School-based Dental Sealant Programs Research Articles

Retention and Effectiveness of School-based Dental Sealant Programs in Lucknow – A Randomized Controlled Trial

Background: Pit-and-fissure sealants, particularly the resin-based type, are widely used as the most efficient technique for preventing caries on the occlusal surfaces of permanent molars. School-based dental sealant (SBDS) program is a system where sealants are applied to the children in their schools with the primary aim to certify and safeguard the permanent molars that are sealed at the earliest after eruption. Aim: The aim of this study was to evaluate the retention and effectiveness of SBDS Programs in Lucknow, UP. Materials and Methods: A split-mouth randomized controlled trial was conducted among 6-year-old school-going children of Lucknow, UP. The study was carried out by a single trained and calibrated investigator who recorded the dentition status. The investigator interviewed the participants using a pro forma and examined the subjects included in the study. The sealant was applied to one tooth in the pair of fully erupted permanent first molars, and no treatment was done on the other side. Results: The proportion of total retention after 1½ years was significantly higher in mandibular as compared with maxillary molars (Z = 2.04; P = 0.04). The risk of having caries was 3.52 times more among children with no treatment as compared to children with treatment (odds ratio [OR] – 3.52 [1.01, 13.11]; P = 0.04; statistically significant). The association between survival rate of sealant and International Caries Detection and Assessment System codes (0 and 1–2) as well as that between retention of sealant and caries status was statistically significant (P < 0.01 and 0.00001, respectively). The risk of having caries was 1.28 times more among males as compared to females (OR – 1.28 [0.38, 4.24]; P = 0.06), 1.61 times for sugar exposure (OR – 1.61 [0.53, 6.19]; P = 0.53; nonsignificant). Conclusion: Sealant application proved to be an efficient method in preventing dental caries development; hence, SBDS programs, wherein the sealants were placed at school, were highly efficacious and acceptable in the vulnerable populace.

The Development and Implementation of a School-Based Dental Sealant Program for Hawaii Public Schools.

School-based dental sealant programs are noted to increase sealant uptake among children, especially those from low-income families and those living in rural and underserved areas. However, nationally school-based dental sealant programs are substantially underutilized. This paper describes a partnership approach to a school-based dental sealant program for Title 1 public schools in Hawaii. The Hawaii Keiki: Healthy and Ready to Learn program partnered with the Hawaii Dental Service to develop and implement an interprofessional, school-based sealant program (SBSP). This article describes the development of key factors, such as partnerships, an interprofessional team, team roles, policies, and marketing tools to optimize program success. The SBSP has completed over 3 academic years of implementation in Hawaii public schools. In its initial year (school year [SY] 2019-2020), which presented challenges due to the COVID-19 pandemic, it served 6 schools (106 students screened) on 1 island. It expanded to 14 schools on 1 island (193 students screened) in its second year (SY 2020-2021), 28 schools on 3 islands (653 students screened) in its third year (SY 2021-2022), and during the Fall of the fourth year, the program reached 50 schools on 3 islands (1821 students screened) and is projected to reach over 70 schools by the end of SY 2022-2023. Taking advantage of strategic partnerships and key interprofessional team members, a school-based dental sealant program can help to improve the oral health of children in public schools by helping to decrease barriers to care.

Implementation problems and adaptations among organizations delivering school-based dental sealant programs.

Although research supports the effectiveness of school-based dental sealant programs (SBDSPs) in increasing access to dental care and reducing dental caries, there is limited information on the implementation processes that impact success at the population level. This study assessed SBDSP program implementation in terms of problems (and adaptations) encountered during school and client (students) recruitment, client attendance, and workforce capacity. These four factors are necessary for reaching eligible youth. We interviewed program personnel (n= 18) at five organizations delivering SBDSPs in Oregon in 2018. Qualitative analysis employed a directed content approach. Specific implementation problems included the following: school recruitment: workforce limitations, school refusals, community objections; client recruitment: ineffective recruitment materials, poor parent/guardian engagement, consent form shortcomings, poor consent forms dissemination and return, low school cooperation; client attendance: poor school cooperation, physical barriers, scheduling conflicts; workforce capacity: insufficient size, high turnover. Participants reported that their respective organizations successfully adapted to resolve these implementation problems with some exceptions (e.g., insufficiencies in workforce capacity). Implementation problems related to school and client recruitment, client attendance, and workforce capacity may impact SBDSP reach. Adaptations to address these problems provide a basis for specific program recommendations. Larger systemic and translational problems were also observed, and recommendations were made regarding organizational communication and the need for additional pre-implementation planning and pilot testing.

