Dental Sealants for Children: Most States Falling Short

The United States is making progress but is still a long way from the goal of providing dental sealants to every child who needs them, according to the Pew Center on the States.

The authors of the report, Falling Short: Most States Lag on Dental Sealants C, published online January 8, assigned letter grades from "A" to "F" to states on the basis of their sealant programs, but found wide gaps.

"I was pleased to note that several states have made progress in the last few years," a consultant to the project, William Maas, DDS, MPH, told Medscape Medical News.

"What we note is that there are sort of leaders and laggers. The great difference is something that some people might find surprising."

Dental sealants on molars prevent caries by arresting decay. The report's authors cite previous research showing that a school-based sealant program reduced the incidence of tooth decay by an average of 60%. However, it found that only a quarter of all poor children, a quarter of all black children, and a quarter of all Hispanic children receive sealants, whereas about a third of white and a third of higher-income children receive them.

Making the Grade

The report gave "A" grades to only 5 states: Maine, Wisconsin, North Dakota, New Hampshire, and Alaska. It gave an "F" to Washington, DC, and 5 states: North Carolina, Hawaii, New Jersey, Montana, and Wyoming.

The Pew researchers used 4 criteria for the grades:

The percentage of low-income schools with sealant programs: From 2011 to 2012, 9 states increased the proportion of low-income schools with sealant programs, but only 15 states have such programs in 50% of these schools, the report says.
Allowing hygienists to provide sealants to patients who have not been examined by dentists: Nineteen states prohibit sealants in such cases. This can result in fewer children getting the sealants they need because many low-income kids do not often see dentists, said Dr. Maas. In addition, he said, it wastes dentists' time and increases the cost of sealant programs.
Whether the states participate in the National Oral Health Surveillance Program: 84% of states participate in the system, which is important to gathering statistics used in forming health policy, according to the report.
Whether at least half the state's children had sealants: This is goal set by the federal Healthy People 2010 program. Only 10 states have attained that goal, the authors found.

Some critics have objected to care being initiated in schools because it is difficult to provide comprehensive follow-up care in these settings, but research has found that sealants can benefit children even when there is no follow-up, the report shows.

More Progress Needed

The researchers noted that even the "A" states have room for improvement in sealant programs, and not all the states doing well with sealants are top performers in other areas of oral disease prevention. For example, New Hampshire gets an "A" for sealants but only provides fluoridated water to 43% of its residents.

In contrast, Kentucky does a better job providing fluoridated water to its residents but got a "D" for sealants, the report shows.

Jessica Lee, DDS, PhD, a pediatric dentistry professor at the University of North Carolina, Chapel Hill, told Medscape Medical News that the grades do not give a complete picture of the nation's sealant programs.

"Pew does a lot of good studies, and we're thrilled when they give attention to oral health," said Dr. Lee, a spokesperson for the American Academy of Pediatric Dentistry, who was not involved in the study. "I wasn't pleased that North Carolina got an 'F,' but when I looked at the criteria, I wasn't surprised."

North Carolina does a better job than most states in getting children with Medicaid coverage into private dental offices, she said, and many of these children get sealants in that way. Counting school-based programs would not show these successes.

"We also fell short as far as reporting our data," she acknowledged.

Although no completely consistent regional pattern emerged from the mapping of the Pew grades, the "D" states clustered disproportionately in the South and the "A" states in the North.

Dr. Maas said he did not know the reason for this distribution. "This is an example of where our public health leadership is not well distributed through the United States," he said.

Lawrence Hill, DDS, MPH, executive director of the American Association of Community Dental Programs, told Medscape Medical News he noticed another pattern: "If you look at your top-ranked states, most of them except Wisconsin are small states with small populations."

Big cities may face more complexity in trying to bring sealants to their diverse and sometimes stressed school systems, said Dr. Hill, who is also not associated with the study.

Dr. Hill, Dr. Maas, and Dr. Lee have disclosed no relevant financial relationships.

Falling Short: Most States Lag on Dental Sealants C. Pew Center on the States. Full text