Giving Back: Lessons in a Lunch Box® Serves Up Oral Health Education Daily

Giving Back: Lessons in a Lunch Box® Serves Up Oral Health Education Daily

"Some wondered what difference 10,000 boxes would make, and I said 'It makes a difference to 10,000 kids. Many baby steps make one giant footprint.'"
Saint Charles School


  • Lessons in a Lunch Box® was created 20 years ago by Dr. Winifred J. Booker and The Children’s Oral Health Institute (COHI) to address oral health education for young children.
  • In 2008, the program was introduced in Maryland schools and rapidly crisscrossed the country to all 50 states and the District of Columbia. Lessons in a Lunch Box® is celebrating its “Sweet 16th Year” this year.
  • To date, collaborative efforts across the dental profession have resulted in distribution of lunch boxes and carrot cases to nearly 75,000 children in the US, Puerto Rico, Haiti, and the Bahamas.
  • Lessons in a Lunch Box® is compliant with the Americans with Disabilities Act and is available in braille and can be taught via American Sign Language. The program and materials can be translated into many different languages.


ADA President Dr. Linda Edgar rallies support to empower children and families.

As any astute second or third grader can tell you, next to recess, one of the best parts of the school day is lunch.

So, naturally, given a captive audience, what better opportunity to provide oral health education? Especially when it’s presented in connection with a nifty lunch box to help motivate children and their families to maintain good oral health.

That’s the thinking behind Lessons in a Lunch Box.® The program was created two decades ago with that very goal in mind; 16 years ago it was introduced in schools, first in Maryland, then Nebraska, Tennessee, Michigan, and Washington, D.C.

Thanks to significant support from oral health care sponsors and with major support from the ADA in 2024, the message is delivered in a highly visible and reusable orange lunch box. Coupled with a travel-sized carrot case, both offer meaningful incentives to help second and third graders develop and maintain proper oral health habits.

And, as an added bonus there is the reflective, mirror-like sticker placed right where the lunch box opens that reads, “See Yourself Becoming a Dentist.” The hope is that some youth might take this message to heart and consider pursuing a career in dental health.

Creating a Tipping Point for Decay

Tooth decay remains the most common chronic disease of children ages five to 17. Dental caries are five times more common than asthma and seven times more common than hay fever. According to the Centers for Disease Control and Prevention, more than half of children aged 6 to 8 have had a cavity in at least one of their primary teeth, and more than half of adolescents aged 12 to 19 have had a cavity in at least one of their permanent teeth. What’s more, children aged 5 to 19 years from low-income families are twice as likely (25%) to have cavities, compared with children from higher-income households (11%).

Poor oral health habits can result in real health impacts for children – and they can also lead to learning loss. According to a 2000 report by the U.S. Surgeon General, more than 51 million school hours are lost each year to dental-related illness. Pain and suffering due to untreated diseases can also lead to problems in eating, speaking and attending to learning.

Not surprisingly, then, ADA President Dr. Linda Edgar saw an opportunity to leverage her leadership position and draw on her own classroom experiences to bolster investment in the program and reach even more children.

Before she became a dentist, and long before she rose to her leadership position as ADA President, Edgar was a high school chemistry teacher. It was an experience that yielded many “ah aha!” moments for her personally and professionally.

Years later, she now recalls it was the lesson on the content of hot dogs that really drew the attention of parents and families and provided a bit of inspiration.

“I quickly realized that what you teach in school does make it home,” said Edgar. “I had parents calling me because their kids would no longer eat hot dogs.”

So connecting the oral health education dots for children at school with Lessons in a Lunch Box®, she reasoned, could very likely transfer to oral health discussions at home.

“There used to be brushing programs in the elementary schools,” she said. “They can create a tipping point for decay.” 

The ADA officially endorsed Lessons in a Lunch Box® in 2017, and their logo is now prominently displayed with other top dental organizations on the front of the lunch box. But Edgar knew that delivering an additional 10,000 lunch boxes beyond the already nearly 75,000 would help broaden the program’s reach among the ADA members and help improve oral health outcomes for yet more kids.

Last fall, in her remarks to the ADA House of Delegates, Edgar underscored the need: “We have an epidemic of tooth decay in our children,” she said. “I would like to help the youngest among us, one lunch box at a time, by improving oral health literacy through the Lessons in a Lunch Box® initiative.”

Dr. Edgar’s endorsement and support has given the program more visibility among ADA members and has helped to increase their level of participation in presenting the program to second- and third-grade youth throughout the country.

Her support is expected to help further expand the existing inventory of lunch boxes and carrot cases by 10,000 pieces in time for National Dental Hygiene Month this fall. To date, The Children’s Oral Health Institute (COHI) has been able to distribute lunch boxes and carrot cases to nearly 75,000 in the US, Puerto Rico, Haiti, and the Bahamas; the contributions generated by Edgar and the ADA will further extend this number to 85,000.

“Some wondered what difference 10,000 boxes would make,” said Edgar. “And I said, ‘It makes a difference to 10,000 kids. Many baby steps make one giant footprint.’”

Dental Care in a Carrot®

The bright orange lunch boxes are hard to miss. That’s by design, according to Maryland dentist and The Children’s Oral Health Institute CEO Winifred Booker, DDS. She came up with the idea after a visit to Walmart where she saw a lunch box with a 3D version of Spiderman on the front. Booker developed and created the program to get children to focus on prevention and take responsibility for their own dental hygiene and snacking behaviors.

