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

Step 3
Staffing

When staffing a school-based dental sealant program, it is important to recruit individuals with strong clinical, public health, and administrative skills. The makeup of the staff varies, depending upon

  • The size and location of the program’s target population
  • The availability of individuals with appropriate skills
  • The requirements of state dental practice acts concerning supervision of auxiliaries conducting assessments and applying dental sealants
  • Available funding

In managing staff, program administrators need to (1) use a credentialing process to verify current registration for licensed professionals and to conduct background checks, when appropriate, (2) provide written job descriptions, and (3) provide and document appropriate staff training (see Step 7, Preparing to Launch. Credentialing must be done for all clinical staff who possess licenses that allow them to practice independently, regardless of whether the individual is a contractor, volunteer, or permanent employee.

Clinical Staff

In most school-based dental sealant programs, dentists conduct assessments (i.e., visual checks, based on a pre-determined set of criteria, to identify teeth that qualify for sealant placement), and a team consisting of a dental hygienist and a dental assistant applies the sealants using a four-handed technique. This technique is recommended for reasons of quality and efficiency,1 and, throughout this manual, it is assumed that school-based dental sealant programs will use it. In efficiently operated school-based dental sealant programs, one team working 5 days per week can place dental sealants on 3,300 to 3,600 students per school year.

Dental practice acts vary from state to state. For example, some states allow dental hygienists to conduct assessments and apply dental sealants without the supervision of a dentist. In other states, exemptions have been granted to the direct supervision requirement to allow for general supervision of dental auxiliaries applying dental sealants in public health programs. ADA defines general supervision as a “type of supervision in which the dentist is not required to be in the dental office or treatment facility when procedures are being performed by the allied dental personnel, but has personally diagnosed the condition to be treated, has personally authorized the procedures, and will evaluate the performance of the allied dental professional.2

In states where dental practice acts require the direct supervision of dental hygienists, dentists and dental hygienists can both apply dental sealants. For reasons of cost, however, it is preferable to have a dentist on site only to conduct assessments. Where state practice acts allow, the use of expanded-function dental assistants to place dental sealants is another cost-effective staffing approach.

It is important to design a school-based dental sealant program according to the supervision requirements and regulations for non-office settings in each individual state’s practice act. Program administrators need to read their state’s practice act carefully and to check it regularly for updates.

Most states have dental boards that regulate the practice of dentistry. However, some states use a central agency that regulates more than one profession. The American Association of Dental Boards provides contact information for all relevant agencies nationwide.

The best source of information about regulations is the state dental practice act, which can be obtained through the state dental board or regulatory agency. Additionally, the American Dental Hygienists’ Association’s Governmental Affairs Division compiles scope-of-practice information at the state level and lists useful summary documents pertaining to legislative activity and statewide comparisons. ADA’s Department of State Government Affairs can also provide information about state dental statutes and regulations.

Administrative Staff

Administrative functions are an important component of school-based dental sealant programs. Staff need to

  • Obtain permission to access schools and develop programs
  • Schedule schools and classrooms
  • Arrange for transportation of equipment from school to school
  • Manage program data
  • Bill and collect reimbursement for clinical services
  • Conduct outreach
  • Make and follow up on referrals

In many programs, dental hygienists and assistants perform these administrative functions (and may also serve as program directors) in addition to providing clinical care. However a number of programs employ non-clinical staff to perform administrative functions. Available funding usually determines whether a program is able to hire non-clinical staff.

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Contractors

Rather than employing staff, some school-based dental sealant programs use contractors to perform program activities, including program coordination, provision of clinical services, outreach, and attainment of defined performance standards (e.g., MCHB performance standard on dental sealants, compliance with quality-assurance measures).

School-based dental sealant programs sometimes contract with dental or dental hygiene schools. Partnering with an academic program provides an excellent opportunity to expose students in that program to public service and offers the potential to add to the public health work force. Working with students can be time consuming, however, and—because students are slower at applying dental sealants than are experienced professionals—taking this approach can reduce productivity, especially if the program has only one portable operatory per school.

Contractual arrangements can also be made with dentists and dental hygienists. In these cases, the dentists and dental hygienists operate just like program staff, but they are not permanent employees.

Volunteers

Depending on their knowledge and skills, volunteers can play a variety of roles in a school-based dental sealant program. Volunteer dentists and dental hygienists can provide the clinical skills needed to conduct assessments and apply dental sealants. Non-clinical volunteers can perform administrative functions.

While using volunteers can be an effective way to engage the local oral health community, some potential drawbacks need to be considered. First, volunteers’ commitment to the program may wane after a period of time, leaving the program without a full complement of staff. Second, Medicaid billing and reimbursement issues may arise with a volunteer dentist or dental hygienist. For example, if the school-based dental sealant program does not have a Medicaid provider number, the program cannot bill Medicaid for services provided by volunteer oral health professionals. Read more about applying to become a Medicaid provider.

Several issues should carefully be considered before bringing on volunteer staff. For example, developing a working relationship with volunteers may be time consuming. Volunteer dentists may not agree with the program’s assessment process (e.g., not using sharp explorers, not taking X-rays). They may want to use a sealant-application technique that differs from the technique used by the school-based dental sealant program (e.g., not opening fissures before placing the sealant). Because many volunteer dentists and dental hygienists come from the private sector, training them to deliver care in a public health setting can be challenging. In addition, credentialing volunteers can be time consuming and costly.

References

  1. Griffin SO, Jones K, Gray SK, Malvitz DM, Gooch BF. 2008. Exploring four-handed delivery and retention of resin-based sealants. Journal of the American Dental Association 139(3):281–289. http://jada.ada.org/content/139/3/281.full.
  2. American Dental Association. 2009. Current Policies: Adopted 1954–2009. Chicago, IL: American Dental Association. http://www.ada.org/currentpolicies.aspx.
  3. New York State Department of Health, Bureau of Dental Health. 2005. Application to Provide Dental Health Services in a School in New York State: Part III Enabling Legislation. Albany, NY: New York State Department of Health, Bureau of Dental Health. http://www.oralhealthtac.org/files/DentalApplication_pt3.pdf.

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