School-based Sealant Programs Research Articles

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.

Dental hygiene student perceptions of a school-based sealant program: A qualitative review.

The purpose of this 2021 study was to explore experiences acquired from a school-based sealant program (SBSP), to improve understanding of the relationship between SBSP and dental hygiene (DH) student outcomes, and to inform institutions of the value of educational experiences aiming to reduce disparities in access to dental care. University of Missouri Kansas City School of Dentistry Senior DH students complete a community engaged course which includes participation in community projects and clinical activities targeting Kansas City's urban and surrounding rural environments. The SBSP is a component of this course. This investigation utilized a qualitative methodology to examine SBSP experiences through the experience of the primary investigator, on-site dentist, and DH students involved in the program. Data analysis resulted in consensus of five synthesized conceptual models and twenty-three emergent themes. The conceptual models include: competence, roles and responsibilities, social justice, value added, and lessons learned. Based on triangulated results, SBSPs improve access to care for children, save dental costs, and provide essential experiences for DH students.

Retention and caries preventive effect of GC fuji VII sealant on the first permanent molars among high-risk residential school children - A three year follow up study

Objective: The objective of the study is to seal the permanent first molars in high-risk children aged 7–8 years with GC Fuji VII and evaluate its retention and caries preventive effect over 3 years. Methodology: The present study was a longitudinal, randomized, interventional trial with a sealant and control group. 538 residential schoolchildren with high caries risk received sealants. 495 day scholars did not receive sealant formed the control group. Children of both the groups were evaluated annually for sealant retention and development of caries for 3 years. Independent sample t-test and Chi-square test were used to compare the sealant retention and caries incidence rates. Kaplan–Meier survival analysis and log-rank test were performed to compare the cumulative molar survival and sealant retention rates over 3 years. Results: Comparison of baseline oral health characteristics between sealant and control group revealed no statistically significant variation (P > 0.05). At the end of 3 years, total retention was 43.4% (n = 178), 45.9% (n = 188), 44.9% (n = 184), and 44.4% (n = 182), respectively. Cumulative mean incidence of dental caries at the end of 3 years showed statistically significant higher caries incidence among control 2.15 ± 3.33 as compared to sealant 0.25 ± 0.85 with mean difference of 1.90 (P = 0.001). Conclusion: School-based sealant program targeting low socioeconomic, high caries risk population can form comprehensive approach for caries-free generation. GC Fuji VII may be a better choice for preventing dental caries in school-based sealant program.

The cost-utility of school-based first permanent molar sealants programs: a Markov model

BackgroundEvidence of the cost-effectiveness of school-based first permanent molar sealants programs is not yet fully conclusive. The aim of this study was to determine the incremental cost-utility ratio (ICUR) of school-based prevention programs for the application of sealants in molars of schoolchildren compared with non-intervention.MethodsA cost-utility analysis based on a Markov model was carried out using probability distribution. The utility was measured in quality-adjusted tooth years (QATY). The assessment was carried out from the public payer’s perspective with a six-year time horizon. Costs and benefits were discounted at 3% per year. Only direct costs were evaluated, expressed in Chilean pesos (CLP) at 7th May at 2019 values (exchange rate USD = CLP 681.09). Univariate deterministic sensitivity analysis and probabilistic analysis were carried out.ResultsAfter a six-year follow up, the cost of sealing all first permanent molars was found to be higher than non-intervention, with a mean cost difference of USD 1.28 (CLP 875) per molar treated. The “seal all” strategy was more effective than non-intervention, generating 0.2 quality-adjusted tooth years more than non-intervention. The ICUR of the “seal all” strategy compared to non-intervention was USD 6.48 (CLP 4,412) per quality-adjusted tooth years. The sensitivity analysis showed that the increase in caries was the variable which most influenced the ICUR.ConclusionsA school-based sealant program is a cost-effective measure in populations with a high prevalence of caries.

An Economic Evaluation of a Comprehensive School-Based Caries Prevention Program.

