School-Based Dental Sealant Programs

Introduction: What Are Dental Sealants?

Dental sealants are thin coatings applied to the tiny grooves on the chewing surfaces of the back teeth (molars), which is where most cavities (tooth decay or dental caries) in children and adolescents occur. In addition to protecting teeth from cavities, sealants stop cavities from growing. After sealants are applied, they protect against 80% of cavities for 2 years and continue to protect against 50% of cavities for up to 4 years.¹ School-age children without sealants have almost 3 times more cavities than those with sealants.² Untreated cavities can cause pain, infection, and problems eating, speaking, and learning.³

 

School-based sealant programs provide pit and fissure sealants to children in a school setting. These programs generally target vulnerable populations that may be at greater risk for developing decay and less likely to receive preventive care.

Compared to children from higher income families, children from low-income families are more likely to

• Have untreated tooth decay²
• Have few or no dental sealants²
• Not have had yearly dental visits⁴

School-Based Sealant Programs Work

School-based programs are an effective way to reach millions of children with sealants. The Community Preventive Services Task Force strongly recommends school-based sealant delivery programs to prevent cavities among children.¹ In addition, school-based sealant programs can be cost-saving within 2 years of placing sealants, and delivering sealants to children at high risk for cavities can be cost-saving to Medicaid.⁵

What Are School-Based Sealant Programs?

School-based dental sealant programs provide sealants to children unlikely to receive them otherwise. Such programs

• Define a target population within a school district
• Verify unmet need for sealants
• Get financial, material, and policy support
• Apply rules for selecting schools and students
• Apply sealants at school or offsite in clinics

School-based sealant programs are especially important for reaching children from low-income families who are less likely to receive private dental care. Programs generally target schools by using the percentage of children eligible for federal free or reduced-cost lunch programs.

Recommendations for School-Based Sealant Programs

“Preventing Dental Caries Through School-Based Sealant Programs: Updated Recommendations and Review of Evidence,” Journal of the American Dental Association, November 2009, provides guidance to school-based sealant programs. The recommendations were developed by a CDC work group of experts in the fields of caries prevention and treatment, oral epidemiology, and evidence-based reviews. The work group also included representatives from professional dental organizations.
The expert work group examined new evidence on

• The effectiveness of sealants in preventing new decay and progression of early decay
• Methods to assess decay
• Sealant placement techniques
• Scientific reviews of program practices

On the basis of this evidence, the following recommendations are provided for practitioners in school-based programs:

• Seal pit-and-fissure tooth surfaces that are sound or have early decay, prioritizing first and second permanent molars.
• Use visual assessment to differentiate surfaces with the earliest signs of tooth decay from more advanced lesions.
• X-rays are not needed solely for sealant placement.
• A toothbrush can be used to help clean the tooth surface before acid etching.
• When resources allow, have an assistant help the dental professional place sealants.
• Provide sealants to children even if follow-up examinations for every child cannot be guaranteed.

These recommendations are designed to guide practices of state and community public health programs for planning, implementing, and evaluating school-based sealant programs, as well as to complement the American Dental Association Council on Scientific Affairs’ “Evidence-Based Clinical Recommendations for Sealant Use” published in 2008.

In August 2016, the American Dental Association and the American Academy of Pediatric Dentistry published a systematic review that examined the effectiveness of sealants for preventing tooth decay. The review concluded that sealants were safe and effective for preventing or stopping the progression of tooth decay, compared with those individuals who either did not have sealants or who received fluoride varnish treatment.

Several other publications provide more detail about the studies that were conducted by work group members. The published studies are provided below.

