Creating a Successful School-Based
Mobile Dental Program
DAVID M. JACKSON, DDS, MPH
LAUREN R. JAHNKE, MPAff
LISA KERBER, PhD
GENIE NYER, RN, MPAff
KAMMI SIEMENS, MSSW
BACKGROUND: Dental disease is one of the leading causes of school absenteeism
for children. This article describes the creation and evolution of the St. David’s Dental
Program, a mobile school-based dental program for children.
METHODS: The dental program is a collaboration of community partners in Central
Texas that provides free dental care to low-income children in schools without relying
on reimbursements or government funding.
RESULTS: Since 1998, the program has provided 132,791 screenings for oral health
treatment needs and 38,634 encounters for sealants or treatment. In 2005, the pro-
gram provided $2.1 million worth of services at a cost of $1.2 million (not including
donated services). Factors important to the program’s success included sustained
funding for general operating costs; well-compensated clinicians to deliver care and
experienced human service workers to manage program operations; the devotion of
resources to maximize consent form return rates; and the development of strong
relationships with school district and individual school staff.
CONCLUSIONS: By removing cost, time, transportation, and bureaucratic barriers,
the program was able to reach more children than ﬁxed-site clinics. The program was
a merging of private and public health dentistries. This model can be useful to other
communities in light of the unmet need for dental care and tighter federal, state, and
local government budgets.
Keywords: dental; mobile; children; oral health.
Citation: Jackson DM, Jahnke LR, Kerber L, Nyer G, Siemens K, Clark C. Creating
a successful school-based mobile dental program. J Sch Health. 2007; 77: 1-6.
Former Clinical Director of St. David’s Dental Program, Current President of Mobile Healthcare Strategies, (firstname.lastname@example.org), 6208 Lost Horizon Drive, Austin,
President, (email@example.com), LRJ Research & Consulting, 5324 Moon Shadow Drive, Austin, TX 78735.
Director of Research and Evaluation, (firstname.lastname@example.org), St. David’s Community Health Foundation (SDCHF), 811 Barton Springs Road, Suite 600, Austin, TX 78704.
Director of Public Health, (email@example.com), St. David’s Community Health Foundation, 811 Barton Springs Road, Suite 600, Austin, TX 78704.
Former Director of Operations of St. David’s Dental Program, (firstname.lastname@example.org), 1807 Palma Plaza, Austin, TX 78703.
General Counsel, (email@example.com), St. David’s Community Health Foundation, 811 Barton Springs Road, Suite 600, Austin, TX 78704.
Address correspondence to: Lisa Kerber, Director of Research and Evaluation, (firstname.lastname@example.org), St. David’s Community Health Foundation (SDCHF), 811 Barton Springs
Road, Suite 600, Austin, TX 78704.
Journal of School Health dJanuary 2007, Vol. 77, No. 1 dª2007, American School Health Association d1
NEED FOR CHILDREN’S DENTAL SERVICES
Dental caries (tooth decay) is the most common
chronic disease among children.
from oral health problems experience serious social
and health issues such as chronic pain, problems
with eating and speaking, inability to concentrate in
school, reduced social and family interaction, and
diminished self-image and self-esteem.
ease is one of the leading causes of school absentee-
ism for children, and more than 51 million school
hours are lost each year due to dental-related illness.
In addition to making it harder for children to learn,
absenteeism causes school districts to lose money in
the 9 states with attendance-based public school
Unmet need for dental care is concentrated
among certain groups. About 80% of untreated cavi-
ties in permanent teeth are found in about 25% of
children 5-17 years old, most from low-income fami-
Children in families with incomes below the
federal poverty level have twice as many carious le-
sions (cavities) as higher-income children and are
less likely to receive treatment.
Children from low-
income families are also less likely to receive preven-
tive services such as sealants (plastic coatings applied
to molar teeth to prevent decay).
programs and most State Children’s Health Insur-
ance Programs offer children’s dental beneﬁts, bar-
riers to access exist, and many providers do not
participate in these programs due to low reimburse-
ments. One study showed that fewer than 20% of
Medicaid-covered children received 1 dental visit in
The federal government’s Healthy People 2010
initiative calls for increasing the proportion of chil-
dren receiving sealants on their molar teeth, increas-
ing the proportion of low-income children and
adolescents receiving preventive dental services, and
increasing the number of school-based oral health
HISTORY AND GROWTH OF PROGRAM
The St. David’s Dental Program screens, treats,
and educates children in 2 counties in Central Texas.