Parental Perceptions of Oral Health and School-based Dental Sealant Programs

Parental Perceptions of Oral Health and School-based Dental Sealant Programs

School-based dental sealant program was effective in preventing carious lesions in first molars

School-based dental sealant program was effective in preventing carious lesions in first molars

Vital Signs: Dental Sealant Use and Untreated Tooth Decay Among U.S. School-Aged Children.

Tooth decay is one of the greatest unmet treatment needs among children. Pain and suffering associated with untreated dental disease can lead to problems with eating, speaking, and learning. School-based dental sealant programs (SBSP) deliver a highly effective intervention to prevent tooth decay in children who might not receive regular dental care. SBSPs benefits exceed their costs when they target children at high risk for tooth decay. CDC used data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 to estimate current prevalences of sealant use and untreated tooth decay among low-income (≤185% of federal poverty level) and higher-income children aged 6-11 years and compared these estimates with 1999-2004 NHANES data. The mean number of decayed and filled first molars (DFFM) was estimated for children with and without sealants. Averted tooth decay resulting from increasing sealant use prevalence was also estimated. All reported differences are significant at p<0.05. From 1999-2004 to 2011-2014, among low- and higher-income children, sealant use prevalence increased by 16.2 and 8.8 percentage points to 38.7% and 47.8%, respectively. Among low-income children aged 7-11 years, the mean DFFM was almost three times higher among children without sealants (0.82) than among children with sealants. Approximately 6.5 million low-income children could potentially benefit from the delivery of sealants through SBSP. The prevalence of dental sealant use has increased; however, most children have not received sealants. Increasing sealant use prevalence could substantially reduce untreated decay, associated problems, and dental treatment costs.

Effectiveness of school-based dental sealant programs among children from low-income backgrounds: a pragmatic randomized clinical trial with a follow-up of 3 years.

A split-mouth randomized clinical trial was carried out to assess the effectiveness of a school-based dental sealant (SBDS) program for French children from low-income backgrounds within 3 years of follow-up. The secondary objectives were to determine the risk factors for the occurrence of new carious lesions (ICDAS 3-6) on first permanent molars, to evaluate the effectiveness of the program according to risk factors and to assess sealant retention. The study included 276 6- to 7-year old pupils (457 pairs of first permanent molars) from Nice. The sealing was performed in first- or second-grade children. The first permanent molars were randomized into two groups: One received resin-based sealant and the other formed a nontreatment group. Carious lesions ICDAS 3-6 on permanent and primary teeth, visible plaque, streptococcus mutans and/or lactobacillus counts were recorded at baseline to assess individual caries risk (ICR). The putative confounders recorded at baseline were sex, grade level, and characteristics of first permanent molars. An intent-to-treat analysis was performed, where the study outcome was the occurrence of new carious lesions within 3 years of follow-up. Univariate and multivariate Cox proportional hazards models (hazard risk, HR) using the procedure PHREG with the option of Covsandwich were performed in SAS to assess the effectiveness of the SBDS program. At 3 years of follow-up, 228 children (378 tooth pairs) remained in the analysis. The survival analysis showed that first permanent molars that received sealants had 67% (adjusted HR: 0.33; 95% CI: 0.24-0.46) less risk of developing new carious lesions during all the follow-up than molars without sealant. In addition, children with carious lesions ICDAS 3-6 on permanent and primary teeth, that is, high ICR, had three times the risk of having a new carious lesion than others without, independently of the sealant treatment (adjusted HR: 3.00; 95% CI: 1.55-5.75). Effectiveness of the SBDS program at 3 years of follow-up depended on the presence of carious lesions ICDAS 3-6 (HR in 173 children with carious lesions: 0.32; 95% CI: 0.23-0.46) at baseline (HR in 103 children without carious lesions: 0.42; 95% CI: 0.16-1.12). Finally, the overall retention rate was 32.3%. The effectiveness of the SBDS program was demonstrated in low socioeconomic areas. Selection of schoolchildren according to the presence of carious lesions ICDAS 3-6 should be considered in a SBDS program.