• “The Effectiveness of Sealants in Managing Caries Lesions,” Journal of Dental Research. February 2008. This study shows that if sealants are placed over early tooth decay, they will stop early decay from becoming a cavity. This information should lessen concerns about accidentally sealing over decay.
• “The Effect of Dental Sealants on Bacteria Levels in Caries Lesions: A Review of the Evidence,” Journal of the American Dental Association. March 2008. This study shows that sealing over tooth decay lowers the number of bacteria in the cavity by at least 100-fold.
• “Exploring Four-Handed Delivery and Retention of Resin-Based Sealants,” Journal of the American Dental Association. March 2008. For sealants to work, they must stay in place or be retained on the tooth. This study concludes that having a dental assistant help the dental professional place the sealant (four-handed technique) may improve sealant retention.
• “A Comparison of the Effects of Toothbrushing and Handpiece Prophylaxis on Retention of Sealants,” Journal of the American Dental Association. January 2009. This study shows that cleaning the tooth’s surface with a toothbrush before applying dental sealants resulted in sealant retention at least as high as when a hand piece was used.
• “Caries Risk in Formerly Sealed Teeth,” Journal of the American Dental Association. April 2009. This study shows that teeth with fully or partially lost sealants did not have a higher risk of developing a cavity than teeth that were never sealed.
• “Techniques for Assessing Tooth Surfaces in School-Based Sealant Programs,” Journal of the American Dental Association. July 2010. The authors conclude that visual examination is appropriate and adequate for caries assessment before placing sealants; the clinician should not use an explorer under force. In addition, radiographs are not indicated solely for the placement of sealants, and the use of magnification and caries detection devices is not necessary to determine cavitation.

Additional Resources

• CDC Vital Signs Report Dental Sealants Prevent Cavities presents important information for parents, school administrators, dental care providers, state officials and Federal government officials to help increase the use of this valuable tool.
• The Association of State and Territorial Dental Directors’ (ASTDD) Best Practice Approach: School-based Dental Sealant Programs [PDF-468K]. This report reviews the scientific evidence that school sealant programs work and presents specific examples of practices in state programs.
• Oral Health in America: A Report of the Surgeon General. This US Surgeon General’s report was the first to focus on oral health provides an overview on effectiveness of sealants and public health strategies to provide sealants to children in community settings.
• Implementation of Evidence-Based Preventive Interventions: School-Based and School-Linked Dental Sealant Programs. The website describes requirements related to dental sealant programs of states funded by a CDC cooperative agreement.
• Sealant Efficiency Assessment for Locals and States (SEALS). The tool is for states and communities to use to determine the effectiveness and efficiency of their school-based or school-linked sealant programs.
• Dental Sealants: Proven to Prevent Tooth Decay. This report, published by the Children’s Dental Health Project and based on research funded by CDC, explores the factors that shape school sealant programs’ ability to reach more children in effective, sustainable ways. The report is based on a series of surveys and interviews with stakeholders across the country.
• Seal America: The Prevention Invention is an online manual designed to assist health professionals initiate and implement a school-based dental sealant program.
• “Workshop on Guidelines for Sealant Use: Recommendations.” The Journal of Public Health Dentistry. Provides recommendations for use of dental sealants in clinical practice and school-based sealant programs from a workshop convened by the Association of State and Territorial Dental Directors, the New York State Department of Health, the Ohio Department of Health, and the School of Public Health, University at Albany, State University of New York.

References

1. Community Preventive Services Task Force. Preventing Dental Caries: School-Based Dental Sealant Delivery Programs website. www.thecommunityguide.org/oral/schoolsealants.html. Accessed October 12, 2016.
2. Griffin SO, Wei L, Gooch B, Weno K, Espinoza L. Changes in dental sealant and untreated tooth decay prevalence and the estimated impact of increasing school-based sealant program coverage. MMWR. 2016;65.
3. Holt K, Barzel R. 2013. Oral Health and Learning: When Children’s Oral Health Suffers, So Does Their Ability to Learn (3rd ed.) Washington, DC: National Maternal and Child Oral Health Resource Center; 2013.
4. Griffin SO, Barker LK, Wei L, Chien-Hsun L, Albuquerque MS, Gooch BF. Use of dental care and effective preventive services in preventing tooth decay among U.S. children and adolescents—Medical Expenditure Panel Survey, United States, 2003–2009 and National Health and Nutrition Examination Survey, United States, 2005–2010. MMWR. 2014;63(2):55–61.
5. Griffin SO, Naavaal S, Scherrer CR, Patel M, Chattopadhyay S. Evaluation of school-based dental sealant programs: an updated Community Guide systematic economic review. Am J Prev Med. In press 2016.

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