Overview
Dental caries (tooth decay) is the most-common chronic
disease among children and youth, and can impact their ability to eat, speak,
learn, and play. Children
who have poor oral health often miss school and receive lower grades than their
healthy counterparts.
While we have seen a decrease in tooth decay among children
and youth since the 1970s, disparities continue to exist.
According to the Centers
for Disease Control and Prevention, (CDC):
Children from low-income families experience more tooth
decay.
- 17% of children have untreated decay in their
primary teeth, 3 times the percentage of children from higher-income
households.
- 23% of children have untreated decay in their
permanent teeth, twice the percentage from higher-income households.
Children from some racial and ethnic groups experience
poorer oral health.
- 33% of Hispanic and 28% of Black children have
experienced tooth decay in their primary teeth, compared to 18% of non-Hispanic
White children.
- Almost 70% of Hispanic children have experienced tooth decay in their permanent teeth, compared to 545 of non-Hispanic White
children.
Children residing in rural communities access dental care
less frequently due to geographic isolation and workforce maldistribution.
- Children and youth living in rural America
experience 8% less access to dental services compared to their urban
counterparts.
- A higher
proportion of homes in rural communities are not served by public water systems
that are fluoridated. Community water
fluoridation reduces tooth decay by 25% in children and adults, resulting in less pain, fewer
fillings or teeth pulled, and fewer missed days of work and school.
Dental Sealants and Fluoride Varnish
Knowing that a focus on prevention is far more cost-effective than treatment, for more than 40 years, dental sealants and fluoride
– both systemic and topical, have been used to prevent tooth decay.
Dental sealants are an effective means for preventing tooth
decay by covering or “sealing” the grooves and crevices found on the top of
molar and premolar teeth, where most tooth decay begins. By covering these pits
and fissures, dental sealants are able to prevent
tooth decay by as much as 80% over a two year period.
Research also shows that dental sealants arrest or prevent
the progression of early, incipient (non-cavitated) decay, alleviating the need
for costly dental treatment.
Topical
fluoride also plays a significant role in the prevention of tooth decay.
In the form of fluoride varnish, it can also slow down tooth decay or even stop
it from progressing. Fluoride varnish works by applying the fluoride mineral,
which is naturally occurring, on the enamel surface of the teeth. This
strengthens that outer surface making it harder for bacteria to demineralize
the tooth surface, eventually causing tooth decay. Fluoride
varnish may be applied up to four times each year, depending on the child’s
risk for tooth decay.
While
there has been a significant increase in the number of children and youth
receiving the benefits of dental sealants and fluoride varnish over the
last two decades, those numbers need to improve. Currently, less than half
(42%) of our nation’s children, ages 6 to 11, have dental sealants and those
percentages are lower for Hispanic children and those living in low-income
families. For youth ages 12 to 19, the percentage is also less than half (48%).
Research has also demonstrated, that school-age
children who don’t have dental sealants have almost three-times as much tooth
decay in their molar teeth as children who do have sealants.
Healthy People 2030
Since its first iteration in 1979, the nation’s health
objectives (Healthy People) have focused on improving the health of our
nation, including oral health. Since 1990, the health objectives have addressed
oral health as a leading health indicator, looking at the prevalence of tooth
decay among children and adolescents and more recently addressing the
proportion of children and adolescents who have dental sealants, and this
continues to hold true with the current and 5th iteration of our
nation’s health objectives.
The Healthy
People 2030 dental sealant objective (OH-10)is, “Increase the
proportion of children and adolescents (3 – 19 years) who have received dental
sealants on one or more of their primary or permanent molar teeth.
School-based Sealant Programs
Since
the 1970s, when school-based sealant programs began, children have
received needed preventive dental care within the school setting. Today, these
highly effective programs are offered in most every state, in urban and rural
communities, providing millions of children with sealants to prevent tooth
decay.
