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J Am Dent Assoc, Vol 140, No 11, 1356-1365.
© 2009 American Dental Association
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COVER STORY

JADA Continuing Education

Preventing Dental Caries Through School-Based Sealant Programs

Updated Recommendations and Reviews of Evidence



Barbara F. Gooch, DMD, MPH, Susan O. Griffin, PhD, Shellie Kolavic Gray, DMD, MPH, William G. Kohn, DDS, R. Gary Rozier, DDS, MPH, Mark Siegal, DDS, MPH, Margherita Fontana, DDS, PhD, Diane Brunson, RDH, MPH, Nancy Carter, RDH, MPH, David K. Curtis, DMD, Kevin J. Donly, DDS, MS, Harold Haering, DMD, Lawrence F. Hill, DDS, MPH, H. Pitts Hinson, DDS, MS, Jayanth Kumar, DDS, MPH, Lewis Lampiris, DDS, MPH, Mark Mallatt, DDS, MSD, Daniel M. Meyer, DDS, Wanda R. Miller, RN, MA, NCSN, FNASN, Susan M. Sanzi-Schaedel, RDH, MPH, Richard Simonsen, DDS, MS, Benedict I. Truman, MD, MPH and Domenick T. Zero, DDS, MS

Background. School-based sealant programs (SBSPs) increase sealant use and reduce caries. Programs target schools that serve children from low-income families and focus on sealing newly erupted permanent molars. In 2004 and 2005, the Centers for Disease Control and Prevention (CDC), Atlanta, sponsored meetings of an expert work group to update recommendations for sealant use in SBSPs on the basis of available evidence regarding the effectiveness of sealants on sound and carious pit and fissure surfaces, caries assessment and selected sealant placement techniques, and the risk of caries’ developing in sealed teeth among children who might be lost to follow-up. The work group also identified topics for which additional evidence review was needed.

Types of Studies Reviewed. The work group used systematic reviews when available. Since 2005, staff members at CDC and subject-matter experts conducted several independent analyses of topics for which no reviews existed. These reviews include a systematic review of the effectiveness of sealants in managing caries.

Results. The evidence supports recommendations to seal sound surfaces and noncavitated lesions, to use visual assessment to detect surface cavitation, to use a toothbrush or handpiece prophylaxis to clean tooth surfaces, and to provide sealants to children even if follow-up cannot be ensured.

Clinical Implications. These recommendations are consistent with the current state of the science and provide appropriate guidance for sealant use in SBSPs. This report also may increase practitioners’ awareness of the SBSP as an important and effective public health approach that complements clinical care.

Key Words: Caries; evidence-based dentistry; pit-and-fissure sealants; preventive dentistry; public health/community dentistry

Abbreviations: ADA: American Dental Association • CDC: Centers for Disease Control and Prevention • IFUs: Instructions for use • RCTs: Randomized controlled trials • SBSPs: School-based sealant programs






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