Dental Caries (Cavities): School-Based Dental Sealant Delivery Programs
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) recommends school-based programs to deliver dental sealants and prevent dental caries (tooth decay) among children.
The full CPSTF Finding and Rationale Statement and supporting documents for Oral Health: Preventing Dental Caries, School-Based Dental Sealant Delivery Programs are available in The Community Guide Collection on CDC Stacks.
Intervention
Dental sealants are clear or opaque plastic materials applied to the chewing surfaces of the back teeth to prevent dental caries. School-based programs provide dental sealants to students in two settings:
- Onsite at schools using portable dental equipment
- Offsite in dental clinics
Programs may target the following:
- Entire schools in low income neighborhoods
- Individuals within a school, based on their risk for tooth decay
About The Systematic Review
The CPSTF finding is based on a systematic review of two types of evidence: evidence of effectiveness of programs that deliver sealants within school settings (4 studies; search period through October 2012), and evidence from one high quality systematic review of the efficacy of sealants among school-aged children (Ahovuo-Saloranta et al. 2013, search period 1946-2012; 34 included studies). The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to oral health.
Study Characteristics
- The majority of evidence came from studies of children aged 5-10 years
- Included evidence comes from studies conducted in the U.S. and Europe
- All studies assessed sealants applied within the school setting, as opposed to off-site in dental clinics
- Most of the data for effectiveness of school-based sealant delivery programs are from areas of middle to low socioeconomic status
Summary of Results
Programs that delivered sealants within school settings increased the proportion of students who received sealants and decreased occurrence of tooth decay.
- Implementing a sealant delivery program led to a 26 percentage point increase in the number of students who received sealants (2 studies). Greater increases were seen among students from low-income families
- Students who received dental sealants had a median of 50% fewer cavities up to four years later as compared with students who did not receive sealants (interquartile interval [IQI]: 38% to 61%; 2 studies)
- In the systematic review of sealant efficacy, dental sealants were shown to reduce dental caries by a median of 81% at 2 year follow up (IQI:74% to 88%; 12 studies)
Summary of Economic Evidence
Economic evidence indicates the benefits of school sealant programs exceed their costs when implemented in schools that have a large number of students at high risk for cavities. The economic review included 14 studies. All monetary values reported are in 2014 U.S. dollars.
Cost Effectiveness
A comparison of the median intervention cost to seal a tooth and the 4-year economic benefit suggests school-based sealant delivery programs become cost-saving within 2 years.
- From a societal perspective: Three of four studies reported school-based sealant delivery programs were cost-saving or cost-neutral based on cost per averted caries or per caries free child
- From a healthcare payers’ (Medicaid) perspective: Two of three studies found that interventions were cost-saving when delivered in settings where the children were at high risk for caries
Applicability
- Findings should be applicable to school-based, sealant delivery programs in communities throughout the U.S.
- Studies included in the review evaluated programs that used a variety of licensed dental professionals (e.g., dentists, dental hygienists, dental therapists) to place dental sealants. No evidence was found to suggest variation in longevity of sealants applied by different dental health professionals
Evidence Gaps
- The effect of school-based sealant delivery programs on racial or ethnic disparities in rates of dental cavities
- The use of school-based sealant delivery programs as part of multicomponent vs. single component programs
- The age at which sealants should be placed
- The need and timing for sealant maintenance
- The effectiveness of dental sealant application onsite and off-site
- The benefit of programs for children at moderate to low risk
Future studies should clearly describe methods by which schools are recruited and programs are implemented. Detailed information should be provided about the following:
- Who consents to participate and who does not?
- Why people do or do not choose to participate?
- The timing and quality of sealant information provided to schools and parents and the timing of parental consent
Finally, future research and evaluation should more clearly examine the costs and benefits of school-based dental sealant delivery programs. Specifically, research should address the following:
- To what extent dental fees and dental reimbursement rates adequately capture the actual resource costs to place sealants?
- What are the productivity losses associated with parents taking their child to a dentist for restorative care?
- What are the future productivity losses for students associated with missed school and lower academic performance attributable to untreated tooth decay?
- What are the specific costs of administering a school-based dental sealant delivery program, and how do they vary by area or setting?
Implementation Considerations and Resources
- Sealant application demands meticulous technique. Licensed dental health professionals should consult the manufacturer’s instructions for use of specific sealant products
- These programs can increase the identification of caries in children who do not regularly visit a dentist and improve access to dental health services by referring children who need dental treatment
- Educating parents, children, and teachers about the benefits of dental sealants may increase program acceptance
- When individual children within a school are targeted for intervention, there may be an associated stigma (when compared with programs that target entire schools)
- Ideally, sealants should be applied as soon as possible after tooth eruption
- Maintenance is encouraged, but a lack of resources or opportunities to maintain sealants should not prevent their use with high risk children
- Sealant delivery programs can be an important way to reach children from low-income families who are at higher risk for caries and less likely to access clinical care
Crosswalks
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.