Dental Sealants Can Improve Children’s Oral Health
By Kristine Goodwin | Vol . 22, No. 41 / November 2014
Did you know?
Dental sealants applied in school-based programs reduce tooth decay by as much as 60 percent.
- One-third of U.S. children ages 6 to 19 have sealants.
- A Colorado Department of Public Health and Environment analysis found that every $1 spent on a school sealant program saved $2 in treatment costs.
Tooth decay is the most common chronic disease for U.S. children—more than one-quarter of children have tooth decay before they enter kindergarten. It is more prevalent among children from lower-income families and children of certain racial and ethnic groups, according to the Centers for Disease Control and Prevention (CDC). Costly for families, communities and states, untreated tooth decay can lead to pain and infection, missed school days, and problems with eating and speaking. Dental expenses for U.S. children ages 5 to 17 were about $20 billion in 2009—almost 18 percent of all health care costs for this group. The financial burden on state budgets is significant. According to a 2013 report from the Pew Charitable Trusts, annual Medicaid spending for dental services is expected to increase by 170 percent—from $8 billion in 2010 to $21 billion in 2020.
Most dental disease can be prevented through early identification and early and effective care, such as dental sealants and fluoride treatments. Sealants—plastic coatings applied to vulnerable molars—help prevent decay and may save money by preventing the need for dental-related emergency room visits and other costly dental care. Some concern exists that sealants may contain trace amounts of Bisphenol A (BPA), a chemical used in plastic products and food packaging. One-time application of sealants has not been found to provide chronic exposure, and applying sealants properly considerably reduces exposure. Based on a review of evidence about sealant safety and risks, the Association of State and Territorial Dental Directors recommends sealants for all children. The CDC reports that only onethird of U.S. children ages 6 to 19 have sealants. The Task Force on Community Preventive Services—an independent, multi-disciplinary task force appointed by the CDC—strongly recommended school sealant programs, and the Healthy People 2020 initiative set goals for increasing the number of children and adolescents who have molar sealants.
Despite these efforts, sealant treatments for children remain low, and states have struggled to increase their use for all children, particularly those most at risk for dental disease. As of 2011, only 11 states had met the Healthy People 2010 objective that 50 percent of 8-yearolds have dental sealants.
States have adopted several strategies to increase sealant use among children and remove barriers to access.
School Sealant Programs. Sealants administered in school have been shown to decrease decay for children and adolescents by 60 percent. They also can reduce dental health disparities and lead to follow-up care and enrollment in health insurance. School sealant programs exist in most states and vary in scope, complexity, funding methods and other factors. According to a 2013 report by The Pew Charitable Trusts, successful sealant programs target high-need children, use a cost-efficient workforce, and eliminate reimbursement and regulatory barriers for providers. Some programs arrange to apply sealants at school-based clinics or in mobile vans, while others link schools to private dental practices where children can receive the services. Faced with multiple pressures to raise achievement levels, however, some schools may lack resources or time to provide oral health services, especially if dental care competes with time allotted for classroom instruction. In 2013, Colorado lawmakers established a grant program to support school-based dental sealant programs, community water fluoridation and other strategies. Ohio also provides grants for school sealant programs that target low-income children.
Workforce. Policymakers have taken steps to expand access to and reimburse for sealant services and providers. Laws in several states allow certain providers to apply sealants in schools or other public health settings. These policies not only expand access to preventive services, especially for underserved children and adolescents, but also address quality and patient safety issues. In 2011, Arkansas lawmakers created a collaborative care program that allows qualified dental hygienists—who collaborate with consulting dentists—to provide sealants and other procedures in public health settings. A 2009 Massachusetts law authorized public health dental hygienists to provide sealants and certain other preventive services without a dentist’s prior examination. The law also allows reimbursement under Medicaid and the Children’s Health Insurance Program (CHIP).
Medicaid and CHIP. States are required to provide oral health benefits to children enrolled in Medicaid and CHIP. Some states have adopted Medicaid policy changes to improve dental access and use, incorporate evidence-based clinical guidelines, and maximize provider participation in Medicaid and CHIP. In 2008, Wyoming Medicaid began reimbursing providers for sealing primary molars—not just permanent ones—as recommended by the American Academy of Pediatric Dentistry.
Data and Surveillance. Policymakers have enacted data and surveillance strategies that help them understand oral health challenges and unmet needs and develop targeted responses. For example, Colorado and Wisconsin use data to evaluate the effectiveness and efficiency of their school sealant programs as well as to allocate funding.
The Affordable Care Act requires individual and small group health plans to provide coverage for children’s oral health services as an essential health benefit. The law also addresses prevention and treatment through various grant programs, including those for school-based dental sealant programs. CDC currently provides funding to 21 states to implement school-based or school-linked sealant programs and to collect and report data to assess their effectiveness.