The Seal-a-Smile A Dental Sealant Portfolio for Dental Hygiene Programs and Wisconsin Communities.
Adverse Event Protocol:
Sealant contains methylacrylates, which may be irritating to the skin and eyes. In case of contact with eyes, rinse immediately with plenty of water and seek medical attention. After contact with skin, wash immediately with plenty of soap and water. The product may cause sensitization by skin contact in susceptible persons. If skin sensitization occurs discontinue use.
Sealant etchant contains phosphoric acid, which may cause burns. Avoid contact with oral tissues, eyes, and skin. If accidental contact occurs, flush affected area with generous amounts of water. In case of contact with eyes, immediately rinse with plenty of water and seek medical attention.
C. Retention of the dental sealant is essential to preventing caries. A sealant is virtually 100 percent effective if it is fully retained on the tooth (NIH, 1984). Studies have demonstrated good retention rates in school-based dental sealant programs. It is recommended that limited resources be spent on placing sealants rather than doing additional retention studies. A sample of the children sealed will provide the program with adequate retention information. Reasons for tracking retention rates should be based on:
program evaluation of a new sealant material
ii. monitoring a new practitioner’s technique.
D. If a sealant is not retained, it should be reapplied.
Follow manufacturers directions for application of pit and fissure sealants.
Use CDC Guidelines for infection control.
Sealant Precautions: A small percentage of the population is known to have an allergic response to acrylate resins. To reduce the risk of allergic reaction, minimize exposure to uncured resins. When resins are in prolonged contact with oral soft tissue, or in case of accidental prolonged exposure, flush with copious amounts of water. Wash skin with soap and water when skin contact occurs.
Etchant Precautions: Conditioner (etch) contains phosphoric acid. Protective eyewear is recommended for both provider staff and individuals receiving services while using etchants. Contact with oral soft tissue, eyes, and skin should be avoided. If accidental contact occurs, flush immediately with copious amounts of water and consult a physician.
Providers and individuals receiving services are required to wear safety glasses.
Do not place dental sealants on individuals with a known allergy to components found in dental sealant (example: methylacrylate).
Sealant and sealant etchant should be tightly closed immediately after use, keep out of direct sunlight, and store at 40-70 degree F and use at room temperature.
Questionable (stained) – seal in accordance with manufacturer directions
Enamel caries (incipient with no evidence of undermining) – seal in accordance with manufacturer directions
Dentin caries (frank, overt with evidence of undermining) refer for restoration
E. Inform parent/legal custodian/guardian of procedures and referral status
F. Evaluate sealed teeth for sealant integrity and retention and caries progression
Sealant Placement Guidelines are consistent with and subject to individual sealant material manufacturer directions:
Step 1: Verify informed consent of the parent/legal custodian/guardian.
Step 2: Review medical history for contraindications (methylacrylate allergy).
Step 3: Provide client protective eyewear.
Step 4: Conduct risk assessment of individual, individual teeth and pits and fissure surfaces.
Step 5: Prepare teeth by cleaning with the method of your choice.
It is absolutely necessary to remove plaque and debris from the enamel and the pits and fissures of the tooth. Any debris that is not removed will interfere with the proper etching process and the sealant penetration into the fissures and pits.
Step 6: Isolate the teeth.
For most sealant material, it is absolutely imperative to keep the tooth free from salivary contamination.
Step 7: Dry the surfaces.
Step 8: Etch the surfaces.
The etchant should be applied to all the pits and fissures. In addition, it should be applied at least a few millimeters beyond the final margin of the sealant and in accordance with manufacturer directions. Do not allow the etchant to come into contact with the soft tissue. If this occurs, rinse the soft tissue thoroughly.
Step 9: Rinse and dry the teeth.
Rinse all the etchant material from the tooth in accordance with manufacturer directions. The tooth is dried until it has a chalky, frosted appearance. If it does not, the tooth should be re-etched in accordance with manufacturer directions. It is imperative to avoid salivary contamination. There is agreement that moisture contamination at this stage of the process is the most common cause of sealant failure.
Step 10: Apply the material and evaluate for voids, marginal discrepancies or retention problems. If noted return to Step 2.
Be careful not to incorporate air bubbles in the material.
Follow protocol for light cured or self cure dental sealant material in accordance with manufacturer directions.
