Please Note: This curriculum was developed prior to the COVID-19 pandemic and may not reflect current guidance for materials, procedures, and infection control.
In addition, most effective programs have the support of key constituencies in their communities (e.g., school administrators, school nurses, dentists). Seal America: The Prevention Invention (3rd ed.) and the Report of the Sealant Work Group: Recommendations and Products provide useful information on how to obtain such support.
For school-based dental sealant programs, the objective of targeting is to provide sealants to the largest possible number of children at high risk for dental caries. Targeting programs to populations has been shown to be more cost-effective1 than targeting them to specific children based on oral health status, and the former is easier to implement.2 National data show that, compared with children from families with higher incomes, children from families with low incomes are at higher risk for experiencing dental caries and for having untreated caries,3,4 are less likely to have sealants,3 and are less likely to have a dental visit in a year.5
During the 2004–2005 school year in Ohio, children in third grade who were at high risk for dental caries and who attended schools with sealant programs were more than twice as likely to have sealants as their counterparts at schools with no programs (59 percent vs. 29 percent). The school-eligibility threshold at that time was > 50 percent student enrollment in the Free and Reduced Price Meals program (FRPM)a.6
ODH considers almost half (48 percent) of all children in the surveyed grade who attend public schools in Ohio to be at higher risk based on either FRPM enrollment, Medicaid enrollment, or the fact that they are uninsured and have not had a dental visit within a year. ODH compared the effects of various school-eligibility thresholds (i.e., > 60 percent of children enrolled in FRPM, > 50 percent enrolled, > 40 percent enrolled, > 30 percent enrolled) on oral health status and the number of children at higher risk per school. Figure 1 shows that for all the thresholds considered, children at schools with higher FRPM enrollment were significantly more likely to have dental caries than children at schools with lower enrollment. Figure 2, however, shows that the number of children per school who are at higher risk drops significantly when less than 40 percent of students at the school are enrolled in FRPM.7
Because of these findings, ODH revised the school-based dental sealant program-eligibility criteria for ODH-funded programs as follows:
School-based dental sealant programs target schools in which 40 percent or more of the children are enrolled in FRPM. Schools in which 40 to 49 percent of children are enrolled in FRPM may be served at any time during the year, if the program assures the ODH Oral Health Section (OHS) that all schools with > 50 percent enrolled in FRPM will be served during the year. Without that assurance, a program can visit only schools with 40–49 percent of children eligible for FRPM after all schools with > 50 percent of children enrolled in FRPM have been served.
School-based dental sealant programs in some eligible schools target children in specific grades (typically grades 2 and 6) to provide sealants for vulnerable, newly erupted permanent molars. With ODH approval, programs may target other grades (e.g., grade 7, with grade 8 follow-up, to seal more newly erupted second molars).
Follow-up in grades 3 and 7 serves two purposes: (1) screening for sealant retention and sealant repair or replacement, if needed, and (2) sealing previously unerupted molars.
The efficiency of a program depends on the extent to which planning takes place before the sealant team arrives at a school, as well as on staff mindset, which must be oriented toward working as efficiently as possible. Making a program more efficient results in more children (e.g., 20 vs. 10) receiving sealants each day, which in turn leads to completing a school in fewer days and serving more schools during a school year. Efficient operations also translate into lower per-child costs for providing sealants.
a. Throughout this module, “Free and Reduced Price Meals program” refers to the National School Lunch Program, a federally assisted meal program operating in public and nonprofit private schools and residential child care institutions. It provides nutritionally balanced, low-cost, or free lunches to children each school day.