School-based dental sealant programs wishing to engage in a more rigorous analysis of their program may want to enlist the help of a dental school or a dental hygiene program or another appropriate research entity interested in conducting such an analysis as an academic project.
A key indicator for measuring dental sealant quality is retention rate. Sealant quality can be measured by checking short-term retention rates, long-term retention rates, or both. Both measures serve important purposes.
An attorney familiar with informed consent can help determine how consent forms should be phrased to cover retention checks and additional sealant placement.
A sample of students who receive dental sealants as part of a school-based dental sealant program can be evaluated a few days or weeks after sealant application to ensure that the sealants are intact, adequately cover the occlusal pits and fissures, and have marginal integrity. The proportion of students’ dental sealants checked and the frequency with which they are checked varies from program to program. Conducting short-term retention checks can be an effective way to evaluate staff performance, identify needed protocol changes, and determine the adequacy of equipment and supplies used. Short-term retention checks offer an opportunity to correct problems with sealant-application techniques, equipment, and supplies. This type of retention check can be especially useful in evaluating the performance of a new operator.
It is recommended that long-term retention checks be conducted within 1 year after sealant placement in school-based dental sealant programs. One-year retention rates of properly applied dental sealants should be high, averaging between 80 percent and 90 percent.2,6
For programs that provide dental sealants for second- and sixth-grade students, retention checks typically involve checking third-grade students who received sealants the year before. Upon graduation from sixth grade, many students change schools, making it difficult to conduct retention checks. If good tracking systems are in place, after the fourth year of a program sixth-grade students can also be checked, thus documenting 4-year retention rates of dental sealants that were placed when these students were in second grade.
To perform yearly retention checks where paper records are used, advance preparation is required. First, student records from the previous year need to be retrieved. Using third-grade class lists, students who received dental sealants the previous year can be identified. New room numbers should be marked or coded on student records before the program is next scheduled to operate in the school, and the records should be taken to the school when the program operates. If electronic records are used, a list of third-grade students with room numbers will need to be generated.
As resources allow, retention checks should be completed on as many students as possible. A space should be available on the student record to indicate retention-check results.
Some school-based dental sealant programs differentiate between lost and partially lost dental sealants; others do not, because both lost and partially lost dental sealants usually result from moisture contamination during the application process. Program planners need to establish retention-check criteria that clearly define lost and partially lost sealants so both are recorded properly. Partially sealed teeth are also identified during retention checks. (Teeth may be partially sealed, for example, when the sealant was applied before the occlusal surface of the tooth was fully erupted.) In these instances, an add-on sealant is indicated to protect the tooth. This tooth, however, should not be counted in the sealant-retention protocol because it was intentionally not completely sealed in the first place.
Program administrators must decide whether lost dental sealants will be reapplied. Some consent forms allow for reapplication of lost sealants that are detected during retention checks in subsequent years. In these instances, lost sealants are reapplied, and new sealants are applied to teeth that have erupted, if appropriate, within the past year.
After all the retention-check information has been collected, the retention rate should be computed for each student and the total number of students in each school. The process of conducting retention checks is similar to the process of conducting student assessments.
