Zachary Zeutzius wore an oversized lab coat, goggles and gloves as he pretended to be a dentist.

Meanwhile, his classmates stood side-by-side to form a row of teeth he carefully brushed.

The activity was part of a program aimed at showing the importance of proper dental hygiene. Experts say children with severe tooth issues struggle in school, may have disciplinary issues and often end up in the emergency room.

Zeutzius and his fellow 4-year-old kindergarten classmates at Beaumont Elementary School in Green Bay learned to brush and floss twice a day, and to visit the dentist twice a year.

Dental Associates visited about 23 schools in the Green Bay area and worked with more than 1,200 students in February as part of the effort.

"The idea is to help them get in the habit early," said Amy Buelow, a dental assistant at Dental Associates who helped conduct the program. "What we like to do is reach out to kids."

The Green Bay School District also receives help on the effort from the Brown County Oral Health Partnership. The nonprofit works on developing and maintaining a coordinated system of dental care and education for low-income uninsured and underinsured children and adults in Brown County.

In addition, Northeast Wisconsin Technical College runs a dental prevention program that correlates with its dental hygienist curriculum in summer and fall. The focus of the program is providing oral health education and offering some dental preventative care for students in the Green Bay School District and Door County, according to Sheila Gross, an instructor and director of the dental hygienist program.

Dental hygienist students provide education and place dental sealants on students' teeth at elementary schools using portable dental equipment.

The summer program, using grant money, also provides dental cleanings, X-rays, sealants and fluoride, Gross said.

The goal of the grant is to provide services to about 100 elementary students in summer and 300 elementary or Head Start students in fall. Program conductors typically see students whose families qualify for medical assistance, she said.

"The level of decay we often see is modest to severe," Gross said. "If it isn't treated, they probably will end up in the ER."

A recent national report shows the number of ER visits for dental problems increased 16 percent from 2006 to 2009. The report, conducted by the Pew Center on the States, indicates the trend could be continuing.

According to the American Academy of Pediatric Dentistry, more than 50 percent of children have some sort of decay before they are 5. In addition, a report from the Office of the Surgeon General notes that more than 51 million school hours are lost each year because of dental-related conditions.

Gross said that a child who is in chronic pain could be distracted from class, could be disruptive or may not even be in the class.

"They could stay home if they feel bad enough," she said. "It definitely impacts the learning environment."

Maria Vasquez, who also helped conduct the session at Beaumont, said culture also can have an impact.

"A lot of times, when you get kids from other countries, this is the first time they're taken to the dentist," she said. "The parents are not educated. And the children have severe issues because they haven't been to a dentist."

That's why education is important, the women said.

"If we can reach them in the early years, we can create lifelong learning patterns," Buelow said.

Beaumont Elementary students received a packet including a toothbrush, floss, toothpaste, a mask, gloves and more.

Teacher Deb Yeager said dental hygiene is part of her students' curriculum.

"These kids are very receptive to learning," she said. "They learn to eat healthy, brush and floss. That you need to visit the dentist."