Seal America, The Prevention Invention
Seal America, The Prevention Invention

Frequently Asked Questions (FAQs)

What level of commitment is expected of the school-based dental sealant program advisory group?
The advisory group can be an important component of a school-based dental sealant program. The advisory group can help to ensure that the community’s needs and interests are met and can serve as champions for the program; however, the group is not involved with the day-to-day activities of implementing the program. The advisory group’s level of commitment depends on the role that the program administrator wants the group to serve. Many advisory groups meet frequently during the program-planning process and then meet on an ad hoc basis after the program is established, to help strengthen and maintain relationships.

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School officials want to make school-based dental sealant program services available to all students in the school rather than to students in specific grades. How should program staff respond?
A school-based dental sealant program is a public health activity that is primarily designed to target students who are least likely to receive oral health care from dentists in private practice. Students from families with low incomes are at higher risk for developing tooth decay than their more affluent counterparts. As a result, programs usually target schools in which at least 50 percent of the students are eligible to receive free or reduced-price meals through the U.S. Department of Agriculture’s National School Lunch Program.

At the school level, programs typically offer dental sealants only to students in specific grades. The occlusal surfaces of first and second permanent molars are the teeth most likely to develop decay. Dental sealants should be placed as soon as possible after the first and second molars erupt. First permanent molars usually erupt when a child is between the ages of 5 and 7. Second permanent molars usually erupt during adolescence, between the ages of 12 and 16. Therefore, programs target students at higher risk of developing tooth decay in certain grades rather than all students in the school. This approach enables programs to operate efficiently and to provide dental sealants to the greatest possible number of students who are at the highest risk for tooth decay

Resources

  • Centers for Disease Control and Prevention. 2001. Impact of targeted, school-based dental sealant programs in reducing racial and economic disparities in sealant prevalence among schoolchildren—Ohio, 1998–1999. Morbidity and Mortality Weekly Report 50(34):736–738. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5034a2.htm.
  • Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. 2005. Fact sheet: Key Findings from NHANES 1999–2002. Surveillance for Dental Caries, Dental Sealants, Tooth Retention, Edentulism, and Enamel Fluorosis—United States, 1988–1994 and 1999–2002.
    http://www.cdc.gov/oralhealth/publications/factsheets/nhanes_findings.htm    .
  • Kuthy RA, Ashton JJ. 1989. Eruption pattern of permanent molars: Implications for school-based dental sealant programs. Journal of Public Health Dentistry 49(1):7–14.
  • Macek MD, Beltran-Aguilar ED, Lockwood SA, Malvitz DM. 2003. Updated comparison of the caries susceptibility of various morphological types of permanent teeth. Journal of Public Health Dentistry 63(3):174–182.

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How can school-based dental sealant program staff address local dentists’ concerns that the program will be treating their patients?
Rather than decreasing the number of students seeking oral health services from private practices, school-based dental sealant programs offers an opportunity to increase local dentists’ patient base. As part of a program’s assessment process, students in need of follow-up care are identified and referred to dentists in private practice.

School-based dental sealant programs usually target schools in which at least 50 percent of the students are from families with low incomes and are thus less likely to receive oral health care in private practices. These students are at higher risk for tooth decay and are less likely to receive dental sealants than their more affluent counterparts. The 1999–2002 National Health and Nutrition Examination Survey data show that half as many (22%) of children and adolescents ages 6–19 from families with low incomes (<100% of the federal poverty level [FPL]) had received a dental sealant, compared with children and adolescents (42%) from higher income families (≥200% FPL). Typically, these students are eligible for Medicaid or the State Children’s Health Insurance Program (SCHIP) or are from families with incomes too high to qualify for Medicaid or SCHIP, but who don’t have dental insurance and cannot afford to pay for oral health services.

Some programs have addressed dentists’ concerns by including a question on the parental consent form asking if the student sees a dentist for his or her regular source of oral health care (dental home). If the student has a regular source of oral health care, the program will contact the student’s parents, the dentist, or both before placing sealants or will not offer sealants to the student.

Resources

  • Centers for Disease Control and Prevention. 2001. Impact of targeted, school-based dental sealant programs in reducing racial and economic disparities in sealant prevalence among schoolchildren—Ohio, 1998–1999. Morbidity and Mortality Weekly Report 50(34):736–738. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5034a2.htm.
  • Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. 2005. Fact Sheet: Key Findings from NHANES 1999–2002. Surveillance for Dental Caries, Dental Sealants, Tooth Retention, Edentulism and Enamel Fluorosis—United States, 1988–1994 and 1999–2002.
    http://www.cdc.gov/oralhealth/publications/factsheets/nhanes_findings.htm    .
  • U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. 2005. The National Survey of Children’s Health 2003. Rockville, MD: U.S. Department of Health and Human Services.
    http://mchb.hrsa.gov/oralhealth/index.htm.

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How can school-based dental sealant program staff respond to dentists’ questions about sealing over incipient lesions (enamel caries)?
There is no evidence that placing dental sealants over small lesions results in progression of tooth decay. To the contrary, placing sealants appears to stop the decay process.

Resources

  • Mertz-Fairhurst EJ, Curtis JW Jr, Ergle JW, Rueggeberg FA, Adair SM. 1998. Ultraconservative and cariostatic sealed restorations: Results at year 10. Journal of the American Dental Association 129(1):55–66.
  • Simonsen RJ. 2002. Pit and fissure sealants: Review of the literature. Pediatric Dentistry 24(5): 393–414.
  • U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health. 1983. Dental Sealants in the Prevention of Tooth Decay. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health. http://consensus.nih.gov/1983/1983DentalSealants040html.htm.

