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Dental Caries (Cavities): School-Based Dental Sealant Delivery Programs


What the CPSTF Found

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. This finding updates and replaces the 2000 CPST finding on School-Based or –Linked Sealant Delivery Programs pdf icon [PDF - 226 KB].

Summary of Results

Information about data variability is available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 579 KB].

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

Information about data variability is available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 579 KB].

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—4 studies with information on resource costs from the original 2002 economic review and 10 studies identified for the current review (search period January 2000-December 2014). All monetary values reported are in 2014 U.S. dollars.

Intervention Cost

  • Labor accounted for about two-thirds of the intervention cost per child in the included studies.

    Intervention Benefit

    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.

    • Intervention costs were lower when sealants were applied in less time or when dental hygienists, rather than dentists, were used to determine whether sealants were appropriate for individual students.
      • The second-most expensive cost contributor was one-time, single-use consumable supplies associated with infection control (e.g., masks, gloves).
      • Costs for these supplies likely were lower for interventions that screened students and applied sealants at the same visit.
      • Medical claims data and economic models were used to estimate the cost of dental treatment averted as a result of sealant placement.
      • Economic models were used to estimate the cost of parents’ averted productivity losses.
      • Cost effectiveness studies were conducted from a societal or healthcare payers’ (Medicaid) perspective.
        • 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, meaning the benefits either exceeded or matched the costs of the intervention.
        • 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.
          • When parents’ averted productivity losses were considered, three of the four estimates of net costs from the third study showed that the intervention was cost-saving or cost-neutral.
      • Estimates of averted caries were converted into disability adjusted life years and showed school-based sealant delivery programs were cost effective.


  • 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

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are 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?

Study Characteristics

  • In most of the included studies, analyses focused only on children who consented to the sealant program, rather than those who were eligible to participate. It is possible that excluding those who did not consent excluded data from highest-risk children.
  • 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.