Preparing to Launch
Before a school-based dental sealant program begins to operate in a school, the following tasks should be completed:
- Staff must receive required training and information.
- School scheduling must be completed to set start and end dates.
- Parent consent forms must be collected and reviewed to make sure they contain parent signatures.
- If student health histories are collected, they must be carefully reviewed, and follow-up with parents or physicians must take place in cases where there are possible health concerns.
- A record must be prepared for each student. Student records should contain demographic, assessment, referral, and billing information, as well as the signed parental consent form or forms. Student records should be arranged by room number so that students can be located easily.
Once school-based dental sealant program staff have been recruited (see Step 3, Staffing), each will require training and will need to receive information before the program begins. The specific type of training and information needed depends upon the duties carried out by the particular staff member.
Sealant program staff are visitors in the school. As such, before implementing the program, the program administrator should contact the principal or appropriate school official to obtain and disseminate the policies and procedures that must be followed. In some cases, this may simply require signing in and out in the main office. In other cases, staff may need to wear identification tags. Regardless, it is imperative that all staff understand and follow school protocol.
Just like dental office staff, school-based dental sealant programs staff must receive training and carefully adhere to principles of infection control. The training should address Occupational Health and Safety Administration regulations, which are detailed in the document Practical Infection Control for Dental Sealant Programs in a Portable Dental Care Environment. Chapter 4, Section 8, of the Safety Net Dental Clinic Manual discusses infection control, as well.
HIPAA and FERPA
Staff should receive training pertaining to HIPAA requirements, and, if relevant, to FERPA requirements.
Equipment Assembly, Operation, and Maintenance
All staff should be familiar with the assembly, operation, and maintenance of the dental equipment they use. All instruction and repair manuals should be readily available. Phone numbers of manufacturers should be accessible. Preventive maintenance schedules should be developed and followed.
Assessment Findings, Sealant-Application Techniques, Tooth-Selection
Criteria, and Evaluation Methods
The program administrators must ensure that all staff are familiar with the tooth-selection criteria, the method used to chart assessment findings, the technique used by the program for dental sealant application, the protocols for referral, and the method for evaluating the program. Staff members’ familiarity with these aspects of the program will provide continuity and enhance productivity.
Although not required, staff training in behavior guidance techniques for working with uncooperative students is beneficial. A helpful resource on behavior guidance in the oral health setting is module 5 of the online curriculum, Special Care: A Health Professional’s Guide to Serving Young Children with Special Health Care Needs.
Training—Oral Health Professionals
Staff members should also receive training and information as detailed in the sections that follow:
Dentists working in school-based dental sealant programs should receive written tooth-selection criteria. It is important that dentists understand program goals and objectives and agree philosophically with the criteria so that their assessment results reflect the criteria. This is key to achieving consistent assessment results, especially when numerous dentists with different levels of training and experience are conducting assessments. Tooth-selection criteria need to be consistent with program goals and with the targeting methods selected for the program (see Step 1: Getting Started). Step 8: Implementing the Program discusses tooth-selection criteria in detail.
Depending on state practice acts, dental hygienists may be conducting assessments. Therefore, they need training on the same tooth-selection criteria discussed for dentists in the preceding section.
Dental hygienists need to be trained in the sealant-application technique the program uses and should be familiar with the sealant material being used. Dental hygienists may or may not have been trained in four-handed dentistry. Such training dramatically increases program efficiency.
Often, experienced dental assistants can train dental hygienists to work four-handed. The best type of training for less-experienced dental hygienists and assistants is to watch an experienced dental hygienist and assistant team apply sealants using the four-handed technique and then practice the technique themselves with the experienced team observing, making suggestions, and answering questions.
