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September 10, 2025Open Access

Empowering health workforce for oral health outreach in Iran’ primary schools: The sixth tooth celebration

Key Points

The Sixth Tooth Celebration significantly increased oral health awareness in primary schools across East Azerbaijan, enhancing community engagement.
Around 300 health professionals were trained to deliver educational sessions that reached 927 schools and positively impacted the community.
The program utilized a cascade training approach, integrating specific materials and methodologies to ensure effective knowledge transfer.
The initiative highlights the importance of social accountability in health training frameworks, aiming for nationwide implementation.

Abstract

Background: The first permanent molar plays a vital role in long-term oral health, yet awareness among parents of young children remains limited. This initiative aimed to empower Iran’s community health workforce—including primary health care (PHC) staff, dental students, and volunteers—to implement the "Sixth Tooth Celebration," an oral health education program targeting first-grade students and their parents in East Azerbaijan. Grounded in social accountability, the program was integrated into Iran’s PHC system. Methods: The intervention was carried out in two phases: a pilot in selected Tabriz schools (2022–2023), followed by a province-wide rollout in fall 2024. Cascade training was conducted in both in-person and online formats for school health educators, PHC staff, dental students, and private-sector dental professionals. Educational materials included a themed poem, posters, PowerPoint slides, and tooth models. The evaluation followed Kirkpatrick’s four-level model: reaction, learning, behavior, and results. Results: Approximately 300 participants were directly trained by the lead educator through workshops and webinars. These trained individuals then conducted local sessions in their districts. The "Sixth Tooth Celebration" was ultimately implemented in 927 schools across 21 counties. Surveys completed by 30 facilitators indicated high satisfaction with training, improved educational delivery skills, and positive community response. Feedback was used to adjust and enhance the program. Conclusion: This initiative demonstrates how localized capacity-building and curriculum integration can advance socially accountable oral health promotion. With strong support from the Ministries of Health and Education, the program has gained national attention and is now under review for formal nationwide adoption.

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