School-based
sealant programs are recommended by the Community Preventive Services Task
Force as an effective means of reaching the most vulnerable children
who don’t have ready access to a dental provider. School-based sealant programs
are also cost-effective. In fact, data shows that applying
sealants in schools for about 7 million children from low-income families could
save up to $300 million in dental treatment costs.
Typically, school-based sealant programs are serving
schools with a high percentage of families who are considered low income (e.g.,
Title I Schools), who attend schools with greater than 50% participation in the
National School Lunch Program, and who are located in remote, rural and
frontier communities where access to regular dental care is challenging.
A school-based sealant program will schedule one to
three days with each school to screen children with parental/guardian consent
to participate as well as apply dental sealants and fluoride varnish. Most
often, school-based sealant programs will target children in grades 1 through 5
with an emphasis on grades 2 and 3, when six-year molars are first erupting.
Some school-based programs also serve middle schools (grades 6 through 8), to
place sealants on 12-year molars when they are erupting. School-based programs
should also have a mechanism for referring children who have other urgent, or
treatment needs to a dental home for follow-up and regular dental care.
Returning for retention checks should also be
scheduled with the school. This is when the school-based program will check
that the sealants are still on the molar teeth, place new sealants as needed,
and reapply fluoride varnish. Retention
checks offer the school-based program a means to evaluate the effectiveness of
the sealant including the material and procedures used for placement.
Retention checks should be done in the short-term -
within a few months after sealant placement, and only need to be completed on a
handful of students to determine the efficiency of the sealant placement.
During a short-term retention check, nearly 100% of the sealants placed should
still be sound.
Long-term retention checks should
be completed – within 12 months of sealant placement, and at least 90% should continue
to be sound. This is an opportunity to replace and/or repair sealants as well
as apply sealants to teeth newly erupted in the previous months.
Consent Forms
Developing a rapport with the school nurses, administration,
teachers, and other personnel will help to promote the oral health program. It is helpful
to have trusted professionals at the school who are enthusiastic advocates for
the program. Also, buy-in from the classroom teachers is essential for consent
form return and high rates of program participation – most often, consent
packets are distributed to the students directly from their classroom teachers.
Guidance counselors are also useful partners, assisting in promoting the
program to families they are aware of that may need assistance with accessing
dental care.
Already scheduled teacher and personnel trainings work well
to educate principals, teachers, and school nurses about the benefits of the
program. Also, visiting the teacher’s lunchroom and leaving information about the
program can be helpful.
In Nevada, the type of consent needed for participation in
health-related activities may vary by county, so it is important to verify with
the school district or school(s) the type of parental/guardian consent that is needed.
- Active
consent is when a parent/guardian signs a consent form if they want the
child to participate.
- Passive
consent is when a parent/guardian signs a consent form if they do not want the
child to participate.
Consent packets at a minimum should include:
- Information
on all procedures that could be provided as part of the oral health program
and include an explanation of each applicable term/service (e.g., dental
sealant and fluoride varnish).
- What
teeth may receive dental sealants.
- The
school-based program’s protocol for referral and follow-up for dental treatment
as needed.
- Information
on the timeline for reassessment and retention checks and reapplication of
dental sealants, if needed, and fluoride varnish.
- The
out-of-pocket cost of the school-based program, if any, to the parent/guardian.
- The
name and location of their current dentist if applicable.
- A basic medical history form to be completed by
the parent/guardian.
- Request for dental insurance information from
parents/guardians.
- Contact
information for a parent/guardian to receive additional information and/or to
refuse to participate or withdraw from the program.
Ideally, the consent packet should be available in
languages other than English if needed, to support cultural competence within
the community being served.
It is also useful to use brightly colored paper for the
consent forms; parents/guardians will be able to locate the form easier and
teachers can locate the returned forms collected at their desk more easily. Some school-based programs have measured success with consent form
return by placing paper wristbands on the children's wrist with a reminder to
parents/guardians about the consent form packet needing to be signed.