After the sealant has set, the operator should wipe the sealed surface with a wet cotton pellet. This allows for the removal of the air-inhibited layer of the non-polymerized resin. Failure to perform this step may leave an objectionable taste in the individual’s mouth.
K. Step 11: Evaluate the sealant.
The sealant should be evaluated visually and tactically. Attempt to dislodge it with an explorer. If there are any deficiencies in the material, more sealant material should be applied.
L. Step 12: Evaluate occlusion.
Unfilled resins will wear down naturally and do not require occlusal adjustment.
M. Step 13: Inform the parent/legal custodian/guardian of procedures that have been completed and the referral status.
The policy will be reviewed annually by program director to ensure that policy guidelines are still in place and are being implemented properly.
American Dental Association Council on Access, Prevention and Interprofessional Relations: ADA Council on Scientific Affairs. 1997. Dental Sealants, Journal of the American Dental Association 128 (4):485-488.
Association of State and Territorial Dental Directors, Basic Screening Survey.
Balistreri, Thomas J., Assistant Attorney General, December 9, 2004 Letter to Steven M. Gloe,General Legal Counsel, Department of Regulation and Licensing.
Casamassimo P, ed. 1996. Bright Futures in Practice: Oral Health. Arlington, VA: National Center for Education in Maternal Health and Child Health.
Seal-a-Smile A Dental Sealant Portfolio for Dental Hygiene Programs and Wisconsin Communities, Children’s Health Alliance of Wisconsin, 1999, revised 2000, and revised 2004.
United States Centers for Disease Control and Prevention, 2003. Guidelines for Recommended Infection Control Practices in Dentistry, MMWR, December 19, 2003:52(RR-17).
United States Department of Health and Human Services (DHHS). Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S. DHHS, National Institute of Dental Craniofacial Research, National Institutes of Health, 2000.
Wisconsin Statutes and Administrative Code Relating to the Practice of Dentistry and Dental Hygiene.
Workshop on Guidelines for Sealant Use: Recommendations. Journal of Public Health Dentistry. 1995; 55 (5 Spec. No.): 263-73.)
Wisconsin Statutes and Administrative Code Relating to the Practice of Dentistry and Dental Hygiene.
Thomas J. Balistreri, Assistant Attorney General, December 9, 2004 Letter to Steven M. Gloe, General Legal Counsel, Department of Regulation and Licensing.
AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director PURPOSE STATEMENT: To improve oral health of children in Pepin County by providing fluoride supplementation to children with inadequate fluoride intake.
POLICY: Pepin County Health Department receives funding from the Wisconsin Division of Public Health to purchase and distribute fluoride supplements to children age 6 months to 16 years who do not have fluorinated home water supplies.
Sodium fluoride tablets (1.0 mg and .5 mg) and sodium fluoride drops (0.25 mg) are purchased by the Pepin County Health Department using grant funds. Supplements are available for all children living in Pepin County who are between the ages of 6 months and 16 years and who do not have fluoridated home water supplies. The tablets or drops are distributed free of charge.
Initiating Fluoride Supplementation:
When a family is interested in fluoride supplementation, they must complete the Application Form for Dietary Fluoride Supplement Program (attached). Clerical will create a note card for the file using the information provided.
The dosage is determined by the age of the child and the fluoride concentration of the water supply.
Arrange water test if indicated (see below).
Upon receipt of application materials and a completed water test result, fluoride may be distributed according to the dosage schedule (see below).
Reorder and general instructions are provided on the General Instructions for Use of Dietary Fluoride Supplements handout.
Fluoride supplementation is dependent on the age of the child and the fluoride concentration in the home water supply. Well water must be tested for fluoride concentration prior to receiving fluoride supplements. All water must be tested with the exception of that in the City of Pepin and Whispering Pines Trailer Court.
The Wisconsin State Laboratory of Hygiene tests the fluoride concentration free of charge if the health department fee exempt number (569) is documented on the water test request form. It is the client’s responsibility to collect and submit the water test to the state lab.
Children getting their water supply from the City of Durand should NOT take fluoride supplements since the city water is fluoridated.
An annual standing prescription/order is provided by Dr. Warren LeMay, in accordance with the recommendations of the American Dental Association and the American Academy of Pediatrics. The prescription is kept on file in the health department office.