Josiah Brown Poster Abstract


Vania Chan
Kathryn Atchison DDS MPH
Kathryn Atchison DDS MPH
A Pilot Study of the Barriers and Facilitators Encountered by School Nurses to Educate Students On Oral Health in Los Angeles Primary Schools
CTSI Summer Program


Dental caries is the most common chronic disease of children and adolescents in the United States even though it is preventable. Dental caries can have a severe impact on children’s psychosocial well-being, ability to eat, smile, and communicate. Schools can play a major role in children’s health. With greater emphasis placed on oral health education and oral health care, schools may be able to help fight the oral disease epidemic. It is not clear that programs to improve oral health literacy are a fully integrated part of the curriculum in many schools.  


The purpose of this study is to examine the current status and barriers of oral health education in primary schools in Los Angeles County.


Cross-sectional study based on telephone interviews with district school nurses in L.A. County.

The UCLA Office for Protection of Human Subjects was contacted and cleared that there was no human subject participation.

The interviewees were asked questions covering current status of teaching oral health education, barriers or facilitators, and the best practices under the current constraints.


Selected district school nurses of L.A. County School Districts specifically LAUSD, Culver City Unified School District, Santa Monica-Malibu Unified School District, Rosemead School District, Long Beach Unified School District, Glendale Unified School District, and Wilsona School District. Participants are surveyed between May 2018 and July 2018.

Main Measures:

A thematic analysis of the following 4 measures was conducted:

  1. oral health education format, topics, and resources available
  2. training and involvement by school nurses
  3. barriers or facilitators
  4. community involvement

Data collected are based on the telephone interviews and email correspondence.

Key Results:

This report is a thematic analysis based on the interview results. 

Several themes were identified:

  1. oral health education format, topics, and resources available:
    • one on one with students as needed when they require care from the school nurse
    • informal instructions
    • limited resources
  2. training and involvement by school nurses
    • no specialized training in oral health
    • no teaching credential, only school nurse credential
  3. barriers or facilitators:
    • oral health education is not a mandate
    • lack of student participation, time and funding,
    • lack of parent participation
    • no established curriculum for oral health education
  4. community involvement
    • importance of  partnerships with external organizations
    • need assistance for oral health education
    • need assistance to provide oral health care from external organizations to mitigate the lack of school resources


A majority of primary schools in the L.A. County do not have strong oral health education programs. This study identified deficiencies including, lack of time, resources, and personnel, oral health is not of high priority to the school districts, and is not a federal mandate. Pragmatic ways such as parental education on the importance of oral health and available resources and leveraging external organizations were identified as potential sources to help alleviate the problem until an oral health education curriculum is mandated in primary schools and sufficient funding is appropriated.