St. Luke's Foundation of Cleveland nominated the project for the RWJF grant and serves as the principal local funding partner. The grant was awarded under the RWJF Local Initiative Funding Partners (LIFP) program, which requires local grant makers to provide dollar-for-dollar matching funds. RWJF, based in Princeton, N.J., is the nation's largest philanthropy devoted exclusively to health and health care.

"Healthy Smiles—Bright Futures" was selected by the Foundation's LIFP out of a pool of 275 applicants. Of those applicants, 80 received invitations to submit proposals, of which 19 projects earned grants.

The new interactive curriculum expands the education component of the "Healthy Smiles—Bright Futures" sealant program in which sealants are applied to children's teeth by teams of CWRU dentists and dental students. Classroom activities will include experiments such as using eggshells coated with fluoride and then soaked in a soft drink to illustrate how fluoride can protect against harmful sugars and acids. There will also be newsletters, videos, activities and school presentations that focus on oral health.

"Healthy Smiles—Bright Futures" provides an estimated $2 million in free dental care through dental examinations and sealants applied to the permanent molars of as many as 15,000 second- and sixth- grade students. Teams of CWRU dental students, along with dental school faculty, visit Cleveland schools in this ongoing health program. Children who need dental care are referred to a network of community dentists who have volunteered to work with the program. The network includes members of the Forest City Dental Society and the Greater Cleveland Dental Society.

James Lalumandier, director of the sealant program and chair of CWRU's department of community dentistry, piloted the program three years ago in six schools with funding from St. Luke's Foundation. The pilot program responded to the Surgeon General's report, "Oral Health in America" (May 2000), on the critical need for dental care among urban residents who lack access to a neighborhood dentist.

"Once our Foundation board looked at the outcomes achieved during the pilot, they quickly embraced the concept of allocating substantial, long-term resources required to develop the program into one of our key strategic initiatives," said St. Luke's Foundation President Denise San Antonio Zeman. "In this way, the program will be assured of a stable fiscal base and attention can be paid to developing other key components of the program designed to transform the way in which urban children experience the oral health system,"

Since then, in addition to primary support from St. Luke's Foundation, the State of Ohio and other foundations have provided funds to expand the program district-wide.

"This grant comes at a critical time when the Cleveland schools are rewriting their health curriculum," said Lalumandier, who serves on several committees that are working on the new health curriculum for the Cleveland schools.

The new support enables the sealant program to hire a full-time health educator. The educator will serve as a resource to Cleveland Municipal Schools as they rewrite the entire health curriculum and will meet with children prior to screening and treatment by teams of CWRU dental students to prepare them for the visit. The educator also will design educational programs for school principals, nurses and teachers and for parents through the schools' parent organizations or parent liaisons. The goal is to educate everyone associated with the children about the long-term benefits of good oral health practices and the importance of dental health as a major part of overall good health.

In the pilot, Lalumandier found that 75 percent of the school children screened had one or more cavities, which prevented the sealing of the teeth. The long-term consequences of oral health problems may result in nutritional deficiencies, infections, increased risk of stroke and heart disease, low birth weight, premature babies and some cancers.

The new educational component co-funded by The Robert Wood Johnson Foundation is critical to the success of the sealant program.

"While one visit to the schools by the health educator provides knowledge about oral health, it does not change behaviors," Lalumandier said.

When people that children respect deliver the messages time and again about brushing and flossing teeth and eating the right foods, it is more likely to make a difference in their behavior, he added.

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