Current economic evaluations of school-based caries prevention programs (SCPPs) do not compare multiple types of SCPPs against each other and do not consider teeth beyond permanent first molars. To assess the cost-effectiveness of a comprehensive SCPP relative to an SCPP focused on delivering sealants for permanent first molars only and to a default of no SCPP. Based on a societal perspective, a simulation model was used that compared the health and cost impacts on 1) permanent first molars only and 2) all posterior teeth. To calibrate the model, we used data from CariedAway, a comprehensive SCPP that used glass ionomer to prevent and arrest active decay among children. We then evaluated the incremental cost-effectiveness of implementing 3 alternate school-based approaches (comprehensive, sealant only, and no program) on only first molars and all posterior teeth. Probabilistic, 1-, and 2-way sensitivity analyses are included for robustness. Cost-effectiveness is assessed with a threshold of $54,639 per averted disability-adjusted life year (DALY). We first compared the 3 programs under the assumption of treating only first molars. This assessment indicated that CariedAway was less cost-effective than school-based sealant programs (SSPs): the resulting incremental cost-effectiveness ratio (ICER) for CariedAway versus SSPs was $283,455 per averted DALY. However, when the model was extended to include CariedAway's treatment of all posterior teeth, CariedAway was not only cost-effective but also cost-saving relative to SSPs (ICER, -$943,460.88 per averted DALY; net cost, -$261.45) and no SCPP (ICER, -$400,645.52 per averted DALY; net cost, -$239.77). This study finds that economic evaluations assessing only cost and health impacts on permanent first molars may underestimate the cost-effectiveness of comprehensive SCPPs 1) preventing and arresting decay and 2) treating all teeth. Hence, there is an urgent need for economic evaluations of SCPPs to assess cost and health impacts across teeth beyond only permanent first molars. The results of this study can be used by policy makers to understand how to evaluate economic evaluations of school-based caries prevention programs and what factors to consider when deciding on what types of programs to implement.

School-Based Dental Sealant Programs Prevent Cavities And Are Cost-Effective.

Untreated cavities can have far-reaching negative consequences for people's ability to eat, speak, and learn. By adolescence, 27percent of low-income children in the United States will have untreated cavities. School-based sealant programs typically provide dental sealants (a protective coating that adheres to the surface of molars) at little or no cost to students attending schools in areas with low socioeconomic status. These programs have been shown to increase the number of students receiving sealants and to prevent cavities. We analyzed the cost-effectiveness of school sealant programs using data (from school programs in fourteen states between 2013 and 2014) on children's cavity risk, including the effects of untreated cavities on a child's quality of life. We found that providing sealants in school programs to 1,000 children would prevent 485 fillings and 1.59 disability-adjusted life-years. School-based sealant programs saved society money and remained cost-effective across a wide range of reasonable values.

Calculating averted caries attributable to school-based sealant programs with a minimal data set.

We describe a methodology for school-based sealant programs (SBSP) to estimate averted cavities, (i.e., difference in cavities without and with SBSP) over 9 years using a minimal data set. A Markov model was used to estimate averted cavities. SBSP would input estimates of their annual attack rate (AR) and 1-year retention rate. The model estimated retention 2+ years after placement with a functional form obtained from the literature. Assuming a constant AR, SBSP can estimate their AR with child-level data collected prior to sealant placement on sealant presence, number of decayed/filled first molars, and age. We demonstrate the methodology with data from the Wisconsin SBSP. Finally, we examine how sensitive averted cavities obtained with this methodology is if an SBSP were to over or underestimate their AR or 1-year retention. Demonstrating the methodology with estimated AR (= 7 percent) and 1-year retention (= 92 percent) from the Wisconsin SBSP data, we found that placing 31,324 sealants averted 10,718 cavities. Sensitivity analysis indicated that for any AR, the magnitude of the error (percent) in estimating averted cavities was always less than the magnitude of the error in specifying the AR and equal to the error in specifying the 1-year retention rate. We also found that estimates of averted cavities were more robust to misspecifications of AR for higher- versus lower-risk children. With Excel (Microsoft Corporation, Redmond, WA, USA) spreadsheets available upon request, SBSP can use this methodology to generate reasonable estimates of their impact with a minimal data set.

