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Program Created:

Swish and Spit Program

Alexandria Drysten

University of Bridgeport
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Introduction

Swish and Spit programs were first introduced decades ago. A swish and spit program is

a school based fluoride program that can help prevent tooth decay. The Association of State and

Territorial Dental Directors (ASTDD) have nothing but good statements to say about the

importance of fluoride treatment and school programs that involve it. “School fluoride mouth

rinse programs are inexpensive compared to professionally applied fluorides especially when

volunteers are used,” (ASTDD) The ASTDD also commented on a review that was completed in

2003 and concluded that, “This review found that supervised regular use of fluoride mouth rinse

by children and adolescents is associated with a large reduction in caries increment in permanent

teeth.” (ASTDD) Also in a paper by Mary Otto after reviewing 37 trials on the effects of fluoride

rinses conducted in several countries she concluded an average of 27% reduction in decay,

missing and filled tooth surfaces compared with a placebo mouth wash (Fluoride Mouth Rinse,

2016). With a goal of decreasing tooth decay among children, I have chosen to create a “Swish

and Spit” program in the Bridgeport Elementary Schools in Bridgeport, Connecticut. Bridgeport

was chosen because of its socioeconomic status. It has a very high poverty rate, 20.80%

compared to that of the United states 12.30% and a much lower median Household income

$44,841. Compared to $57,652. Respectively. (U.S. Census)

Through personal experiences with school aged children in the Bridgeport, Connecticut

area I have concluded that the prevalence of caries is very high. I will be implementing a “Swish

and Spit” fluoride program within the elementary schools in Bridgeport, Connecticut. Although

there is fluoride present in the public water in Bridgeport, these vulnerable aged children still

come to school every day with decay and some pain from decay. This infers that there is a need

for action. The purpose of this program is intended to help demineralized areas of enamel on
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children’s teeth to re-mineralize and prevent decay. The program will only take place throughout

the academic school year. The program will be run by dental hygiene interns from the Fones

School of Dental Hygiene.

Goals and Objectives

GOAL 1: Reduce the prevalence of dental caries among elementary aged children in

Bridgeport, Connecticut school system to those with parental consent.

Objective 1: Visit elementary schools for a minimum of four visits to conduct basic screening

surveys, and to deliver a swish and spit program

Objective 2: The Healthy People 2020 Oral Health Objectives have been adapted for this

program.

OH. 1.2 : Reduce the proportion of children age 6-9 years with dental caries

experience in their primary and permanent teeth.

OH. 2.2: Reduce the proportion of children age 6-9 years with untreated dental

decay in their primary and permanent teeth.

GOAL 2: Educate parents, teachers and children on the importance of oral hygiene as well as

fluoride treatments.

Objective 1: Deliver in class lessons to students and teachers

Objective 2: Send home informational handouts to parents and guardians with a child’s

permission slip to receive fluoride.

Program Design

 Parental consent forms will be sent home with each child two weeks before initial

screenings.
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 Initial Basic Screen Survey (BSS) conducted for baseline data of all children that have a

parental consent form signed. See Appendix A for the BSS form.

 Twice a month, the program will attend local elementary schools in Bridgeport,

Connecticut to have the children with consent from their parents participate in the “swish

and spit” program.

 Each child will be given a cup with tasteless fluoride and a napkin. At a predetermined

time, each child will swish the fluoride around their mouth for 60 seconds and then spit

the fluoride back into the cup.

o The napkin is used to clean the child's mouth, and then the child will return to

their classroom and refrain from eating or drinking for 30 minutes.

 Only children with parental consent will be able to participate in this program to help

prevent tooth decay.

 It is not recommended that Kindergarten children participate in this program due to their

underdeveloped swallowing reflexes, these children are unable to “swish”.

 Final BSS will be conducted to compare final results to baseline data at the end of the one

year.

The method used to collect the quantitative data will be through a BSS survey. This

screening identifies visually obvious tooth decay, but it is not a thorough exam.

In the screening, the child is not touched directly. A flashlight or dental loupes will be

used to shine light in the child’s mouth and a BSS kit will be used. The kit includes, a tongue

blade, a cotton tip applicator, gauze, gloves, masks a disposable mirror and the BSS form.

The child’s mouth will be scanned with a tongue blade, starting upper right quadrant and

proceeding to the upper left, dropping down and scanning the lower left and moving to the
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lower right. The data collected will include, untreated decay, sealants on permanent molars,

Early Childhood Caries and the need for dental care.

The indices being used will be a decayed, extracted, missing teeth (deft/DMFT) due to

decay depending on the dentition present in the child’s mouth. The DMFT index is used to

determine the status of dental caries activity of decayed, missing and dulled teeth in

permanent dentition. (32 teeth). See Appendix B for DMFT guidelines. The deft index is

used to determine the status of decay, extraction and filled teeth on primary teeth. (20 teeth).

In order to orchestrate this program, there are resources that will be needed. The

personnel running the public health program are the dental hygiene interns from the

University of Bridgeport. The space used will be the classrooms at the elementary schools.

