Expanding School-Based Sealant Programs to Realize Treatment Cost Savings in Colorado

Children of lower socioeconomic status suffer a disproportionate amount of dental caries compared to their higher income counterparts. Dental sealants have been shown to be effective in preventing caries in permanent molars. Targeting school-based sealant programs using free and reduced lunch participation as a proxy for income is cost-effective in reducing decay in populations at greater risk for dental disease. In 2004, the prevalence of dental sealants in first permanent molars among third-graders in Colorado was determined using a random sample of 44 schools. Approximately 34% of third-graders were found to have at least one sealant, significantly less than the desired Healthy People 2010 objective of 50%. In 2005, the Colorado Oral Health Program, Be Smart and Seal Them, embarked on an expansion of school-based sealant programs focused on meeting the Healthy People 2010 objective and incorporating the use of CDC-developed software (SEALS) to evaluate efficiencies and monitor program impact. The ground work for this expansion was based on a yet unpublished cost-effectiveness study by health economist Joan O’Connell, PhD, et al in 2004. Sealant delivery, targeted to second-graders in greatest need of oral disease prevention, was secured through contractual agreements with independently practicing dental hygienists. In 2006, the efforts of the Colorado Be Smart and Seal Them program doubled the percentage of schools participating in the program and the number of children served increased by 55%. An estimated 2200 occlusal caries were averted saving an estimated $212 000 in treatment costs of single surface, occlusal, amalgams. In 2005-2006 Be Smart and Seal Them developed in capacity (contractors, coordinator, schools, students); uniform data reporting (SEALS coordinating all contractor activities); and meeting the greatest oral health needs (disparities reduced, disease averted, cost savings). Contractors and the state coordinator reported areas of growth and improvement and identified further needs.