By Christine Nathe, RDH, MS
A report titled “Report of the Sealant Work Group Recommendations & Products” was published in April. The report describes four priorities for sealant programs and defines specific recommendations for these programs.
The idea for this report began with funding from the US Centers for Disease Control and Prevention (CDC) after the Children’s Dental Health Project (CDHP) produced a report examining the challenges of school sealant programs (SSPs) in 2014. One of the recommendations from this report was the creation of a group to develop strategies for improving operations and sustainability of sealant programs. The next year, CDHP took steps to form and convene the national Sealant Work Group (SWG) composed of 13 experts to develop a report to address these areas.
The SWG was funded by these organizations: American Dental Hygienists’ Association’s Institute for Oral Health, Delta Dental of Iowa Foundation, Delta Dental of Minnesota Foundation, Future Smiles, Oral Health America, the Pew Charitable Trusts, and Washington Dental Service Foundation.
The report describes priorities that focus on solid scientific best practices, and the incorporation of research so that populations and outcomes can continually be addressed. These priorities reminded me of the first use of dental hygienists in schools, since Dr. Fones instilled the same priorities and made sure that he researched the outcomes to show whether a new provider was effective in preventing disease and improving health. Additionally, communication with all stakeholders is emphasized, as well as the need to address bureaucratic issues that can hinder preventive care.
These priorities are discussed and specific recommendations are provided to address the priorities. Specifically, certification standards are recommended to ensure quality care, best practices, and well-planned communication to all involved. These may seem second nature to some, but this is an important area for all the parties involved.
Priority: Promoting evidence-based and promising practices
- State health departments should develop certification standards for SSPs and actively involve experts in the discussion of the certification process.
- SSPs should commit to having a culturally competent and proficient staff guided by public health principles who work to the fullest extent allowed by their education, training, and state license.
- SSPs should be aware of tooth eruption patterns among the children they serve and take these patterns, and children’s risk for tooth decay, into account when choosing the appropriate grades for sealant placement.
- SSPs should use the criteria from the Association of State and Territorial Dental Directors’ (ASTDD) Basic Screening Survey (BSS) to assess the severity of dental disease in children.
- SSPs should conduct retention checks eight to 14 months after sealant placement on an appropriate sample size based on the number of children whose teeth were sealed.
- SSPs should incorporate a minimum of two fluoride varnish applications into the services they provide children each year.
Priority: Communicating with families, the community and school staff
- SSPs should develop and periodically update a communication plan that identifies the messages, communication vehicles, and other details that will guide efforts to engage school officials, school staff, families, and children, and strive to strengthen and expand sealant programs.
- SSPs should create a memorandum of understanding (MOU) or a memorandum of agreement (MOA) signed by the SSP operator and an appropriate representative of the school or school district where services will be provided.
- Oral health advocates and school officials should work together to communicate the value of investing in SSPs to state Medicaid programs, legislators, school board officials, and other policymakers.
Priority: Collecting, analyzing, and reporting data
- SSPs should collect, analyze, and report 11 specific types of data.
- State licensing boards and/or legislatures should evaluate existing rules and regulations that restrict the use of appropriately trained and licensed members of the workforce. Rules, laws, and/or regulations should be changed to allow patients to receive services in the most cost-effective manner.
Priority: Addressing Medicaid and regulatory hurdles
- State Medicaid programs should allow all licensed dental providers (e.g., dental hygienists and dental therapists) to enroll as Medicaid providers, as well as allow them to submit claims and receive direct reimbursement for oral health services in all settings, particularly in states where they can place sealants without a prior exam by a dentist.
- States should simplify the Medicaid application and credentialing process for all licensed dental professionals. This would help to facilitate the efforts of SSPs.
- State Medicaid programs should require that managed care organizations (MCOs) abide by the same payment and contracting requirements that govern the state Medicaid program.
- State Medicaid programs should complete a cost-benefit and budget impact analysis on the recently approved Current Dental Terminology (CDT) codes for case management services to prepare for implementing these codes. In addition, Medicaid agencies should educate dental providers on the types of case management that are covered and how to use these codes appropriately.
Dental hygienists should read this report and use it when planning and evaluating school programs. This document would be key in planning for new programs or improving existing programs because it is comprehensive in nature and addresses all aspects of school sealant programs. This can also be helpful when advocating for changes in practice to ensure access to care for all. RDH
CHRISTINE NATHE, RDH, MS, is director at the University of New Mexico, Division of Dental Hygiene, in Albuquerque, N.M. She is also the author of “Dental Public Health Research” (www.pearsonhighered.com/educator), which is in its third edition with Pearson. She can be reached at [email protected] or (505) 272-8147.