Health Department

For Parents

Consent form/Medical History En Espanol
– Print, complete, and return to school if you want your child to participate in the sealant program. Here is a list of participating schools.

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HIPPA Statement En Espanol
– Copy of privacy information

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Report of Dental Inspection En Espanol
– You will receive a report that looks like this with the dentist’s findings from your child’s screening or exam.

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Silver Diamine Fluoride Reports
–Your child will receive a report with the dentist's findings from your child's screening or exam. Your child will also receive another report if silver diamine fluoride was applied. Silver diamine fluoride is a liquid placed on a cavity that kills bacteria and strengthens that part of the tooth.
–SDF Treatment Report in English and Spanish

Sealant Fact Sheet En Espanol
– Dental sealants are thin plastic coatings that are painted on the chewing surfaces of back teeth in order to help prevent cavities. More info is available in the fact sheet above.

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For Faculty and Staff

Information packets

• Introduction letter to elementary school faculty and staff
• Introduction letter to middle school faculty and staff
• Endorsement letter from Knox County Schools
• Materials Needed Sheet
  – Explains what schools need to provide to KCHD to help implement the program.

For more information, contact the Knox County School-Based Dental Prevention Program, at kchd.sbdpp@knoxcounty.org, or by phone at 865-215-5773.