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



Seal America: The Prevention Invention provides practical guidance for individuals who wish to start a school-based dental sealant program. The manual also addresses issues related to referring students with unmet oral health needs to a dentist, as well as sustainability issues. Established school-based dental sealant programs may also find the manual of interest as they work to improve specific aspects of their program.

Individuals who may be interested in starting a school-based dental sealant program include, but are not limited to, the following:

  • State and local oral health program directors
  • School nurses
  • Community health center staff
  • Other safety net providers
  • Dentistry and dental-hygiene-school faculty
  • Other dentists and dental hygienists

No two school-based dental sealant programs are exactly alike. This manual was written to reflect the needs and circumstances of many school-based dental sealant programs, but it may not address the working or political environments, requirements, or situations facing your program. Readers are encouraged to adapt the information contained in this manual to meet their program's particular needs and circumstances. Throughout the planning process, each program should develop its own manual, which should include protocols, procedures, and forms.

School-based dental sealant program staff, directors of health departments and oral health programs, public health professionals, researchers, policymakers, funders, and others working at the national, state, and local levels have shared their expertise to create and update this manual in an effort to increase the effectiveness of the next generation of school-based dental sealant programs. New research, techniques, materials, and federal and state policies will continue to affect school-based dental sealant programs in the future. The manual will be updated periodically as new information becomes available.

The manual is a project of the American Association of Community Dental Programs in cooperation with the Association of State and Territorial Dental Directors, the Health Resources and Services Administration's Maternal and Child Health Bureau (MCHB), the Centers for Disease Control and Prevention's (CDC's) Division of Oral Health, and the National Maternal and Child Oral Health Resource Center.

The Burden of Oral Disease

Dental caries among children remains a serious public health concern. In 2000, the U.S. Surgeon General published a landmark report, Oral Health in America: A Report of the Surgeon General, which highlighted the magnitude of the problem. The report noted that dental caries is one of the most common diseases among children and adolescents ages 5 to 17, occurring far more frequently than asthma or hay fever.1

Among children, 90 percent of tooth decay is in pits and fissures on the occlusal surfaces of posterior teeth,2 with permanent first and second molars most at risk for developing caries.3 The placement of dental sealants on these vulnerable surfaces is highly effective in preventing caries.4 Children and adolescents from families with low incomes and from racial and ethnic minority groups are less likely to receive dental sealants than their higher-income and non-Hispanic white counterparts, although this gap is not as large as it once was.5

To address this issue, the U.S. Public Health Service included a national objective in Healthy People 2020, which calls for an increase in the percentage of children and adolescents who have received dental sealants on their molar teeth.6 MCHB also established a national performance measure whereby state maternal and child health programs are required to report on the percentage of third-grade students who have received dental sealants on at least one permanent molar tooth.7

Many state and local health departments have responded by establishing community- and school-based dental sealant programs. Research supports the effectiveness of these programs, not only in reducing the risk of tooth decay 8 but also in reducing racial and economic disparities in dental sealant prevalence among children.9

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School-Based Dental Sealant Programs

School-based dental sealant programs offer several advantages over other approaches, such as privately operated mobile dental vans, for delivering oral health care in school settings. These advantages include

  • Established ties to the community
  • Referral of students in the program to address unmet oral health needs
  • Ongoing, long-term relationships with participating schools
  • Quality of care through follow-up and repair of previously applied dental sealants

In general, school-based dental sealant programs provide dental sealants to students in vulnerable populations who are less likely than other students to receive oral health care from dentists in private practice.10 Programs are conducted in school settings with oral health professionals (dentists, dental hygienists, and dental assistants) normally using portable equipment. Usually, dentists assess children's teeth, and dental hygienists apply the dental sealants with the aid of a dental assistant.

For simplicity, throughout the manual, it is assumed that a dentist will be assessing students' teeth and that a dental hygienist and dental assistant team will be applying dental sealants. This may differ by program according to the particular state's dental practice act and other considerations. In some states, state dental practice acts allow dental hygienists to assess students' teeth or dental assistants to apply dental sealants. If a state practice act requires direct supervision of dental hygienists placing sealants, a dentist must be on site at all times during the program and may also be placing sealants.