Many of the
resources listed under “Educational Materials, Resources, and Manuals,” offer
information on how to develop a program consent form and other necessary
documents.
Distribution of the consent forms should be coordinated with the
school’s office staff and most often goes home via the classroom teacher. If
possible, consent packets should be included with the distribution of other
materials at the beginning of the school year to increase the consent return
rate by parents/guardians. In some school districts, two distributions may work
well: one at the start of the school year for schools scheduled in September to
December, and a later distribution of consent packets for schools scheduled to
be served from January to June.
At a minimum, consent forms should be collected one to two
weeks in advance of the date screenings and sealants and fluoride are
scheduled. This allows time for the medical histories to be reviewed and
paperwork to be prepared. If forms are returned with incomplete information,
including signatures, there will be time to contact the parents/guardians and
receive the needed information.
Many successful programs offer incentives to increase the
number of consent forms returned (positive and negative), including –
- Individual incentive - A small toy (e.g., super
ball, sticker, etc.) for each student who returns their consent form.
- Classroom incentive – A pizza or ice cream
party, if a high percentage of consent forms (e.g., 85%, 90%, 100%, etc.) are
returned.
- Teacher incentive – A gift card or electric
toothbrush for the classroom teacher, if a high percentage of consent forms
(e.g., 85%, 90%, 100%, etc.) are returned.
If the consent form return rate is low, the packets should
be distributed again to the families of the students who did not return a form,
possibly with a note to the parent/guardians or “Second Notice” stamped in red
at the top of the packets front page to garner their attention.
Schools may utilize automated telephone messages to remind
parents and families about upcoming events; this useful tool could be used to
promote the sealant program. Information may also be shared through the school’s
website, calendar, newsletter, school lunch menus, emails, parent meetings, and
parent facilitators.
Promotion can’t be started too soon – community events are
also effective means for getting the word out. Setting up a booth or passing
information out to promote the program at neighborhood Little League and soccer
games and other sporting events. Community health fairs offer another
opportunity to promote not only the school-based sealant program, but oral
health in general. Finally, consider contacting the local newspaper about
including an article about the school-based program.
At the conclusion of the student’s visit with the
school-based sealant program, parents/guardians
should be provided with written information outlining what dental services were
provided (e.g., what teeth received sealants) and if follow-up treatment needs
to be provided by a licensed dentist. The information should include a list of partner
dentists and/or local dentists, including any who accept Medicaid or information
on who the parent/guardian may contact for assistance in finding a dentist to
provide follow-up/needed care. The school nurse should also be made aware of
the services that were provided for each child with consent as well as any
children with follow-up and urgent dental needs.
It is important to remember, that
all effective school-based sealant programs should support the participating
child being referred to a dental home for continuous care.
Infection Control
Infection control in a school-based program is an essential
component of a written protocol to assure school leadership as well as parents
to support the safety of the preventive services provided. Often, it is also
easier to maintain infection control practices in a school-based program due to
the use of “disposables,” including dental instruments, rather than having to
transport and autoclave soiled instruments. Also, most preventive procedures
including dental sealants and fluoride produce limited aerosols.
There are several online trainings and resources focused on
infection control for school-based sealant programs. Each is designed to
supplement the Centers for Disease Control and Prevention (CDC) guidance and
include additional considerations for oral care outside of the traditional
dental setting. A list of these
trainings and resources is included at the end of this guidance (see Educational Materials, Resources, and Manuals).
Understanding the Evidence – Clinical Guidelines and Recommendations for dental sealants and school-based dental sealant programs
In 2004 and 2005, the Centers for Disease Control and
Prevention (CDC) sponsored meetings of an expert work group to update
recommendations for sealant use in SBSPs based on 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.