Oral health status and academic performance among Ohio third-graders, 2009-2010.

Although recent literature indicated an association between dental caries and poor academic performance, previous work relied on self-reported measures. This analysis sought to determine the association between academic performance and untreated dental caries (tooth decay) using objective measures, controlling for school-level characteristics. School-level untreated caries prevalence was estimated from a 2009-2010 oral health survey of Ohio third-graders. Prevalence estimates were combined with school-level academic performance and other school characteristics obtained from the Ohio Department of Education. Linear regression models were developed as a result of bivariate testing, and final models were stratified based upon the presence of a school-based dental sealant program (SBSP). Preliminary bivariate analysis indicated a significant relationship between untreated caries and academic performance, which was more pronounced at schools with an SBSP. After controlling for other school characteristics, the prevalence of untreated caries was found to be a significant predictor of academic performance at schools without an SBSP (P=0.001) but not at schools with an SBSP (P=0.833). The results suggest the association between untreated caries and academic performance may be affected by the presence of a school-based oral health program. Further research focused on oral health and academic performance should consider the presence and/or availability of these programs.

School-based Dental Programs Prevent Dental Caries in Children at High Risk for Caries From Low Socioeconomic Backgrounds

Subjects: The study population comprised 276 first- and second-graders, age 6–7 years, attending 16 elementary schools located in low socioeconomic zones in Nice, France. All children in the relevant class were invited to participate. Key Exposure/Study Factor: The key exposure was the placement of a resin-based dental sealant on the occlusal surface of one of a pair of mandibular and/or maxillary first permanent molars. The contralateral unsealed molar acted as control in this split-mouth study. A total of 457 pairs of permanent first molars in 276 children (133 girls and 143 boys) were included. Active caries in permanent or primary teeth, visible plaque, and Streptococcus mutans and Lactobacillus counts were recorded at baseline to assess individual caries risk. Main Outcome Measure: The main outcome measure was the occurrence of new caries (ICDAS code 3-6) at the 1-year follow-up. The secondary outcome was the sealant's status after 1 year of follow-up, specifically, total retention, partially lost, or fully lost. The sealant was considered partially lost if it did not cover all occlusal pits and fissures. Main Results: At 1-year follow-up, 253 children (421 tooth pairs) remained in the study. First permanent molars that received sealants were less at risk for developing new caries lesions after 1 year of follow-up compared with those from the control group (OR = 0.26, 95% CI: 0.14–0.49). The effect of the sealants was significant only when the analyses included subjects with active caries or a high S. mutans count at baseline. At the 1-year follow-up, total retention was recorded in 52.7% (n = 222) of the treated teeth. Conclusions: The 1-year effectiveness of a school-based dental sealant program in preventing dental caries was demonstrated in children from low socioeconomic areas. The selection of schoolchildren according to individual caries risk factors should be considered in such programs.

Dental caries among children visiting a mobile dental clinic in South Central Kentucky: a pooled cross-sectional study

BackgroundDental caries is one of the most common chronic childhood diseases affecting a large portion of children in the United States. The prevalence of childhood dental caries in Kentucky is among the highest in the nation. The purposes of this study are to (1) compare sociodemographic differences between caries and no caries groups and (2) investigate factors associated with untreated dental caries among children who visited a mobile dental clinic in South Central Kentucky.MethodsStudy subjects were children aged 6 to 15 years who participated in the school-based dental sealant program through the mobile dental clinic operated by the Institute for Rural Health at Western Kentucky University between September 2006 and May 2011 (n = 2,453). Descriptive statistics were calculated for sociodemographic factors (age, gender, race/ethnicity, insurance status, and urban versus rural residential location) and caries status. We used chi-square tests to compare sociodemographic differences of children stratified by caries and no caries status as well as three levels of caries severity. We developed a logistic regression model to investigate factors associated with untreated dental caries while controlling for sociodemographic characteristics.ResultsThe proportion of children having untreated dental caries was 49.7% and the mean number of untreated dental caries was 2.0. The proportion of untreated dental caries was higher in older children, children with no insurance and living in rural residential locations, and caries severity was also higher in these groups. Odds ratio indicated that older ages, not having private insurance (having only public, government-sponsored insurance or no insurance at all) and rural residential location were associated with having untreated dental caries after controlling for sociodemographic characteristics of children.ConclusionsUntreated dental caries was more likely to be present in older children living in rural areas without insurance. Health interventionists may use this information and target rural children without having proper insurance in order to reduce geographic disparities in untreated dental caries in South Central Kentucky.

