Overview
Summary
The Metro North (MN) School Dental Service (SDS) has for many years provided a Fluoride Varnish Program (FVP), to participating schools and children in the MN catchment area.
Dates: January 2024 - January 2025
Implementation sites: Metro North Hospital and Health Service
Aim
- School aged children have access to oral health promotion and evidence-based fluoride varnish via the FVP that supports them to make healthy oral choices.
- The SDS and education systems work together to support healthy mouths and healthy lives by advocation of the SDS to children and families.
Outcomes
- By targeting schools experiencing social disadvantage the FVP ensures timely, and person-centred access to evidence-based practice with the biannual application of fluoride varnish.
- Targeted outreach and collaborative care pathways of the FVP program have enabled earlier intervention for those children most at risk of oral disease and promotes the reputation of the SDS in schools and to the community.
- The outcomes of this program reflect a culture of teamwork, integrity, high performance and collaboration with the school community.
- Approximately 56 schools across the Metro North catchment area participated in the program from prep to year 10 receiving a screening, oral health education and a fluoride treatment in 2025.
Background
Oral health considered as an integral part of health care and not a separate entity is well established in the literature. To recognise the strong interplay between oral health and overall health, many of the common risk factors for general health are applicable to oral health and needed to be considered within the broader socio-environmental context.
In recent years, Queensland children's oral health has deteriorated across all age groups and dental attendance rates are significantly poor.
The Metro North catchment demonstrates a high proportion of eligible children who are known to be at high risk of developing oral health diseases. By the time children present at SDS facilities, their deciduous dentition has been compromised; children's teeth are either grossly decayed or developing white spot lesions. Many require dental extractions. Repairing and replacing decayed teeth is extremely costly in terms of time and money and is a major drain on the resources of healthcare systems.
At present access to General Anaesthetic sessions is limited and hence patients may be required for wait approximately 24 months for this treatment.
Based on this data MNOHS is focussing preventive efforts on children at higher risk of experiencing dental disease by the implementation and continual reassessment of their Fluoride Varnish program (FVP). An effective and proven form of prevention is the application of Fluoride directly to teeth in the form of fluoride varnish. When fluoride varnish is applied to deciduous teeth only, children experienced a reduction in decayed, missing and filled tooth surfaces.
The establishment of the FVP introduces the promotion and education of healthy oral health habits, minimisation of at-risk food behaviours and the importance in establishing effective and efficient toothbrushing habits to children not just to improve oral health but overall health into the future.
Proportional universalism with a risk stratified approach to target low seriocomic schools was needed to ensure oral health care is provided to these children in their evolving stage of a child's oral health journey transitioning form primary (baby) teeth to secondary (adult) teeth. For the school communities participating in the FVP, this means early identification and reach to children with different levels of health literacy, active disease and those with reduced access to protecting fluoride exposure.
Collectively, these achievements highlight the SDS's dedication to delivering equitable, safe, compassionate and evidence based oral health services for young patients, in alignment with Metro North Health's values and commitment to exceptional care
Methods
FVP is a multi-strategy, oral health promotion and decay prevention program. The program includes three key components which are integrated within the World Health Organisation's Health Promoting Schools Framework:
- Oral Health Promotion: Engaging children through in-class Oral health education and skills development, including weekly tooth brushing with fluoride toothpaste.
- Fluoride Varnish: 5% sodium fluoride varnish professional applied at least 6 monthly within the school setting.
- Dental Referral Pathway: Dental screening by registered oral health and dental therapists and establishment of a dental referral pathway to oral health practitioners for any necessary treatment.
Children who have parental consent are provided with a dental screening prior to their fluoride varnish application. The dental screening prioritises children who need further dental care, due to tooth decay or other oral health care needs. Referral letters are given to parents to follow-up dental care through their local public sector oral health clinics. Parents may seek any required treatment through their preferred private practice provider.
Discussion
The FVP project succeeds because it operated in an environment that prioritised equity, partnership, and flexible service design. Strong relationships with participating school have enabled proactive outreach, triage, and earlier intervention for children who would otherwise wait up to two years for care.
Strengths of the program included its risk stratified approach, strong interdisciplinary collaboration, and expansion of FVP to all schools in Metro North. Additionally, the FVP model has been replicated in the Deadly Smiles project where the SDS participate in community events such as NAIDOC week, Park n Play events, Koobara Kindy which has extended the SDS reach into community and formalised integrated care pathways with primary care and Aboriginal and Torres Strait Islander health services.
Key lessons included the value of consistent on site presence, and trust building through culturally safe engagement.
Opportunities exist to increase the SDS footprint with the FVP actively seeking out community events to participate in such as school fetes, Under 8's week etc extending oral health screening into the wider community and increasing the reputation of the SDS as the provider of choice for children's oral health needs.
Next steps include strengthening data systems, and embedding sustained outreach and culturally safe care practices to ensure long term equity and improved oral health outcomes for Queensland children
References
Queensland Statewide Oral Health Services Plan
Key contact
Dr Tarini Singh
Director, School Dental Service, Metro North
Community and Oral Health
Metro North Hospital and Health Service