For the 2016 updated guidelines
for the placement of pit and fissure sealants for preventing carious lesions on
the occlusal surfaces of primary and permanent teeth, a panel of experts was
convened by the ADA Council on Scientific Affairs, in collaboration with the
American Academy of Pediatric Dentistry. The 2016 clinical guidelines updated
the 2009, Evidence-based
clinical recommendations for the use of pit-and-fissure sealants: a report of
the American Dental Association Council on Scientific Affairs, which addressed the
following clinical questions: 1. Under what circumstances should sealants be
placed to prevent caries? 2. Does placing sealants over early (non-cavitated)
lesions prevent progression of the lesion? 3. Are there conditions that favor
the placement of resin-based versus glass ionomer cement sealants in terms of
retention or caries prevention? 4. Are there any techniques that could improve
sealants' retention and effectiveness in caries prevention?
1. Evidence-based
Clinical Practice Guideline for the Placement of Pit and Fissure Sealants,(JADA, August 2016)
ABSTRACT: Background. This article presents evidence-based clinical recommendations for the use
of pit-and-fissure sealants on the occlusal surfaces of primary and permanent
molars in children and adolescents. A guideline panel convened by the American
Dental Association (ADA) Council on Scientific Affairs and the American Academy
of Pediatric Dentistry conducted a systematic review and formulated
recommendations to address clinical questions in relation to the efficacy,
retention, and potential side effects of sealants to prevent dental caries;
their efficacy compared with fluoride varnishes; and a head-to-head
comparison of the different types of sealant material used to prevent caries on
pits and fissures of occlusal surfaces. Types of Studies Reviewed. This
is an update of the ADA 2008 recommendations on the use of pit-and-fissure
sealants on the occlusal surfaces of primary and permanent molars. The authors
conducted a systematic search in MEDLINE, Embase, Cochrane Central Register of
Controlled Trials, and other sources to identify randomized controlled trials
reporting on the effect of sealants (available on the US market) when applied
to the occlusal surfaces of primary and permanent molars. The authors used the
Grading of Recommendations Assessment, Development, and Evaluation approach to
assess the quality of the evidence and to move from the evidence to the
decisions. Results. The guideline panel formulated 3 main
recommendations. They concluded that sealants are effective in preventing
and arresting pit-and-fissure occlusal carious lesions of primary and permanent
molars in children and adolescents compared with the nonuse of sealants or
use of fluoride varnishes. They also concluded that sealants could minimize
the progression of non-cavitated occlusal carious lesions (also referred to as
initial lesions) that receive a sealant. Finally, based on the available
limited evidence, the panel was unable to provide specific recommendations
on the relative merits of 1 type of sealant material over the others. Conclusions
and Practical Implications. These recommendations are designed to
inform practitioners during the clinical decision-making process in relation to
the prevention of occlusal carious lesions in children and adolescents.
Clinicians are encouraged to discuss the information in this guideline with
patients or the parents of patients. The authors recommend that clinicians
reorient their efforts toward increasing the use of sealants on the occlusal
surfaces of primary and permanent molars in children and adolescents.
