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Sealants: The Added Link in Prevention

Course Number: 673

Public Health Programs

Pit and fissure sealants can be placed in many settings; therefore, it is a portable procedure. This has led to many uses by public health dentistry. Most of the historical studies that were used to determine the efficacy of dental sealants were done in public health settings. Since this procedure can be done with minimal equipment and costs, those with access problems can be accommodated. There are governmental programs such as “Seal America” and SEALS which provide resources for community groups to start sealant programs.

A 2018 systematic review and meta-analysis concluded that “It seems that GIC-based sealants, with their lower technique sensitivity, good adherence, and fluoride-releasing properties, have an additive effect of being a sealant and fluoride provider for the prevention of occlusal caries. Therefore, GIC-based sealants may be a good alternative to RBSs specifically in community procedures when there is limited equipment, no chairside assistant for the dentist or dental hygienist, and a considerable number of children at high risk of developing caries.”6

A 6-year prospective open cohort study in 33 US public elementary schools which utilized GICs demonstrated a 50% reduction in the prevalence of untreated caries. The study provided care to 6,927 children including dental hygienists that provided twice-yearly prophylaxis, glass ionomer sealants (e.g., HVGIC, Fuji IX, GC America), glass ionomer interim therapeutic restorations, fluoride varnish, toothbrushes, fluoride toothpaste, oral hygiene instruction, and referral to community dentists as needed.19

There has been more focus on population-based health at the state and national level. United States Public Health Service has established a national health objective for the year 2020 to increase the proportion of children and adolescents who have received dental sealants on their molar teeth. Oregon’s Senate Bill 660 states “By using evidence-based data and best practices, the Oregon Health Authority shall promote oral health throughout this state by ensuring the availability of dental sealant programs to students attending school in Oregon.” A report released by the Centers for Disease Control and Prevention in 2016, reported that overall sealant use prevalence has increased to 46% during the period of 2011-2014 as compared to 31% measured from 1999-2004 but disparities still exist among socioeconomic groups.20 Pew Children’s Dental Campaign released a report focusing on prevention, examining states’ efforts to improve access to sealants for low-income kids. They reported that 39 states and the District of Columbia do not have sealant programs in a majority of high-need schools—those with a high proportion of children most at risk of decay. Unfortunately, two states have no programs in these schools. “Only 13 states have met the Healthy People 2010 goal of sealing the permanent molars of at least half of their 8-year-olds.”21