Permanent first molar eruption and caries patterns in American Indian and Alaska Native children: challenging the concept of targeting second grade for school‐based sealant programs

To describe first permanent molar eruption and caries patterns among American Indian and Alaska Native (AI/AN) children in order to identify the appropriate target grade for school-based sealant programs. We used data from the 2011-2012 Indian Health Service oral health surveillance survey of AI/AN children in kindergarten through third grade. Children were screened by trained examiners. Cavitated lesions were classified as decayed, and teeth with any portion of the crown exposed were considered erupted. We screened 15,611 AI/AN children in 186 schools. The percentage with four erupted first molars was 27 percent of kindergarten, 76 percent of first, 96 percent of second, and 99 percent of third-grade children. About 7 percent of kindergarteners had decayed, missing, or filled molars compared with 20 percent, 30 percent, and 38 percent of first, second, and third graders, respectively. School-based sealant programs for AI/AN children should target kindergarten and first grade with follow-up programs for second-grade children.

Reaction to “Oral Epidemiological Trends in Maryland”

The paper by Vargas et al. describes trends in oral health in Maryland over the past 10 years, illustrating Maryland's considerable progress in improving oral health for children covered by Medicaid 1. Some of the factors identified that impact children's oral health included the following: Strong dental and dental hygiene workforce. Death of 12-year-old Deamonte Driver because of a dentally related infection. Strong water fluoridation program statewide. Doubling of the percentage of Medicaid enrolled children under 21 years of age. Physician's participation in providing oral health preventive service. Increase in school-based sealant program resulting in a doubling of the percentage of Maryland children with sealants. The net result of these factors, as well as others, has been positive for the oral health of Maryland's children. In addition, over the past 10 years, Maryland has also seen modest reductions in edentulism and age-adjusted oral cancer incidence and mortality. While this is all good news, the findings of Vargas et al. also illustrate the oral health chasm that still exists in Maryland and, indeed, throughout the nation 1. The “chasm” issues include the apparent continuing disparities in oral health, which are largely related to geography, income, socioeconomic-ethnic status, and oral health literacy. While the caries experience in children declined over a 10-year period, there still remains a gap of 25-30 percent untreated caries, which is close to the national average. From this author's perspective, the benchmark comparison of Health People 2020's objective of 25.9 percent of 6- to 9-year-olds with untreated caries is appropriate but, simply stated, the benchmark itself is too low, given the resources in the nation and the amount of money spent on health care. The paper demonstrated Maryland's commitment to preventive care and their willingness to use the eight benchmarks created by the Pew Center for the States. However, the data reveal that the percentage of children with a preventive visit and who received dental treatment in 2009 still ranks below the national average. The lack of a statewide sealant program is a further illustration of the gap in prevention that continues. So, although Maryland has achieved success in reducing caries in children, it has probably reached a steady state until prevention becomes more widespread and the diagnostic coding and reimbursement system rewards the oral health workforce for preventive services and for rewarding improvements in health outcomes rather than paying for procedures. The unsettled state of the US economy and the resultant reductions in funding for Medicaid across many states suggests an increase in oral and systemic chronic disease problems in the future. A recent report in the New York Times demonstrated that more places are “defluoridating” water supplies to save money 2! How can that be helpful? Vargas et al. also point out that the poverty index has been increasing, thus putting more individuals with declining incomes into the Medicaid-eligible category. Indeed, at the national level, recent studies on The Pine Ridge Reservation in South Dakota demonstrated that 90 percent of adults and children had active decay and about half were missing teeth 3. Batliner points out that in the Pine Ridge community oral diseases are rampant and access to care is a “cruel joke”2, 4. The call by Batliner and others is to rethink the make up of the oral health workforce to include a midlevel provider (dental therapist) 2-6. There is considerable discussion of this issue as the most appropriate comprehensive means to address the oral health-care access problem. This author's reaction to the data of Vargas et al. is to compliment Maryland on its proactive status as it moves forward with health-care reform and health exchange to include dental. At the same time, there remains disappointment in how far Maryland and the nation needs to go to truly improve access to quality oral health care and to reduce the burden of disease. The data show that Maryland can be recognized as a leader at a pivotal time in the nation's commitment to the elimination of disparities, which improve access to care and for demonstrating the power of a committed coalition aimed at improving the oral and systemic health of its citizens. The author declares no conflict of interest.