2. Sealants for Preventing and
Arresting Pit-and-Fissure Occlusal Caries in Primary and Permanent Molars: A
systematic review of randomized controlled trials – a report of the American
Dental Association and the American Academy of Pediatric Dentistry, (JADA, August 2016)
ABSTRACT: Background. National
Health and Nutrition Examination Survey 2011-2012 data indicated that, in the
United States, nearly one-fourth of children and over one-half of adolescents
experienced dental caries in their permanent teeth. The purpose of this review
was to summarize the available clinical evidence regarding the effect of dental
sealants for the prevention and management of pit-and-fissure occlusal carious
lesions in primary and permanent molars, compared with a control without
sealants, with fluoride varnishes, or with other head-to head comparisons. Type
of Studies Reviewed. The authors included parallel and split-mouth
randomized controlled trials that included at least 2 years of follow-up, which
they identified using MEDLINE (via PubMed), Embase, LILACS, the Cochrane
Central Register of Controlled Trials, and registers of ongoing trials. Pairs
of reviewers independently conducted the selection of studies, data extraction,
risk of bias assessments, and quality of the evidence assessments by using the
Grading of Recommendations Assessment, Development and Evaluation approach. Results. Of 2,869 records screened, the authors determined that 24 articles
(representing 23 studies) proved eligible. Moderate-quality evidence suggested
that participants who received sealants had a reduced risk of developing
carious lesions in occlusal surfaces of permanent molars compared with those
who did not receive sealants (odds ratio [OR], 0.15; 95% confidence interval
[CI], 0.08-0.27) after 7 or more years of follow-up. When the authors compared
studies whose investigators had compared sealants with fluoride varnishes, they
found that sealants reduced the incidence of carious lesions after 7 or more
years of follow-up (OR, 0.19; 95% CI, 0.07-0.51); however, this finding was
supported by low-quality evidence. Based on the evidence, the authors could not
provide a hierarchy of effectiveness among the studies whose investigators had
conducted head-to-head comparisons. The investigators of 2 trials provided
information about adverse events, but they did not report any adverse events. Conclusions
and Practical Implications. Available evidence suggests that sealants are
effective and safe to prevent or arrest the progression of non-cavitated
carious lesions compared with a control without sealants or fluoride varnishes.
Further research is needed to provide information about the relative merits of
the different types of sealant materials.
3. The
Effect of Dental Sealants on Bacteria Levels in Caries Lesions, (JADA,
March 2008)
ABSTRACT: Background. Concern
about inadvertently sealing over caries often prevents dentists from providing
dental sealants. The objective of the review was to examine the effects of
sealants on bacteria levels within caries lesions under dental sealants. Methods. The authors searched electronic databases for comparative studies examining
bacteria levels in sealed permanent teeth. To measure the effect of sealants on
bacteria levels, they used the log10 reduction in mean total
viable bacteria counts (VBC) between sealed and not-sealed caries and the
percentage reduction in the proportion of samples with viable bacteria. Results.
Six studies—three randomized controlled trials, two controlled trials
and one before-and-after study—were included in the analysis. Although studies
varied considerably, there were no findings of significant increases in
bacteria under sealants. Sealing caries was associated with a 100-fold
reduction in mean total VBC (four studies, 138 samples). Sealants reduced the
probability of viable bacteria by about 50.0 percent (four studies, 117
samples). Conclusions. The authors found that sealants reduced bacteria
in carious lesions, but that in some studies, low levels of bacteria persisted.
These findings do not support reported concerns about poorer outcomes
associated with inadvertently sealing caries. Clinical Implications. Practitioners
should not be reluctant to provide sealants—an intervention proven to be highly
effective in preventing caries—because of concerns about inadvertently sealing
over caries.
4.A
Comparison of the Effects of Toothbrushing and Handpiece Prophylaxis on
Retention of Sealants, (JADA, January 2009)
ABSTRACT: Background. Tooth surface cleaning before acid
etching is considered to be an important step in the retention of resin-based
pit-and-fissure sealants. Methods. The authors reviewed and
summarized instructions for cleaning tooth surfaces from five manufacturers of
10 unfilled resin-based sealants marketed in the United States. The authors
also searched electronic databases for studies that directly compared the effects
of different surface-cleaning methods on sealant retention and for systematic
reviews of the effectiveness of sealants. They explored the association between
surface-cleaning methods and sealant retention in the studies included in the
systematic reviews. They calculated the summary weighted retention rates for
studies that used either a handpiece or toothbrush prophylaxis. Results.
All of the sealant manufacturers' instructions for use (IFU) recommended
cleaning the tooth before acid etching. None of the IFU directly stated that a
handpiece was required to perform the cleaning, but five IFU implied the use of
handpiece prophylaxis. None of the IFU recommended surface-altering procedures
in caries-free teeth. Direct evidence from two clinical trials showed no
difference in complete sealant retention between surfaces cleaned mechanically
with pumice or prophylaxis paste and those cleaned with air-water syringe or
dry toothbrushing. Indirect evidence from 10 studies found that weighted
summary retention by year after sealant placement in studies that used
toothbrush prophylaxis was greater than or equivalent to values for studies
that used handpiece prophylaxis. Conclusions. Levels of sealant
retention after surface cleaning with toothbrush prophylaxis were at least as
high as those associated with hand-piece prophylaxis. Clinical Implications.
