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Sealing the underserved

Feb. 1, 2011
Kumar and Wadhawan stated in 2002, "Targeting sealants to children and teeth at high risk for dental caries has been accepted as a desirable strategy ...

Georgia program tackles challenge of school-based sealants

by Natalia Lamonaca, RDH, BSDHEd

Kumar and Wadhawan stated in 2002, "Targeting sealants to children and teeth at high risk for dental caries has been accepted as a desirable strategy in school-based programs." Are children who receive dental sealants in school-based sealant programs (SBSPs) predominately at a higher risk for dental caries?

A study conducted compared the prevalence of sealants (by caries risks) amongs elementary students with and without SBSPs. Researchers postulated that segments of children who were considered a high risk for dental caries were chosen to receive sealants through SBSP. (Siegal and Detty, 2010). The results indicated that in schools which did not employ SBSPs, the participating children that were considered "high risk" were not likely to have received dental sealants as opposed to "low risk" children. Conversely, in schools that employed SBSPs, sealant prevalence for both "high" and "low" risk groups was comparable (Siegal et al., 2010).

The prevalence of pit and fissure sealants considerably decreased carious lesions on occlusal surfaces among children in the United States (Cohen and Horowitz, 1993). However, a national health survey conducted by NDIR (National Data Investors Research) in 1986-7 exhibited that fewer than 8% of children ages between 5-17 had pit and fissure sealants on their teeth (Cohen et al., 1993). The extensive dental carious lesions found on children's primary teeth in the 2-4 year age group had proliferated from 18% in 1988-1994 to 24% in 1999-2004 (Tomar and Reeves, 2009).

Preliminary detection of caries in children/adolescents is critical for maintaining children's general health (Miller, 2005). If caries are left untreated, this can result in pain, dental infections, and loss of teeth. In the year 2000, grant contributions were provided to a diverse number of oral health-care provider organizations by the Illinois Department of Public Health (Division of Oral Health) to obtain resources for the distribution of preventative series to elementary children participating in the free-and-reduced lunch programs (Mills, 2005). The "Dental Sealant Grant Program at Southern University" utilized dental hygiene students to provide these services. According to Miller (2005), this allowed dental hygiene students to participate in community services, which impacted elementary children as well as their dental hygiene.

The Georgia Oral Health Coalition (GOHC) was formed in 1996 to refine the oral health unit infrastructure of Georgia's Division of Public Health. GOHC's policy strengthened oral health priority resulting in the expansion of state oral health plans, which assisted in development of the statewide school-based Georgia Health Preventive Programs. The GOHC strongly advocated enhanced access to oral health for the underserved (GOHC, 2009).

According to the CDC (Centers for Disease Control and Prevention), the regulation of SBSPs increased sealants, resulting in decreased caries incidence (Gooch et al., 2009) in underserved, low-income children. With a focus to serve the underserved population within the Atlanta area, Georgia Seal Day at Georgia Perimeter College (GPC) was established. Georgia Seal Day is a local SBSP, a viable component of the "Seal America Campaign" (Carter, 2007), as well as a statewide program between the CDC (Karelitz, 2010) and the DeKalb County Public Health Department.

Georgia Seal Day

In 2003, GPC developed a partnership along with Coca-Cola Industries, Wachovia Bank, and John H. Harland. These partnerships provided important resources for GPC's Dental Hygiene Department such as purchasing new equipment for the clinic. For the fiscal year 2003, a total of $548,520 was allocated for the dental hygiene clinic (Chronicle, 2003).

In 2001, the program was initially established and implemented by Jennie Fleming, RDH, MEd, a former dental hygiene instructor. Program goals included providing dental sealants and dental hygiene education to low income children. The program also provided a valuable hands-on experience to dental hygiene students for the placement of sealants, as well as delivery of dental hygiene education. The local health department assessed and determined children's needs and who required sealants as a preventive measure (Karelitz, 2010). As a result, the Georgia Seal program's needs were also determined by the local health department.

Priorities determining goals for the Georgia Seal Event included sealant placement, fluoride varnishes, and dental hygiene education to elementary low-income children. The program objectives were adopted from the "Healthy People 2010 Objectives" (CDC, 2010). The objectives are:

  • "Decrease the proportion of children who have dental caries experience in the second molars"
  • "Increase the proportion of children who have received dental sealants on their molar teeth"
  • "Increase the proportion of school based heath center with an oral health component"

The Georgia Seal activities included both "clinical and educational" components, which benefited both elementary schools as well as dental hygiene students. The clinical components incorporated sophomore dental hygiene students administering dental sealants to elementary children. Freshman students assisted in suction and retraction. This sealant placement was accompanied by fluoride varnish application.