Dental assistants need an organized system for maintaining and storing supplies, performing infection control, and tracking paperwork (e.g., consent forms). Less-experienced dental assistants can benefit by observing an experienced dental hygienist and assistant team set up and break down equipment and apply dental sealants, and also by observing a dentist assess students’ teeth. Although dental assistants do not typically apply dental sealants without the assistance of a dental hygienist, it is important for assistants to understand the sealant-application process, since they may be the primary liaison with schools, parents, and students. In addition, dental assistants may be responsible for charting during the assessment, so they need to be familiar with the selection and charting criteria.
Making Initial Contact
School-based dental sealant program administrators must keep in mind that their program will be competing with other programs for time and space in the school. Administrators need to be courteous and well prepared when they first contact a principal or other school personnel.
In recent years, school personnel have been under increasing pressure to improve standardized test scores to meet state-mandated educational goals. Often, schools with low test scores are the same schools that are targeted for school-based dental sealant programs. Many students at high risk for oral disease are also struggling academically, so, school personnel may be reluctant to allow programs that interrupt classroom instruction. It is important for school personnel to understand the relationship between oral disease and a student’s ability to learn. They should be made aware that students from families with low incomes are at increased risk for tooth decay and should understand the role that dental sealants can play in preventing oral disease.
When scheduling a school for the first time, the school-based dental sealant program administrators may wish to make an appointment to meet with the principal or another school representative such as the assistant principal or nurse to describe the program, discuss space needs, answer questions, and look at the space where the program will operate. One dental operatory requires approximately a 10 ft. x 8 ft. space and should include a table (borrowed from the school) to use as a sterilization area. The space must have adequate electrical outlets, be well ventilated, have good lighting, and be as close to ground level as possible. Stages of auditoriums, corners of gymnasiums, large hallways, locker rooms, and vacant classrooms are the usual locations for school-based dental sealant programs. Consideration should be given to the movement of students to and from the program and their classrooms.
It is important to document information discussed during the initial meeting with the principal or other school personnel, especially since the initial meeting usually takes place well in advance of the program’s start date. An initial contact form can be used to document information.
The following items should be discussed during the initial meeting, documented, and included in a letter of agreement or memorandum of understanding with the school:
- Date of initial contact
- Name of initial contact person (e.g., principal, assistant principal)
- School hours, including recess and lunch periods
- Scope of program
- Agreed-upon responsibilities of school personnel (e.g., supervision of students in hallways, collection of consent forms)
- Program dates (verify that no assemblies, field trips, achievement tests, plays, or other activities are scheduled during this period)
- Time of arrival at the school
- Dates for conducting presentations to students eligible for program
- Date consent forms will be collected
Click here for more information about conducting presentations and collecting consent forms.
Additional Information That Should Be Documented Following the Initial Contact
After the initial contact has taken place, it is also important to document that school personnel have been notified about the following: (1) time and date when dental equipment will be delivered, (2) where the dental equipment should be placed for program operation, (3) time and date when the dental assistants or other staff will arrive to set up the equipment, and (4) need for a list of all of the classrooms that will be participating in the program so consent forms can be distributed appropriately.
Involving School Nurses
Whenever possible, school-based dental sealant program administrators should talk with school nurses about the details of the program so that nurses can later answer students’, parents’, and school personnel’s questions. School nurses are in a position to help encourage the return of consent forms and to promote the program.
Estimating the Number of Days Required to Provide Sealants
In estimating the number of days required to provide dental sealants for all participating students in a school, it is important to keep in mind that most school-based dental sealant programs average a 50 to 60 percent consent return rate for students eligible for the program. After the school-based dental sealant program has been in operation for 1 year, administrators should take into account the first year’s participation rate when estimating the number of days needed to provide dental sealants in future years.
Efficient programs using a four-handed application technique can place dental sealants on 15 to 18 students per team per school day. If one dental hygienist and assistant team treats 15 students per day at a school where 60 students eligible for the program returned consent forms, it will take 4 days to apply dental sealants for all participating students.
