Toolkit
- Toolkit
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For more information on any of our initiatives, please contact us at [email protected]
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…
Start CourseDocuments
Principal FYI Memo
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
Contacting Superintendent
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
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
Contacting physician of record/dentist of record
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
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
Guidelines for the School Dental Health Program for Pennsylvania's School Age Children and Adolescents
Oral Health in Your School Summary
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
What is dental caries/decay
Content coming soon…
What is fluoride?
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:
American Dental Association. (2018). Fluoridation facts. American Dental Association.
Discussing FL - PA Oral Health Coalition Water information
I Like My Teeth (Video)
Benefits, research (CWF data)
Content coming soon…
BSS Data
PA Oral Health Plan 2020-2030
Oral Health: School Fluoride Varnish Delivery Programs – Systematic Review
How to apply
- Video or live in person demonstration
- Post op – rip offs per manufacturer
- How long are the benefits
Oral Health Education (Print or electronic – poster options available for select)
- Why Children Need Fluoride? (ilikemyteeth.org)
- CDC building block
- Tooth development chart primary and permanent teeth
- Common questions about fluoride (AAP)
- Tooth tips for tweens and teens (AAP)
- What is Fluoride Varnish?
- Bright Futures Pocket Guide
- Oral Health Professional Resource Page
- A Guide To Packing a Healthy Lunch (PCOH)
- How Fluoride Works
- Healthy Smiles (multiple languages) from HTHC to use as a poster in Health Room
- Healthy Sips (PCOH)
Part II
Parent/Guardian
FAQs
What is Fluoride Varnish?
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).
Why is Fluoride Varnish recommended?
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.
Is Fluoride Varnish safe?
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.
How is Fluoride Varnish applied?
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.
How long does Fluoride Varnish last?
Fluoride varnish protects teeth for several months. It works best when reapplied every three to six months.
Can my child eat or drink after application?
Eating and drinking after application is ok. If possible to avoid hot, hard or sticky foods for 4-6 hours.
Memos & Forms
Parent/Caregiver/Guardian Memo
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
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
What is topical fluoride varnish?
Choose Oral Health
Common questions about fluoride (AAP)
Colgate - steps to good oral health
ACFF Fact vs. Fiction Fluoride
A Guide to Packing a Healthy Lunch
Healthy Sips
Sugar in drinks YouTube (Attach as QR code on poster)
Finding Dental Care (PCOH)
Fluoride Fast Facts
Public Health Collaborative: Fluoride Resource
Locate Community Health Center (PACHC)
My Water's Fluoride
Fluoride Information
Water and Fluoride Information
Healthy Habit All Stars: How to Brush
Healthy Habit All Stars: How to Floss
Healthy Habit All Stars: How to Prevent Cavities
Part III
Program Tools / Documentation
Walk through on how to document SHARRS
SHAARS Documentation
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
How to fit into school year

Quick Guide
View the Quick Guide
Quick Guide
- Introduction to Topical Fluoride Varnish
Overview: What is fluoride varnish and its benefits?
Evidence-Based Practices: Research supporting its use in preventing dental caries.
- 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.
- 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.
- Incorporating into Daily Tasks
Integration with School Routine: How to incorporate fluoride varnish application into the school day without disrupting classes.
- Record Keeping
Documentation Templates: Forms for recording each application (date, time, nurse’s name, etc.).
SHARRS: How to use SHARRS to maintain records.
- 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.
- 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
References
- CareQuest Institute for Oral Health
- U.S. Centers for Disease Control and Prevention Oral Health
- Colgate
- Smiles for Life
- Association of State & Territorial Dental Directors
- American Journal of Orthodontics & Dentofacial Orthopedics
- Oral Health Progress and Equity Network
- From the First Tooth
- Journal of The American Dental Association
- Pennsylvania School Health Guidelines
- American Dental Association – Fluoride Facts
- Bright Futures: Oral Health—Pocket Guide, 3rd edition
- Pennsylvania Coalition for Oral Health Resources
Valuable Website to Visit
- Pennsylvania School Health Guidelines
- CareQuest Institute for Oral Health
- Pennsylvania Chapter, American Academy of Pediatrics: Oral health and resources
- Healthy Teeth, Healthy Children
- Pennsylvania Coalition for Oral Health
- Pennsylvania Office of Rural Health
- Pennsylvania Office of Community Health Centers
- National Maternal and Child Oral Health Resource Center
- Bright Futures: Oral Health—Pocket Guide, 3rd edition
- Smiles for Life
- From the First Tooth
- American Dental Association
- School-Based Health Alliance
- National School Nurse Association – Oral Health Connections
- Pennsylvania Association of School Nurses and Pracitioners
- CDC Healthy Schools
- Oral Health Learning Cafe
- Missouri Department of Health and Senior Services Office of Dental Health: Oral Health Guide for Caregivers of School-Aged Children – Dental First Aid