Dental Sealants & School-Based Prevention — Comprehensive Study Notes
Page 1
Topic & Speakers
Role of Sealants in the Control & Prevention of Dental Caries
Framed within “Health Promotion & Disease Prevention.”
Lecturer of record: Michelle Goldstein, DMD, Assistant Clinical Professor
Acknowledges adaptation from: Kristin Memoli, RDH and Heather Camhi, DDS, MPH, MS (Dept. of Pediatric Dentistry)
Essential Context
Sets the public–health lens: sealing pits/fissures = primary disease-prevention strategy.
Page 2
Professional Background / Credibility Signals
NYU College of Dentistry faculty; Director of Pediatric Outreach & Prevention Programs.
Practice site: “Rockaway Beach Orthodontics & Pediatric Dentistry,” NYC.
Visual collage of university seals (Brandeis, Boston U., NYU) → illustrates inter-institutional pedigree.
Key Take-away
Instructor has both academic & community-based experience → authority to discuss school programs.
Page 3
Evidence Base for School Programs
School-based prevention, esp. sealant programs, rank among leading evidence-based interventions for childhood caries control.
Practical meaning: large reach, high ROI, documented efficacy.
Page 4
Stated Goal
Demonstrate effectiveness of sealants for reducing caries prevalence.
Explore role of school-based sealant programs in serving vulnerable pediatric populations.
Page 5
Session Objectives
Explain evidence behind sealant effectiveness in caries prevention.
Define a “school-based sealant program” & quantify its impact on oral health of school-aged children.
Critically list pros/cons of sealants when operating in a school setting.
Page 6 – The Classic Caries Triad (Modified)
Bullet chart shows that caries require simultaneous presence of:
Fermentable carbohydrates in diet.
Cariogenic bacteria.
Susceptible tooth surfaces (host factor).
Sealants mainly target susceptible tooth component by creating a physical barrier.
Page 7 – Why Sealants?
Fluoride is superb for smooth surfaces but less so for occlusal pits & fissures → majority of lesions.
Brush bristles & saliva fail to reach deep grooves; acid neutralization slower.
Implication: combining fluoride + sealants addresses both surface types.
Page 8 – Tooth-Level Risk Factors
Newly erupted enamel = higher organic matrix & permeability → easier acid diffusion.
Pit/fissure morphology fosters plaque stagnation.
Enamel thinner at base of pits/fissures → faster demineralization.
Molars erupt over extended period → prolonged exposure, harder OH.
Page 9 – Fissure Shapes & Brush Limitations
Micro-graph: depth 500\,\mu m.
Distribution of fissure types: V-type 34\%, U-type 14\%, I-type 1\%, IK-type 26\% (remainder implied).
Illustrates that toothbrush bristle cannot fully enter most pits.
Page 10 – Epidemiologic Facts
• Pit/fissure caries ≈ 90\% of caries in permanent posteriors & 44\% in primary teeth.
• NHANES 2015-16: overall caries prevalence ages 2!\text{–}!19 = 45.8\%.
– Ages 2!\text{–}!5 → 21.4\%
– Ages 6!\text{–}!11 → 50.5\%
– Ages 12!\text{–}!19 → 53.8\%
• Adult sealant prevalence: 5\% (ages 18!\text{–}!24); 2\% (ages 25!\text{–}!39).
Significance: Need persists beyond childhood, but uptake drops sharply in adulthood.
Page 11 – CDC Key Metrics
Sealants prevent 80\% of molar cavities (where \tfrac{9}{10} occur).
60\% of U.S. children 6!\text{–}!11 lack sealants.
Low-income kids 20\% less likely to receive sealants vs. higher-income peers.
Ethical Lens: Equity gap is both socioeconomic & racial.
Page 12 – Definition of a Sealant
Thin, protective coating of resin or glass-ionomer placed on occlusal surfaces of posteriors.
Functions: Blocks food/plaque impaction; isolates enamel from bacterial acids.
Page 13 – Historical Timeline
• 1955 – Buonocore introduces phosphoric-acid etch → resin adhesion revolution.
• 1965 – Cueto fabricates first clinically intended sealant.
• 1970 – Light-cured resin by Buonocore.
• Mid-1970s – Glass ionomer sealants appear (fluoride-releasing).
Trend: Constant enhancement toward ease, retention, & fluoride delivery.
Page 14 – Contemporary Sealant Categories
Resin-Based (RB)
Self- or light-cured.
Micromechanical bonding after etch.
Requires dry field.
Glass Ionomer (GI)
Self-cured acid-base.
Chemical bond to tooth; fluoride release.
Can tolerate moisture → valuable in field programs.
Generates minimal/no aerosol (COVID-era relevancy).
Both demonstrate “significant” preventive effect.
Page 15 – Resin-Based Variety
Opaque / tinted ↑ detectability vs. clear (needs tactile eval).
Both light- & auto-polymerizing versions exist.
Clinical pearl: choose color that supports easy recall audits.
Page 16 – Sealants on Primary Molars
Considerations
Shallower pits may obviate need; still risk-based decision.
