Preventing Dental Caries: School-Based or -Linked Sealant Delivery

Task Force Finding*

School-based or school-linked pit and fissure sealant delivery programs directly provide pit and fissure sealants to children unlikely to receive them otherwise. School-based programs are conducted entirely in the school setting, and school-linked programs are conducted in both schools and clinic settings outside schools. Such programs define a target population within a school district; verify unmet need for sealants (by conducting surveys); get financial, material, and policy support; apply rules for selecting schools and students; screen and enroll students at school; and apply sealant at school or offsite in clinics. Many programs target what are referred to as high-risk children with high-risk teeth. High-risk children include vulnerable populations less likely to receive private dental care, such as children eligible for free or reduced-cost lunch programs. High-risk teeth (i.e., those with deep pits and fissures) are the first and second permanent molars that erupt into the mouth around the ages of 6 and 12 years, respectively.

School-based and school-linked sealant delivery programs are strongly recommended on the basis of strong evidence of effectiveness in reducing caries on occlusal surfaces of posterior teeth among children.

Other potential positive and negative effects of school-based or school-linked sealant delivery programs have been mentioned but remain unsupported by empirical evidence of effectiveness. For example, successful programs may lead to the positive effects of (1) increased support for coordinated school-based programs to address related dental and nondental needs of children from low-income families (e.g., immunization and better nutrition); and (2) increased willingness of third-party payers to pay for sealants applied in all settings. Potential negative effects are expressed in concerns that (1) sealants containing Bisphenol-A may have estrogenic effects in the recipient; and (2) effective delivery of sealants (from all sources) might encourage recipients to ignore other anticaries interventions (e.g., use of fluorides).

Economic evaluation studies reported sealant program costs per person served ranging from $18.50 to $59.83 (median=$39.10). The cost effectiveness ratios (adjusted cost per averted decayed surface) ranged from cost saving (<$0) to $487. A hypothetical school-based sealant program that sealed first permanent molars would be cost saving if unsealed molars were decaying at the average rate of >0.47 surfaces per year.

*From the following publication:

Task Force on Community Preventive Services. Recommendations on selected interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. [PDF - 69KB] Am J Prev Med 2002;23(1S):16-20.

Review completed: February 2000