Sealant Program Research Articles

Evaluation of a school‐based fluoride mouthrinsing and clinic‐based sealant program on a non‐fluoridated island

For many years the children of Guam have experienced a high prevalence of dental caries. Surveys conducted on the fluoride-deficient island found that caries levels were double those of US mainland children. In 1976 a school-based fluoride mouthrinse program was initiated involving over 22,000 children in grades kindergarten through eight in weekly rinses with 0.2% neutral NaF. A clinic-based dental pit and fissure sealant program was added in 1984 to the fluoride mouthrinse program. Over 15,000 children participated annually in the sealant program where more than 75,000 teeth were sealed the first year. After 8 yr of fluoride mouthrinsing (1976-1984) mean DMFS scores were 1.79 surfaces per child lower compared to baseline, a decrease of 0.22 DMFS per child per year. During this period proximal DMFS scores decreased 61%, buccal-lingual surfaces 31%, and occlusal surfaces 7%. After 2 yr of fluoride mouthrinsing and sealant application combined overall DMFS scores decreased an additional 2.34 surfaces per child, a reduction of 1.17 DMFS per child per year. Most of this decline took place on pit and fissure surfaces. For the 10-yr period a reduction of 4.13 DMFS per child was seen--a decline from 7.06 DMF at baseline to 2.93 DMF surfaces per child in 1986. This long-term evaluation indicates that dental sealants when used in combination with fluoride mouthrinse were particularly effective in lowering the prevalence of dental caries. Schoolchildren in participating grades on Guam now have dental caries rates close to those of US schoolchildren.

The effectiveness of pit and fissure sealants.

This review addresses two major issues related to the use of pit and fissure sealants. First, the epidemiology of occlusal caries for children and adults is examined to determine if there is a basis for administering sealant programs to different age groups. Second, the effectiveness of pit and fissure sealants in fluoridated and non-fluoridated communities is compared. Changes in effectiveness of sealant over time are evaluated in terms of percent effectiveness, complete retention, caries incidence, and reapplication rates. Based on epidemiologic evidence, sealant programs can be justified for children and young adults, but not for older age groups. Based on the literature reviewed, following one application of autopolymerized or visible-light-cured sealant, the median percent effectiveness declines from 83 percent after one year to 55 percent after seven years. Similarly, the median complete retention declines from 92 percent after one year to 66 percent after seven years. Conversely, the median percent of sealed first molars becoming carious and/or restored increases from 4 percent after one year to 31 percent after seven years. Large differences in sealant effectiveness are not apparent between studies performed in fluoridated and fluoride-deficient communities.

Caries incidence and costs of prevention programs.

Data on caries increments and costs of prevention programs are presented as background information for participants in the workshop. Estimates of annual caries increments were derived from control groups in clinical trials, epidemiologic studies, and national surveys. Cost data were obtained from dental public health directors, program administrators, fluoridation engineers, and water plant operators in different parts of the US. Caries incidence data are reported for age groups: 5-17 years (fluoridated and nonfluoridated areas), 18-44 years, 45-64 years, and 65 and over. Program costs include direct costs primarily and do not allow for program inefficiencies, nor have they attempted to include social costs. All cost data are expressed in 1988 dollars. Direct program costs are included for community water fluoridation, fluoride supplements, fluoride mouthrinses, school fluoridation, and sealant programs. For professionally and self-applied fluoride programs, only material and salary costs are included because total costs could not be located in the literature nor obtained from program directors. All factors and necessary assumptions included in the cost assessments are described.

An evaluation of the Saskatchewan pit and fissure sealant program: a longitudinal followup.

The Saskatchewan Health Dental Plan (SHDP) is a publicly funded dental insurance program for children between the ages of five and 16 years residing in the province. In 1981, fissure sealants were added as a covered expense. Until September 1, 1987, sealants and other dental treatments covered under the SHDP were provided to schoolchildren by dental therapists in dental clinics established in elementary schools throughout the province. After September 1, 1987, the provision of dental services was transferred to private practitioners in the province. The objectives of this study were to (1) estimate the retention rates of sealants after one, two, and three years of placement; and (2) conduct a longitudinal followup of sealed and unsealed sound teeth to measure the effectiveness of sealants in reducing dental caries incidence. Relative to the first objective, a cohort of children was identified and comparisons were carried out for the periods of 1982-83, 1982-84, and 1982-85. For the last objective, a longitudinal evaluation of effectiveness was carried out only for children five to seven years of age in 1981. Saskatchewan children, who experienced higher caries prevalence than children in the United States, had the highest caries increments on occlusal surfaces of posterior teeth. About 79 percent of the sealants applied by dental therapists were retained three years after application. Sealed teeth experienced 46 percent less caries than unsealed teeth four years after the application of sealants.(ABSTRACT TRUNCATED AT 250 WORDS)

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)

Evaluation of a Clinic‐based Sealant Program

In 1984 a comprehensive sealant program was initiated for Guamanian children in grades one through eight. The goal of the program was to reduce caries rates in children on the fluoride-deficient island to a level at or below US mainland scores. At the initiation of the program, decayed, missing, and filled surfaces (DMFS) scores on Guam were approximately double those for US mainland children under 17 years of age. For the clinic-based preventive program, children in grades one through eight were bussed to one of two public health clinics for preventive services. These services included oral health education, toothbrushing instructions, and sealant application. Baseline and follow-up dental examinations (DMFS) were conducted in 1984 and 1986 on 1,061 and 987 children respectively, in grades one through eight to evaluate program impact. From 1984 to 1986, after the advent of a pit and fissure sealant program where over 15,000 children annually had sealants applied to their teeth, DMFS scores decreased 45 percent. The entire reduction in DMFS scores occurred on pitted and grooved surfaces and the effect reduced the DMFS by 2.4 surfaces/child in two years. The overall participation rate for both the elementary and middle schools was 80 percent and the first annual follow-up showed an overall sealant retention rate of 94 percent.

