School-based Dental Sealant Program

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School-based Dental Sealant ProgramDivision of Dental Health, VDH Revised 2016


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


Dental Sealant ProgramsSchool-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


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


Infection ControlCDC 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


CDC infection control policies to be followed at all times including: Clean and heat-sterilize semi-critical and critical dental instruments before each use including HP motors. 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


Screening Guidelines & Criteria for School-Based ProgramPerform BSS as instructed Evaluate and chart 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


Screening Guidelines & Criteria for School-Based ProgramAssess 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.


Clinical Detection of Noncavitated Pit and Fissure Carious Lesions and Evidence-based Recommendation for Sealing ThemVisual 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


Screening Guidelines & CriteriaCriteria to Identify Teeth that are Eligible for Placement of Dental SealantsSeal America, 2007


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


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


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


Sealant PlacementWash and dry teeth Use manual toothbrush to clean surfaces before sealing 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


Sealant PlacementMake 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.


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


Sealant PlacementCheck 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.


CompletionRinse 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.


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

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Last Updated: 8th March 2018

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