The number of school-based dental sealant programs has held steady over the years. In 2009, 39 states reported having dental sealant programs.11 Historically, dental sealant programs were developed independently, although a few sought input from more established programs. This approach often resulted in programs that were more expensive, less effective, and slow to be established, with each new program experiencing and working through similar issues and challenges. Since the release of the first edition of Seal America: The Prevention Invention (1995), several efforts have been undertaken to provide school-based dental sealant program administrators with an opportunity to share knowledge, skills, approaches to overcoming challenges, and lessons learned. These efforts include the following:

  • A workshop to develop guidelines for dental-sealant use in public health settings was held at the National Oral Health Conference in February 1998 in Austin, TX.
  • In June 2004 and April 2005 in Atlanta, GA, CDC convened a panel of dental sealant and cariology experts to discuss diagnostic and treatment criteria for dental sealant placement.
  • MCHB sponsored an expert meeting, held in May 2006 in Washington, DC, to discuss strategies for strengthening school-based dental sealant program linkages with Medicaid and the Children's Health Insurance Program (CIHP) and dental homes.12
  • An expert panel convened by the American Dental Association, Council on Scientific Affairs, released evidence-based clinical recommendations for the use of pit-and-fissure sealants in March 2008.13
  • A CDC-sponsored expert workgroup on school-based dental sealant programs released updated evidence-based recommendations for sealant use in school-based dental sealant programs in November 2009.10


School-based dental sealant programs have been implemented successfully around the country in response to children's and adolescents' need for protection against pit-and-fissure dental caries. With the help of this manual, it is our hope that others will launch similar programs to help children and adolescents from vulnerable populations enjoy the best possible oral health, and, in turn, the best possible quality of life.


  1. U.S. Department of Health and Human Services. 2000. Oral Health in America: A Report of the Surgeon General. Rockville, MD: National Institute of Dental and Craniofacial Research.
  2. Kaste LM, Selwitz RH, Oldakowski RJ, Brunelle JA, Winn DM, Brown LJ. 1996. Coronal caries in the primary and permanent dentition of children and adolescents 1-17 years of age: United States, 1988-1991. Journal of Dental Research 75(Special Issue):631-641.
  3. 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.
  4. Truman BI, Gooch BF, Sulemana I, Gift HG, Horowitz AM, Evans CA, Griffin SO, Carande-Kulis VG. 2005. Oral Health. In Task Force on Community Preventive Services, with Zaza S, Briss PA, Harris KW, eds., The Guide to Community Preventive Services: What Works to Promote Health? (pp. 304-328). New York, NY: Oxford University Press.
  5. Dye BA, Thorton-Evans G. 2010. Trends in oral health by poverty statues as measured by Healthy People 2010 Objectives. Public Health Reports 125(6):817–830.
  6. Office of Disease Prevention and Health Promotion. 2010. Healthy People 2020. Rockville, MD: Office of Disease Prevention and Health Promotion.
  7. Health Resources and Services Administration, Maternal and Child Health Bureau. Search TVIS. National Performance Measures.
  8. Dorantes C, Childers NK, Makhija SK, Elliott R, Chafin T, Dasanayake AP. 2005. Assessment of retention rates and clinical benefits of a community sealant program. Pediatric Dentistry 27(3):212-216.
  9. 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.
  10. Gooch BF, Griffin SO, Gray SK, Kohn WG, Rozier RG, Siegal M, Fontana M, Brunson D, Carter N, Curtis DK, Donly KJ, Haering H, Hill LF, Hinson HP, Kumar J, Lampiris L, Mallatt M, Meyer DM, Miller WR, Sanzi-Schaedel SM, Simonsen R, Truman BI, Zero DT; Centers for Disease Control and Prevention. 2009. Preventing dental caries through school-based sealant programs: Updated recommendations and reviews of evidence. Journal of the American Dental Association 140(11):1356–1365.
  11. Centers for Disease Control and Prevention, National Center for Chronic Disease and Health Promotion. Oral Health Resources. Synopses of State and Territorial Dental Public Health Programs: Trends.
  12. Zimmerman B. 2006. Improving the Oral Health of School-Aged Children: Strengthening School-Based Dental Sealant Program Linkages with Medicaid/SCHIP and Dental Homes. Washington, DC: Health Systems Research.
  13. Beauchamp J, Caufield PW, Crall JP, Donly K, Feigal R, Gooch BF, Ismail A, Kohn W, Siegal M, Simonsen R; American Dental Association Council on Scientific Affairs. 2008. Evidence-based clinical recommendations for the use of pit-and-fissure sealants: A report of the American Dental Association Council on Scientific Affairs. Journal of the American Dental Association. 139(3):257–268.


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