This framework offers ideas for school-based health centers (SBHCs) to consider when integrating sustainable comprehensive oral health services into primary care. Implementing these ideas can improve the quality of care and ultimately the oral health and overall health and well-being of school-age children and adolescents.

The framework begins with a description of the impact of oral health problems on children's and adolescents' school performance and a description of the Maternal and Child Health Bureau's (MCHB's) School-Based Comprehensive Oral Health Services (SBCOHS) grant program, followed by a description of six levels of integration to help SBHCs identify their current level of integration. The advantages and disadvantages of each level of integration are also identified. In addition, the framework outlines 10 key elements of integration and includes a set of action steps, highlighted activities from the SBCOHS grantees, and relevant resources for each element. Based on this information, SBHCs can use the 10 key elements to more fully integrate sustainable comprehensive oral health services into primary care in SBHCs.

The framework has a flexible design that allows SBHCs to infuse their own ideas into the planning process, engage local partners, and tailor efforts to best meet their specific program needs. Information presented in the framework is based on lessons learned from MCHB's SBCOHS 2011–2015 grantees as well as on useful information that was compiled to support grantees' efforts to plan, implement, and evaluate integration activities.

In this framework, "sustainable" is loosely defined. It can mean simply that program services can continue despite resource shifts or losses. It can also refer to institutionalizing services or continued activities and impacts; creating a legacy; continuing organizational ideals, principles, and beliefs; upholding existing relationships; or maintaining consistent outcomes. 1

Oral Health and School Performance

tooth decay chart

Despite decreases in tooth decay rates among children and adolescents, tooth decay remains a persistent problem in the United States. 2 As children get older, they experience both more tooth decay and more untreated tooth decay. In addition to affecting their overall health and well-being, oral disease can negatively impact children's performance at school. 3

Children and adolescents with oral health problems are more likely to have problems at school and less likely to completed their homework compared to those without oral health problems. 4 Also, children and adolescents who had toothaches in the last 6 month months are almost four times more likely to have a grade point average below 2.8 compared to their counterparts who did not have toothaches. 5 The worse a child's or adolescent's oral health status, the more likely the child or adolescent is to miss school as a result of pain or infection. 6

One proven strategy for reaching children and adolescents at high risk for oral disease is through school-based programs with linkages to oral health professionals and other health partners in the community. These programs serve as models for improving access to oral health education, prevention, and treatment services for school-age children and adolescents at high risk for oral disease. 7

Another approach that is gaining ground is the provision of comprehensive oral health care services that are integrated into primary care delivered in school-based health centers (SBHCs). In fully operational integrated SBHCs clinical and behavior staff work at the top of their license and conduct screenings, provide preventive care, where appropriate, and make referrals within and outside the SBHC to meet all of the physical, behavioral, and oral health needs of each child.