Application of Sealants Through School-Based Sealant Programs Decreases Dental Caries Prevalence

Centers for Disease Control and Prevention. Preventing dental caries through school-based sealant programs: updated recommendations and reviews of evidence. Gooch BF, Griffin SO, Gray SK, Kohn WG, Rozier RG, Siegal M, et al. J Am Dent Assoc 2009;140(11):1356-65. Natalia I. Chalmers, DDS, PhD To update the recommendations for sealant use in school-based sealant programs (SBSPs) based on the current scientific evidence. The work group was sponsored by the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. Systematic review Level 1: Good-quality, patient-oriented evidence Grade A: Consistent, good-quality patient-oriented evidence

Dental Sealants: A Public Health Perspective

This article discusses the oral health status of California children, including sealant prevalence, and reasons why sealants are underutilized, including current reimbursement levels. The article also explains similarities and differences between sealant use in private practice versus public health settings, as well as the effectiveness and economic aspects of school-based sealant programs. Finally, the article briefly discusses the advantages of combined topical fluoride and sealant programs in public health settings.

Techniques for assessing tooth surfaces in school-based sealant programs

The authors reviewed the evidence supporting current guidelines for the detection of cavitated carious lesions. Currently, cavitation is the point at which sealants are not placed in school-based programs. The authors did not perform a formal systematic review. However, they examined existing systematic reviews of caries detection and diagnosis, including those presented at the 2001 National Institutes of Health Consensus Conference on Management of Caries, published evidence related to the International Caries Detection and Assessment System criteria and other peer-reviewed publications. Where the authors found ambiguity or uncertainty in the evidence, they consulted with fellow members of an expert work group. Visual examination is appropriate and adequate for caries assessment before placing sealants. The clinician should not use an explorer under force. 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. This report focuses on tooth assessment, in particular the detection of carious lesion cavitation in school-based sealant programs. These recommendations must be balanced with the dentist's expertise, available treatment options, the patient's preferences and access to care.

Tocilizumab Ameliorates Clinical Symptoms in Polymyalgia Rheumatica: Figure 1.

<b>Purpose:</b> The purpose of this study was to use qualitative methods to describe the key lessons learned during the stakeholder engagement stage of planning a randomized clinical trial comparing outcomes of silver diamine fluoride (SDF) as an alternative to pit-and-fissure sealants in a school-based delivery system. <b>Methods:</b> Eighteen caregivers and community-based stakeholders with involvement in the school-based sealant program Sealants for Smiles from the state of Montana, were recruited for this qualitative study. United States (U.S.) Patient-Centered Outcomes Research Institute (PCORI) methodology standards were used to develop two semi-structured interview guides consisting of 6 questions. One interview guide was used for telephone interviews with caregivers and the second was used for a stakeholder focus group. Content analytic methods were used to analyze the data. <b>Results:</b> All participants believed that a study comparing SDF and sealants was clinically relevant. Non-caregiver stakeholders agreed with the proposed primary outcome of the study (caries prevention) whereas caregivers also emphasized the importance of child-centered outcomes such as minimizing dental anxiety associated with dental care. Stakeholders described potential concerns associated with SDF such as staining and perceptions of safety and discussed ways to address these concerns through community engagement, appropriate framing of the study, proper consent procedures, and ongoing safety monitoring during the trial. Finally, stakeholders suggested dissemination strategies such as direct communication of findings through professional organizations and encouraging insurance plans to incentivize SDF use by reimbursing dental providers. <b>Conclusions:</b> Involving key stakeholders in early planning is essential in developing patient-centered research questions, outcomes measures, study protocols, and dissemination plans for oral health research involving a school-based delivery system.