The program reaches children in public schools dur-
ing school hours. Treatment occurs on mobile dental
vans (Theo Tooth Mobiles) parked in schools’ park-
ing lots. Schools are effective places for identifying
and treating children at high risk for dental disease
due to the number of children readily available.
The dental program does not receive reimburse-
ments or government funding. Its services are free to
The program began in 1998 as a collaboration
between the City of Austin and St. David’s Commu-
nity Health Foundation (SDCHF). Its initial goal was
to enhance an existing program that was providing
dental sealants to children in Austin’s low-income
public schools using portable equipment. The City
loaned a mobile dental van, and the SDCHF pro-
vided funding for dental supplies and van mainte-
nance and hired a dentist and a dental assistant.
The program has grown from a sealant program
to one of prevention and treatment (Table 1). From
1998 to 2005, the program more than tripled the
number of patient encounters. Since 1998, the pro-
gram has provided 132,791 screenings for oral health
treatment needs and 38,634 encounters for sealants
or treatment (Table 2). In 2000, the collaboration
acquired its ﬁrst van, Theo I. This self-contained,
fully equipped mobile dental facility made it possible
to offer therapeutic services to children in schools.
In 2000, the program received the Award for
Excellence in Texas School Health from the Texas
Table 1. Changes Over Time, St. David’s Dental Program, Austin, TX
Program name Central Texas Children’s Dental
St. David’s Dental Program
Services provided Sealants Preventive and acute care and
Clinic type 1 mobile sealant clinic 1 mobile sealant clinic, 4 mobile
Clinical staff 1 dentist, 1 dental assistant 2.33 dentists, 3 dental assistants
Clinic sites 1 ISD, 46 schools 3 ISDs, 67 schools,
12 community-based organizations
Program budget $100,000 $1,200,000
Children screened 15,000 37,383
Patients who received sealants 2500 2800
Patients who received treatment 0 4609
Data management Hard copies only, paper office Electronic systems
ISD, independent school district.
2dJournal of School Health dJanuary 2007, Vol. 77, No. 1 dª2007, American School Health Association
Department of Health. In 2002, the program added
its second van (Theo II) and associated clinical staff
(dentist and dental assistant) and increased the
number of children served by 26%. Theo III,
a donated van, functioned part-time from 2004 to
2005. A new Theo III is under construction, and
funding is committed for Theo IV and Theo V. One
van will devote half its time to treating the home-
less, leaving 4.5 vans primarily to serve school chil-
dren. Each new van and associated clinical team,
when operating full time, can deliver about 2000
more patient encounters per year.
FUNDING AND PARTNERS
SDCHF, the lead agency for the St. David’s Dental
Program, offers sustained operational funding for
the dental program. Sustained funding for general
operating costs, including a paid professional staff, is
critical to success because programs that rely on vol-
unteer help or inconsistent funding can ﬂounder
after the initial burst of enthusiasm wanes.
The St. David’s Dental Program applies to other
funding sources for grants to cover vans and equip-
ment. Private foundations in Central Texas including
the Michael and Susan Dell Foundation, Topfer
Family Foundation, Still Water Foundation, and A
Glimmer of Hope Foundation have funded vans,
mobile sealant equipment, and oral health educa-
tion. Other funders include the Dell Corporation
Foundation, Austin Community Foundation, Texas
Department of State Health Services, and individual
The involvement of many partners has been
instrumental in lowering some of the barriers to ac-
cessing dental care. The cooperation and trust of
school district and school staff are necessary to the
success of the program. Teachers, school nurses, and
other school staff work with program staff to access
children in the schools and encourage families to re-
turn consent forms. The City of Austin has supplied
a van and dental hygienists and coordinated its
sealant services with the vans’ acute-care services.
Manos de Cristo Clinic, a private nonproﬁt safety-
net provider, has provided dental and health educa-
tion. Austin Energy provides free electrical drops to
power the vans. The Capital Area Dental Society rai-
ses funds for dental education and provides volun-
teers to the program. Volunteer dentists who serve
on the vans can raise community awareness about
the need for dental care and are able to reassure the
local dental community that the dental program is
not competing for paying patients.
