Factors Contributing to Labor Efficiency in School Sealant Programs in 11 US States, 2017-2023

Financial viability can be a challenge in implementing school sealant programs (SSPs). We provided efficiency benchmarks for 2 measures-clinical labor time and labor cost per child-to help SSPs evaluate their performance and quantify the effect of implementation practices on these efficiency measures.

We analyzed a convenience sample of data from 107 SSPs delivering sealants in 11 US states to 58 664 students during school years 2017-2018 through 2022-2023. We estimated measures of sealant service efficiency (SSE) per child sealed (SSE_time and SSE_{labor cost}) and used multivariable linear regression models to identify associations between SSP practices and each SSE measure. Because of their skewed distributions, we log-transformed SSE measures. To aid interpretation, we converted resulting regression coefficients back to their original linear scales (hours and US dollars).

The median SSE_time and SSE_{labor cost} were 0.95 hours (IQR, 0.56-1.53) and $43.25 (IQR, $23.22-$74.91). The smallest SSP size (sealing 11-60 students) as compared with the largest (sealing 390-14 589 students) was associated with an increase in SSE_time of 0.34 hours (20 minutes; β = 0.399, SE = 0.189, P = .04) and SSE_{labor cost} of $14.45 (β = 0.431, SE = 0.200, P = .03). The use of dentists as dental operators was also significantly associated with increased SSE_{labor cost} at an increase of $3.61 (β = 0.126, SE = 0.140, P = .02).

Our findings suggest that SSP labor efficiency could increase with program size (ie, economies of scale) and by using nondentist operators when possible.