Considerations for School Sealant Programs During the Coronavirus Disease 2019 (COVID-19) Pandemic

Background

School sealant programs (SSPs) are a very effective way to provide preventive oral health services to children who are at higher risk of developing cavities and less likely to receive private dental care.

Many SSPs have been suspended as communities respond to the coronavirus disease 2019 (COVID-19) pandemic. As programs are restarted, the information presented here can be used to protect the health, safety, and well-being of students, teachers, staff, and dental healthcare personnel (DHCP) who participate in SSPs.

This information is for:

  • Oral health programs that conduct SSPs.
  • DHCP who provide direct oral health services.
  • School administrators.

How to Decide Whether to Restart SSPs

CDC provides Indicators for Dynamic School Decision-Making to help schools determine when it is safe to open for in-person learning. Many schools have reopened with in-person learning and may be considering restarting their SSPs.

Oral health programs, school administrators, and state, local, territorial, or tribal health officials should work together to make decisions about whether to restart SSPs. Specifically, oral health programs should:

  • Work with school administrators and public health officials to develop policies to safely provide oral health services to SSP participants.
  • Balance the need to provide necessary preventive oral health services with the need to minimize risk to students, school staff, DHCP, and their families.
  • Use the Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic to help determine the scope of delivery of nonemergency care.
  • Consult with their state, local, territorial, or tribal health departments for current information about requirements specific to their jurisdictions and to determine how the degree of COVID-19 community transmission will affect local policies.
  • Monitor trends in local case counts and deaths, especially spikes in local cases, and other core indicators, such as the percentage of positive tests over the past 14 days. Work with public health officials to identify a threshold for canceling SSPs if local transmission increases. SSPs should follow all federal, state, local, territorial, or tribal health and safety laws, rules, and regulations that schools must comply with.
  • Work with state education agencies and local school administrators to understand region-specific recommendations for school programs.
  • Be prepared to follow site-specific guidance for additional precautions related to COVID-19.

How to Plan for Restarting SSPs

Before restarting SSPs, DHCP should:

  • Be familiar with and fully prepared to practice according to CDC’s Guidance for Dental Settings on how to provide oral health services during the COVID-19 pandemic.
  • Follow CDC’s guidance for Schools and Child Care Programs and any local school-specific policies while working in a school setting.

Oral health programs should:

  • Be familiar with each school’s designated COVID-19 point of contact who is responsible for responding to COVID-19 concerns. Oral health programs should work with this contact and with school administrators to determine a process consistent with school policies for screening both DHCP and SSP participants for fever and symptoms consistent with COVID-19 or exposure to others with SARS-CoV-2 infection. Factors to consider include who will be responsible for the screenings, where and when the screenings will take place, and what methods will be used.
  • Create a process to respond to SARS-CoV-2 exposures among DHCP and program participants.
  • Ask school administrators to contact the oral health program if an SSP participant develops signs or symptoms or is diagnosed with COVID-19 up to 2 days after participation in the SSP. The oral health program should also contact the school if DHCP develop signs or symptoms or are diagnosed with COVID-19. For more information on screening and exposures to SARS-CoV-2, see CDC’s Guidance for Dental Settings and the Interim Guidance for Case Investigation and Contact Tracing in K-12 Schools.
  • Work with school administrators to ensure that the SSP follows the school’s policies for grouping (cohorting, alternate schedules, staggered schedules) and transporting students.
  • Ensure that they have the correct amount and types of equipment and supplies to support the SSP. CDC’s burn rate calculator provides information to help healthcare providers plan and optimize the use of personal protective equipment (PPE) during the COVID-19 pandemic.
  • Create policies and standard operating procedures for waste disposal and environmental infection control that are consistent with school policies and state and local guidelines.
  • Work with school administrators or the school district engineer to choose an area to set up the SSP. The area must have good ventilation and be large enough to allow for adequate social distancing and spacing of patients at least 6 feet apart. It should have an adequate number of sinks for hand hygiene, space for clean storage and dirty storage, and places where staff can put on and take off PPE. The area must also have floors and surfaces that are easy to clean and disinfect. Carpeted floors and furniture with cloth upholstery are not recommended. They are harder to keep clean than nonporous, hard-surfaces and cannot be reliably disinfected, especially after spills of blood and body substances.

Other Factors to Consider

Before entering the school, ideally the designated COVID-19 point of contact or the school nurse should:

  • Take the temperature of all DHCP.
  • Ask all DHCP if they are experiencing any symptoms of COVID-19 or if they have been advised to self-quarantine because of exposure to someone with COVID-19.
  • Document this information in the appropriate program records.

If DHCP experience a work-related exposure to SARS-CoV-2, see CDC’s Guidance for Dental Settings for more information.

In addition, all DHCP working in the SSP should:

  • Review CDC’s Guidance for Dental Settings, which provides information on how to set up a treatment area to ensure at least 6 feet of space and physical barriers between patient chairs. DCHP can also consider setting up only one patient chair and treating one patient at a time.
  • Consider using a portable HEPA air filtration system to reduce aerosol concentrations in the room and increase the effectiveness of the air turnover time.
  • Screen all students for any signs or symptoms consistent with COVID-19 or exposure to someone with COVID-19 before they enter the treatment area. DHCP should follow the recommendations in the Guidance for Dental Settings and work with school administrators to determine methods consistent with school policies, as well as state and local policies. If a student has a fever or any other sign or symptom of COVID-19, oral health services should be postponed. The student should be taken to the school’s designated COVID-19 point of contact or school nurse for further evaluation and isolation from other students. For more information, see CDC’s Screening K-12 Students for Symptoms of COVID-19: Limitations and Considerations.
  • Follow the PPE recommendations in the Guidance for Dental Settings for treating patients without known or suspected COVID-19. If DHCP are transporting students between classrooms and the treatment area, they should remove their PPE when leaving the treatment area. DHCP should continue to practice universal source control and wear a mask over the nose and mouth at all times while in the school setting. DHCP working in schools in communities with moderate to substantial transmission are more likely to encounter people who are asymptomatic or presymptomatic. In these settings, they should also implement universal eye protection and wear eye protection in addition to their surgical mask at all times during clinical care.
  • Follow the recommendations for environmental infection control and sterilization and disinfection of patient care items in the Guidance for Dental Settings. Routine cleaning and disinfection procedures should be performed after each patient, including cleaning the surfaces before applying an Environmental Protection Agency (EPA)-registered, hospital-grade disinfectantexternal icon to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label. High-touch surfaces can be covered with barriers, and barriers should be changed between each patient.
  • Properly dispose of single-use devices and secure any contaminated reusable items for transport. Most of the waste generated during an SSP is general medical waste that can be disposed of with ordinary waste. Examples include used gloves, masks, gowns, lightly soiled gauze or cotton rolls, and environmental barriers (e.g., plastic sheets or bags) used to cover equipment during treatment. Pour blood, suctioned fluids, or other liquid waste carefully into a drain connected to a sanitary sewer system—if local sewage discharge requirements are met and the state has declared this an acceptable method of disposal. Wear appropriate PPE while performing this task.

All DHCP and program participants should follow physical distancing and source control policies when not involved in clinical care. CDC provides information on How to Select, Wear, and Clean Your Mask. If SSPs have a waiting area, chairs should be placed at least 6 feet apart. SSPs should follow the school’s guidance on how many children can be in one area at a time and should keep students from different classrooms or cohorts separated at all times.