Project Summary/Abstract:
Adolescent dental decay and its complications diminish quality of life and can lead to lost
school days, emergency room visits, and in extreme cases even death. Dental sealants are an
effective intervention to reduce dental decay, but sealant prevalence among adolescents
remains low and has disparities by sociodemographic characteristics. While 2nd molars are
seldom erupted enough to receive sealant application prior to middle school, the majority of
school-based sealant programs (SBSP) — an efficient public health initiative typically aimed at
low-income schools — serve elementary schools only, and thus predominantly limit their reach
to 1st molars. This lack of adoption of SBSPs for 2nd molars represents a critical gap in
implementation of an effective oral health intervention for adolescents that is also well
documented to reduce disparities. The objective of this research is to investigate the effect of
2nd molar sealants on dental caries, the reach of middle school sealant programs in the US, and
the impact of increasing access to 2nd molar sealants through SBSPs on oral health and related
disparities among adolescents.
The first aim is to determine the prevalence of 2nd molar sealants and the resulting
impact on dental caries in adolescents among various racial/ethnic and income groups.
Multivariable regression models will be used to examine the probabilities of receiving 2nd molar
sealants and of experiencing dental caries in the presence/absence of sealants. The second
aim is to gather data on middle school sealant programs in the US by surveying state oral health
program directors, SBSP coordinators, and providers. This data will be analyzed to understand
availability and reach of SBSPs to adolescents including number of middle school programs,
their size, program characteristics, funding mechanisms, costs and student participation rates.
The third aim is to estimate the impact of increasing availability of SBSPs to adolescents using
estimates and data from Aim 1, Aim 2, and the literature. A simulation model will be built to
model various SBSP characteristics and to measure resulting impact in number of sealants,
averted decay, and cost-savings of averted restoration by race/ethnicity and income level.
This research will fill a critical gap in information on SBSPs and provide clearer
understanding of the sealant and related dental caries experience for 2nd molars by
race/ethnicity and income level. The findings will furnish comprehensive information about the
status of middle school sealant programs in the country. It will produce reliable estimates of the
potential impact of increasing the reach of SBSPs to more adolescents and its contribution to
reducing disparities. This R21 will lead to a subsequent R01 project to support increased
implementation of SBSPs for adolescents, identify ways to improve the efficiency of these
programs and reduce oral health disparities.