The educational component of Georgia Seal included brushing/flossing, nutritional counseling, and oral health educational videos. Four activity stations were organized; each station was labeled either "S," "E," "A," or "L." When students completed a station, they received the activity station's call letter on their nametags. When the letters spelling the word SEAL was completed on their nametags, students would be rewarded with a pencil and a photo with the "tooth fairy." A freshman student volunteered to perform as the tooth fairy.

During clinical and educational Seal Event activities, five student escorts directed the elementary children to and from the clinic and/or OHI classroom. Faculty members monitored the OHI classroom. The clinical instructors' duties included performing sealant checks for students as well as documenting students' semester sealant requirements.

The event utilized the GPC dental hygiene clinic and all of its resources. All Seal Event supplies were ordered within a current budget of $500. The listed supplies included toothbrushes, sunglasses, Polaroid film, disposable mouth mirrors, goodie bags, sealants materials, fluoride varnishes, pumice, articulating paper, mirror/explorer, handpieces, bib clips, and all infection control packets that were preassembled by the dispensary assistant.

GPC provides 17 curing lights, but due to the operatory/student ratio, more were required. Dr. Dwayne Turner, a public health dentist, provided four additional curing lights to fulfill our student/operatory ratio. GPC maintained the necessary educational tools such as videos, puppets, and plastic foods for nutritional counseling. The "Seal Certificate" and S-E-A-L letter-stickers were supplied by the second year clinical coordinator's spouse.

In order to ensure minimal problems, manpower was a critical factor. Seal Georgia utilized two dentists, 14 dental hygienists, 53 dental hygiene students, one dispensary assistant, and one security guard.

Several constraints presented themselves during the Seal Event. One constraint included availability of elementary students who required dental sealants. Performing elementary dental screenings could have inhibited the problem. Several elementary students were unintentionally admitted on this "field trip" to the GPC Seal Event without having received a local health department dental screening. As a result, approximately six of the 35 students did not require sealants for one of two reasons: sealants had previously been placed on permanent teeth or the teeth already had fillings.

Another constraint included a lack of informed consent. Some students failed to obtain a signed parental informed consent, which permitted them to have sealants placed or their picture taken. This factor posed a problem for the 2010 Seal Event stemming from an unbalanced elementary/dental hygiene student ratio. To assist in facilitating the elementary/dental hygiene student ratios, sophomore dental hygiene students shared several elementary students who had eight or more teeth requiring sealants. This camaraderie demonstrated that team effort was fundamental and beneficial for everyone.

According to DeAngelis and Warren (2010), in order to develop a "community-based oral health project," it is pertinent to employ strategic planning procedures within the program. Such methods are inclusive of comprehensive planning, competent execution, and a judicious outcome assessment of the program. During program planning, goal development and objectives (Nathe, 2005) remain critical.

The Georgia Seal Day goals included providing dental sealants to all elementary students who have little or no access to dental health care as well as providing dental health care education. During the planning component, the coordinator must develop a "blueprint" (Nathe, 2005). The blueprint quantifies the program's overall rate of success.

Each program coordinator must revise a detailed handout for participants. This accounts for all components of the program in a detailed step-by-step process. The coordinator must also organize the sophomore/freshman dental hygiene students' ratio, escort assignments, tooth fairy assignment, translators, OHI students, and faculty assignments to ensure a smooth and seamless operation.

The operatory groups rotated during the clinical sessions. This rotation ensured that all students were given an opportunity to provide clinical care to a minimum of one child.

A program's "revision and evaluation" is an ongoing process generated throughout each stage of program planning. The GPC Georgia Seal Day is evaluated biannually. Based upon each year's results, the faculties continue to strive at developing modifications to accomplish a consistently fluid process. The program ventures to service more children by expanding both clinical and educational experiences of the students.

Utilizing SBSP is an exceptional method for delivering dental care and dental health education to low income, underserved children. Assessing goals and priorities of any dental health care program are definitely critical elements to possess in any program's success. Critical assessment and planning ensures continued successful oral health events for dental hygiene students as well as servicing lower income children within the community.

Natalia Lamonaca, RDH, BSDHEd, coordinated the February 2010 Georgia Seal Event at Georgia Perimeter College. She is adjunct faculty in the department of dental hygiene at Georgia Perimeter College.


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