School-Based and School-Linked Dental Sealant Programs

School-based and school-linked dental sealant programs (SBSP) are highly effective strategies for preventing tooth decay in children. School-based sealant programs provide pit and fissure sealants to children in a school setting, and school-linked programs screen the children in school and refer them to private dental practices or public dental clinics that place the sealants.

School-Based Dental Sealant Programs

School-based and school-linked programs generally target vulnerable populations that may be at greater risk for developing decay and less likely to receive dental care. When developing, coordinating, and implementing a SBSP, state oral health program strategies should

  • Promote policies that allow the use of dental personnel to the top of their licensure. State health departments may educate decision makers on the potential cost savings and increased utilization of school-based sealant programs when dentists are not required to be on site when the sealants are placed.
  • Develop referral networks. School-based and school-linked programs are encouraged to work with dental practitioners in their communities so they can provide referrals to dental homes for children who currently do not have one.
  • Increase efficiency. School-based and school-linked sealant programs are encouraged to collaborate with targeted schools to increase the number of children that can be seen in schools. Programs should work with school staff to identify children with dental needs and to ensure that parental consent forms are returned in order to increase the cost-effectiveness and efficiency of these programs.

Data collection and analysis. State health departments are encouraged to work with all school sealant programs in their state to systematically collect and analyze data in order to document program impact and efficiency. CDC has developed software (SEALS) that can assist sealant programs in their data efforts.

CDC grantee states are required to report the following measures related to SBSP coverage annually:

  • Percentage of eligible schools[1] with a school-based/linked sealant program.
  • Percentage and number of children attending these schools receiving at least one permanent molar sealant from SBSP stratified by grade and age.

CDC grantee states are required to report the following measures related to SBSP effectiveness annually:

  • Percentage of children with caries experience.
  • Percentage of children with untreated decay.
  • Percentage of children without sealants at screening.
  • Number of molar sealants placed.
  • Percentage of children referred for dental treatment.
  • Percentage of children with referrals for urgent dental treatment.

CDC grantee states should conduct an analysis documenting the effectiveness of their SBSP. This analysis should include baseline measures of sealant prevalence and first molar caries prevalence and severity.

CDC grantee states with advanced capacity should conduct an in-depth cost analysis of their school-based or school-linked dental sealant program. A sealant cost calculator tool will be available to the states in 2015.

Demonstrate progress and leadership. Over funding period, states should demonstrate significant progress toward increasing the proportion of eligible schools participating in a sealant program and the proportion of children in funded schools receiving at least one sealant. Additional elements of leadership include

  • Providing training and technical assistance to community sealant programs, providers, and other types of sealant programs.
  • Submission of sealant best practice approaches to ASTDD for sharing with other programs.
  • Reporting progress toward sustainability and institutionalization of sealant programs through leveraging of funding, partnership participation, billing Medicaid and/or SCHIP or other sources of support.

Reporting analysis of program quality assurance measures, such as sealant retention data.


[1] All public elementary or secondary urban schools with > 50% of students on the free/reduced lunch program and all rural schools are considered eligible for a school-based/-linked sealant program.


Additional Resources

Healthy People 2030: Oral Health Objectives

Comprehensive Dental Sealant Program Logic Model [PDF–33KB]

Sealant Efficiency Assessment for Locals and States (SEALS)

Guide to Community Preventive Services [Community Guide] – Oral Health

ASTDD Best Practice Approach Report: School-based Dental Sealant Programs

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