California CDC-Sponsored Expert Work Group Publishes Updated Recommendations for School-Based Sealant Programs: The recommendations were developed by a work group of experts in the fields of caries prevention and treatment, oral epidemiology, and evidence-based reviews. The work group also included representatives from professional dental organizations.

The expert work group examined new evidence on:

• The effectiveness of sealants in preventing new decay and progression of early decay
• Methods to assess decay
• Sealant placement techniques
• Scientific reviews of program practices

Based on this evidence, the following recommendations are provided for practitioners in school-based programs:

• Seal pit-and-fissure tooth surfaces that are sound or have early decay, prioritizing first and second permanent molars.
• Use visual assessment to differentiate surfaces with the earliest signs of tooth decay from more advanced lesions.
• X-rays are not needed solely for sealant placement.
• A toothbrush can be used to help clean the tooth surface before acid etching.
• When resources allow, have an assistant help the dental professional place sealants.
• Provide sealants to children even if follow-up examinations for every child cannot be guaranteed.

These recommendations are designed to guide practices of state and community public health programs for planning, implementing, and evaluating school-based sealant programs, as well as to complement the American Dental Association Council on Scientific Affairs’ evidence-based clinical recommendations for sealant use* published in 2008.

Several other publications provide more detail about the studies that were conducted by work group members. The published studies are provided below.

• “The Effectiveness of Sealants in Managing Caries Lesions,”* Journal of Dental Research. February 2008. This study shows that if sealants are placed over early tooth decay, they will stop early decay from becoming a cavity. This information should lessen concerns about accidentally sealing over decay.
• “The Effect of Dental Sealants on Bacteria Levels in Caries Lesions: A Review of the Evidence,”* Journal of the American Dental Association. March 2008. This study shows that sealing over tooth decay lowers the number of bacteria in the cavity by at least 100-fold.
• “Exploring Four-Handed Delivery and Retention of Resin-Based Sealants,”* Journal of the American Dental Association. March 2008. For sealants to work, they must stay in place or be retained on the tooth. This study concludes that having a dental assistant help the dental professional place the sealant (four-handed technique) may improve sealant retention.
• “A Comparison of the Effects of Toothbrushing and Handpiece Prophylaxis on Retention of Sealants,”* Journal of the American Dental Association. January 2009. This study shows that cleaning the tooth’s surface with a toothbrush before applying dental sealants resulted in sealant retention at least as high as when a hand piece was used.
• “Caries Risk in Formerly Sealed Teeth,”* Journal of the American Dental Association. April 2009. This study shows that teeth with fully or partially lost sealants did not have a higher risk of developing a cavity than teeth that were never sealed.