By Tony Edwards, editor in chief

May 14, 2014 -- As dental sealants may help cut the rate of tooth decay in a child's most cavity-prone teeth by up to 60%, the U.S. Community Preventive Services Task Force recommended last year that school-based sealant programs (SBSP) be used, or increased, to prevent decay in children's teeth.

While there is broad consensus that dental sealants are effective, funding for such school-based programs is not consistent throughout the U.S. These programs also often face financial and other challenges that can limit their effectiveness.

“General and pediatric dentists play an important role in reinforcing the value of dental sealants to parents.”
— Patrice Pascual, executive director, Children's Dental Health Project

This week, the Children's Dental Health Project (CDHP) released a new report that outlines the difficulties faced by school-based sealant programs. The study was able to identify more than 640 of these programs, with most delivering sealants as part of a broader school-affiliated caries prevention program that may include dental screening, dental prophylaxis, topical application of fluorides, and oral health education.

And, as Patrice Pascual, executive director of CDHP told, general and pediatric dentists have a crucial role in helping care for and advance these programs.

"General and pediatric dentists play an important role in reinforcing the value of dental sealants to parents," she said. "And because school sealant programs rarely provide restorative care, program managers and area dentists can work together to meet the needs of children for follow-up care."

The CDHP's report, based on a series of surveys and interviews from officials in 39 states and the District of Columbia, listed four keys to success for SSPs:

  • Financing: While many approaches can support effective SSPs, the report calls it "critically important" for states to be able to bill Medicaid or a state's Children's Health Insurance Program (CHIP) when providing services to enrolled children.

  • Partnerships and collaboration:For the most part, those sealant programs that are successful had state oral health programs that acted as leaders and facilitators. These leaders and facilitators arranged partnership agreements and formalized contracts for quality control of local SSPs.

  • Cost efficiencies: The report found that efficient programs maintained effective administrative structures and tracked accountability. Some of the states surveyed have dental practice acts that permit dental hygienists to place sealants in public health settings under general supervision.

  • Adaptability: Successful SSPs recognize and respond creatively to the changing political, policy, and administrative landscapes.

As the report notes, the Patient Protection and Affordable Care Act may authorize the expansion of school-based health centers by tying dental benefits for children to "benchmark dental plans" that mostly include coverage for dental sealants to age 16, and also by determining that the only preventive services that must be provided at no cost to the beneficiary are those receiving an A or B grade (recommended) from the U.S. Preventive Services Task Force.

As with any program such as this, sources of funding are an issue. The report notes that sources of financing include, but are not limited to, the following:

  • State oral health grants -- competitive five-year cooperative agreements with states from the Centers for Disease Control and Prevention Division of Oral Health through its State-Based Oral Disease Prevention Program
  • The Title V Maternal and Child Health Services Block Grant Program that states may allocate to oral health programs
  • Grants to states under the Health Resources and Services Administration Bureau of Health Profession's State Oral Health Workforce Grants
  • Reimbursements from Medicaid through the state-administered Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) pediatric dental benefit and the state's CHIP (in states that maintain CHIP plans separately from Medicaid EPSDT)

In addition, states and locales may provide direct funding for SSPs through general revenues by way of grants, contracts, and cooperative agreements; also, foundations, professional associations, and other nonprofits may provide charitable financing. Industry may provide discounts for dental materials and supplies to safety-net programs, including SSPs. While not common, SSPs may also collect fees from commercial insurers when children served have private dental coverage.

Ultimately, as the cost of preventing tooth decay by placing dental sealants through SSPs is considerably less than the cost of treating caries, expanding the reach and effectiveness of these programs can prevent the most common cavities in the permanent teeth of school-age children and also reduce overall healthcare costs, according to the CDHP. Prevention has consistently been shown to be a powerful tool for not only cost savings, but for measurable improvements in the health and well-being of children who are at greatest risk for the significant consequences of unaddressed tooth decay.

Copyright © 2014

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