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.

Preventing Dental Caries Through School-Based Sealant Programs: Updated Recommendations and Reviews of Evidence

School-based sealant programs (SBSPs) increase sealant use and reduce caries. Programs target schools that serve children from low-income families and focus on sealing newly erupted permanent molars. In 2004 and 2005, the Centers for Disease Control and Prevention (CDC), Atlanta, sponsored meetings of an expert work group to update recommendations for sealant use in SBSPs on the basis of available evidence regarding the effectiveness of sealants on sound and carious pit and fissure surfaces, caries assessment and selected sealant placement techniques, and the risk of caries' developing in sealed teeth among children who might be lost to follow-up. The work group also identified topics for which additional evidence review was needed. The work group used systematic reviews when available. Since 2005, staff members at CDC and subject-matter experts conducted several independent analyses of topics for which no reviews existed. These reviews include a systematic review of the effectiveness of sealants in managing caries. The evidence supports recommendations to seal sound surfaces and noncavitated lesions, to use visual assessment to detect surface cavitation, to use a toothbrush or handpiece prophylaxis to clean tooth surfaces, and to provide sealants to children even if follow-up cannot be ensured. These recommendations are consistent with the current state of the science and provide appropriate guidance for sealant use in SBSPs. This report also may increase practitioners' awareness of the SBSP as an important and effective public health approach that complements clinical care.

Public Health Sealant Delivery Programs: Optimal Delivery and the Cost of Practice Acts

The greatest unmet health need for US children is dental care. School-based sealant programs target low-income, high-risk second graders and are effective in preventing caries for as long as the sealant material remains in place. However, it is not clear whether such programs make efficient use of available resources and staffing. The authors used discrete event simulation to determine the optimal combinations of staffing levels and sealant stations for school-based sealant programs. Using data provided by state programs and the literature, they modeled different-sized programs under different practice act constraints and determined times and associated costs. A detailed economic analysis was done for Wisconsin. For general, direct, or indirect supervision, it is optimal to have only 1 dentist or no dentists for no supervision. For general supervision, it is optimal to have the dentist and dental assistant to come on separate days to screen. The cost savings for adding an assistant and chair averaged over all of the program sizes and travel distances ranged from 4.50% (SE= 0.89) to 10.94% (SE= 0.56). Significant cost savings also result from reducing the required supervision level (8.72% [SE = 1.61] to 29.96% [SE= 1.67]). The cost of the practice act for the state of Wisconsin for 2003 was from USD 83,041 to USD 346,156, significantly more than its annual budget. States could save money by relaxing restrictions on the type of personnel who can deliver sealants in public health settings and by productivity gains through proper consideration of staffing. The savings could be used to improve access to sealant programs and further reduce disparities in oral health.

Twelve‐month Sealant Retention in a School‐based Program Using a Self‐etching Primer/Adhesive

Very little independent research has been done on the new self-etching primer/adhesives in dentistry. A recent clinical study compared two sealant application techniques involving self-etching primer adhesives and the traditional phosphoric acid etch. The purpose of this study was to compare these two techniques in an Iowa school-based sealant program. Twelve-month sealant retention data on 208 students from the Des Moines, Iowa, school-based sealant program were analyzed retrospectively. Sealant retention reported at the person level showed that 60 percent of the students who received sealants at the five schools had to be recalled at one year to have one or more surfaces resealed. A logistic regression model at the person level demonstrated that the phosphoric acid technique was six times as likely to have retention of all the sealed tooth surfaces as those sealed with Prompt-L-Pop. In this study, many students had to be recalled to the chair 12 months after sealant application due to incomplete retention. Though sealants were retained in larger numbers with phosphoric acid, overall sealant retention at the tooth level was lower than previously published for clinical studies and school-based programs. Examining retention data at the person level, however, allows program administrators to plan resources more effectively and reevaluate sealant protocol to ensure as few children return for sealant reapplication.