Medicaid reimbursement inconsistencies by state.
Evaluate: caries risk, fissure anatomy, tooth’s remaining lifespan, patient cooperation.
Page 17 – Longevity Data
Functional lifespan: 5!\text{–}!10 years, contingent on retention.
Major failure mode = saliva contamination during placement → underscores isolation training.
Inspect & repair at recall visits.
Page 18 – Adult Sealant Indications
High-risk subgroups: xerostomia-inducing meds, head/neck radiation, disability limiting oral hygiene.
CONS: cost, limited insurance coverage.
Cost-benefit remains positive in truly high-risk adults despite out-of-pocket barrier.
Page 19 – Military Context
Personnel are relatively young but subject to high stress → amplified caries risk; sealants part of readiness policy.
Broader point: occupational settings can also host on-site sealant programs.
Page 20 – Decision Matrix “To Seal or Not to Seal”
Best predictors of future pit/fissure decay:
Past caries experience (patient-level).
Fissure anatomy (tooth-level).
Home-care & plaque load (behavioral).
Risk-based application is evidence-aligned & cost-efficient.
Page 21 – Longitudinal Efficacy
• >80\% caries reduction in permanent molars for first 2 years post-placement.
• 50\% protection persists up to 4 years.
Utilization Gap
Low-income vs higher-income disparity; >80\% of low-income kids without sealants will develop a cavity vs 52\% of higher-income.
Policy implication: closing sealant gap could halve disease burden in vulnerable cohorts.
Page 22 – NHANES Trend Graph
Low-income children with sealants rose from 23\% (1999-2004) → 39\% (2011-14).
Higher-income from 39\% → 48\%.
Progress but still below Healthy People targets.
Page 23 – Cavities per 100 Children (Visual)
Without sealants: low-income children experience 82 first-molar cavities / 100 kids vs 29 with sealants. Similar though lower ratios in higher-income cohort.
Interpretation: absolute disease prevented is greatest where baseline risk is greatest → justifies program targeting.
Page 24 – Barriers to Utilization (Provider & System)
Technical skill deficiency / fear of sealing over occult lesions.
Insurance fee schedules inadequate.
Treatment-oriented vs prevention mindset.
Reluctance to communicate benefits to parents.
Auxiliary placement restrictions by state boards.
Regulatory barriers to school-based programs.
Limited public awareness & demand.
These multi-level barriers explain under-penetration despite strong evidence.
Page 25 – Why Sealants Fail (Clinical)
Moisture contamination (isolation failure).
Clinician inexperience.
Uncooperative patient movement.
Educational insight: Simulation labs must emphasize rubber dam/dry-field techniques & behavior management.
Page 26 – Safety: Bisphenol A Discussion
BPA detected at trace levels on some resin sealants.
Estimated dental contribution ≈ 0.001\% of total BPA exposure → negligible, far below international safety thresholds.
Multiple literature reviews (2018) concur on safety; risk–benefit heavily favors sealant use.
Page 27 – Healthy People 2030 Objective OH-10
Metric: Increase % of 3!\text{–}!19 yr-olds with ≥1 sealed molar.
Baseline (2013-16): 37.0\%
Latest (2017-20): 25.4\% – trend getting worse (COVID-19 likely factor).
Target 42.5\%.
Public-health urgency underscored by declining trend.
Page 28 – Visual: Sealant Placement Process & School Reach
3-panel schematic from CDC: tooth ➔ application ➔ sealed.
“School-based programs are one way to reach millions of children.”
Page 29 – Definition: Community-Based Oral Healthcare
Deliver dental services where people live, work, learn, worship.
Goals: education, access improvement, risk-factor identification, prevention, embed oral health in existing infrastructures.
Connection: Mirrors CDC’s socio-ecological model; upstream determinants.
Page 30 – Access to Care Crisis
\approx59\,\text{million} U.S. residents in dental Health Professional Shortage Areas (HPSAs).
New York: 2.8\,\text{million} in HPSAs.
For vulnerable kids, school may be only point of dental contact.
Ethical angle: duty to bridge geographic/provider gaps.
Page 31 – Rationale for School-Centered Strategy
Boost oral-health literacy in high-risk kids.
Instill lifelong habits.
Tackle social determinants (family/peer influence, access).
Deliver age-targeted services at susceptible windows (eruption stages).
Develop care-management systems & connect to dental homes.
Source: SBH Alliance & Oral Health 2020 Network.
Page 32 – Impact on Education & Equity
School oral-health programs cut missed classroom hours & blunt long-standing racial/ethnic dental inequities.
Broader benefit: oral health ↔ academic performance.
Page 33 – Barriers Eliminated by School-Sealant Programs
• Lack of insurance
• Parent work absence
• Student class absence
• Language & transportation hurdles
• Social/cultural reservations
Concept: “Bringing care to the child” neutralizes traditional access vectors.
Page 34 – Structural Features of School Programs
Target vulnerable populations (≥50 % free/reduced lunch typically).
