Dr. Nancy Hodur is the Center for Social Research Director at North Dakota State University. Nancy has over 25 years of professional experience in applied research, public policy, and outreach education. Additionally, Xiangping ‘Coco’ Gao, M.S., is a research specialist at the Center for Social Research. She has a broad range of working experience in the U.S. and China as a tourism and recreation researcher, a university instructor, an urban planner, and an NGO professional. Together at the Center, Nancy and Coco evaluate a number of the North Dakota Department of Health’s Oral Health Programs. In this article, they give a brief overview of one of these evaluated programs – SEAL!ND, a school-based dental sealant program.
The North Dakota Department of Health, Oral Health Program (OHP) is committed to improving the oral health of North Dakotans through prevention and education by using innovative and cost-effective approaches to promote oral health care. The OHP seeks to foster community and statewide partnerships to improve oral health and enhance access to dental care. One successful program that illustrates how the North Dakota Department of Health is achieving this goal is SEAL!ND.
SEAL!ND, a school-based dental sealant program, targets schools attended by a large number of low-income children, as these children are typically at higher risk for tooth decay (cavities) and may lack access to dental care.
According to the Centers for Disease Control and Prevention (CDC), in the United States, cavities are one of the most common chronic conditions in children. If left untreated, cavities can cause pain and infections that could result in eating, speaking, learning, and playing difficulties. Fortunately, cavities are preventable. One way to help prevent cavities is to apply dental sealants to permanent molars (back teeth) of children (CDC, 2014). “Dental sealants are thin plastic coatings that are applied to the grooves on the chewing surfaces of the back teeth” (CDC, 2013). Studies have found that sealants reduce cavities by “81 percent for 2 years after they are placed on the tooth and continue to be effective for 4 years after placement” (CDC, 2014).
The program is supported by funding from the Centers for Disease Control and Prevention and the Health Resources and Services Administration (HRSA). School-based dental sealant programs seek to ensure that all children receive highly effective dental prevention treatment through a proven community-based approach. Schools represent an opportune channel for reaching underserved and vulnerable children with public health messaging, education and direct services to advance oral health.
SEAL!ND identifies low income schools based on the percentage of students that participate in the free and reduced-fee lunch program. Schools with 40 percent or greater of their students that participate in the free and reduced-fee lunch program are targeted for participation in the SEAL!ND program. Currently, 42 schools participate in the program. SEAL!ND has expanded considerably since it was launched in the 2014-2015 school year. The first year of the program 18 schools participated. The number of participating schools increased to 40 in the second year of the program.
During the program's first year, 897 students in 18 schools were screened and 314 students received sealants. During the second year, the number of students who were screened increased by nearly 250 percent and those who had sealants applied increased by nearly 375 percent (Table 1). During the 2015-2016 school year, SEAL!ND delivered screening services to 3,124 students in 40 schools and sealants were applied to 4,390 permanent molar teeth of 1,486 students. Analysis of the number of students served in 2016-2017 is currently ongoing. Findings for the 2016-2017 school year will be available mid-summer of 2017.
To quantify the benefits and cost effectiveness of the school sealant program, the North Dakota State University - Center for Social Research uses methodology developed by the CDC to calculate the number of averted cavities attributable to school-based dental sealant programs like SEAL!ND (Griffin et al., 2016). Data collected by the public health hygienists that screen students and apply sealants include the number of students served, number of teeth sealed, that number of teeth with cavities, etc. The data are used to calculate the number of cavities that are prevented as a result of the school-based dental sealant program.
Using the weighted average attack rate (risk for tooth decay in the absence of school sealant), sealant retention rate (the percentage of sealants that stayed intact for 12 months), and the number of teeth sealed, the number of cavities prevented was calculated. In 2015-2016 it was estimated that school-based dental sealant programs sponsored by the OHP prevented 1,235 cavities. Stated another way, for every 3.6 molars that received sealant, one cavity was prevented. In 2014-2015, it was estimated that, 423 cavities were prevented. Again, for every 2.2 teeth that received sealant, one cavity was prevented.
SEAL!ND also provides a dental screening that identifies students with untreated cavities. Nearly one in four students or 693 students were identified with untreated cavities in 2015-2016. In 2014-2015, nearly one in three students or 258 students were identified with untreated cavities. Those students were referred to local dental providers for treatment.
SEAL!ND is one example of the innovative and cost-effective approaches used by the North Dakota Department of Health’s, Oral Health Program. In just two years the SEAL!ND program has helped to prevent 1,658 cavities in permanent molars in North Dakota students and referred 951 students to dental providers for treatment. Preventing cavities not only saves money by avoiding heath care costs, but helps students to do better in school. Children with poor oral health are more than three times more likely to miss school due to dental pain. SEAL!ND not only improves oral health in children, but improves educational outcomes by helping to keep children in class and focused on learning rather than on dental pain.
Centers for Disease Control and Prevention (2014). Children's Oral Health. https://www.cdc.gov/oralhealth/children_adults/child.htm
Centers for Disease Control and Prevention (2013). Dental Sealants. https://www.cdc.gov/oralhealth/publications/faqs/sealants.htm
Griffin, Jones, and Crespin (2016). Calculating averted caries attributable to school-based sealant programs with a minimal data set. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4813799/