This finding may translate into lower resource costs for sealant placement.
Caries
Risk in Formerly Sealed Teeth, (JADA, March 2009)
ABSTRACT: Background.
The authors examined the risk of caries development in teeth with partially or
fully lost sealant (formerly sealed [FS] teeth) relative to the risk in teeth
that never have received sealants (never sealed [NS] teeth). Methods.
The authors searched the population of studies used in five reviews of sealant
effectiveness as established in split-mouth design studies involving
resin-based sealants with no reapplication of lost sealant. They required
included studies to contain sufficient data to estimate the risk of caries in
FS teeth relative to that in NS teeth and its 95 percent confidence interval
(CI). To estimate the mean RR by year since sealant placement, they used a
weighted bivariate model and tested for heterogeneity using the quantity I 2. Results.
The weighted mean RR was 0.998 (95 percent CI, 0.817-1.220) one year after
placement (four studies, 345 tooth pairs) and 0.936 (95 percent CI,
0.896-0.978) at four years (five studies, 1,423 tooth pairs). Conclusions.
Teeth with fully or partially lost sealant were not at a higher risk of
developing caries than were teeth that had never been sealed. Clinical Implications.
Inability to provide a retention-check
examination to all children participating in school sealant programs because of
loss to follow-up should not disqualify a child from receiving sealants.
Preventing Dental Caries Through
School-based Sealant Programs: Updated Recommendations and Reviews of Evidence, (JADA,
November 2009)
ABSTRACT: Background. 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 based on 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. Types of Studies Reviewed. 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. Results. The evidence
supports recommendations to seal sound surfaces and non-cavitated 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. Clinical Implications.
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.
Techniques for
Assessing Tooth Surfaces in School-Based Sealant Programs, (JADA,
July 2010)
ABSTRACT: Background. 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. Types of Studies Reviewed. 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. Results.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. Clinical Implications.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 provider’s expertise, available
treatment options, the patient's preferences, and access to care.
Sealant Materials
While there
are different sealant materials that may be used in a school-based program, it
is important to consider the retention of the material selected. While
resin-based sealant materials have traditionally demonstrated the best
retention, recent studies have shown that glass ionomer materials demonstrate
equal short-term retention. In
a study published in the International Journal of Clinical Pediatric Dentistry, the general consensus comparing
several glass ionomer products to resin-based sealants showed little to no
statistical difference in retention at three months. Though, the same study
demonstrated that at six, nine, and 12-months the resin-based materials were
significantly better.
Because glass ionomers don’t require the clinician to
maintain a dry field, perhaps making them easier to place, it is important to
remember the population that is being served. Recognizing that the child may
not have regular access to a dental professional to have the sealant replaced
if it falls off. So, while most
resin-based sealants due require a dry field, they are longer lasting and more
resistant to chewing and grinding, and some come tinted to assist in their placement.
Program Efficiency
First and foremost, school-based sealant programs should
recognize they are “guests” in a school and that the purpose of the
children being there is their education and learning. Having an established
written protocol in place that is followed by all involved will assure that the
children are out of their classroom for a minimal amount of time – usually 15 and
no more than 20 minutes. While one child is in the chair receiving sealants
and fluoride, another child should be dry brushing their teeth while watching
their classmate. When the first child is finished, they should return to the
classroom and another child is selected to leave to receive their sealants.
Providing the classroom teacher with a list of students who have consent to
participate will allow them to make the decision on which child should leave
the classroom and when.
