Guidance and Resources for School-based Sealant Programs

Overview

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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

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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.

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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 5^th 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

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 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 –

1. Individual incentive - A small toy (e.g., super ball, sticker, etc.) for each student who returns their consent form.
2. Classroom incentive – A pizza or ice cream party, if a high percentage of consent forms (e.g., 85%, 90%, 100%, etc.) are returned.
3. 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

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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

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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

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 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 1^st/2^nd 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 

1. Reno-4055 S. Virginia St. 89502
2. Sparks- 630 Greenbrae Dr. 89431
3. 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]  
  • Best Practice Approach Report: School-Based Dental Sealant Programs provides a guide for program planning, development, implementation, and evaluation. Specifically, it offers guidelines, recommendations, and evidence reviews developed by nationally recognized experts and organizations to support the establishment of school-based dental sealant programs, considerations that need to be considered when implementing school-based dental sealant programs as well as state practice examples illustrating strategies and interventions for school-based dental sealant programs.
  • Mobile and Portable School-Based/School-Linked Oral Health Programs: Delivery Models to Expand Care for Children and Adolescents is intended to provide guidance on issues to consider in developing and implementing a school-based or school-linked mobile or portable oral health program. It includes links to resources and information about entities that can provide state specific guidance.
  • Whole School, Whole Community, Whole Child Oral Health Integration and Recommendations provides information and examples to show school-based oral health programs how the CDC’s Whole School, Whole Community, Whole Child model may be applied to improve and protect the oral health of children.
   
• 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]
• Policy Frameworks Supporting School-Based Dental Sealant Programs and Their Application in Minnesota is an issue brief that addresses legal barriers to school-based dental sealant programs and highlights strategies to overcome these challenges. Particular attention is paid to Minnesota’s laws and regulations relating to school-based dental sealant programs, but examples from other states are highlighted throughout.

• 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/]

• 2022 – 2032 Oral Health State Plan provides a roadmap to improve oral health across the state by reducing the burden of oral disease with a focus on health disparities and underserved populations as well asidentifying objectives and strategies for advancing oral health priorities at the state and local level. 

• 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] 
  • Infection Prevention & Control Guide for School Sealant Programs is designed to supplement CDC guidance with additional considerations for practical implementation. The primary objective is to protect the health, safety, and well-being of students, teachers, staff, and dental healthcare personnel (DHCP) who participate in school sealant programs.
  • Infection Control Checklist for Dental Settings Using Mobile Vans or Portable Dental Equipment
   
• 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.