Vital Signs

Dental Sealant Use and Untreated Tooth Decay Among U.S. School-Aged Children

Susan O. Griffin, PhD; Liang Wei, MS; Barbara F. Gooch, DMD; Katherine Weno, DDS; Lorena Espinoza, DDS


Morbidity and Mortality Weekly Report. 2016;65(41):1141-1145. 

In This Article

Abstract and Introduction


Background: Tooth decay is one of the greatest unmet treatment needs among children. Pain and suffering associated with untreated dental disease can lead to problems with eating, speaking, and learning. School-based dental sealant programs (SBSP) deliver a highly effective intervention to prevent tooth decay in children who might not receive regular dental care. SBSPs benefits exceed their costs when they target children at high risk for tooth decay.

Methods: CDC used data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014 to estimate current prevalences of sealant use and untreated tooth decay among low-income (≤185% of federal poverty level) and higher-income children aged 6–11 years and compared these estimates with 1999–2004 NHANES data. The mean number of decayed and filled first molars (DFFM) was estimated for children with and without sealants. Averted tooth decay resulting from increasing sealant use prevalence was also estimated. All reported differences are significant at p<0.05.

Results: From 1999–2004 to 2011–2014, among low- and higher-income children, sealant use prevalence increased by 16.2 and 8.8 percentage points to 38.7% and 47.8%, respectively. Among low-income children aged 7–11 years, the mean DFFM was almost three times higher among children without sealants (0.82) than among children with sealants. Approximately 6.5 million low-income children could potentially benefit from the delivery of sealants through SBSP.

Conclusions and Implications for Public Health Practice: The prevalence of dental sealant use has increased; however, most children have not received sealants. Increasing sealant use prevalence could substantially reduce untreated decay, associated problems, and dental treatment costs.


National data from 1999–2004 indicate that by age 19 years, approximately one in five children have untreated tooth decay.[1] Children living in poverty are more than twice as likely to have untreated decay (27%) than are children in families whose income exceeds 200% of the federal poverty level (FPL) (13%). Untreated tooth decay can lead to pain and infection, resulting in problems with eating, speaking, and learning.[2] Approximately 16% of children living in poverty were reported by a parent to have had a toothache within the last 6 months.[3] A recent multivariate analysis also found that children with poor oral health miss more school days and receive lower grades than children with good oral health.[4]

Approximately 90% of tooth decay in permanent teeth occurs in the chewing surfaces of the back teeth.[5] Much of this decay could be prevented with the application of dental sealants. Sealants are plastic coatings applied to the pits and fissures in tooth surfaces to prevent decay-causing bacteria and food particles from collecting in these hard-to-clean surfaces. Studies on sealant effectiveness indicate that sealants delivered in clinical or school settings prevent about 81% of decay at 2 years after placement, 50% at 4 years and can continue to be effective for up to 9 years through adolescence;[6] no clinically significant adverse effects have been associated with receipt of sealants.[6] Sealants are underused, especially among low-income children who have the highest risk for decay. National data from 1999–2004 indicated the prevalence of sealant use among children aged 6–11 years living in poverty was 21% compared with 40% among children from families with incomes >200% of the FPL.[1] Increasing sealant use prevalence is a national health goal[7] and the National Quality Forum* has endorsed dental care performance measures aimed at increasing sealant use prevalence in children at elevated risk for tooth decay.[8]

School-based sealant programs (SBSP) typically deliver sealants in schools attended by a large number of children participating in the free/reduced-price meal program (i.e., family income ≤185% of the FPL).[6] The Community Preventive Services Task Force (Task Force) recommends SBSP, on the basis of strong evidence that these programs prevent tooth decay and increase the number of children receiving sealants at schools.[6] A second, systematic review of economic evaluations of SBSP conducted for the Task Force found that the benefits of SBSP exceed their cost when they serve children at high risk for tooth decay, becoming cost-saving after 2 years[6] and saving $11.70 per tooth sealed over 4 years.[9]

In this report, CDC estimated prevalence of sealant use and untreated tooth decay among low-income (≤185% of FPL, the qualification point for free/reduced-price meal program) and higher-income children aged 6–11 years using data from the recently released 2011–2014 NHANES and compared these data with data from the 1999–2004 NHANES. Estimates of tooth decay averted by providing sealants to children were also calculated.