The Process of Rebuilding a School-Based Dental Sealant Program

Danica Loring says she’s seen her fair share of people in need of oral care at Penobscot Community Health Care (PCHC) in Bangor, Maine — and not just adults.

“We live in an area where there is a mixed group of community members, and there is a high number of the lower-income community members,” says Loring, CDA, an expanded functions dental assistant and the director of operations at PCHC's Dental Center and Jackman Community Health Center. “And it saddens me to see when we have a teenager come into the dental center and their teeth are in desperate need of care.”

Something as simple as placing dental sealants on that child’s molar teeth, Loring says, could have prevented those cavities. But ensuring children get those sealants has become even more challenging in the past few years. Like in many other health centers across the US, the COVID-19 pandemic made it challenging to provide access to preventive oral care in rural communities. PCHC shut down its school-based dental program in 2020.

“We really had to focus on our dental center,” says Loring. “Just because of the limitations and unknown of the situation of COVID when it initiated, we really had to step back from that position.”

But now they are rebuilding the program with a small change — something that came to Loring when she attended a CareQuest Institute webinar entitled “Best Practices and Innovative Approaches to Strengthen School-Based Dental Sealant Programs.”

“It was just like a light switch,” she says. “Like, let’s start small. Why not start with sealants?”

The Benefit of Oral Care in Schools

During the webinar, an expert panel — Steve Geiermann, DDS, chair, Association of State & Territorial Dental Directors (ASTDD) Best Practices Committee; Beth Lowe, MPH, BSDH, health education specialist, National Maternal and Child Oral Health Resource Center, Georgetown University; Shailee Gupta, DDS, MPH, director of dental programs, St. David’s Foundation; and Karen Phillips, MPH, RDH, EPP, school oral health programs coordinator at Oregon Health Authority — explained the importance of school-based sealant programs and reviewed the findings and recommendations from ASTDD’s School-Based Dental Sealant Program Best Practice Approach Report. The 2022 report highlights key steps for building and improving effective programs, including the use of evidence-based practices, clinical quality measures, and innovative design.

“I always feel like I pull at least one or two things out in each webinar,” says Loring, a frequent participant at CareQuest Institute webinars. “While it doesn’t seem like much, it really adds up.”

PCHC had run a school-based dental program for several years until 2020 — not only providing sealants, but also fillings, extractions, and other preventive services. Their team of providers, assistants, and hygienists helped improve hundreds of children’s oral health care, many of whom would never go to a dentist outside of school.

“Parents are busy,” Loring says. “Most homes, both parents are working. It’s hard to take time out of the day to take a kid out to a dental appointment. And oftentimes, people look at dental care as secondary to medical care, which is truly unfortunate, because it truly is integrated.”

Starting Small with Sealants

State and school leaders had been asking PCHC when they were going to be back in schools. Over the past 4–5 months, PCHC has been trying to rebuild the program, but the path was filled with obstacles.

“We were thinking [of] the big picture — like, we’ve got to get a dentist in there every Friday,” says Loring. “We’ve got to get a hygienist in there every week. We need to start doing fillings, stainless steel crowns. We need to do all of this.”

The biggest hurdle? The shortage of dental assistants and providers. On top of that, Loring says it’s a challenge to ask the providers who are available to work on Fridays, which are normally their days off.

But when Loring attended the CareQuest Institute webinar, she got some much-needed inspiration: The speakers highlighted the fact that dental hygienists can place those sealants with approval from a provider and open the door for future care.

“When I attended the webinar, I realized, you know what? Maybe instead of doing these elaborate treatment plans, why don’t we start with a sealant program over there, and just start slow, and then slowly rehabilitating us getting back in there to full capacity,” Loring says.

Although the school-based program will not be as big as it once was, Loring believes it’s an important step in the right direction.

“This also gives us an opportunity to see the kids’ oral health in general,” says Loring. “We can see what they need, and then our plan this fall is to have a true provider in there providing full-on restorative care.”

Editor’s Note: Watch the recording of the webinar and access the related PowerPoint presentation in the “Past Webinars” section on carequest.org.