School-based Dental Sealant Program

1. School-based Dental Sealant Program Division of Dental Health, VDH Revised 2014 http://vdhweb/OFHS/Dental/websealantmanual.asp

2. Rationale for Dental Sealants • 90% of childhood decay now occurs in pits and fissure surfaces • Sealants proven effective in reducing decay on occlusal surfaces of permanent posterior dentition

3. Dental Sealant Programs • School-based sealant programs are a major preventative strategy and emphasis of the CDC • US Task Force on Community Prevention Services issued a strong recommendation for school-based sealant delivery program • Evidence shows a median reduction of 60% in occlusal caries with school-based sealant programs

4. Screening Logistics • Assess, seal and varnish in a single visit for optimum efficiency • Having at least one child “waiting” for treatment avoids downtime and creates a learning opportunity • All paperwork must be completed prior to screening (MAKE SURE AGE, DOB, SEX, ETC. ARE ACCURATE) • Review children’s medical histories and consult with the school nurse as needed • Children with asthma should have their inhaler • Children with diabetes should be asked if they have had their regular meals/snacks

5. Infection Control • CDC infection control policies to be followed at all times: • Barrier protection at all times • Change gloves between patients regardless of the visible state of the gloves. • Hands are washed with soap immediately before donning and after removing gloves. • Hand sanitizer may be used in lieu of hand-washing if preferred. • Wash hands between every patient

6. CDC infection control policies to be followed at all times including: • Clean and heat-sterilize semi-critical and critical dental instruments before each use. Allow packages to dry in the sterilizer before they are handled to avoid contamination. • Ensure that noncritical patient-care items are barrier-protected or cleaned, or if visibly soiled, cleaned and disinfected after each use with an EPA-registered hospital disinfectant. If visibly contaminated with blood, use an EPA-registered hospital disinfectant with a tuberculocidal claim. • Clean and disinfect all surfaces, and countertops at end of day. CDC: Guidelines for Infection Control in Dental Health-Care Settings --- 2003

7. Screening Guidelines & Criteria for School-Based Program • Evaluate and chart only permanent molars • Use I. Screening section of the form to mark tooth surfaces: • “D” for decay suspected • “F” for filled • “M” for missing • “S” for sealant present • “PS” to prescribe sealant • “PE” for partially erupted • “N/I” if sealant Not Indicated • Sign and date tx plan

8. Screening Guidelines & Criteria for School-Based Program • Assess teeth that are clean and dry under good lighting • Clean debris from teeth with air/water and explorer if needed. • Pits and grooves may be gently probed with a blunt explorer – Do not push into the grooves to see if it catches. • Not advised to use a sharp explorer. • Use good lighting • Remember to examine the buccal pits of mandibular molars and the lingual pits of maxillary molars.

9. Clinical Detection of Noncavitated Pit and Fissure Carious Lesions and Evidence-based Recommendation for Sealing Them • Visual examination after cleaning and drying the tooth is sufficient to detect early noncavitated lesions in pits and fissures. • Noncavitated lesions may appear as white demineralization lines or light yellow-brown discolorations surrounding the pit or fissure area. May also appear as light to dark yellow-brown demineralization in the pit or fissure. • The use of explorers is not necessary for detection of early lesions and forceful use of a sharp explorer may damage teeth. • Sealants should be placed on early (noncavitated) carious lesions in children, adolescents, and adults to reduce the percentage of lesions that progress. JADA, March 2008, Evidence-based Clinical Recommendations for the Use of Pit and Fissure Sealants

10. Screening Guidelines & Criteria Criteria to Identify Teeth that are Eligible for Placement of Dental Sealants Seal America, 2007 http://www.mchoralhealth.org/seal/index.html)

11. Screening Guidelines & Criteria • Visually inspect for cavitated lesions. • Do not seal cavitated lesions or teeth with dentinal shadowing (discoloration, translucencies) indicative of dentinal decay.

12. Screening Guidelines & Criteria • Do seal permanent molars with the following criteria: • Fully or partially erupted, caries-free molars • Seal partially erupted molars only if surfaces to be sealed can be isolated and kept dry during isolation • White spot lesions • Stained grooves and/or darkened pits that are not cavitated • Deep pits and grooves of buccal and lingual surfaces

13. Sealant Evaluation • Evaluate retention of sealants on all children who had sealants placed during the prior year. • Use III Follow-Up section of the form to: • Mark tooth surfaces “R” for retained sealants in good condition • Mark tooth surfaces “RS” for reseal • Mark tooth surfaces “S” if sealed for the first time at this visit • Sign and date

14. Sealant Placement • Wash and dry teeth • Use tapered brush in straight handpiece to clean all teeth • Pumice may be used if teeth are dirty but must be thoroughly washed off. • Place dry angle over Stenson’s duct • Isolate with cotton rolls • Easiest to do mandibular molar first, then move to maxillary molar on same side

15. Sealant Placement • Make sure tooth is dry • Etch for 30 seconds – No less! • Rinse for 10-15 seconds and dry tooth thoroughly • Place bonding adhesive • Apply sealant • Use disposable brush or syringe to help flow into all occlusal grooves and buccal/lingual grooves and pits as appropriate. • Don’t rub the sealant back and forth as that will incorporate more air bubbles • Light cure according to manufacturer’s directions. Generally this will be for at least 20 seconds per surface sealed.

16. Bonding Technique • 3m Adper Single Bond & others • Improves Adhesion in Moist Environments • Place after etching & drying • Thin with compressed air • Place sealant and cure normally

17. Sealant Placement • Check sealant with explorer to make sure coverage of pits and fissures is complete. • If there is a surface air bubble: • More sealant can be applied if the tooth has remained uncontaminated. • Otherwise, the tooth must be re-etched for 10 seconds, washed and dried before adding sealant.

18. Completion • Rinse teeth and wipe surface with wet gauze or cotton roll • Advise child that they might feel something hard between their teeth, but it will go away in about a day.

19. Evaluation Follow Up Criteria for Retained status per surface: pits and fissures are covered with sealant Sealants are “Retained” according to above even if there are chips, wear or loss of bulk