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5.1 Effective Program Operations

Targeting Populations

Targeting Schools

For programs, the objective of targeting is to provide dental sealants to the largest possible number of children at high risk for dental caries. Targeting programs to populations has been shown to be more cost-effective than targeting them to specific children based on oral health status, and the former is easier to implement.1,2 National data show that, compared with children from families with higher incomes, children from families with low incomes are at higher risk for experiencing dental caries and for having untreated caries. Children from families with low incomes also are less likely to have dental sealants and less likely to have had a dental visit within the past year.3,4,5

The Association of State and Territorial Dental Directors (ASTDD) states that "school-based sealant programs generally are designed to maximize effectiveness by targeting high-risk children." ASTDD "fully supports, endorses, and promotes expansion of school-based and school-linked dental sealant programs that follow evidence-based guidelines as part of a comprehensive community strategy to serve the greatest number of children and adolescents at highest risk for dental disease." ASTDD also recommends "school-based and school-linked dental sealant programs as an important and effective public health approach that complements clinical care systems in promoting the oral health of children and adolescents."6

The Oral Health Survey of Maryland School Children, 2011–2012 revealed that 40.4 percent of children in third grade who were sampled had at least one dental sealant. Overall, 32.9 percent of children in kindergarten and third grade in the state had at least one dental sealant on a permanent first molar, and 67.1 percent had no dental sealants.7 The prevalence of sealants for children in third grade in Maryland was notably higher than that reported for the nation during the Healthy People 2010 final review (target 23 percent), and for children in Maryland surveyed in 2000–2001 (24 percent).8 This result also surpasses the Healthy People 2020 objective (target 28.1 percent) for sealants in children ages 6–9.9 Children in kindergarten were significantly less likely to have had at least one sealant than were children in third grade. This finding was expected because permanent first molars are usually not yet fully erupted among children in kindergarten. The Eastern Shore region had the highest prevalence of dental sealants, and the Central Baltimore region had a significantly lower prevalence. Non-Hispanic black children in third grade were significantly less likely to have dental sealants than were non-Hispanic white children in third grade.7