Dental sealants. Who needs them?

Most childhood tooth decay is preventable with a combination of fluoride--which protects the smooth surfaces of a tooth--and dental sealants--which protect tooth surfaces with irregularities called pits and fissures. Sealants are plastic coatings that protect these vulnerable areas, often narrower than a single toothbrush bristle, from decay-causing bacteria and food in the mouth. Yet, 1988-1991 data from the National Health and Nutrition Examination Survey showed that while many children still had cavities, over 80% of which were related to pits and fissures, relatively few children had sealants applied to permanent teeth. As caries has gone from a ubiquitous disease to one affecting only half of children in early elementary school and two-thirds of those who are 15 years of age, dentists must consider how to best target sealants to individual children who are at greatest risk for new disease. Most sealants are placed in private dental offices, but children at greatest risk for problems resulting from tooth decay are least likely to get private care. State and local health departments, therefore, have gone after hard-to-reach children and adolescents through school-based and school-linked sealant programs, often using portable dental equipment. This article focuses on public health strategies for community-based prevention.