Frequently Asked Questions (FAQs)
What level of commitment is expected of the school-based dental sealant program advisory group?
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 serve. 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.
School officials want to make school-based dental sealant program services available to all students in the school rather than to students in specific grades. How should program staff respond?
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 tooth decay 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. The occlusal surfaces of first and second permanent molars are the teeth most likely to develop decay. 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 the ages of 5 and 7. Second permanent molars usually erupt during adolescence, between the ages of 12 and 16. Therefore, many programs target students at higher risk of developing tooth decay 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 tooth decay.
- 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.
- Dye BA, Thornton-Evans G, Li X, Iafolla TJ. 2015. Dental caries and sealant prevalence in children and adolescents in the United States, 2011–2012. NCHS Data Brief 191:1–8.
- Kuthy RA, Ashton JJ. 1989. Eruption pattern of permanent molars: Implications for school-based dental sealant programs. Journal of Public Health Dentistry 49(1):7–14.
- 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.
How can school-based dental sealant program staff address local dentists’ concerns that the program will be treating their patients?
Rather than decreasing the number of students seeking oral health services from private practices, school-based dental sealant programs offers an opportunity to increase local dentists’ patient base. As part of a program’s assessment process, students in need of follow-up 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 and are thus less likely to receive oral health care in private practices. These students are at higher risk for developing tooth decay and are less likely to receive dental sealants than their more affluent counterparts. The 2009–2010 National Health and Nutrition Examination Survey data show dental sealant prevalence was lower among children living at or below 100 percent of the federal poverty level compared with children living above the poverty level. A similar pattern was found among adolescents ages 13 to 15. 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 services.
Some programs have addressed dentists’ concerns by including a question on the parental consent form asking if the student sees a dentist for his or her 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.
How can school-based dental sealant program staff respond to dentists’ questions about sealing over incipient lesions (enamel caries)?
There is no evidence that placing dental sealants over small lesions results in progression of tooth decay. To the contrary, placing sealants appears to stop the decay process.
- Griffin SO, Oong E, Kohn B, Gooch BF, Bader J, Clarkson J, Fontana MR, Meyer DM, Rozier RG, Weintraub JA, Zero DT. 2008. The effectiveness of sealants in managing caries lesions. Journal of Dental Research 87(2):169–174
- Mertz-Fairhurst EJ, Curtis JW Jr, Ergle JW, Rueggeberg FA, Adair SM. 1998. Ultraconservative and cariostatic sealed restorations: Results at year 10. Journal of the American Dental Association 129(1):55–66.
- Simonsen RJ. 2002. Pit and fissure sealant: Review of the literature. Pediatric Dentistry 24(5):393–414.
- Tinanoff N, Coll JA, Dhar V, Maas WR, Chhibber S, and Zokaei L. 2015. Evidence-based update of pediatric dental restorative procedures: Preventive strategies. Journal of Clinical Pediatric Dentistry 39(3):193-197.
Is it safe and appropriate to conduct an oral assessment without using a sharp explorer?
Using a sharp explorer to assess for tooth decay has not been shown to be an effective method for accurately detecting occlusal caries. A systematic review of methods used to identify tooth decay found that the number of false positives using a dental explorer to detect occlusal caries varied widely, resulting in poor sensitivity rates.
In addition, noncavitated incipient lesions may remineralize if the surface layer covering the demineralized area or lesion remains intact. The use of a sharp explorer can disrupt the surface layer and prevent remineralization.
Is it acceptable to seal teeth without taking bitewing X-rays to determine whether tooth decay is present between the teeth?
The use of portable X-ray equipment in a school-based setting carries a high risk of exposing dental sealant program staff and students to needless radiation. The American Dental Association’s Council on Scientific Affairs and the U.S. Department of Health and Human Service’s Food and Drug Administration encourage oral health professionals to follow the “as low as reasonably achievable” principle to minimize the risk of radioactive exposure to protect oral health professionals and their patients.
In addition, nearly 90 percent of tooth decay among children and adolescents occurs on the occlusal surfaces of the permanent first and second molars. For this reason, along with the high risk of radiation exposure, the cost of taking bitewing X-rays in a school-based setting is too high to justify.
- American Dental Association, Council on Scientific Affairs; U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration. 2012. Dental Radiation Exposure. Chicago, IL: American Dental Association, Council on Scientific Affairs; Silver Spring, MD: U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration.
- American Dental Association, Council on Scientific Affairs. 2006. The use of dental radiographs: Updates and recommendations. Journal of the American Dental Association 137(9):1304–1312.
- Griffin SO, Gray SK, Malvitz DM, Gooch BF. 2009. Caries risk in formerly sealed teeth. Journal of the American Dental Association 140(4):415–423.
- Ripa LW, Leske GL, Sposato A. 1985. The surface-specific caries pattern of participants in a school-based fluoride mouthrinse program with implications for the use of sealants. Journal of Dental Public Health 45(2):90–94.
How often should teeth be checked to see if dental sealants are still in place?
A key indicator for measuring dental-sealant quality is retention rate. Sealant quality can be measured by determining short-term and 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 students a few days or weeks after sealant application 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 tooth decay, yearly 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 yearly thereafter for as many students as possible