Effectiveness of school‐based dental sealant programs among children from low‐income backgrounds in France: a pragmatic randomized clinical trial

A split-mouth randomized clinical trial was carried out to assess the effectiveness of a school-based dental sealant (SBDS) program for French children from low-income backgrounds. The secondary objectives were to determine the effectiveness of the program according to the baseline individual caries risk (ICR) and to assess the sealant retention. The study included 276 pupils from Nice. The sealing was performed in the first or second grades. The permanent first molars were randomized into two groups: one received resin-based sealant and the other no treatment. Active caries on permanent and temporary teeth, visible plaque, Streptococcus mutans (SM) and Lactobacillus counts were recorded at baseline to assess ICR. An intent-to-treat analysis was performed based on the occurrence of new caries at 1 year of follow-up (study outcome). Univariate and multivariable conditional tooth-matched logistic regression analyses (Proc phreg; SAS) were used to assess the effectiveness of the SBDS program. At 1 year of follow-up, 253 children (421 pairs) remained in the analysis. In the adjusted analysis, first permanent molars that received sealants were less at risk of developing new caries at 1 year of follow-up compared with those from the control group (OR = 0.26, 95% CI: 0.14-0.49). Independently of the treatment, SM count, and all other covariates, only the variable 'active caries at baseline' remained related to new caries on first molars at 1 year (OR = 3.11, 95% CI: 1.27-7.62). The effect of the sealants was significant only when the analyses included subjects with active caries (OR = 0.25; 95% CI: 0.12-0.50) or with a high SM count (>10(5) , OR = 0.20; 95% CI: 0.10-0.41) at baseline. At the 1-year follow-up, total retention was recorded in 52.7% (n = 222) of the treated teeth. The 1-year effectiveness of the SBDS program was demonstrated in low socio-economic areas. Selection of schoolchildren according to individual caries risk factors should be considered in a SBDS program.

The Importance of Substate Surveillance in Detection of Geographic Oral Health Inequalities in a Small State

Considering that 42% of children and adolescents and 91% of dentate adults experience dental caries, oral disease is a public health problem. Although the population's oral health is improving, certain subgroups remain at increased risk for dental disease. To assess the oral health status at the substate level and explore the possibility of geographic oral health inequalities in New Hampshire while building upon existing surveillance data sets. We used the Third Grade Oral Health and NH Behavioral Risk Factor Surveillance System surveys. We ensured the availability of substate level data and compared county/region specific estimates. New Hampshire. Adults and third-grade students in public schools. The prevalence of dental caries, untreated caries, and dental sealants among children; and the insurance status, utilization of dental services, and edentulism among adults. Of the 10 counties, the northernmost Coos County had consistently worse outcomes when compared with other counties. Only 64% of adult Coos County residents reported a dental visit in the past year; of these, 66% reported dental cleaning. Among adults 65 years and older, 29% were edentulous. In comparison with the state overall, these estimates were 76%, 77%, and 19%, respectively. Coos County third-grade students had the highest prevalence of dental caries experience (64% compared with 44% in New Hampshire) and untreated caries (31% compared with 12%), and only 24% had dental sealants (state prevalence is 60%). Overall oral health status in our state is favorable and comparable with the nation, yet significant geographic inequalities exist among children and adults. The oral health status of disparate groups can be improved using tailored interventions such as community water fluoridation or expansion of school-based dental sealant programs. Surveillance at the substate level is an essential part of the planning, targeting, and progress monitoring.