When serving a larger geographic area, completing schools
that are near each other will save time. Plan on working an entire school day –
working a partial day is not efficient. When scheduling classroom education and
screenings, which may require the program to be in the school for only a
partial day, scheduling retention checks at a nearby school, could fill the
balance of the day.
When scheduling the school-based program at each school,
check with the school nurse, teachers, and principal to make sure there are no
field trips, testing, special guests, parties, etc., planned for the classes
being screened or receiving sealants and fluoride. The last thing you want to
do is show-up and find out the students are out of the school for the day.
Keeping a list of schools that could be scheduled on short
notice, i.e., 1 to 2 days, is useful just in case there are unforeseen
cancellations or even school cancellations due to weather.
Arrive at the
school early to set-up the equipment before school begins to be ready to begin
immediately after the school day begins. Many schools don’t have entire
classrooms they can assign for the school-based program and often the school
nurse’s office is too busy. Be flexible – in the gymnasium, in the hallway, or
under a stairwell, may seem non-traditional, but works just fine if you have an
electrical source. Bring extra extension cords, power strips, duct tape, extra
light bulbs, screwdriver, and pliers. Also, have the contact information for
your portable equipment servicer; many times, troubleshooting can be done over
the telephone. A component of the school-based sealant program’s protocol
should be a schedule of maintenance for the equipment.
Sustainability
Most school-based sealant programs are serving the most
vulnerable and high-risk children, either due to income or residence. The
majority may be covered by Medicaid insurance or the Children’s Health
Insurance Plan (CHIP), and in some instances, a family may not meet the
requirements for publicly funded dental insurance.
While it is important for school-based sealant programs to
remain sustainable, it is essential for these programs to recognize that all
school-age children, regardless of their insurance status, benefit from
preventive dental care and especially sealants and fluoride, which can prevent
more extensive and expensive dental treatment needs in the future.
Care should be given in determining the qualifications for
participation in a school-based sealant program to assure that no child who
needs care is left out.
In Nevada, Medicaid covers:
D0190 - Screening of a patient: 1 unit per 6 rolling months
D1120 - Dental Prophylaxis Child:
D1206 - Topical Fluoride Varnish: 1 unit per 6 months
D1208 - Topical App Fluoride excluding Varnish: 1 unit per 6
months
D1351- Dental sealant: 1 per 60 months, only fully erupted
pre-molars, and 1st/2nd molars
D1353 - Sealant repair- per tooth: 1 unit per 36 months
D1354 - Interim Caries Arresting Medicament Application
(SDF): 1 unit per tooth per 6 months
D1355 - Caries Preventative Medicament (non-fluoride): 1
unit per 6 months
Complete NV Medicaid Billing Guide may be found at Nevada Medicaid (nv.gov)
To enroll in Medicaid, contact the Welfare Offices-
dwss.nv.gov
- Reno-4055
S. Virginia St. 89502
- Sparks-
630 Greenbrae Dr. 89431
- Carson
City- 2533 N. Carson St. Ste 200 89706
Phone 775-684-7200/702-486-1646 or 1-800-9992-0900
To support sources of funding outside of Medicaid
reimbursement, up-to-date record keeping, and data collection is important to
document the number of children served, dental decay averted due to sealant
placement, retention rates, and to demonstrate a return on investment for
future funders and other philanthropic opportunities.
Educational Materials, Resources, and Manuals
- Association
of State and Territorial Dental Directors is a national non-profit organization representing the directors and staff of
state/territorial public health agency programs for oral health. It was
organized in 1948 and is one of 20 affiliates of the Association of State and
Territorial Health Officials (ASTHO). [www.astdd.org]
- CareQuest Institute for Oral Health is a
non-profit championing a more equitable future where every person can reach
their full potential through excellent health. [www.carequest.org]
- Best
Practices and Innovative Approaches to Strengthen School-Based Dental Sealant
Programs will explore the topic and
updated School-Based Dental Sealant Program Best Practice Approach Report. The
2022 report highlights key steps for building and improving effective programs,
including the use of evidence-based practices, clinical quality measures, and
innovative design. The expert panel will share insights from the report and
offer practical guidance for building and improving a program to promote
children's oral health. [www.cdc.gov]
- Centers for Disease Control and
Prevention (CDC) offers evidence-based information and
data on the effectiveness of dental sealants and information to support the
implementation and evaluation of school-based sealant programs.