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.

Controversy over the supervision of dental hygienists: impact on a community-based sealant program.

In 1983, the New Mexico Board of Dentistry ruled that the New Mexico Health and Environment Department's sealant program violated its rules and regulations concerning the supervision of dental hygienists. The state was forced to reduce the number of children served by the program to comply with the decision. Attempts to secure a revision of the rules and regulations to accommodate the needs of public programs were unsuccessful. Relief eventually came through the revision of the Dental Practice Act itself to permit general supervision of all dental hygienists. The supervision controversy was an explosive political issue between dentists and dental hygienists that had negative repercussions for the state dental public health preventive program.

The effects for recall patients of a comprehensive sealant program in a clinical dental public health setting.

The preventive outcomes of a comprehensive sealant program in a dental public health treatment center for low SES children are reported. The Linn County (Iowa) Dental Health Center implemented a comprehensive sealant philosophy in 1978. Since then, virtually all pits and fissures in primary and permanent teeth for all new and recall patients have been sealed. The comprehensive sealant philosophy was formulated following a previously reported Dental Health Center study documenting the negative outcomes of unmet treatment need as a result of the lack of continuity of care for this specific low SES target population. Sealants were evaluated for all recall patients seen over a two-month period. The sealants had been placed six months to six years before the two-month examination period. Ninety-five percent of the sealants were intact for the recall patients. Only 3.3 percent of the sealants were in need of repair or resealing--a procedure easily incorporated into the preventive recall appointment. Only 1.5 percent of the teeth were carious, and to a minor extent. To maintain the total sealant treatment philosophy on repaired and newly erupted teeth for recall patients in the dental public health setting requires on the average approximately five additional minutes per recall appointment. Low SES children are at highest risk to dental caries, but are still not guaranteed access to ongoing preventive services. Sealants are of much greater importance than the usual prophylaxis-fluoride regimen for low SES children displaying more episodic than preventive dental behavior. Comprehensive sealant programs should be considered for all dental public health clinical treatment programs for children.

Developing a sealant program: the Massachusetts approach.

This paper describes the program structure and strategies being used by the Massachusetts Department of Public Health to promote the utilization of sealants. The program design includes four components: clinical demonstration, consumer education, professional education, and reimbursement. Eighteen Massachusetts neighborhood health centers and six local health departments are participating in the clinical demonstration component. Since March 1984, dental personnel from these sites have applied sealants to 4,398 schoolchildren. The promotional theme "Save Teeth: Seal Them" has been incorporated into brochures designed to increase knowledge and awareness of consumers. Curriculum materials have been developed to educate dentists and dental hygienists to apply sealants and understand the rationale and scientific basis for their use. Since January 1984, 18 sealant educational sessions have been conducted statewide for 630 dental providers. Information is being presented to third-party carriers, some of whom have subsequently adopted a policy to include reimbursement for sealants.

Personnel and equipment considerations for a community‐based sealant program

Journal of Dental EducationVolume 48, Issue 2 p. 75-79 Article Personnel and equipment considerations for a community-based sealant program JA Disney, JA DisneySearch for more papers by this author JA Disney, JA DisneySearch for more papers by this author First published: 01 February 1984 https://doi.org/10.1002/j.0022-0337.1984.48.2.tb01758.xCitations: 2About ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume48, Issue2February 1984Pages 75-79 RelatedInformation

Indications for sealant use in a community‐based preventive dentistry program

Dental caries is a disease that recently has undergone, and may still be undergoing, dramatic changes in distribution of incidence and prevalence. The most recent epidemiologic data available have been reviewed in this paper to illustrate that caries is becoming a disease primarily of pits and fissures, with less differentiation than previously acknowledged between fluoridated and fluoride-deficient areas. The present distribution of caries suggests that prevention may be accomplished more effectively through targeted sealant programs than through currently popular mass preventive programs. Existing information can be used to identify logical target groups for sealant programs, and age specific tooth eruption and caries attack information can be used to design delivery methods. Although the adoption of targeted sealant programs represents a departure from the traditional mass approach to prevention in dental programs, the present-day caries distribution requires that the initiation of such programs be given serious consideration. At the very least program administrators are encouraged to invoke the planning-implementation-evaluation process. Current programs should be evaluated carefully in view of today's disease patterns and the clinical significance of the results achieved. The content, design, and timing of future community-based programs should reflect individualized community diagnosis and the application of new epidemiologic data as well as a careful evaluation of the results achieved by current preventive procedures.

Epidemiology of dental caries in the premolar and second molar teeth of Scottish children in relation to pits and fissures

To evaluate the potential benefits from elimination of dental caries in the fissures of teeth, surface patterns of decay were calculated for all surfaces of the premolar and second molar teeth of 98 children followed longitudinally for 5 years, between ages 11 and 15 years. Tooth eruption and susceptibility were also examined in relation to the administration of sealant programs. The children who were part of the control group of a fluoride dentifrice study on the Scottish Isle of Lewis, had low exposure to fluorides, high caries attack and very low restorative treatment levels; so true surface caries distribution was not masked. Variation in tooth eruption and susceptibility suggested that semiannual applications of preventive agents at each year age 10 through 15 might be required. Using hypothetical percentage reductions, the substantial potential benefits for caries control of the early use of completely retained occlusal, as well as buccal and lingual (molars), fissure sealants are conclusively demonstrated. However, improvements in the present technology of fissure sealants and their application are apparently required if these benefits are to be extended to large groups of children.