California School Nurses' Knowledge in Identifying Common Dental Conditions and Making Appropriate Dental Referrals

In 2011, the Institute of Medicine (IOM) recommended a minimum of 4 clinical oral health competencies for nondental professionals to promote optimal oral health, including (1) recognizing risk for oral disease through competent oral examinations and (2) making and tracking referrals.

We determined whether California school nurses (SNs) knew about specific components of the 2 IOM competencies mentioned above using 3 clinical case scenarios following the Association of State and Territorial Dental Directors Basic Screening Survey Methodology.

In this cross-sectional study, a 23-item pilot-tested online survey was completed by 358 active California School Nurses Organization members between April and June 2023. We conducted univariate, bivariate, and multivariable linear regression analyses.

For the first scenario, 61% of SNs correctly identified the condition as "root tips," with 93% indicating correctly that such a case should be referred immediately. In the second scenario, almost 77% of SNs correctly identified "untreated tooth decay," with 50% correctly suggesting that a child with untreated tooth decay without dental pain should visit a dental office within several weeks. In the third scenario, almost 50% correctly identified an abscessed tooth, with 75% indicating that a child with this condition should be referred immediately. Multivariable adjusted linear regression analysis showed that SNs with a bachelor's degree or lower had significantly lower overall knowledge in accurately identifying dental conditions and choosing appropriate dental referrals (P = 0.02).

At least half of the participating SNs accurately identified the dental conditions and chose the appropriate dental referrals. The educational status of SNs was a strong predictor of SNs' overall knowledge of identifying oral health conditions and appropriate dental referrals. SNs, when adequately trained, can assess oral health needs and make appropriate dental referrals as part of school-linked dental programs.

SNs can identify common dental conditions in children and appropriately refer them to a dental professional. When adequately trained, they can be a valuable resource in implementing school-linked dental programs.