Frequently Asked Questions (FAQs)

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 members 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 play. 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.

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 dental caries 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. This decision is based on the eruption patterns of children’s teeth. The occlusal surfaces of first and second permanent molars are the teeth most likely to develop dental caries. 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 ages 5 and 7. Second permanent molars usually erupt during adolescence, between ages 12 and 16. Therefore, many programs target students at higher risk of developing dental caries 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 developing dental caries.

Rather than decreasing the number of students seeking oral health services from private practices, school-based dental sealant programs offer an opportunity to increase local dentists’ patient base. As part of a program’s assessment process, students in need of follow-up oral health 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 (e.g., eligible to receive free or reduced-price meals through the U.S. Department of Agriculture’s National School Lunch Program) and are thus less likely to receive oral health care in private practices. These students are at higher risk for developing dental caries and are less likely to receive dental sealants than their more affluent counterparts. Dental sealant prevalence is lower among children living at or below 100 percent of the federal poverty level compared with children living above the poverty level. Typically, these students are eligible for Medicaid or the Children’s Health Insurance Program (CHIP) or are from families with incomes too high to qualify for Medicaid or CHIP but who do not have dental insurance and cannot afford to pay for oral health care.

Some programs have addressed dentists’ concerns by including a question on the parental consent form asking if the student sees a dentist for their 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.

There is no evidence that placing dental sealants over small lesions results in progression of dental caries. On the contrary, placing sealants appears to stop the dental caries process.

Yes. A visual assessment alone is sufficient to detect surface cavitation and signs of dentin involvement before the placement of dental sealants. Using a sharp explorer to assess for dental caries has not been shown to be an effective or necessary method for accurately detecting occlusal caries.

Dental-caries-detection devices and technologies are also not required to determine need for dental sealants. Using such devices incurs an unnecessary cost and could lead to teeth being misclassified as not needing sealants.

In addition, non-cavitated incipient lesions may remineralize if the surface layer covering the demineralized area or lesion remains intact. Forceful use of a sharp explorer can disrupt the surface layer and prevent remineralization.

Yes. Bitewing X-rays are not necessary to determine whether dental sealants are needed. Sealants are placed on the chewing surfaces of teeth, which can be seen in a visual assessment. Bitewing X-rays are taken to view surfaces between the teeth that cannot be seen in a visual assessment. They are taken by a dentist as part of a comprehensive oral exam.

In addition, nearly 90 percent of dental caries among children occurs on the occlusal (chewing) surfaces of the permanent first and second molars. For this reason, bitewing X-rays are not recommended for determining whether dental sealants should be placed.

A key indicator for measuring dental-sealant quality is retention rate. Sealant quality can be measured by determining short-term and long-term (e.g., 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 student is recommended a few days or weeks after sealant application. This 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 dental caries, long-term 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 annually thereafter for as many students as possible.