Volunteers are also an important source of supple-
mental help. During school year (SY) 2004-2005,
133 volunteer dentists typically worked one to two
4-hour shifts. In calendar year (CY) 2005, volunteer
dentists provided 9% of the program’s dental serv-
ices. To make treatment on the vans more consis-
tent, operations more efﬁcient, and ensure that
people without ﬁnancial resources can receive the
treatment they need, the program is changing the
way it uses volunteers. Rather than providing serv-
ices on the vans, volunteer dentists from the com-
munity are now providing pro bono services for
children and adults who need more intensive den-
tistry than can be completed on the vans.
The dental program and its vans target low-
income children by traveling to title I schools in 3
school districts in Central Texas. A title I campus is
one at which a majority of its students are economi-
cally disadvantaged or eligible for the federal free or
reduced meal program. Table 3 shows number of
children screened, identiﬁed as needing treatment,
and treated by SY.
Theo vans initially operated only during the SY.
In 2003, to maximize resources and increase pro-
ductivity, the vans began to operate during the summer,
treating children and adults at local nonproﬁt
Table 2. Number of Encounters With School Children,
St. David’s Dental Program, Austin, TX
Screenings Sealants or Treatments
1998-1999 15,000 2449*
1999-2000 17,000 3990*
2000-2001 19,060 4690
2001-2002 21,801 5629
2002-2003 23,961 7110
2003-2004 30,586 7357
2004-2005 37,383 7409
Total 132,791 38,634
Table 3. Children Treated at Schools by the St. David’s Dental
Program, Austin, TX, 2002-2005
2002-2003 2003-2004 2004-2005
Schools visited 46 51 67
Number of students
in schools visited
27,650 35,701 45,945
Number of students screened 23,961 30,586 37,383
Number of students
identified as needing dental
services (consent forms sent
home with these students)
14,055 14,040 16,040
Signed consent forms returned 9339 8711 9009
Number of students who
received sealants or treatment
7110 7357 7409
Journal of School Health dJanuary 2007, Vol. 77, No. 1 dª2007, American School Health Association d3
agencies and safety-net health care clinics. Service
delivery by appointment at these agencies is less
efﬁcient than having ready access to a school’s pop-
Currently, 90% of dental patients are children
from low-income families who display decay, gingi-
vitis, pain, or other acute symptoms at their school.
About 10% of the patients are children, adults, and
seniors referred through health and social service
agencies during summer months (Table 4).
The actual delivery of dental services proceeds
through the following ﬁve steps:
1. Program staff maps out a master screening and
site sequence for the SY.
2. At each school, program staff meets with teach-
ers and school administrators to explain the
program, its importance, the role of teachers
and administrators, and data on past perfor-
mance speciﬁc to the individual campus. Staff
also instructs teachers to give students ‘‘opt-
out’’ forms to be signed by parents who do not
want their children screened. In the current
SY, 2005-2006, about 2% of students are opt-
ing out of screening.
3. On screening day, a dentist screens all students
who did not opt out of screening to determine
their dental needs. The dentist gives each stu-
dent 1 of 4 language-appropriate forms that
explains the screening results and requests con-
sent if the child needs sealants or treatment.
dChild does not need immediate dental work
and is reminded to see a dentist regularly (pink
dChild needs dental work that cannot be per-
formed on a Tooth Mobile (yellow form).
dChild has no visible cavities but would bene-
ﬁt from receiving sealants through program
(blue consent form).
dChild needs therapeutic dental work that can be
done on a Tooth Mobile (white consent form).
4. Operations staff provides site-tailored reminders
and incentives to encourage families to return
consent forms, collects signed forms from
school, and processes them.
5. Three weeks after screening, a van goes to the
school, and clinic begins for those students who
returned consent forms. Throughout the pro-
cess, program staff strives for minimal disrup-
tion of the school’s educational environment.
Portable sealant clinics are set up inside the
school to deliver dental sealants to children. At
the same time, children who need therapeutic
dental care go in groups from their classrooms
to a Tooth Mobile on the school campus.