“We want this oral health education resource to be constantly visible,” Booker submits. “This way, information about healthy food consumption and dental hygiene behaviors is better recalled and the health care recommendations more likely practiced by the families.”

According to Dr. Leslie Grant, director of advocacy and outreach for COHI, “The goal of the Lessons in a Lunch Box® program is to empower children and their families with the proper knowledge about routine dental care, oral health maintenance, and good dietary choices using this ‘dentally designed’ lunch box. It is also developed to encourage the next generation of dental professionals.”

As a pediatric dentist, Booker said that she was frustrated with what seemed to be the lack of attentiveness by parents and educators to reinforce the oral health prevention messaging provided to patients at their biannual check-up appointments.

Decorated on all sides with a range of important information, the box itself serves as a mini oral health billboard. The front includes a brushing illustration and an array of fruits and vegetables. It also includes the logos of organized dentistry, including the American Dental Association (ADA) and the Academy of General Dentistry (AGD). Similarly, the back highlights the names of various sponsoring organizations and their logos.

On one side, there’s a place for the student to write their name and a small reflective smile sticker near the handle encouraging a student to “See Yourself Becoming a Dentist.” On the other, there’s the address of the American Dental Education Association (ADEA), to encourage careers in health care and dentistry. (In fact, in 2022, the ADEA reported that a dental school applicant documented participation in the Lessons in a Lunch Box® program while attending elementary school!)

Inside the box, the container illustrates flossing and brushing. Since good nutrition is also part of good oral hygiene, the kit also includes an image of the U.S. Department of Agriculture’s MyPlate diagram, a visual reminder to students to make healthy food choices from each of the five core food groups. The image is presented in English and Spanish.

Nestled inside, students will also find their very own Dental Care in a Carrot® case which contains all the essentials children need to complete their dental routine. For starters, the top of the carrot serves as a rinse cup. Inside the carrot is a toothbrush, toothpaste, dental floss, a mirror, and instructions on how to brush and floss. The dental case/carrot is also imprinted with braille for those who are blind or have impaired vision.

Unfortunately, good products aren’t enough to move the needle on children’s oral health care. That’s why COHI also created a wrap-around set of training, lessons, and follow-up support for use by dentists, hygienists, and others not necessarily directly connected to health care.

Like Dr. Edgar, Sherry H. Senter, a teacher and the longtime Education Resource Consultant to the COHI, appreciates the value of the program. Senter has also seen an epidemic of tooth decay among students and has shared stories from her classroom of students with obvious tooth decay and dental pain. She agrees with Dr. Edgar’s assessment of the problem and advocates for the goals of COHI. Both the former-teacher-turned-ADA-president and the current elementary school teacher agree that Lessons in a Lunch Box® can help to ensure students receive training on brushing, flossing and proper nutrition.

To support that education, lesson sheets and follow-up information about good nutritional habits, proper dental health and other important oral health reminders can be downloaded from the COHI website.

A More Oral Health-Conscious America

For the program to work, though, the lunch boxes filled with carrot cases need to find their way into schools. Dentists and other stakeholders — hygienists, nurses, physicians, and educators — play a critical role in connecting classrooms with the program.

Signing up to participate in the program is a straightforward process (see How to Participate).

"We want this oral health education resource to be constantly visible."

For those interested in sponsoring an elementary school, go to The Children’s Oral Health Institute website to take a one-hour CE course and learn how to sign up. COHI charges a handling fee to ship lunch boxes directly to elementary schools anywhere in the country. This fee can be covered by a sponsoring dental school, dental society, private practice or philanthropic interest.

“The outcomes from Lessons in a Lunch Box® are consistent with the hallmark of the dental profession: prevention,” said Booker. “Establishing viable oral health curriculum standards, combined with concrete classroom support, comprise the foundation for success. Collaboration between teachers and dentists is vital to expanding oral health awareness. The intent is to cultivate a more productive and oral health-conscious America.”

Booker says the growth and development of the Lessons in a Lunch Box® program continues to be celebrated after 16 years, not because of any one person, but rather, a network of dental health professionals united in support of healthy children.

“As the saying goes, ‘teamwork makes the dream work,’ and Lessons in a Lunch Box® is the pinnacle of the cliché,” added Booker.

“These successes are due to the benevolence of so many dedicated student dentists, and members of organized dentistry, and civic group volunteers, and leaders like the current president of the ADA, Dr. Linda Edgar.”

How to Participate

  1. Register an elementary school for the program by going to The Children’s Oral Health Institute website, The green registration button is on the left-hand side of the home page. Send an email via the CONTACT US button; COHI will send you additional materials to register.
  2. The first thing to complete is the permission memo that must be signed by the elementary school principal.
  3. Once the registration is complete, and the date of the Lessons in a Lunch Box® program presentation at the school has been scheduled, the lunch boxes are shipped directly to the school.
  4. The dentist who registers the program is the coordinator and must take a free one-hour continuing education course on presenting the program content. The course, “Improving Oral Health Literacy: Teaching Primary School Students through the Lessons in a Lunch Box® Program,” is offered at Type 456 into the search engine.
  5. An important rule of thumb is for every 10 children, there should be at least one volunteer to help them navigate their newly acquired lunch box and carrot case items during the program presentation.

This article originally appeared in Issue 2, 2024 of the WSDA News magazine.