Operate in-school via portable equipment, vans, or fixed clinics.
Design principle: flexibility to adapt to facility constraints.
Page 35 – Documented Benefits & Cost-Effectiveness
Reduces racial/economic disparities; leverages “captive audience.”
Children keep learning; parents keep working.
CDC estimate: sealing \approx7\,\text{million} low-income children could save \$300\,\text{M} in treatment costs.
Task Force meta-analysis: mean 60\% decay reduction up to 5 yrs.
Economic lens: programs become cost-saving after 2 yrs; \$11.70 saved per sealed tooth over 4 yrs.
Page 36 – Operational Challenges
• Patient-specific: value perception, consent logistics without parent present.
• Infrastructure: adequate space, sink, electricity, instrument transport.
• Referral & follow-up for restorative needs identified.
Lesson: requires multi-stakeholder coordination & robust tracking.
Page 37 – CDC Cost Study Summary
Programs serving high-risk children yield benefits > costs; break-even at 2 yrs → net savings thereafter.
Key Quote: “School-based Sealant Programs Work!!!”
Page 38 – School Eligibility (NY Guidelines)
≥50\% students on free/reduced meals.
Space ~80\,\text{ft}^2 + sink nearby.
On-site “dental champion.”
Grades 2–3 (first molars) & Grade 6 (second molars) present.
NY State Department of Health approval.
Page 39 – New York Oral Health Survey (2009-11)
40.1\% of 3rd-graders had sealant on ≥1 molar.
44.1\% had treated/untreated decay.
22.1\% had untreated decay.
Gap highlights unmet preventive need.
Page 40 – State Policy Benchmarks
Grading criteria:
• % high-need schools served
• Hygienist placement authority w/o prior exam
• National database participation
• Student coverage proportion.
Best-practice frameworks guide policymakers.
Page 41 – Pew Grades (2013)
New York State: C (“falling short”).
Comparison: New Hampshire =A, Hawaii =F.
Advocacy pointer: legislative modernization can raise grade.
Page 42 – NYU Dental Student Involvement
Services delivered by D2 students within program:
• Oral-health education
• Screenings
• Fluoride varnish
• Sealant placement
• Referrals & follow-up
Educational synergy: public-health curriculum meets clinical skill development.
Page 43 – Current Partner Schools (Examples)
PS 1, PS 42, PS 64, PS 140, PS 184 (Chinatown, LES, East Village).
Illustrates geographic clustering in underserved NYC neighborhoods.
Page 44 – Equipment Logistics (Photo Slide)
Visual list of portable dental units, sterilization boxes, PPE, etc.
Practical note: must meet infection-control regulations in non-traditional settings.
Page 45 – Creating a Program: 4-Step Blueprint
Identify school partner.
Cultivate relationship with “dental champion.”
Integrate into school culture (events, comms).
Educate staff & administration (annual trainings, resources).
Page 46 – Step 1 Detailed (NYC Example)
Partnership with NYC & NYS Dept. of Health helps pinpoint schools with unmet dental needs (HPSA, FRL %).
Completion of SBHC-D application to NYSDOH necessary.
Page 47 – Using Demographic Data (P.S. 188 Case)
Dashboard shows:
• Enrollment 407, 89\% attendance, 94\% FRL, ethnic/racial mix.
Take-away: Data-driven selection ensures resource allocation matches need.
Page 48 – Step 2: Role of Dental Champion
Nurse, parent coordinator, principal, teacher, social worker may act as liaison → smooth consent flow, space coordination, student pull-outs.
Page 49 – Step 3: Integrate into Community
Parent workshops, health fairs, PTA meetings showcase oral-health value.
Branding (“Bringing Smiles to NYC Schools”) builds trust & visibility.
Page 50 – Step 4: Educate School Staff
Annual teacher in-services about recognizing oral disease & reinforcing brushing.
Supply classroom teaching aids.
Behavioral science insight: teachers become oral-health influencers.
Page 51 – Bilingual Medical/Dental History Forms
Collects demographics, medical conditions, habits, fluoride exposure, pain history.
Multilingual (English/Chinese) to overcome language barriers.
HIPAA & FERPA compliance essential.
Page 52 – Student Learning Outcomes
Participation benefits dental students:
High-volume pediatric examinations; age-specific development recognition.
Enhanced communication & behavior-guidance (Tell-Show-Do).
Real-world application of public-health & advocacy coursework.
Appreciation of health equity & cultural competence.
Page 53 – Evidence-Based Conclusion (Lecture Slide 54)
Sealants: safe, superior to fluoride varnish in pits/fissures, and cost-effective.
Should be integral part of comprehensive caries-management strategy.
Page 54 – “5 P” Public-Health Framework
Principles: Health promotion, prevention, disease management, equity.
Problem: Dental caries.
Population: Children.
Program: Sealant initiatives.
Progress: Evidence proves effectiveness & cost-savings.
Page 55 – Closing & Contact
“Thank you!! Any Questions?”
Email: mfg305@nyu.edu
Reinforces openness to further inquiry & mentorship.