are pleased to inform you that our school nurse will be applying topical fluoride varnish to students’ teeth during this school year [2024-2025]. This preventive measure is designed to enhance oral health and protect against cavities. 

Fluoride varnish is a safe and effective way to strengthen tooth enamel and reduce the risk of tooth decay. The application process is quick and painless, and it can significantly benefit your child’s dental health. 

For more information about fluoride application and its oral health benefits, please refer to the resources provided. We encourage you to review these materials to better understand how fluoride can help maintain your child’s smile. Please fill out the attached consent form and return by [DATE] to ensure your child can participate in this oral health program.  

If you have any questions or concerns, please feel free to reach out. 

Thank you for your support in promoting your child’s health! 

Warm regards, 

 

[Your Name] 

[Your Position] 

[School Name] 

[Contact Information] 

Topical Fluoride Varnish Consent Form 

[School Header] 

A licensed health professional will be applying fluoride varnish to your child’s teeth as a means of preventing tooth decay (cavities). Tooth decay is the most common chronic disease found in children. Fluoride varnish is a protective coating that is painted on teeth to strengthen teeth and prevent tooth decay.  

For you or your child to receive the fluoride varnish you will need to give permission by completing the form below. 

___ YES I would like my child to receive the fluoride varnish application 

___ NO I do not wish for my child to receive the fluoride varnish application 

 

Name of person receiving fluoride varnish ___________________________________ 

Date of Birth _____________________________ 

Does the person receiving fluoride varnish see a dentist at least once per year? 

 ___ YES ___ NO    If Yes, name of dentist: _________________________________ 

 

____________________________ __________ 

Signature of Parent/Caregiver Date 

 

______________________________ __________ 

Please print name of Parent/Caregiver Date 

 

 

 

Any questions, please follow up with the school nurse.  

Parent & CSN Resources

Part III

Program Tools / Documentation

Walk through on how to document SHARRS

School nurses should be reporting their fluoride information from the current school year during the SHARRS Reporting window.  

*For example, 2024-2025 school year reporting window runs from May 2025 – September 2025.   

There are two areas of the SHARRS report that are applicable to fluoride programs: 

  • Itemized Expenditures:


  • Mandated Dental Services Program  

 

  • Daily reporting sheet 

Suggest Models

Quick Guide

Quick Guide 

 

  1. Introduction to Topical Fluoride Varnish

Overview: What is fluoride varnish and its benefits? 

Evidence-Based Practices: Research supporting its use in preventing dental caries. 

 

  1. Application Guidelines

Step-by-Step Instructions: Detailed guide on how to apply fluoride varnish. 

Safety Measures: Proper handling, storage, and disposal of materials. 

Video Demonstrations: Visual aids to complement written instructions. 

 

  1. Consents

Superintendent/Principal Approval: Letter explaining program and benefits of fluoride varnish  

Physician of record and Dentist of record approval: Letter explaining program and confirming necessary documentation is completed (signing off on running order for fluoride) 

Parent Consent Form Template: A sample form that includes necessary information (child’s name, date of birth, parent/guardian contact information, etc.). 

Instructions for Parents: Clear explanation of what fluoride varnish is, its benefits, and any potential side effects. 

Distribution Plan: How to distribute and collect consent forms from parents. 

 

  1. Incorporating into Daily Tasks

Integration with School Routine: How to incorporate fluoride varnish application into the school day without disrupting classes. 

 

  1. Record Keeping

Documentation Templates: Forms for recording each application (date, time, nurse’s name, etc.). 

SHARRS: How to use SHARRS to maintain records. 

 

  1. Training and Resources

Training and workshops: Opportunities for school nurses to receive hands-on training and support. 

Reference Materials: Handouts, guides, and quick-reference resources. 

Support Network: Contact information for dental professionals, oral health organizations, dental/dental hygiene programs, and support resources.  

 

  1. Evaluation and Feedback

Monitoring and Assessment: Methods to evaluate the effectiveness of the fluoride varnish program. 

Feedback Mechanism: How to gather feedback from parents, students, and staff to improve the program. 

Resources