Implementation of School Sealant Programs

The Community Preventive Services Task Force strongly recommends school-based sealant delivery programs to prevent cavities among children. The following guidelines and recommendations, clinical studies, and additional resources are relevant to running a school sealant program:

Guidelines and Recommendations

Preventing Dental Caries Through School-Based Sealant Programs: Updated Recommendations and Review of Evidenceexternal icon,” published in the November 2009 issue of Journal of the American Dental Association (JADA) provides guidance to using school-based sealant programs. The recommendations were developed by a CDC work group of experts in the fields of cavity prevention and treatment, oral epidemiology, and evidence-based reviews. The work group also included representatives from professional dental organizations. The expert work group examined new evidence on the following:

  • The effectiveness of sealants in preventing new decay and progression of early decay.
  • Methods to assess decay.
  • Sealant placement techniques.
  • Scientific reviews of program practices.

On the basis of this evidence, the following recommendations are provided for practitioners in school-based programs:

  • Seal all pit-and-fissure tooth surfaces that are sound or have early decay, prioritizing first and second permanent molars.
  • Use visual assessment to differentiate surfaces with the earliest signs of tooth decay from more advanced lesions.
  • Avoid using X-rays solely for sealant placement.
  • Use a toothbrush to help clean the tooth surface before acid etching.
  • Have an assistant help the dental professional place sealants when resources allow.
  • Provide sealants to children even if follow-up examinations for every child cannot be guaranteed.

These recommendations are designed to guide practices of state and community public health programs for planning, carrying out, and evaluating school-based sealant programs, as well as to complement the American Dental Association (ADA) Council on Scientific Affairs’ article “Evidence-Based Clinical Recommendations for Sealant Useexternal icon” published in the August 2016 issue of the Journal of American Dental Association (JADA).

  • The Implementation of Evidence-Based Preventive Interventions: School-Based and School-Linked Dental Sealant Programs website describes requirements related to dental sealant programs of states funded by a CDC cooperative agreement.
  • Seal America: The Prevention Inventionexternal icon is an online manual designed to assist health professionals initiate and carry out a school-based dental sealant program.
  • Dental Sealants: Proven to Prevent Tooth Decayexternal icon is a report, published by the Children’s Dental Health Project that used research funded by CDC to explore the factors that shape school sealant programs’ ability to reach more children in effective, sustainable ways. The report was published using data from a series of surveys and interviews with stakeholders across the country.

Clinical Studies

  • Participants who received sealants had a reduced risk of developing cavities in permanent molars by 80% when compared with those who did not receive sealants.
  • When compared with fluoride varnishes, the authors found that sealants reduced the incidence of cavities after 7 or more years of follow-up.
  • The evidence base supporting sealants suggests that they are effective and safe to prevent or arrest the progression of cavities compared with a control without sealants or fluoride varnishes.
  • The Effectiveness of Sealants in Managing Caries Lesions,” published in the February 2008 issue of the Journal of Dental Research, is a study that shows if sealants are placed over early tooth decay, they will stop early decay from becoming a cavity. This information should lessen concerns about accidentally sealing over decay.
  • The Effect of Dental Sealants on Bacteria Levels in Caries Lesions: A Review of the Evidenceexternal icon,” published in the March 2008 issue of the Journal of the American Dental Association, is a study that shows sealing over tooth decay lowers the number of bacteria in the cavity by at least 100-fold.
  • Exploring Four-Handed Delivery and Retention of Resin-Based Sealantsexternal icon,” published in the March 2008 issue of the Journal of the American Dental Association, reports that for sealants to work, they must stay in place or be retained on the tooth. This study concludes that having a dental assistant help the dental professional place the sealant (four-handed technique) may improve sealant retention.
  • A Comparison of the Effects of Toothbrushing and Handpiece Prophylaxis on Retention of Sealantsexternal icon,” published in the January 2009 issue of the Journal of the American Dental Association, shows that cleaning the tooth’s surface with a toothbrush before applying dental sealants resulted in sealant retention at least as high as when a hand piece was used.
  • Caries Risk in Formerly Sealed Teethexternal icon,” published in the April 2009 issue of Journal of the American Dental Association, shows that teeth with fully or partially lost sealants did not have a higher risk of developing a cavity than teeth that were never sealed.
  • Techniques for Assessing Tooth Surfaces in School-Based Sealant Programs [PDF-467K]external icon,” published in the July 2010 issue of the Journal of the American Dental Association, states that authors conclude that visual examination is appropriate and adequate for caries assessment before placing sealants. The clinician should not use an explorer under force. In addition, X-rays are not indicated solely for the placement of sealants, and the use of magnification and caries detection devices is not necessary to determine cavitation.

Additional Resources