Scheduling Dates for Program Operation
When scheduling the dates on which the school-based dental sealant program will be operating in a school, avoid days when standardized testing, assemblies, field trips, career days, teacher in-services or planning days, or other events are planned.
Obtaining signed parental consent forms can be difficult, but it is a critical component of an effective school-based dental sealant program. Second-grade students are most likely to return signed consent forms, with participation rates averaging 55 to 60 percent. For sixth-grade students, the average rate is 40 to 50 percent, while for seventh- and eighth-grade students, it may fall to around 30 percent.
Understanding How to Improve Program Participation Rates
There are a variety of reasons why parents may not sign consent forms. These include
- Student fails to bring form home for the parent to sign
- Parents lack knowledge about dental sealants
- Parents have had negative experiences with receiving oral health care services or have preconceived ideas about oral health
- Other health, social, cultural, and family factors
Program administrators need to be creative when developing strategies for gaining parental consent for students to receive dental sealants. It is useful to identify organizations or events where a large number of parents may gather and to set up an information booth there. Administrators should bring plenty of consent forms so that parents can sign their child up for the program on the spot.
Following are examples of places where outreach can be conducted:
- Parent meetings
- Faith-based organizations
- Community health centers and safety net clinics
- Health fairs
- Grocery stores
- Beauty salons
- Street fairs
- Cultural festivals
- Local sports events (e.g., soccer, baseball, and basketball games)
To better understand the factors that inhibit participation, the Cincinnati Health Department conducted a 3-year study in 1989–1991 in which participation in the Cincinnati Sealant Program was studied extensively. Click here to read more about study findings.1
To ensure that the largest possible number of students eligible for the program participate, program administrators should
- Schedule a specific date and time to go back to the school to collect the forms
- Call ahead to confirm when the forms will be collected
- Make sure forms from all classrooms have been collected before leaving the school
- Encourage staff to accept completed consent forms after the due date
Often, forms are held in classrooms instead of being returned to the office. If the response rate from some classrooms is unusually low, program administrators may wish to redistribute forms in those classrooms and to provide additional information about the program’s value. In some school-based dental sealant programs, the name of each student who has not returned a form is written on a new form. These forms are placed in teachers’ mailboxes for redistribution.
In large geographic districts, consent forms may have to be mailed back to the school-based dental sealant program. Program administrators may wish to call school personnel if response rates are unusually low or if entire classrooms are missing. Owing to the personal nature of information provided on consent forms, the forms should not be faxed to the program using “open” (non-private) fax lines.
Some school-based dental sealant program administrators feel that obtaining student health histories is not necessary because of the non-invasive nature of the dental sealant-placement procedure. In 1989, the American Heart Association (AHA) revised its recommended protocols for the use of antibiotics in patients at risk for developing bacteremias from dental procedures. The association concluded that there was insufficient evidence to support the use of antibiotic prophylaxis in dentistry for most medical conditions, and that the widespread risk of bacterial resistance to antibiotics is more important than perceived benefits.2
Controversy and concern still exists regarding AHA’s recommendations. Because of the lack of scientific evidence, some continue to believe that certain health conditions may indicate the need for special considerations. Still others feel that student health histories should be obtained for legal reasons.
Programs that request health information typically ask if the student has had a history of rheumatic fever or rheumatic heart disease, heart murmurs, or asthma; whether the student has medication or latex allergies; if a dentist or physician has indicated that the student should take antibiotics before receiving oral health care (health professionals recommending prophylactic antibiotics should be contacted to confirm that they are needed for placement of dental sealants); and what medications the student is currently taking.
- Dubeck PJ, Barteck L, Hill L, Carter N. 1993. The Effects of Incentives on Participation in an Elementary School Dental Sealant Program. Unpublished manuscript.
- Tong DC, Rothwell, BR. 2000. Antibiotic prophylaxis in dentistry: A review and practice recommendations. Journal of the American Dental Association 131(3):366-374. http://www.ncbi.nlm.nih.gov/pubmed/10715929.