Selecting Supplies and Equipment

Selecting Supplies and Equipment

Supplies

Many school-based dental sealant programs have opted to use disposable instruments (e.g., evacuator and syringe tips, mirrors, cotton roll holders, bite blocks). Use of disposables eliminates the need to purchase an autoclave and ultrasonic cleaner, which reduces up-front equipment costs, sterilization and testing supplies (sterilizer bags, weekly spore testing) costs, and time spent on testing and maintenance.

The supplies a school-based dental sealant program needs depend upon the method of dental sealant application selected, the decision to use disposable or reusable instruments, and program administrators’ and staff preferences. The table below provides a list of supply categories to consider when making purchases.

Table 4.1 School-Based Dental Sealant Program Supplies

Staff and Student Protection

  • Air and water syringe tips*
  • Antibacterial gel/wipes
  • Patient bib clips/holders*
  • Patient bibs
  • Sunglasses (for students)
  • Gloves (latex-free)
  • Face masks or shields
  • Gowns
  • Hand soap
  • Headrest covers or paper towels
  • Light-handle covers
  • Plastic sleeves for air and water syringe and evacuator hoses**

Student Treatment

  • Cotton roll holders*
  • Cotton rolls
  • Bite blocks*
  • Dry angles
  • Evacuator tips*
  • Explorers (for retention checks)*
  • Mouth mirrors*
  • Dental sealant and etchant material
  • Toothbrushes
  • Trays*
  • Fluoride varnish (optional)

Sterilization and Disinfection

  • Containers for used and clean instruments**
  • Dishpan**
  • Distilled water for sterilizer**
  • Evacuation system cleaner
  • Plastic covers for curing light and portable dental lamp
  • Gauze squares
  • Paper towels
  • Spore testing supplies**
  • Sterilizer bags**
  • Sterilizer cleaner**
  • Surface disinfectant
  • Large kitchen trash can and trash can liners
  • Ultrasonic cleaner solution**

Additional Supplies

  • Extra bulb for dental light
  • First-aid kit, including an eye wash kit
  • Heavy-duty extension cords
  • Office supplies (stapler, paperclips, tape, pens, extra forms)
  • Plug adapters (three-prong, two-prong)
  • Tool kit for equipment repair
  • Tray table for operator
*    Available as a disposable
**  Not required if disposables are used

The cost of purchasing durable equipment (e.g., mouth mirrors, cotton roll holders, trash cans, dishpans, extension cords, tray tables) should be estimated for budget purposes. Be sure to make allowances for replacement in the event of breakages. The annual cost of disposable single-use infection control and supplies should also be estimated.


Selecting Dental Sealant Materials

Many manufacturers produce a variety of dental sealant materials. The material chosen should appear on ADA’s Seal of Acceptance Program list. This program approves sealant materials based on information about material working time, setting and curing time, depth of cured and uncured thickness, and biocompatibility with the oral environment.

When selecting the dental sealant material for use in a school-based dental sealant program, program administrators should look for cost-effective materials that have prolonged retention properties, have low solubility in the oral environment, and are simple to apply. The type of sealants, bonding agents, and enamel etchants should also be considered carefully.

Sealants are Safe

Type of Dental Sealants
There are four general classifications of dental sealant materials that can be used in school-based dental sealant programs. All are effective in arresting and preventing pit-and-fissure occlusal caries and minimizing the progression of noncavitated occlusal caries that received a sealant. No sealant material is more effective than the others.1

The four classifications of dental sealant materials include

  • Resin-based dental sealants are urethane dimethacrylate (UMDA), bisphenol A-glycidyl methacrylate, or bishenol A-glycidyl (BPA) monomers that are polymerized by mixing the sealant material with a catalyst or with a curing light. Resin-based sealants come in two types: unfilled and colorless, or tinted materials; or filled and opaque, tooth colored, or white materials. In terms of retention and effectiveness, no resin type is superior to the others.

    School-based dental sealant programs commonly use unfilled resin-based dental sealants. These sealants have low viscosity, which allows for easy flow into pits and fissures. Occlusal adjustments are not required after placement, as any high points in occlusion will abrade with normal chewing.

    Dental sealant materials are also available that are partially filled (less than 10 percent). Like their unfilled counterpart, partially filled sealants do not require occlusal adjustments after placement. They have low viscosity, which allows for easy flow into pits and fissures, and they release fluoride that may aid in delaying or preventing the caries process.

    Filled dental sealant resins are more viscous than unfilled sealants and offer greater bonding strength and resistance to wear and abrasion. Because they do not abrade rapidly, adjustments to the occlusion may be needed after they are placed.1 Under most state practice acts, a dentist is the only oral health professional allowed to perform this procedure. Occlusal adjustments also require the use of a handpiece and add time to the procedure. These requirements decrease efficiency and increase the school-based program’s equipment and operating costs.