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Is it safe and appropriate to conduct an oral assessment without using a sharp explorer?
Using a sharp explorer to assess for tooth decay has not been shown to be an effective method for accurately detecting occlusal caries. A systematic review of methods used to identify tooth decay found that the number of false positives using a dental explorer to detect occlusal caries varied widely, resulting in poor sensitivity rates.
In addition, noncavitated incipient lesions may remineralize if the surface layer covering the demineralized area or lesion remains intact. The use of a sharp explorer can disrupt the surface layer and prevent remineralization.

Resources

  • Bader JD, Shugars DA, Bonito AJ. 2002. A systematic review of the performance of methods for identifying carious lesions. Journal of Public Health Dentistry 62(4):201–213.
  • Ismail AI. 2004. Visual and visuo-tactile detection of dental caries. Journal of Dental Research 83(Special number C):C56–C66.
    http://jdr.iadrjournals.org/cgi/content/abstract/83/suppl_1/C56.
  • Yassin OM. 1995. In vitro studies of the effect of a dental explorer on the formation of an artificial carious lesion. Journal of Dentistry for Children 62(2):111–117.

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Is it acceptable to seal teeth without taking bitewing x-rays to determine whether tooth decay is present between the teeth?
The use of portable x-ray equipment in a school-based setting carries a high risk of exposing dental sealant program staff and students to needless radiation. The American Dental Association’s Council on Scientific Affairs and the U.S. Department of Health and Human Service’s Food and Drug Administration encourages oral health professionals to follow the “low as reasonably achievable” principle to minimize the risk of radioactive exposure to protect oral health professionals and their patients.

In addition, nearly 90 percent of tooth decay among children and adolescents occurs on the occlusal surfaces of the permanent first and second molars. For this reason, along with the high risk of radiation exposure, the cost of taking bitewing x-rays is too high to justify.

Resources

  • American Dental Association, Council on Dental Benefit Programs, Council on Scientific Affairs; U.S. Food and Drug Administration, Public Health Service, Food and Drug Administration. 2004. The Selection of Patients for Dental Radiographic Examinations.
    http://www.fda.gov/cdrh/radhealth/adaxray-1.html.
  • American Dental Association, Council on Scientific Affairs. 2006. The use of dental radiographs: Updates and recommendations. Journal of the American Dental Association 137(9):1304–1312.
  • Griffin SO, Gray SK, Malvitz DM, Gooch BF. 2009. Caries risk in formerly sealed teeth. Journal of the American Dental Association 140(4):415–423.
  • Ripa LW, Leske GL, Sposato A. 1985. The surface specific caries pattern of participants in a school-based fluoride mouthrinse program with implications for the use of sealants. Journal of Dental Public Health 45(2):90–94.

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Why is it better to use unfilled sealants rather than filled sealants?
Filled sealants contain particles that have been added to increase resistance to abrasion and wear. Because of this, they require adjustments to the occlusion, which increases the amount of time spent with each student and requires a handpiece and a dentist to perform the procedure. Unfilled sealants naturally wear into occlusion in approximately 24 to 48 hours, eliminating the need to adjust the occlusion.

Resources

  • Stach DJ, Hatch RA, Tilliss TS, Cross-Poline GN. 1992. Change in occlusal height resulting from placement of pit and fissure sealants. Journal of Prosthetic Dentistry 68(5):750–753.
  • Tilliss TS, Stach DJ, Hatch RA, Cross-Poline GN. 1992. Occlusal discrepancies after sealant therapy. Journal of Prosthetic Dentistry 68(2):223–228.

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How often should teeth be checked to see if dental sealants are still in place?
A key indicator for measuring dental-sealant quality is retention rate. Sealant quality can be measured by determining short-term and yearly retention rates. Both measures serve important purposes and should be considered as program resources allow.

Conducting short-term retention checks on a small sample of students a few days or weeks after sealant application can be an effective way to evaluate staff performance, identify needed protocol changes, and determine the efficacy of material and equipment used. Short-term retention checks offer an opportunity to correct problems with sealant-application techniques, material, and equipment.

Because sealants must remain in place to prevent tooth decay, yearly retention checks are important for measuring program success. Yearly retention checks should begin in the second year of the program and, in a best-case scenario, would occur yearly thereafter for as many students as possible.

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How long do dental sealants last?
Dental sealants can stay in place on the pits and fissures of permanent molars for up to 10 years or longer. Even though only a handful of studies have looked at dental sealant retention rates over a 10-year period or longer, a systematic review of dental sealant studies found that the median rate of fully retained sealants ranged from 92 percent one year after sealants were applied to 66 percent after 7 years among children at high risk for developing tooth decay.

A critical factor in sealant retention is the technique used by the oral health professional applying the sealants. Keeping the tooth dry throughout the application process is essential to successful sealant retention. Oral health professionals who place a large number of sealants on a regular basis (e.g., dental hygienists practicing in school-based dental sealant programs) have retention rates that often exceed 90 percent after one year.

Under ideal conditions, retention checks should be conducted on an annual basis. This allows for timely repair or replacement of dental sealants that may have partially or completely come off the tooth surface. Routine dental sealant retention checks and maintenance can achieve high rates of success over time.

Resources

  • Dennison JB, Straffon LH, Smith RC. 2000. Effectiveness of sealant treatment over five years in an insured population. Journal of the American Dental Association 131(5):597–605.
  • Folke BD, Walton J, Feigal RJ. 2004. Occlusal sealant success over ten years in a private practice: Comparing longevity of sealants placed by dentists, hygienists, and assistants. Pediatric Dentistry 26(5):426–432.
  • Simonsen RJ. 2002. Pit and fissure sealants: Review of the literature. Pediatric Dentistry 24(5):393–414.
  • Weintraub JA. 2001. Pit and fissure sealants in high-caries-risk individuals. Journal of Dental Education 65(10):184–1090.

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