Do school-based dental sealant programs reach higher risk children?

This report compares sealant prevalence by caries risk status among third graders at Ohio schools with and without school-based dental sealant programs (S-BSPs), and estimates the percent of children receiving sealants in S-BSPs who are higher risk for dental caries. We analyzed data from a statewide open-mouth oral health survey of Ohio third grade schoolchildren for sealant prevalence by S-BSP availability and caries risk classification. Children were classified as higher or lower risk for dental caries based on school lunch program enrollment and other non-clinical access-related indicators. Differences between groups were evaluated by the chi-square test (P < 0.05). At schools with no S-BSPs, higher risk children were less likely to have dental sealants than lower risk children (28.7 percent versus 42.7 percent, P < 0.001). At schools with S-BSPs, sealant prevalence for both risk categories was equivalent for higher and lower risk children (59.4 percent, 63.4 percent, P = 0.428). Higher risk children at schools with S-BSPs were more than twice as likely to have a sealant as higher risk children at non-S-BSP schools (59.4 percent versus 28.7 percent, P < 0.001). Of higher risk children with at least one sealant, 61 percent attended a school with an S-BSP compared with 12.3 percent of lower risk children with at least one sealant. Higher risk children accounted for at least 75 percent of children receiving sealants through S-BSPs. In Ohio, targeting S-BSPs by family income-based school-level criteria was effective in reaching higher risk children.

Targeting school-based dental sealant programs: who is at “higher risk?”

To assess the effect of various school-level Free and Reduced Price Meal Program (FRPMP) enrollment-based risk thresholds on the ability of school-based sealant programs (S-BSPs) to reach higher risk children. We used data from a statewide third grade oral health survey to compare: a) prevalence of dental caries for higher-risk children, using three different sets of child risk criteria based on social determinants; and b) dental caries and other access-related indicators for children at higher-risk schools based on four FRPMP-based thresholds (> or = 60 percent of children FRPMP-enrolled, > or = 50 percent, > or = 40 percent, > or = 30 percent). In addition, we used school enrollment and FRPMP enrollment data to compare the percentages of eligible schools and of higher-risk children resulting from the various thresholds. The prevalence of caries experiences and untreated caries were not significantly different for higher risk children categorized by the respective child caries risk criteria. Regardless of school-level risk threshold, children at higher risk schools were more likely to have caries experience, untreated caries, and no recent dental visit and less likely to have private dental insurance than children at lower risk schools. For these measures, children at higher risk schools were similar to each other regardless of risk threshold and were similar to higher risk children at all schools. The number of additional higher risk children per additional higher risk school showed a large decline between the 40-49 percent and 30-39 percent FRPMP enrollment tiers. Targeting higher risk schools to reach higher risk children is a practical and effective approach for increasing sealant prevalence through S-BSPs.

Statistical model for assessing the impact of targeted, school-based dental sealant programs on sealant prevalence among third graders in Ohio.

Since Ohio school-based dental sealant programs target economically disadvantaged groups, simple comparison of sealant prevalence between schools with sealant programs and those without is problematic due to underlying disparities between the two in sealant prevalence. The goal of our analysis was to estimate the impact of sealant programs on sealant prevalence among third graders in Ohio by applying a statistical model to data from a 1998-99 Ohio oral health screening survey of schoolchildren to control for differences in background characteristics. Included in the analysis were 9,747 third graders at randomly selected schools in Ohio. Chi-square statistics and survey logistic regression were used to analyze the association of sealant presence with school sealant program participation, dental care payment method, sex, race, and school lunch program eligibility. The unadjusted odds ratio for dental sealant presence was 3.4 (95% confidence interval [CI]=2.6, 4.4; P<.01). Adjusting for race and income, the odds of having dental sealants among children in schools with dental sealant programs increased to 4.8 (95% CI=3.5, 6.5; P<.01). Not controlling for confounders can result in underestimation of the impact of targeted school sealant programs.