- Dental Sealant Educational Resources are
printable resources to provide information on dental sealants.
- Infection
Prevention & Control in a Dental
Settings offers evidence-based
recommendations, a training course, and mobile application to guide infection
prevention and control practices in all setting where dental treatment is
provided including school-based and mobile operations.
- SEALSis an
evaluation tool that provides workbooks and forms for school-based sealant
programs to evaluate administrative and supply costs, and resources used to
deliver services in schools.
- Maternal
and Child Oral Health Resource Center is
a national center serving the maternal and child health
community with high-quality oral health technical assistance and resources.
[www.mchoralhealth.org]
- Dental
Sealants: A Resource Guide features materials on
policy, practice guidance, professional education and training, public
education, and state and local programs to help promote the use of dental
sealants. It also includes descriptions of organizations that can provide
additional support.
- Promoting
Oral Health in Schools: A Resource Guide provides information about materials for promoting oral
health in schools. The guide features materials on data and surveillance;
policy; professional education, tools, and training; program development; and
public education. Selected materials include a toolkit to help improve the
quality of school meals, best practice reports about school-based dental
sealant programs and about use of fluoride in schools, and a curriculum for
students in kindergarten through grades 10.
- School-based Dental Sealant Programs: Second Edition is a series of five modules designed to
ensure that school-based dental sealant program personnel have a thorough
understanding of the history, operations, and underlying principles of these
programs. This resource also includes one module on infection control
practices.
- SEAL AMERICA: The Prevention Invention is designed to assist health professionals in launching and
sustaining school-based dental sealant programs. In addition to offering a
step-by-step approach for planning and implementing these programs, this manual
addresses issues related to referring students with unmet oral health needs to
a dental home. Professionals working in established school-based dental sealant
programs may also find the manual helpful as they work to improve specific
aspects of their program. SEAL America does offer information on storing
school-based information, and examples of consent and medical history forms.
- Network
for Public Health Law is
a non-profit organization whose mission it to use the power of public health
law and policy to improve lives and make communities safer, healthier,
stronger, and more equitable. [www.networkforphl.org]
- Nevada Oral Health Program located within the Department of Health and Human Services, Division of Public and Behavioral Health has a mission of protecting, promoting and improving the oral health of Nevadans. The work of this program is implemented through collaborations with sister agencies as well as educational institutions and community-based and non-profit organizations statewide. [https://dpbh.nv.gov/Programs/OH/OH-Home/]
- Organization for
Safety, Asepsis and Prevention (OSAP) is a national organization that focuses
exclusively on dental infection prevention and patient and provider safety.
They help operationalize dental infection control and safety laws, regulations,
guidelines, standards, and best practices to ensure every dental visit is a
safe visit. [www.osap.org]
- Ohio
Department of Health
has been a leader in supporting school-based sealant programs since the
mid-1980s.
- School-based Dental Sealant Program
Manual (2023)
provides information consistent with the state-of-the-science, and clearly
states expectations and standards for Ohio Department of Health (ODH) -funded
SBSPs. The RFP and this manual are the basis for evaluating ODH’s statewide
SBSP initiative and the individual programs involved.
- Rural Health Information Hub is a
national clearinghouse on rural health issues. The Hub is funded by the Federal
Office of Rural Health Policy and is committed to supporting healthcare and
population health in rural communities. [www.ruralhealthinfo.org]
- School-based
Model offers information and considerations for portable and mobile
dental services programs via rural oral health toolkit as well as examples of
successfully implemented rural programs.