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Letters: Pew responds

May 06, 2013

Dr. James Gillcrist raised concerns ("My View: Tennessee Sealant Experience at Variance with Pew Report," March 4, ADA News) about the data and benchmarks to assess state performance in our report, Falling Short: Many States Lag on Dental Sealants. The Pew Charitable Trusts stands by its report, its methodology and conclusions.

Pew used the federal government’s Healthy People 2010 sealant goal—instead of the 2020 goal—because we felt it was unfair to grade states on a benchmark more than seven years before it was supposed to be achieved. Further, Pew did not use sealant data for low-income children—data that was collected by the Centers for Medicare and Medicaid Services—because officials there informed us that they did not have a high level of confidence in the quality of these 2010 statistics. In addition, relying on these data would underestimate state efforts because many sealant programs do not seek reimbursement from Medicaid.

Questions were also raised about whether sealant programs are obstructed by rules requiring a dentist’s prior exam before hygienists apply sealants. In 2009, Pew commissioned a report in which 35 experts—ranging from state dental directors to sealant program managers—were interviewed about barriers to expanding their school-based efforts. These experts concluded that reducing restrictions on dental hygienists was "without question the most frequently noted [policy]" that would help expand school-based sealant programs.

States recognize the prior exam requirement is outdated and unproductive, which is why 32 states have removed or loosened it. Virginia is one of them. The state removed its prior exam requirement, with leadership from the dental association, after a pilot program showed that doing so lowered costs 20 percent and allowed them to reach more children.

Sealants are high on the list of evidence-based health approaches that states can use to stem the tide of decay. Yet almost everywhere they are poorly funded, fragmented and rarely reach most low-income children. Our nation can do better.

While Pew’s first two 50-state reports included benchmarks on sealants, we chose to focus our third solely on sealants to raise the visibility of this preventive measure, provide a research basis for policymakers and assist advocates in improving sealant programs in their states.

A number of states have succeeded. Oral health advocates in Hawaii have drafted legislation to expand sealants. Stakeholders in Florida are using the Pew report this year as a catalyst for resolving Medicaid-related billing problems for sealant programs.

After Pew released its 2010 report, Arkansas legislators enacted laws to expand community water fluoridation, discard the prior exam requirement and reimburse medical staff for providing fluoride varnish to young children.

The state senator who sponsored these bills specifically cited Pew’s "F" grade as the impetus for his efforts.

In fact, Pew gets more complaints about high grades—which may slow momentum if policymakers are think the problem is "solved"—than low grades. Effective advocates can use low grades to argue for more funding and a stronger set of policies.

Sealants are a cost-effective strategy for reducing decay in children’s molars, their most cavity-prone teeth. Pew’s report uses valid benchmarks, the best available data and specific state case studies to paint a picture for policy-makers that more needs to be done. Pew is proud to join the efforts of advocates, dental providers, and state officials like Dr. Gilchrist in making sure that happens.

Shelly Gehshan
Pew Children’s Dental Campaign
Washington, D.C.