Cost-Effectiveness Analysis of a School-Based Dental Sealant Program for Low-Socioeconomic-Status Children: A Practice-Based Report

Cost-Effectiveness Analysis of a School-Based Dental Sealant Program for Low-Socioeconomic-Status Children: A Practice-Based Report

Longitudinal evaluation of sealing molars with and without incipient dental caries in a public health program.

This study undertook a retrospective evaluation of the effect of sealants on the caries experience of initially sound and incipient permanent first molar pit and fissure surfaces. Records of children with complete five-year records were obtained from a school-based dental sealant program in a fluoridated community. Sealants were placed on 677 tooth surfaces in 96 children; 120 tooth surfaces in 17 children who received baseline examinations were not sealed because of lack of caregiver consent. Tooth surfaces were initially diagnosed as being sound or having incipient lesions, and evaluated for caries status after five years. For initially incipient surfaces the five-year decay rate was 10.8 percent (41 of 380 surfaces) for sealed surfaces and 51.8 percent (29 of 56 surfaces) for nonsealed surfaces with an odds ratio of 8.88 (95% CI = 4.56, 17.35). Initially sound surfaces had a decay rate of 8.1 percent (24 of 297 surfaces) for sealed surfaces and 12.5 percent (8 of 64 surfaces) for nonsealed surfaces with an odds ratio of 1.63 (95% CI = 0.63, 4.08). The two odds ratios were significantly different. Initially sound tooth surfaces were unlikely to become decayed in five years, and did not benefit greatly from the application of sealants. Within the limitations of this study, there were clear efficiencies in sealing incipient, but not sound, surfaces. The targeting of teeth with incipient caries for sealants is therefore recommended.

Dental pit and fissure sealants: implications for school health personnel.

While tooth decay among schoolchildren has declined in recent years, 95% of all schoolchildren still experience tooth decay. School-based fluoride rinse programs have made a significant contribution to the decrease in tooth decay. Pit and fissure sealants, one other preventive dentistry measure, also fight tooth decay. A pit and fissure sealant placed on the chewing surfaces of permanent molars acts as a barrier and protects caries-prone areas of the teeth. For sealants to be effective, it is important that school health educators, nurses, and administrators have the dental health knowledge necessary to make informed decisions about school-based dental sealant programs. Examples of successful programs are discussed.

Eruption pattern of permanent molars: implications for school-based dental sealant programs.

Dental caries remains a prevalent, chronic disease of childhood. The preponderance of dental caries is located on the pit and fissure surfaces of teeth, an area where dental sealants are most effective in preventing this malady. In the school year 1987-88, 4,879 Ohio schoolchildren participated in an assessment of dental health. Grades chosen for this assessment included 1, 2, 3, 6, 7, 8, and 11. This study focuses on eruption of first and second permanent molars in development of a timing strategy for placement of occlusal sealants in a school-based program. An eruption score was developed for the determination of the first or second molar eruption status for each child. The data were analyzed for grade, sex, race, locale, fluoridation status, and percent of children on free or reduced-cost lunch programs. Analyses were performed on 2,215 children in grades 1-3 and 1,840 children in grades 6-8. Fifty-seven percent of first graders had all first permanent molars sufficiently erupted for sealant placement on the occlusal surface. Likewise, 23.6 percent of sixth graders had sufficient occlusal exposure on the second molar. Females showed an earlier eruption pattern than males for both first (P less than .05) and second (P less than .001) molars. Black children preceded white children only in the eruption of the second molar (P less than .001). This study provides dental public health decision makers with state-specific information on the earliest time to initiate a school-based occlusal sealant program.(ABSTRACT TRUNCATED AT 250 WORDS)

Usefulness of a Local Oral Health Survey in Program Development

In 1986, the Columbus (Ohio) Health Department conducted an oral health survey of children in grades 1, 2, 6, and 7. The World Health Organization's Pathfinder methodology served as the basis for survey design. The survey was made possible through collaboration and sharing resources among the local and state health departments and two universities. The findings of the children's portion of the survey proved useful in program planning, marketing (including resource procurement), constituency building, and educating the dental profession and the public. The data were used to support successful grant requests that led to the implementation of a school-based dental sealant program. The local government expanded the health department's dental budget to continue the sealant program beyond the grant period. The state health department considered the survey to be a pilot for a statewide effort.