The program will be running during school hours, 9 am to 3 pm. The supplies needed to run

the program are: cups, paper towels, garbage bags, gloves, masks, fl2, ProSpray wipes,

Drape-it-all, hand sanitizer and a disposable mirror. It is intended that a majority of this

program will be funded by the board of education of Bridgeport, Connecticut. In addition, a

grant(s) will be proposed to the State of Connecticut’s Department of Public Health in order

to fund the program. The proposed budget/financial list is listed below.

The following budget is based upon current enrollment of Bridgeport elementary schools.

It is anticipated that there will be at least 50% participation in this program, which would

be based on 30 schools and 190 participation from each school.

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Table 1: Budget for Swish and Spit Program Per

School
Student Price/Scho
Items Units Needed Price cost ol

Disposables

Cup 380 $17.00 $0.09 $17.10

Paper Towels 380 $15.00 $0.08 $15.20
Floride 380 oz $120.00 $0.63 $119.70
Disposable Mirror 380 $153.00 $0.81 $153.90

Infection Control

Gloves (Latex free) 380 $42.00 $0.22 $41.80

Masks 380 $120.00 $0.63 $119.70
Trash Bags 1000 $43.00 $0.23 $43.70
ProSpray Wipes 380 $102.00 $0.54 $102.60
Purell Han Sanitizer 180 oz $60.00 $0.32 $60.80
Drape-it-all 380 $256.00 $1.35 $256.50

Goody Bag

Toothbrush 190 $100.00 $0.53 $100.70

Toothpaste 190 $75.00 $0.40 $76.00
Floss Picks 190 $105.00 $0.55 $104.50
Bags 190 $70.00 $0.37 $70.30
Handouts 500-1000 $60.00 $0.32 $60.80
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Table 2: Budget Totals for Swish and Spit Program

Price Per Price Per Price for

Total Student School Bridgeport

Disposable $1.61 $305.90 $9,177.00

Infection Control $3.33 $625.10 $18,753.00

Goody Bag $2.17 $412.30 $12,369.00

Total $7.11 $1,343.30 $40,299.00

A formative and summative evaluation will both be determined at the end of the

program/academic year. Before the program begins, the students who will be participating in the

program will be screened using the BSS survey. The children’s deft/DMFT score will be

recorded. Throughout the duration of the school year the children’s deft/DMFT scores will be re-

measured routinely to measure if there is an increase or decrease in decay. There will be a

decrease in decay if those students who were referred to a dentist actually followed through with

their dentist referral. This monitoring throughout the program is the formative evaluation.

The summative evaluation will be conducted at the end of the program. The results from the

children’s deft/DMFT scores will be evaluated to see if the prevalence of decay stayed the same

and did not progress. If this is the case this will prove the program was effective and the goals

were met.
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Conclusion

The expected outcome of the program is: Prevalence of decay did not progress in 75% of

the children and the results were worth the cost of the program. This program exhibits

sustainability because it is fairly inexpensive. The most effective aspect to the program is the

fluoride rinse which is an essential component to the program. Areas that are in need of

improvement are the parental consent forms and overall participation of children. Parents

need to fill out and send in parental consent forms in order for their children to have access to

our fluoride program

The interdisciplinary team will be the dental hygiene interns and a referral to a dentist if

decay is present. This program will be fairly cost effective considering this will be part of a

rotation from the Fones School of Dental Hygiene. Personnel needed for the program will not

be paid because this is part of a public health rotation. The interns will be delivering care and

education to a vulnerable age group most of a low socio-economic class. From my

experience going to Tisdale Elementary school, I can recall seeing some of these children

who would come into the schools six-chair dental clinic with significant decay. Some of

these children have had up to 8 referrals sent home to their guardians, referring them to a

dentist for care. This means that up to 8 different occasions the child was seen in the clinic

and it was not followed through to get dental care. Having a swish and spit program will not

solve the problem entirely for decay, but it could arrest the current decay and help prevent

caries in this age group that suffers from barriers.

To conclude, the purpose of this program is to help prevent and arrest childhood decay

amongst school aged children. If the program proves to be successful, this will be a cost

effective program that could be implemented over and over.

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Reference:

Caries Prevalence DMFT/DMFS.” Till Startsidan, Malmö Högskola, 29 Sept. 2010,

www.mah.se/CAPP/Methods-and-Indices/for-Measurement-of-dental-diseases/for-

Caries-prevalence/.

“Fluoride Mouth Rinsing by Children Receives Renewed Attention.” Association of Health Care

Journalists, 27 Sept. 2016, healthjournalism.org

Lofton, Kara Leigh. “Decades Later, Fluoride Rinse Programs Continue to Be Effective

in Protecting Against Tooth Decay.” West Virginia Public Broadcasting

School-Based Fluoride Mouth rinse Programs Policy Statement Association of State and

Territorial Dental Directors (ASTDD), adopted March 1, 2011

U.S. Census Bureau Quick Fact, Bridgeport, Connecticut

Appendix A

The BSS form used to collect the before and after data.
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Appendix B

The DMFT