Because dental practice acts vary from state to state, the make-up of school-based dental sealant program staff will vary accordingly. For example, many states allow direct access where dental hygienists or dental hygienists with advanced practice training can conduct oral health assessments and apply dental sealants without the supervision of a dentist or with a collaborative practice agreement with a dentist or public health agency.1 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. General supervision is defined as a type of supervision in which the dentist is not required to be onsite when procedures are being performed by the allied oral health professional but has personally diagnosed the condition to be treated, has personally authorized the procedures, and will evaluate the performance of the allied dental professional.
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 a cost-effective staffing approach where allowed by state practice acts.
The type of sealant material used in the school-based dental sealant program also impacts staffing. The use of a four-handed technique is recommended for improved quality and efficiency during the placement of resin-based dental sealants.2 Based on the dental practice act in the state where the sealant program is located, the oral health team might include a dental hygienist and a dental assistant or an expanded-function dental assistant and a dental assistant. The use of the four-handed technique is not needed when glass ionomer cement dental sealants are placed as maintaining a dry field is not necessary (see Module 4.2 in School-Based Dental Sealant Programs).
It is important for program administrators to review their state dental practice act and design a school-based dental sealant program according to the supervision requirements and regulations for non-office settings. 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 Dental Association webpage, State 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 compiles scope of practice overviews at the state level and lists useful summary documents pertaining to direct access, scope of practice, Medicaid reimbursement, restorative services, anesthesia, dental hygiene diagnosis, and silver diamine fluoride.
