A dentist or dental hygienist conducts limited assessments (i.e., visual checks, based on a pre-determined set of criteria, to identify teeth that qualify for dental sealant placement), and a team consisting of a dental hygienist and a dental assistant or a team of a dental assistant with expanded function training and another dental assistant applies the sealants using a four-handed technique.
The use of a four-handed technique is recommended for improved quality and efficiency.1 It also enables clinical staff to work at the top of their license and enhances job satisfaction. Throughout this manual, it is assumed that school-based dental sealant programs will use the same methodology.
Dental practice acts vary from state to state. For example, many states allow dental hygienists to conduct assessments and apply dental sealants without the supervision of a dentist or with collaborative management agreements with dentists or public health agencies. In other states, exemptions have been granted to the direct supervision requirement to allow for general supervision of dental hygienists and dental assistants applying sealants in public health programs. The American Dental Association (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. The use of expanded-function dental assistants to place sealants is another cost-effective staffing approach where allowed by state practice acts.
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 changes.
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 dental hygiene practice issues at the state level and lists useful summary documents pertaining to licensure, direct access, scope of practice, and reimbursement issues. ADA members can also find out more about individual state dental statutes and regulations by logging into ADA’s State Legislative Report.