    The effectiveness of resin-based dental sealants is technique dependent. To adhere to the tooth, resins require an isolated, clear, dry enamel surface. This can be difficult to acquire if teeth are partially erupted or if the student is uncooperative.

    PBA is a component of some dental sealants. There are concerns about systemic absorption of unpolymerized BPA. To date, exposure to PBA as a result of sealant application has proven to be negligible.2 Sealants should remain a part of routine preventive oral health care.

  • Glass ionomer (GI) dental sealants are cements that release fluoride, which may aid in delaying or preventing the caries process. They can be used in fields that are difficult to keep dry (e.g., partially erupted occlusal surfaces). School-based dental sealant programs that use GIs often target students at ages where teeth are sealed before they are fully erupted or where cavitated lesions are sealed as an interim caries-management strategy.

    Over time, GIs have lower retention rates than resin-based dental sealants. However it is unclear whether their caries-prevention attributes are lost if a visual examination indicates that the sealant is missing. There may be microscopic tags of sealant bonded to the tooth that allow a sealing effect deep in pits and fissures. Programs that use GIs should monitor and replace sealants, if needed.3
  • Poly-acid modified resin dental sealants, also referred to as compomers, combine resin-based materials found in traditional resin-based sealants with fluoride-releasing and adhesive properties of GIs.

  • Resin-modified glass ionomer (RMGI) dental sealants are essentially GIs with resin components. RMGIs are reinforced with a composite-like material that results in improved flexion and increased tensile strength. These sealants have similar fluoride-release properties as GIs, but RMGIs have a longer working time and are less water-sensitive than GIs.

Once a decision is made to purchase a specific dental sealant material, it is important to review the manufacturer’s application instructions carefully. Placement techniques can vary from one sealant type and one brand to another.

Bonding Agents
Research on the placement of bonding agents or primers before dental sealant placement has shown improved retention rates, particularly in the buccal pits and lingual grooves.4 The use of a bonding agent, however, adds a step to the application process. This involves applying a bonding agent layer to the tooth surface and then air thinning this layer before the sealant can be placed.

Enamel Etchants
The usual acid used for enamel etching is 37 percent phosphoric acid. Acceptable bonding is obtained if the etchant is in contact with clean enamel for 15 to 20 seconds. Topical fluoride treatments can be applied before dental sealants are placed without impairing the sealant’s retention.5

Other factors to consider when selecting dental sealant materials include the following:

  • Whether to use light-cured or self-cured dental sealants. Self-cured sealants come in two parts that are mixed to begin the polymerization process. Setting time can vary from 60 to 90 seconds, and the warmer the temperature, the more quickly the sealants will set. Light-cured sealants harden when exposed to a curing light. An obvious advantage of light-cured sealants is that they allow for increased working time. However, if light-cured sealants are used, a light must be purchased (See dental curing lights in Step 4, Selecting Supplies and Equipment, Dental Curing Lights). Self-cured sealants can usually be applied more quickly by using a quadrant or half-mouth technique. This way, all the sealants can cure simultaneously instead of individually.

  • Whether to use clear or colored dental sealants. Sealants can be clear, tinted, or opaque; some sealant material is tinted when it is applied and changes to an opaque color after it has set. Tinted or opaque sealants are easier to evaluate than clear ones during retention checks.

Some school-based dental sealant programs may be eligible for free sealant materials through Oral Health America’s Smiles Across America Program. Under this program, the alliance has pledged to seal 2 million teeth by 2020 through school-based or school-linked programs throughout the United States. Smiles Across America’s Product Donation Project also distributes more than 500,000 units of donated dental products annually. A product donation request form is available online.

Other dental supply companies and distributers may offer products at a discounted rate to school-based dental sealant programs that serve students from families with low incomes or that are affiliated with local, county, or state entities. Additionally, large programs may be able to negotiate price savings if large quantities of a select number of products are purchased.

Storing Supplies

Since school-based dental sealant programs cannot carry large volumes of supplies from school to school, a central storage location is needed. Supplies are sent to the program from central storage, as needed. For programs located in rural areas, supplies can be shipped directly to the home of a staff member. Stored supplies should be kept off the floor on palettes or shelves.

Climate should also be considered, particularly in areas of the country with extreme temperatures (hot and cold). Some equipment and supplies should not be stored in vehicles during the day or overnight. Be sure to carefully follow all storage instructions for each set of supplies and equipment.

Estimated Cost of Supplies

Supply costs vary among school-based dental sealant programs because each program operates differently, selects different supplies, and uses different purchasing processes. When planning a program, however, an estimate of supply costs is helpful. For example, a program in Ohio examined 4,000 students per year from 2003 to 2006 and placed about 20,000 dental sealants on 3,600 students per year. Supply costs averaged $20,000 per year over the 3 years. Supply costs, therefore, were approximately $5.50 per student per year during this period.

 

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