New report on dental sealants

Dental sealants, when applied in school-based programs, have been shown to reduce tooth decay by as much as 60 percent.(1) Improving access to high-risk children, and saving high-risk teeth, is a public health victory. However, there are differences in how states manage, finance, and measure school sealant programs (SSPs). That is the impetus for the Children's Dental Health Project (CDHP) report released May 13, 2014. Funded by the Centers for Disease Control and Prevention (CDC), the report reviews factors that influence State Sealant Programs (SSPs') influence and sustainability. The CDC supports sealant and other oral health activities in 21 states, but the report focuses on five states where SSPs have operated for over 10 years, and help a large number of children. The states are: Illinois, New York, Ohio, South Carolina and Wisconsin. The report shares information on the things that has made these programs successful, in the areas of financing, partnerships and collaborations, program effectiveness, and adaptability. There is a page with Successful Tools for States.(2) Through a cooperative agreement with the CDC, the CDHP develops these tools, resources and training to help state oral health programs build capacity and infrastructure. These tools include reports, fact sheets, press releases, and more. There are also tools focusing on prevention.(3) The new report is entitled: Dental Sealants: Proven to Prevent Tooth Decay: A Look at Issues Impacting the Delivery of State and Local School‐Based Sealant Programs. The report states that school‐based dental sealant delivery programs are an evidence‐based public health approach for preventing tooth decay among school‐aged children. The methods of data compilation are presented. The report outlines regional patterns, financing sources and lessons learned from the 5 states with sustainable and substantial SSPS. One of the variations noted is the Medicaid policy on billing by non‐dentist providers. Sealant programs flourish in Chicago, where two‐thirds of the state’s SSPs provide more sealants to children than any other locality or state in the nation! One of the states highlighted is South Carolina.

The report states that the state program has been in existence since 2003 and that the state has regulatory authority to approve dental hygienists as providers in schools under an arrangement called “public health supervision” governed by a memorandum of agreement (MOA).(4) In reality, the statute in South Carolina was changed in 2000 to allow students direct access to dental hygiene preventive services that include prophylaxis, the application of dental sealants and fluoride, and referral for any care that falls outside the scope of dental hygiene. In 2003, in an unsuccessful attempt to avoid restraint of trade charges by the Federal Trade Commission, the acting dental director worked with the South Carolina Dental Association and the South Carolina Dental Board to insert a barrier requiring an exam “only” in a school or nursing home setting, if a dental hygienist does not have an MOA with the Department of Health and Environmental Control.

Tammi Byrd, RDH, is a public health dental hygienist and an entrepreneur! She started a successful school-based dental program called Health Promotion Specialists (HPS), where she is CEO/Clinical Director, in 2000. Health Promotion Specialists treats thousands of children every year in South Carolina and is responsible for eighty percent (80%) of the children seen in S.C. schools.(5) Tammi reaches out to the dentally underserved populations. Looking at their state statistics, you can see the changes the program brought about. The Medicaid reimbursement rate was raised significantly in January 2000. The number of Medicaid children seeking dental care continued to plummet. HPS started serving children in January 2001 and saw an immediate increase in the number of children connecting to dental services.(6) When asked about the success of her program, Tammi stated, “First and foremost, it is by the grace of God that our program has been successful in reaching so many children. Through faith and perseverance, HPS has overcome many obstacles and risen to the challenge. We like to call it our character enhancing opportunity.”

Above photos, including image of Christian Burchell (at left), courtesy of Health Promotion Specialsts

Tammi has held numerous officer and council positions with the American Dental Hygienists' Association (ADHA), including president of the ADHA. Tammi has received the ADHA Distinguished Service Award, the South Carolina Dental Hygienist of the Year (twice), and the South Carolina American Association of University Women/Women of Distinction Award.

In Wisconsin, state policies allow dental hygienists to practice in public health settings, including schools, under a dentist’s general supervision and to place sealants without the requirement that a dentist first examine the child. Medicaid can be billed directly for both sealants and an oral health assessment provided in schools.(4)

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There are recommendations in the report. The authors say that the 20‐year‐old guidelines for sealant use in community programs must be updated. The revised guidelines should then be promoted by federal, state, and local officials who manage sealant programs. An expert SSP Design and Operations Work Group should be convened to revise the guidelines. Barriers should also be addressed in the revision.

Could one of the barriers be state dental practice acts which prohibit dental hygienists from providing care directly to the public? Prevention is a powerful tool, and dental hygienists are prevention specialists.