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Evidence indicates sealants improve children's oral health

School-based sealant programs are an effective public health approach to preventing caries, according to a November article in The Journal of the American Dental Association that reinforces the evidence that such programs help improve the oral health of children, especially those from vulnerable populations.

The article contains updated recommendations for school based programs, which complement the ADA's 2008 evidence-based clinical recommendations on the use of dental sealants. The recommendations were developed by a Centers for Disease Control and Prevention work group put together at the behest of the Association of State and Territorial Dental Directors to assist community health programs seeking to improve the oral health of school children.

Dental sealant programs typically target schools that serve large populations of low-income children and focus on sealing newly erupted permanent molar teeth. They work in collaboration with local dentists, dental associations, school nurses, administrators, public health clinics and parents. The new recommendations are designed to assist state and community oral health programs interested in implementing their own programs and also to assist private practitioners who provide care in school-based settings.

"School-based dental sealant programs increase sealant use and reduce tooth decay," said Dr. Barbara F. Gooch, CDC Dental Officer and the report's lead author. "Although we have evidence that dental sealants provided in school programs can prevent about 60 percent of tooth decay in sealed permanent posterior teeth, this preventive intervention is underused, especially in children from low-income families."

Nationally, one in five children from low-income families currently have sealants, the article states, and are nearly twice as likely to have decay in their permanent teeth.

"We hope that by reading this article dentists will become more aware of the effectiveness of school-based sealant programs and have the information they need to advocate for and encourage collaboration with public health efforts," Dr. Gooch said. "Our overall national goal is to decrease the burden of disease. Prevention is key as is working together."

Dr. William Kohn, director of the CDC Division of Oral Health and a co-author of the report, stressed the need for the dental profession as a whole to support school-based sealant programs as part of the solution to the access to care crisis.

"The best thing we can do is to prevent disease in the first place," he said. "We're not going to treat our way out of the childhood caries and disparities problem. We need to prevent it where it's occurring, and children are in that group."

"We all have to work together in this country to maximize opportunities to prevent dental disease," echoed Dr. Gooch. "We have to maximize prevention."

Said ADA President Ronald L. Tankersley, "The two most prevalent dental diseases, dental caries and periodontal disease, are both preventable. The proper use of dental sealants at an early age is an effective tool for preventing dental caries in the most susceptible patients. Unfortunately, there are many patients who still have inadequate access to this effective preventive measure."

The new recommendations state that programs:

  • should seal pit-and-fissure tooth surfaces that are sound or have early decay, prioritizing first and second permanent molars;
  • should use visual assessment to differentiate surfaces with the earliest signs of tooth decay from more advanced lesions;
  • consider a toothbrush prophylaxis as an acceptable method to clean the tooth surface before acid etching;
  • should use four-handed technique to place sealants, when resources allow.

The recommendations also say that sealants should be provided to children even if follow-up examinations for every child cannot be guaranteed because "research has found that teeth with fully or partially lost sealants were not at greater risk for developing decay compared with teeth that were never sealed."

In Ohio, dental care is the "No. 1 unmet health care need" for children, according to Dr. Mark Siegal, chief, Bureau of Oral Health Services, Ohio Department of Health, and a co-author of the report.

Dr. Siegal said the state began funding local agencies to place sealants in the 1980s when the State Department of Health targeted schools where 50 percent or more of the children received reduced-fee or free lunches. The sealants were then offered to the entire second/third and sixth/seventh grades after securing parental permission.

A recent analysis of Ohio data led the Department to lower the lunch program enrollment threshold to 40 percent of children at a school. More than 30,000 Ohio children receive sealants through school-based programs each year. For the schools that participate, 59 percent of their higher-risk kids (for example, those eligible for Medicaid, the school lunch program, uninsured and not having a recent dental visit) have sealants. In those schools without programs, only 29 percent have sealants.

"The more we understand about sealant programs, the better. The greatest help a dentist can be is to be a friend of the SBSPs," Dr. Siegal said. "If a child has decay on a tooth that requires a restoration, he/she has a need beyond the scope of the program. If a dentist is willing to volunteer to provide that needed care, that's the greatest gift of all. It's Give Kids A Smile all year-round."

For clinicians interested in getting involved with school-based sealant programs, Dr. Gooch recommended they contact their local health department or state or local dental association. In some cases, the most important thing clinicians can do is volunteer their services for follow-up care to children who may have caries too advanced for sealants to do any good.

Said Dr. Gary Rozier, who chaired the work group and is a professor of Health Policy and Management at the University of North Carolina at Chapel Hill, "Sealants are a major public health intervention that is underutilized. Dentists in communities without a SBSP should advocate for one as a cost-effective strategy to help reduce dental disease."

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