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Dental Public Health Activities: Descriptive Summaries

Collaborative School Dental Sealant Program

Practice Number: 41004
Submitted By: Division of Oral Health, Republic of Palau
Submission Date: July 2008
Last Reviewed: July 2017
Last Updated: July 2017
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In the Republic of Palau, the oral disease rates have been documented to be very high and there is limited access to dental care by the school population (only 2 small dental clinics serving the country).  To improve access to both preventive and restorative oral health care for all children in Palau, a Collaborative School Dental Sealant Program between the Ministry of Health (Division of Oral Health) and the Ministry of Education has been established since 2003. 

The program involves the Division of Oral Health staff establishing mobile clinics serving all public and private elementary schools throughout Palau, providing services to approximately 2,800 students each year.  Every year, clinics are established in schools, at adjacent community health centers, dispensaries, and/or in meeting houses.  All students are provided oral exams and sealants if needed.  Additionally, restorative care with a focus on treating permanent teeth is completed for all rural schools.  A limited amount of restorative care is completed for the urban schools as time allows, usually delivering 50% of required care among the students.  Dental health educational presentations are provided to all students in grades 1-3 during the outreach visits.  Education addresses betel nut and tobacco use, nutrition and oral hygiene.  Supplies are provided by the Division of Oral Health, Community Health Center (CHC) and the Ministry of Education.  The CHC in Palau is funding 50% of the school programs as there are not any grants available to support this program. The program costs approximately $50,000 - $60,000 per year (not including equipment start-up costs). The Division of Oral Health has purchased two new pro-cart mobile units to use in school programs.

Oral health surveys conducted in 1993, 1997 and 2005 have shown a dramatic increase in sealants among school children and a dramatic reduction in decayed permanent teeth over the course of the program:

    -  In 1993, 14% children age 6-8 years and 25% children age 12 years with sealants.

    -  In 1997, 81% children age 6-8 years and 93% children age 12 years with sealants.

    -  In 2005, 81% children age 6-8 years and 91% children age 12 years with sealants.

Additionally, there is less unmet dental treatment needs in the school student population.  The Division of Oral Health has observed that currently fewer extractions of permanent teeth due to decay are needed for the school aged children, whereas prior to the school dental program such treatment was common. 

In 2017, the oral health team continues to provide preventive sealants to all elementary and preschool students in Palau.  In-house dental hygienists are trained to provide sealants to students who have returned a signed consent form.


In school year:

- 2014-2015: 563 teeth were sealed on school students.

- 2015-2016: 833 teeth were sealed on school students.

- 2016- 2017:842 teeth were sealed on school students.

Lessons Learned:

1.   The sealant program is still ongoing and also we have extended our services to restorations also in all elementary schools.

2.   The betel-nut and tobacco use have declined during these past years, so we know that our health education is effective.

3.   The daily school tooth brushing programs have stopped due to lack of commitment from the school principal.

  1. Despite the lack of funding (still no grants to support the program) the division of oral health is still providing exams and sealant treatment to all the Elementary Schools in Palau.
  2. The division of oral health is working in collaboration with the Head Start Program, Public Health Nurses in conducting parents training on the importance of primary teeth and their role and how to keep them caries free.
  3. The in-house training for the dental assistants was a success.  A grant was secured to bring a oral health instructor from the Fiji National University who gave an intense in-house hygienist training for the 10 dental assistants to upgrade their skills.  An external examiner also came for the in- house exams.  To date, the 10 dental assistants were elevated to local dental hygienists who are now providing services to the school students.
  4. The oral health surveillance system is still outdated and we also need a full time staff to enter data.

A plan to hire more Dental Assistants trainees to be trained locally is pending depending on the budget


Contact Person(s) for Inquiries:

Dr. Louisa Santos, Community/Outreach Supervisor, Oral Health Division, Ministry of Health P.O. Box 6027, Koror, Republic of Palau, 96940, Phone: (680) 488-2440/2342, Email: