The Arizona Department of Health, Bureau of Women’s and Children’s Health, Office of Oral Health has administered the Arizona Dental Sealant Program since 1987. Originally in one county, Maricopa County, the program now serves six of fifteen counties in the state. This school-based dental sealant program targets children in 2nd and 6th grades attending eligible schools in Arizona. Eligible schools are public and charter schools with a high proportion of students participating in the National School Lunch Program (free and reduced lunch program). All children in 2nd and 6th grade attending eligible schools are entitled to receive a dental screening; those who are uninsured, Medicaid and SCHIP beneficiaries, covered by Indian Health Services or by a state-funded primary care health care program and do not have private dental insurance also qualify for dental sealants. Counties and individual providers are contracted by the state Office of Oral Health to implement the program.
Dental caries (tooth decay) remains one of the most common chronic diseases of childhood.
In Arizona, a 2009-2010 survey of third grade students in 100 randomly selected public schools showed that 75 percent of Arizona’s third grade children have tooth decay experience, 40 percent have untreated tooth decay, and 29% percent lack dental insurance. Uninsured children, as well as those covered by Medicaid, have greater levels of untreated dental disease and less access to dental care.
When properly placed and retained, dental sealants are highly effective in preventing tooth decay on the chewing surfaces of first and second permanent molar teeth. However, sealants remain underused, particularly among children from low-income families and from racial/ethnic minority groups. This 2009-2010 oral health survey of Arizona school children revealed that 47 percent of third graders had at least one dental sealant. While this is below the HP 2020 target of 50 percent, it represents a significant increase over the 1999-2003 survey which showed only 31 percent of 6-9 year-olds with a dental sealant.
School-based dental sealant programs have been shown to be effective in reducing disparities in prevalence of dental sealants for socially disadvantaged children (Impact of Targeted, School-Based Dental Sealant Programs in Reducing Racial and Economic Disparities in Sealant Prevalence Among Schoolchildren – Ohio, 1998-1999, MMWR August 31, 2001/ 50(34);736-8).
A Program Manager at the Arizona Department of Health Services, Office of Oral Health (OOH) administers the Arizona Dental Sealant Program (AZDSP). OOH contracts county health departments and individual providers to implement the program. Funding is available through federal grants, private donation funds and reimbursement from the state’s Medicaid program.
All public and charter schools are eligible for the program if a high proportion of the students attending the school are enrolled in the National School Lunch Program (the free/reduced lunch program). Each school year, eligible schools are selected based on availability of funding and providers; schools are prioritized from highest to lowest percentage of school lunch enrollment.
The AZDSP schedules schools for dental screenings and dental sealant applications from August through May of each school year. Portable dental equipment is used to deliver care at the schools. Only 2nd and 6th grade students are eligible for the sealant program services and parental consent is required. Program dentists assess and determine the need for dental sealants for each participating child evaluating the individual surfaces of permanent molar teeth only.
A dentist screens approximately 100-120 children in an average school day and prescribes the necessary dental sealants. At the end of the screening day, the school receives a list of children with urgent dental needs. On a subsequently scheduled date, the program dental hygienists, working with dental assistants, place sealants as prescribed at the screening. A dental hygienist can apply sealants to the teeth of 15-20 students per day.
The OOH requires all providers to be trained and standardized in collecting program data, providing a dental screening, applying sealants and making dental referrals based on local resources. All aspects of the program utilize specific protocols and techniques. While the OOH provides portable dental equipment for most sites to deliver program services, the purchase of all dental supplies and coordination and scheduling of schools is made at the local or county level.
The AZDSP also collects oral health status information utilizing the Basic Screening Survey (BSS) protocol recording data on standard paper forms. This information is processed as follows:
• A findings form is sent home with the child on the day of the screening.
• On the day of the screening, the school receives a list of children with urgent needs.
• All collected data is entered and tabulated at the OOH central office.
• Findings letters notifying parents of their child’s need for dental treatment are sent to schools.
• Each school receives a report that includes the number of children served and the oral health treatment needs of individual students. This school report provides a tool for the school nurse/personnel to triage and follow up on needed dental care.
• Data analysis and reporting of program services are generated for the state, county and school levels.
The AZDSP has a quality improvement program focusing on sealant retention, provider satisfaction, school personnel satisfaction, participation and efficiency. The evaluation of sealant retention was integrated into the program in FY 2000-01. Approximately 25 percent of students in 3rd and 7th grades who received sealants when they were 2nd and 6th graders are randomly selected and reassessed for retention of sealants. Analysis of three surface areas on maxillary and two surface areas on mandibular teeth provides the annual retention rate for fully retained sealants. Since retention of a dental sealant is required to prevent tooth decay, retention rates directly impact the overall effectiveness of the Sealant Program.
In the 2011-2012 school year:
• 11,411 second and sixth grade students in participating schools received a dental screening.
• 6,412 of the children screened received dental sealants.
• Approximately 29 percent of the children screened reported that they did not have dental insurance.
• Approximately 24 percent of the children seen in the school-based dental sealant program were identified as having untreated decay.
A partnership with the Arizona Dental Association was established in 2001 to help recruit dental providers for the AZDSP, especially in areas where OOH has difficulty contracting providers.
Budget Estimates and Formulas of the Practice:
The Maternal and Child Health Block Grant, Arizona’s Medicaid program (Arizona Health Care Cost Containment System) reimbursements, and private foundation donations fund the operation of the Arizona Dental Sealant Program. The funds are used to pay for staff, travel, supplies, training, equipment, etc. All equipment is owned by the Arizona Department of Health Services but is loaned on a semi-permanent basis to contracted community sites.
The Arizona Dental Sealant Program Manual provides specific protocols and techniques and includes various program data collection forms.