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Dental Public Health Activities: Descriptive Summaries

Community Dental Care School-Based Dental Sealant Program

Practice Number: 26009
Submitted By: Community Dental Care
Submission Date: December 2017
Last Reviewed: December 2017
Last Updated: December 2017
Best Practice Approach Example -
 

Community Dental Care is a 501(c) (3) nonprofit dental clinic based in Minnesota (MN) that, as of 2017, partners with 23 Twin Cities metro area schools to provide dental screenings, sealants, and fluoride varnish for children in school communities at high risk for dental disease.  Approximately 50% of the children participating in Community Dental Care school-based events are referred for early or urgent dental needs. While provision of preventive services (sealants and fluoride varnish) is effective in preventing future disease, program data demonstrates the need to better address active disease as well.  Since a large number of Community Dental Care referrals for follow-up care are associated with moderate to severe dental caries, the program is researching options to add the application of silver diamine fluoride (SDF) to the school-based services we provide in an effort to arrest or inhibit progression of this disease. 

Community Care Dental is currently developing protocols regarding the use of SDF by licensed, collaborative practice dental hygienists in the school setting, and plan to pilot its use in one of our high needs partner schools during the 2018/19 school year.  In order for a collaborative practice dental hygienist to apply SDF as a ‘caries arresting medicament’ in Minnesota school-based programs, a diagnosis of dental caries by a licensed dentist is required. The goal is to use tele-communication, allowing the dental hygienist to consult with the collaborating dentist (verbal report coupled with digital images) for diagnosis and authorization for application of SDF as a caries arresting medicament. 

SDF is currently used in Community Dental Care clinics and patient/parent educational protocols and informed consent documents have been created for use in the clinic setting.  The program is developing protocols and adapting documents for informing parents of this treatment option and acquiring parental consent at school sites.  With the use of SDF as a dental caries arresting medicament being relatively new to the U.S., the dental hygienist will return to the school at a later date to apply SDF for selected children with parental consent. 

During the 2016/17 school year 1268 students participated in Community Dental Care dental sealant events, and 909 of those participants received fluoride varnish at the same event.  

Lessons Learned:

During this process Community Dental Care has discovered that a number of “grey areas” exist with regard to use of SDF by collaborative dental hygienists in non-traditional settings.  The program utilizes collaborative hygienists to provide services during school events.  Best practices for use of SDF in this application are being investigated as the collaborating dentist is not on-site during sealant events.  While SDF has been approved for use in MN, there are no clear descriptions or protocols for its use by collaborative hygienists in non-traditional settings.  Application of SDF is within the scope of practice for MN registered dental hygienists, although diagnosis of caries by a licensed dentist is required for use of SDF as a caries arresting/inhibiting medicament. Community Dental Care is developing protocols for using tele-communication (verbal reports coupled with digital images) to enable diagnosis and treatment planning. 

Obtaining informed consent from parents within a school-based setting is challenging.  Community Dental Care recognizes that informing parents of the risks and benefits will be critical to successful and effective use of SDF, and are currently investigating best practices related to this issue.  We expect to develop an appropriate protocol spring of 2018 with a goal of implementing the pilot program during the upcoming 2018/19 school year. 

Contact Person(s) for Inquiries:

Ann Copeland, Director of Programs, Community Dental Care, 1670 Beam Ave., Maplewood, MN, 55109, Phone: 651-925-8412, Email: anncopeland@cdentc.org

Katherine Sievert, DDS, Director of Dental Services, Community Dental Care, 1670 Beam Ave., Maplewood, MN, 55109, Phone: 651-925-8400, Email: katherinesievert@cdentc.org

Kate Iverson, RDH, School-Based Program Manager, Community Dental Care, 1670 Beam Ave., Maplewood, MN, 55109, Phone: 651-925-8400, Email: kateiverson@cdentc.org

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