Donated electricity powers the vans, so genera-
tors are rarely used, saving money and lowering
the noise level. The dentists move from child to
child unencumbered by a ﬁxed schedule.
The number of patients treated in the clinic
varies. In CY 2005, the average number of people
treated per day per dentist was 8. In SY 2004-2005,
the average number of elementary and middle
school children treated per day per dentist was 10.
More comprehensive treatment takes more time
with fewer patients being treated, and less compre-
hensive care allows more patients to receive services.
Treating low-income adults and older teenagers also
takes more time and resources than treating younger
children from low-income families. During summer
break 2004, the dental program served 842 people,
mostly children, in community-based organizations.
In summer 2005, the program served 628 people,
mostly adults, in community-based organizations.
Other factors inﬂuencing the number of patients
treated include van maintenance and mechanical
problems, equipment failure, staff development,
early closure for staff meetings, staff absences, and
variations in production among dentists. Optimally,
when the clinical team is operating only at elemen-
tary schools for a full 6.5 hours (excluding 30 mi-
nutes to open the clinic, 30 minutes to close clinic,
and 30 minutes for lunch), the program can expect
to treat 13 patients per day per dentist.
To maximize the program’s resources and pa-
tients’ comfort and care, the program prioritizes
treating decay in permanent teeth, relieving pain,
and resolving infection. Preventive care and instruc-
tions for home care are also important. As a mobile
‘‘safety-net’’ provider, the program does not serve as
a ‘‘dental home’’ for patients. Dentists on the vans
do not treat highly decayed teeth needing compli-
cated care or give pain medications other than local
anesthesia. The program is not equipped to build or
supply prosthetic devices such as crowns, bridges, or
Table 4. Age Group and Race/Ethnicity of Acute-Care Patients,
St. David’s Dental Program, Austin, TX, 1998-2006
Age group (%)
Elementary school aged 80
Middle school aged 8
High school aged 4
Adults to age 54 7
Adults 55 years and older 1
African American 3
4dJournal of School Health dJanuary 2007, Vol. 77, No. 1 dª2007, American School Health Association
dentures. Providing these resource-intensive treat-
ments to a few patients would prevent many others
from being treated at all.
COST AND VALUE OF SERVICES
In CY 2005, the cost of the program, excluding
services donated in kind, was $1.2 million. Average
cost per patient was about approximately $114. The
value of services rendered was $2.1 million. Aver-
age value per encounter was about $183, and aver-
age value of services per patient was about $337.
An operations team and a clinical team make up
the dental program. The operations team includes
8 positions. Director of Operations manages all staff
and all program activities except individual clinical
treatment decisions. The Clinical Director, a dentist
who reports to the Director of Operations, develops
clinical policy and is responsible for quality assur-
ance. The Information Resource Manager analyzes
and reports on program data, develops and main-
tains the information/technology (IT) system, and
acts as IT liaison to partners and vendors. The Site
Coordinator promotes the program, ensures that
schools are prepared to host the program, and iden-
tiﬁes and trains allies at each school who assist the
program in boosting consent form return rates. A
Consent Form Coordinator promotes the program in
English and Spanish, picks up batches of signed con-
sent forms from schools, and enters data into the
patient record before each school’s clinic. The Con-
sent Form Coordinator also assists the sealant clinic
in the schools. The Oral Health Educator, a bilingual
social worker, provides oral health education to chil-
dren and adults. A Volunteer Coordinator, who
works three-fourths time, maintains relationships
with private dentists in the community, manages the
pro bono dentist referral system, and arranges refer-
rals to dentists. The Van Assistant spends two thirds
of her time escorting children to and from the vans,
interacting with school staff, sterilizing and placing
instruments for dental professionals, and entering
patient treatment data on the vans. She spends one
third of her time translating forms in English and
Spanish and scheduling after-school appointments
for children and adults.
The clinical staff devote their time solely to den-
tistry. Full-time, well-compensated dentists who
want a career in public health are the key to sustain-
ability and high productivity. Currently, the program
employs 2 full-time dentists and 1 dentist who works
one-third time. Three dental assistants work with
the dentists. Two part-time dental hygienists, donated
in kind by the City of Austin, deliver sealants inside
the schools, while the van clinics function outside
the school buildings.
The program is in the early stages of designing
a longitudinal study to estimate the impact of the
program’s services on individuals and the commu-
nity over time. Currently, Open Dental practice
management software provides a centralized data-
base for patient records and performance measure-
ment. Dental assistants can call up patient records
and record procedures. The program’s current met-
rics measure productivity and efﬁciency and account
for many factors that inﬂuence the number of
1. fair market value of services provided per
patient encounter and by clinic date (based on
80th percentile of the National Dental Advisory
Service Comprehensive Fee Report),
2. actual program costs,
3. number and types of dental procedures per-
4. number of children who received sealants,
5. number of children treated per day per dentist,
6. number of operational van days per year,
7. number and percentage of consent forms re-
8. number of volunteers and services provided by
Qualitative measures include level of awareness
and positive image in the community and among
community dentists and quality of relationships with
schools and agencies.
OVERCOMING SPECIFIC CHALLENGES
Higher consent form return rates mean more chil-
dren can be treated. Consent form return rates are
much higher when teachers and other school staff
understand the program, choose to emphasize it to
students and parents, and encourage the return of
consent forms. Recently, program staff began to
strengthen promotional activities and an incentive
program that motivates teachers and students to re-
turn consent forms. Currently, 2.5 full-time equiva-
lents develop and maintain relationships with school
personnel and parents and offer incentives such as gift
certiﬁcates to local businesses for teachers and chil-
dren. In 2004-2005, the percentage of consent forms
returned was 54%. It jumped to 75% in 2005-2006.
The program originally assigned clinic days to
schools based on the number of signed consent
forms received from each campus the previous year,
Journal of School Health dJanuary 2007, Vol. 77, No. 1 dª2007, American School Health Association d5
with the intent to visit all partner schools in a single
academic year. This rigid schedule of clinic dates
prevented the clinical team from treating every child
with a signed consent form, and children with iden-
tiﬁed needs went without care. In fall 2005, the
program implemented a more ﬂexible schedule in
which dental vans remain on campus until all eligi-
ble children receive treatment. This positive change
does lengthen the number of months required to
visit the schools and requires greater communication
and ﬂexibility between program and school staff
because the clinic schedule can change with little
Some children have dental needs that cannot be
addressed on a van, and few providers in the com-
munity offer comprehensive care at low or no cost.
The program is currently developing a referral system
and building a network of private dentists willing to
provide free services in their ofﬁces to at least 2 pa-
tients per year.
Keeping the vans and dental equipment properly
maintained is challenging. The vans move fre-
quently, and each move jostles the equipment. The
equipment on the vans is also more frequently used
than the equipment in many private dentists’ ofﬁces.
The program is attempting to better maintain the
vans and equipment with frequently scheduled pre-
ventive maintenance days.
An unmet need for dental care remains in Central
Texas. In the next few years, the program expects to
expand services to all title I schools in the 10-county
area surrounding Austin and continue to serve chil-
dren and adults at nonproﬁt organizations and clin-
ics during school holidays and summer breaks. The
program will treat more children with more compre-
hensive care as resources become available. The
long-term goal is to provide dental treatment for all
children in title I public schools.
The St. David’s Dental Program, a collaboration of
nonproﬁt and public agencies, delivers dental
screenings, sealants, treatment, and education to
children in Central Texas through fully equipped
mobile vans and portable dental facilities that travel
to schools. The school setting is an optimal platform
for service delivery because the ‘‘captive’’ audience
is made up of many children who have little or no
access to dental care. Because the program provides
free services in schools, it removes most barriers to
oral health care including parents’ inﬂexible work
schedules, lack of transportation, eligibility, and
bureaucratic processes, and cost. Through the dental
program, children achieve better health, and schools
beneﬁt from healthier children who are more ready
In 2005, the program provided $2.1 million worth
of services at a cost of $1.2 million (not including
donated services). Factors important to the program’s
success include sustained funding for general operat-
ing costs, well-compensated clinicians to deliver care
and experienced human service workers to manage
program operations, the devotion of resources to
maximize consent form return rates, and the devel-
opment of strong relationships with school district
and individual school staff.
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6dJournal of School Health dJanuary 2007, Vol. 77, No. 1 dª2007, American School Health Association