Louisiana Seals Smiles

Dental sealants are effective in preventing tooth decay, but are underused, particularly among children from families with low incomes and who lack access to care. School dental sealant programs, like Louisiana Seals Smiles, offer an effective approach for reaching these children.  This step-by-step program implementation guide is designed to assist stakeholders in launching and sustaining an effective school dental sealant program.

What are dental sealants? 

Dental sealants prevent 80% of cavities on the back teeth, where nine out of every ten cavities occur.  Dental sealants are thin plastic coatings that are applied to the chewing surfaces of the first and second molars where food and bacteria are not easily removed. The sealant acts as a barrier to protect the teeth from plaque and acids, which cause tooth decay. When correctly applied, dental sealants last several years before reapplication is needed.

What is a school dental sealant program? 

Only two out of every five Louisiana third graders have dental sealants.  School dental sealant programs are an evidence-based best practice for preventing tooth decay among children who are less likely than other students to receive oral health care from dentists in private practice.  Louisiana Seals Smiles provides free oral health screenings and dental sealants to eligible students between ages 6 and 14.  School dental sealant programs can be school-based or school-linked.  School-based programs are conducted completely within the school setting using portable dental equipment.  School-linked programs are implemented through schools, but services are implemented in a mobile unit or clinic setting. 

Six steps to host a dental sealant program

Dental care is often a child's top unmet health need.  Although childhood obesity has more than tripled since the 1970's, tooth decay remains the most common chronic disease among children.  Follow the steps below to implement Louisiana Seals Smiles in a school in your community.  

Gain Community Support

Gaining and sustaining community support is key to implementing a successful Louisiana Seals Smiles program in a school in your community.  Remember to consider all community members and organizations that could provide financial, in-kind, or volunteer support for the program.  

Be sure to connect with:  

  • Local dental providers and hygienists
  • Nearby academic institutions - dental schools, dental hygiene programs, and dental assistant programs 
  • School board members, school administrators and staff, teachers, school health advisory committees, and school nurses
  • Parent teacher associations (PTAs) 
  • Community service clubs, especially those that are serve youth  
  • Faith-based organizations  
  • Healthy community coalitions
  • Community health centers 
  • Business leaders
  • Local dental associations 
  • Local school of public health 
  • Local health education or health promotion programs within university

Choose a School

Choose an elementary school in your community in which at least 50% of students qualify for the federal or Louisiana free or reduced meal programs.  Schools that are also located in dental healthcare provider shortage area or located in an area without community water fluoridation should be given first priority.  Remember, all students who participate in the Louisiana Seals Smiles program should be between the ages of 6 and 14.  

Contact the school principal, nurse, or teacher.  You can do this by email, phone, or an in-person meeting!  Always be sure your communication is clear and connects with school staff and administrators.  Use the materials below to get the conversation started! 

Once a school has agreed to participate, be sure to identify a primary contact that can help you launch and implement your program! 

Gather Supplies and Equipment

Depending on whether you'd like to implement a school-based or school-linked program, there are options for applying dental sealants in a school setting.  

  1. Set up a dental clinic within a school-based health center
  2. Outfit or utilize a mobile van with dental equipment
  3. Use portable dental equipment 

Well-Ahead Louisiana has all portable dental equipment needed to implement a Louisiana Seals Smiles program.  This equipment will be provided to partners upon request. Portable dental equipment includes the following: 

  • Portable dental sealant unit.  This should include: an air/water syringe, a clean self-contained water system, a compressed air system, an air filter/dryer, and a low volume vacuum system. 
  • Portable operator stools 
  • Portable LED standing lights 
  • Portable patient chair 
  • Sealant curing lights 

If you'd like to utilize Well-Ahead's equipment, please email wellahead@la.gov to make a request.  If you have access to your own equipment, it can be used, as long as it includes all required elements to conduct the program.  If you have access to a mobile van, it can also be used! 

You will also need patient supplies to conduct the program.  Connect with a local dental provider for a recommendation on sourcing and sterilizing supplies.  There are several resources online to order supplies.   

For a complete checklist of equipment and supplies needed, click here.  

Prepare to Launch

Before a Louisiana Seals Smiles program is implemented at your chosen school, you must complete the following launch tasks with your program's staff, school, and parents.
 
Staff
  • Ensure your staff members have the required permits and licenses for portable or mobile van dentistry.  Note: Louisiana requires a prior exam by a dentist, and further requires a dentist to be present when a sealant is applied in a school dental sealant program. 
  • Ensure there is one primary point of contact at your organization and the school.  

Schools
  • Determine if your school dental sealant program will be school-based or school-linked.  
  • If the program will be school-based, discuss space at the school for the program. The space should have exceptional lighting, proper ventilation, and an adequate number of electrical outlets.  Portable dental equipment can be noisy, so be sure to consider this when determining a location within the school.   
  • Discuss the oral health educational component of Louisiana Seals Smiles.  There should be a student educational component and a parent educational component.

