Advancing Oral Health in Great Harbour Cay: A Collaborative School-Based Program Supporting the WHO's Global Oral Health Action Plan

An oral health promotion program is provided for the children of Great Harbour Cay (GHC), a Berry Island in the Bahamas, aimed at advancing the World Health Organization's (WHO) Global Oral Health Action Plan (GOHAP). The island lacks a dental facility to provide oral health and dental services. Since 2016, interprofessional teams of dental hygiene (CT State Tunxis) and occupational therapy (Quinnipiac University) faculty and students have been implementing the program at R.N. Gomez Comprehensive School, serving approximately 120 children from preschool through twelfth grade during the years 2016, 2017, 2018, 2019, 2024, and 2025.

The program is based on the Ecological Model of School-Based Health Promotion, which has been adapted to provide oral health and nutritional education, DMFT/dmft screenings (as established by the Association of State and Territorial Dental Directors), fluoride varnish, sodium diamine fluoride (SDF), sealants, and oral health products to schoolchildren, with the aim of improving oral health outcomes for young people. On the first day, the program begins with oral health and nutrition education. Each child performs toothbrushing using a disclosing agent to help visually remove plaque. Oral screenings are conducted by dental hygiene faculty and students, while occupational therapy faculty and students record the data. Fluoride varnish is applied, oral health products are provided, and students then move to a table supervised by an occupational therapy team member for oral health activities. The screening process ensures that all students receive fluoride varnish, and the program uses the tell-show-do format to alleviate any fears, allowing ample time for questions.

After all children are screened, the data is compiled and assessed, with focus directed to classrooms showing the greatest oral health needs for SDF and sealants. Portable dental units, provided by the Bahamas Dental Council and the CT State Tunxis Dental Hygiene Program, are used to deliver SDF and sealants. The interprofessional team also provides classroom education tailored to meet specific oral and overall health objectives outlined in the Bahamas curriculum. Dental hygiene faculty and students, with the support of the occupational therapy team, administer glass ionomer wet-environment sealants and SDF, while the occupational therapy team leads oral health activities at the tables. In 2025, the team performed 115 screenings, applied 115 fluoride varnish treatments, treated 40 teeth with SDF, and provided 415 sealants. Additionally, eight children were identified as needing urgent care due to dental pain. Program outcomes are shared with the principal, the island's medical clinic, and the Bahamas Minister of Oral Health. Parents also receive a form detailing any necessary dental appointments, oral hygiene instructions, and services provided.

This model emphasizes collaboration among public policy and curriculum leaders, school authorities, the Bahamas Dental Council, health clinic staff, parents, dental corporations, and the community. All stakeholders work together to promote the well-being of students in partnership with the interprofessional dental hygiene service learning/mission team. Additionally, the program aims to provide timely DMFT/dmft surveillance data to the Bahamas Minister of Oral Health and identify children in need of urgent dental care.

This program supports the Bahamas in achieving WHO's Global Oral Health Action Plan (GOHAP). GOHAP's Strategic Objective One: Oral Health Governance, is reflected in the Bahamas Dental Council's approval of the program and the credentials of dental hygiene faculty before implementation. This also enhanced governance by securing portable units to provide services and enabling the communication of program outcomes, including screening data and identifying urgent care needs.

GOHAP’s Strategic Objective Two: Oral Health Promotion and Oral Disease Prevention forms the basis of the program, focusing on oral and overall health education and preventive services. Over the years, the program has seen increased value placed on oral health, as evidenced by greater participation and positive feedback from the children of GHC. This supports GOHAP's Objective Two on Oral Health Promotion and Oral Disease Prevention. The interprofessional team also demonstrates a creative use of other healthcare professionals to assist with data collection, education, and the delivery of preventive services, addressing GOHAP's Strategic Objective Three: Health Workforce.

The GHC oral health program team has been able to provide oral health services through support from dental and corporate manufacturers, professional donations, and fundraising for dental materials, clinical supplies, and oral health products. The dental team raises funds to cover travel costs for flights and private charters and relies on donations to provide services and oral health kits to islanders, all at no cost to them. This effort supports GOHAP’s Objective Four: Oral Health Care by ensuring the provision of affordable oral health care.

GOHAP’s Strategic Objective Five: Oral Health Information Systems is addressed through DMFT/dmft surveillance data, which includes a list of children in need of urgent care. Since 2024, this data has been enhanced by including images of urgent care cases, with parental consent. GOHAP’s Strategic Objective Six: Oral Health Research Agenda has been strengthened by providing surveillance data on DMFT/dmft and services rendered to the Bahamas Dental Council. This data helps identify gaps where improved surveillance can support health policy development, secure funding, and improve access to care.

The 2025 data was compared to the 2024 data for children identified with urgent care needs. Of the eight children identified in 2025, two were not screened in 2024. The other five had caries identified in teeth with pain in 2024, and one student was newly identified with dental pain indicating urgent care. This data highlights a gap in restorative care for children on the island. The Bahamas Dental Board can use this data to assess and develop strategies for providing restorative care to the children of GHC such as manpower and portable equipment, and supplies.