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Implementing the Program

Implementing the Program

Student Assessments

Organizing and Conducting Assessments

Student assessments determine the need for dental sealants. In some school-based dental sealant programs, assessments are performed before the program starts so that program administrators know ahead of time how many students need sealants. Other programs conduct assessments on the same days that sealants are applied. How the assessments are organized and conducted is dependent on each state’s scope-of-practice laws.

Dental Sealant Assessment Process When a Dentist Must Conduct the Assessment

In states where state dental practice acts do not allow dental hygienists to make assessments and in cases where assessments are conducted while the program is under way, dentists should be scheduled to conduct assessments on the first 2 days at each school, even if the assessments could be completed in a single day. Having the dentist available on 2 days helps increase participation by allowing assessment of additional students who were absent on the first day. Also, some students decide they would like to participate in the program after seeing their classmates participate. Having the dentist available on the second day allows students who take consent forms home on the first day and return signed forms the next day to receive assessments.

Assuming that assessments were not conducted on an earlier date, the first assessment should be under way 15 minutes after school starts on the first day of the program. To make sure the program begins on schedule, shortly after school begins, a dental assistant goes to the first classroom of students who are to receive dental sealants, confirms that the teacher knows how the program works, and gathers all the students in the class who returned signed consent forms. If electronic records are not being used, the dental assistant hands students their own records and escorts them to the assessment area.

In the assessment area, the students line up, and the dentist/dental hygienist assesses them, normally at a rate of 45 to 50 students per hour. The dentist first verifies that students are matched with the correct record by addressing each student by name and asking the student his or her birthdate.

Meanwhile, the dental assistant or dental hygienist places a headrest cover on the dental chair (paper towel squares are an excellent substitute for headrest covers, as they are easier to change and less expensive). The first student sits in the dental chair to be assessed. During the assessment, the dentist calls aloud the results, including which teeth need dental sealants and which teeth or surfaces are decayed, missing, or filled. The dentist deposits used instruments into containers on the floor, if reusable instruments are used, and throws disposable instruments and gloves in a nearby trash can. The dental assistant/dental hygienist records the findings in the student’s paper or electronic record.

Afterward, the student is either sent back to class (to be called back later for dental sealant placement) or kept to receive sealants, and the next student moves to the first chair to be assessed. Since conducting assessments take less time than applying sealants, most students return to class after being assessed and are called back for sealant placement. If two operatories with two teams are set up in one school, the second team can begin placing sealants as soon as the first student is assessed.

This process allows for a large number of students to be assessed at one time and gives the school-based dental sealant program team a better estimate of how many days it will take to work through each classroom. Unfortunately, screening groups of students at one time significantly disrupts classroom instruction, which principals and teachers may not welcome.

Student Flow When Dental Sealant Assessment Must Be Completed by a Dentist

Student Flow When Dental Sealant Assessment Must Be Completed by a Dentist (Two Operatories in Place).

Dental Sealant Assessment Process When a Dentist Is Not Required to Be Present

In states where the state practice act allows qualified dental hygienists to assess for dental sealants, the dental assistant goes to the classroom, confirms that the teacher knows how the program works, and escorts one student with a signed consent form to the sealant area. The dental hygienist conducts the assessment and applies the sealants, if indicated. If the student does not require sealants, he or she is escorted or sent back to the classroom. If the student is sent back to the classroom on his or her own, he or she will let the next student know that it is his or her turn to go to the sealant area. Otherwise the dental assistant escorts the next student from the classroom to the operatory. This process is repeated until all eligible students in the classroom are seen.

Student Flow When a Qualified Dental Hygienist Is Allowed to Assess for Dental Sealants

Where qualified dental assistants are allowed to apply dental sealants and a second operatory is in place, two students can be brought back to the sealant area at the same time. The dental hygienist assesses the dental assistant’s student first and then the second student. Both operators apply sealants at the same time. The same process of escorting or sending each student back to his or her classroom and escorting or sending the next student to the sealant area is used.

This same process can be used in the few states where a dentist must be present at all times during the assessment and application of dental sealants in school-based settings.

Student Flow When a Qualified Dental Assistant Is Allowed to Apply Dental Sealants

These processes minimize the amount of time that students are out of the classroom. However, it may be more difficult for the dental sealant team to determine how long it will take to complete each classroom.