    For Parents: This should include a verbal or written explanation on the importance of dental sealants. This could be delivered during via a presentation at a PTA meeting, during parent teacher conferences, or in a school newsletter.   

    For Students: At a minimum, this include a brushing/flossing demonstration.  Click here for a free download of an oral health worksheet.  Will this education be delivered on the same date(s) as the clinic or on a different date? Will the parent portion be delivered via email, flyer, or at a parent teacher conference? 

  • Determine dates and times for all aspects of the program. Dependent on the number of participating students, number of dental providers, etc.  you may need between two and three days for your program.  If possible, also schedule a day for follow-ups.  Be sure to send written confirmation to verify dates and times.  
  • Discuss communication with parents.  Determine when and how flyers and forms should be distributed and returned. For more information on communication with parents, see below.  
  • Be sure to discuss compliance with the Health Insurance Portability and Accountability Act (HIPPA) and special language needs of students prior to the program.   
Parents or Guardians 

Parent or guardian support is essential for a successful program.  Utilize the materials below to communicate with parents/guardians about Louisiana Seals Smiles! 

  • Parent Flyer.  This can be used to notify parents/guardians about Louisiana Seals Smiles. 
  • Student Consent Form.  This form should be used to obtain consent for participation from parents/guardians.  
  • Additional Information on Dental Sealants.  This can be used to provide more in-depth information on the importance of dental sealants. 

 

Implement the Program

If you are implementing a school-based dental sealant program, its efficiency will depend upon preparations made to transport and setup dental equipment and supplies.  Be sure your equipment and supplies are well organized so they can be unpacked and setup quickly!  Tip: Label your storage containers to identify their contents!  

Either on the day before the program is scheduled to begin, or early in the morning on the same day, dental equipment should be delivered to the school and placed in the area where the program will operate. It is recommended that all equipment setup and breakdown, sterilization, instrument-tray preparation, and paperwork should occur before and after school. 

A group of ten students (or less) are excused from class at a time.  Students are screened for tooth decay, untreated cavities, and dental sealants.  This process should take between two to three minutes per student.  

Placing dental sealants generally takes between 10 and 15 minutes.   To apply, the tooth's surface is cleaned with a pumice and prophy cup, then rinsed and dried.  The tooth is then isolated using dry angles and cotton rolls and the enamel surface is etched.  The tooth is rinsed and dried again.  The sealant material is then applied to the grooves of the tooth using a micro-brush to ensure even distribution.  The sealant is then light-cured.  Last, a final check ensures the sealant is intact, covers the surface of the tooth, and does not have any bubbles or voids.  

Remember to explain to the student that their teeth may "feel too tall" for a little while, but that will go away soon! Be sure to tell them they should not eat anything sticky or hard for the rest of the day.  

After the treatment is complete, the Clinic Charting Form and Dental Report Card should be completed.  The Dental Report Card should be used to share screening results and sealant application information with parents/guardians. If an organization other than a safety net clinic is implementing Louisiana Seals Smiles, the organization should ensure proper referral to a dental provider.  This information can be added to the Dental Report Card or could be provided separately.  

RETENTION CHECKS 

Retention checks are one of the most important aspects of dental sealant delivery. After sealant placement, you should have a plan in place to return to the school to determine if the sealants are retained. You should use a random sampling process of the students. This helps to accurately determine the retention rate. A random sample gives each student an equal chance to be selected, regardless of their characteristics, such as which school they go to or which provider served them.

SPECIAL CONSIDERATIONS 
  • Please reference the Louisiana Dental Practice Act.  Be sure to adhere to all Portable and Mobile Dentistry Statues.  
  • Please reference recommendations from the CDC's Guidelines for Infection Control in Dental Health-Care Settings
  • Services provided through Louisiana Seals Smiles are able to be reimbursed through Medicaid and LaCHIP.  The consent form provides a space for the student's identification number for reimbursement.  
  • The Health Information Portability and Accountability Act requires that all health information be kept confidential.  Information regarding screening, sealant placement, etc.  should be kept in strict confidence with only the staff providing treatment, school personnel, and parents.  If the information is stored digitally, it should be encrypted, locked or password protected.  
  • If any program staff suspects child abuse or neglect, it is mandatory that he or she report the suspicion to the school administration and proper authorities.  

Evaluate the Program

Applying high-quality dental sealants to as many students as cost-effectively as possible is the goal of Louisiana Seals Smiles.  To determine whether a program is operating effectively and efficiently requires evaluating the program on a regular basis. 

To evaluate your program, about a week after the clinic, send the School Evaluation Form to your primary contact at the school.  In addition, send the survey link to the dental professionals that participated in your program.  

 

Funding school sealant programs

To operate effectively and ensure sustainability, all Louisiana Seals Smiles programs need adequate funding. Considering direct reimbursement through Medicaid, CHIP or by sliding fee payments, is an option to secure a means for ongoing services.
All Louisiana Seals Smiles programs should be implemented in accordance with the Louisiana Dental Practice Act.