Recording Assessment Findings

The following information is recorded in student charts during the assessment:

  • Assessment date
  • Caries history
  • Presence and location of untreated caries
  • Assessor code and signature
  • Presence and location of existing dental sealants
  • Location where sealants need to be placed
  • Any notes concerning the student’s behavior or specific health considerations or oral health needs

If electronic recordkeeping is used, students’ demographic information should be entered ahead of time to speed up the assessment process. This creates program efficiency and reduces the amount of time that students are out of the classroom.

After each student’s assessment is complete, the student may be given a reward (e.g., toothbrushing kit) for participating in the program before he or she returns to the classroom.

As soon as all assessments are completed for the day, the assessor signs the student charts or verifies the electronic records. If paper records are used, the responsible dental sealant team staff member organizes student records by classroom and separates the records of students who do not need sealants. Records can also be separated into two categories: students who require referral and students who do not. Step 9, Referral and Follow-Up provides additional information about referral. Meanwhile, the dental assistant prepares the assessment instruments for sterilization, if required, and the dental operatory for sealant application.

Indications for Dental Sealant Placement

CDC has convened two meetings of a workgroup consisting of experts in dental sealant research practice and policy, as well as caries assessment, prevention, and treatment. The workgroup also included representatives from professional dental organizations. In November 2009, the workgroup released recommendations on the use of dental sealant programs in school-based settings. These recommendations included the following guidelines on tooth-surface assessment and indications for sealant placement.

Table 8.1 outlines guidelines for tooth surface assessment.

Differentiate Between Cavitated and Non-Cavitated Lesions

Unaided visual assessment is appropriate and adequate.

Dry teeth before assessment with cotton rolls, gauze, or, when available, compressed air.

An explorer may be used to gently confirm cavitations (that is, breaks in the continuity of the surface); DO NOT USE a sharp explorer under force.

X-rays are unnecessary for sealant placement only.

Other diagnostic technologies are not required.

Sources: Gooch BF, Griffin SO, Gray SK, Kohn WG, Rozier RG, Siegal M, Fontana M, Brunson D, Carter N, Curtis DK, Donly KJ, Haering H, Hill LF, Hinson HP, Kumar J, Lampiris L, Mallat M, Meyer DM, Miller WR, Sanzi-Schaedel SM, Simonsen R, Truman BI, Zero DT; Centers for Disease Control and Prevention. 2009. Preventing dental caries through school-based dental sealant programs: Updated recommendations and reviews of evidence. Journal of the American Dental Association 140(11):1356–1365.

Fontana M, Zero DT, Beltran-Aguilar ED, Gray SK. 2010. Techniques for assessing tooth surfaces in school-based sealant programs. Journal of the American Dental Association 141(7):854–860.

Table 8.2 outlines indications for dental sealant placement on teeth that are sufficiently erupted for sealant application.

Tooth Status

Indications for Sealants

Caries-free teeth

Seal

Non-cavitated carious lesions

Seal

Teeth with cavitated lesions with no visual signs of dental caries

Do not seal; refer for treatment (if the student is unlikely to receive prompt treatment, dental sealants may be placed as an interim measure).

Teeth with cavitated lesions

Do not seal; refer for treatment (if the student is unlikely to receive prompt treatment, autraumatic restorative treatment [interim restorative therapy] may be delivered if it is within the dental team member’s scope of practice).

Source: Gooch BF, Griffin SO, Gray SK, Kohn WG, Rozier RG, Siegal M, Fontana M, Brunson D, Carter N, Curtis DK, Donly KJ, Haering H, Hill LF, Hinson HP, Kumar J, Lampiris L, Mallat M, Meyer DM, Miller WR, Sanzi-Schaedel SM, Simonsen R, Truman BI, Zero DT; Centers for Disease Control and Prevention. 2009. Preventing dental caries through school-based dental sealant programs: Updated recommendations and reviews of evidence . Journal of the American Dental Association 140(11):1356–1365.

Fully erupted molars can be sealed. Buccal and lingual surfaces with deep pits and grooves can be sealed as well.

The Ohio Department of Health developed a reference guide on how to visually assess the need for dental sealant placement that is used in all state-sponsored school-based dental sealant programs. In addition to providing a protocol for the visual assessment, images of non-cavitated and cavitated teeth and sealants needing repair are included.

 

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