Tooth Decay and Dental Sealants in School-Aged Children

Tooth Decay and Dental Sealants in School-Aged Children
Dr. David Holcombe

By the age of 19, one in five children has tooth decay.  Poverty plays an important role, with twice as many low-income children having cavities than their better off counterparts.  When untreated, cavities lead to pain, problems chewing, speech difficulties and even learning problems.  Parents of low-income families report one or more episodes of toothache in the last six months in 16% of their children.  Such dentally-challenged children miss more school and have lower grades than children with better dental health.  Most tooth decay occurs in the permanent back teeth, a serious and costly problem.


Poverty is difficult to address, but cavities are responsive to better dental care, notably with the use of sealants.  Sealants are an easy-to-apply plastic coating that covers small holes and cracks in the enamel that lead to tooth decay.  Once applied, sealants reduce cavities by 81% in the first two years and 50% within four years of application.  The seal remains effective almost a decade.  Sealants have no down side and the application process is simple, effective and without side effects.


Sadly, this simple and effective treatment is woefully underutilized, especially among the population groups that would most benefit.  Among children 6 to 11, only 43% have received an application of sealant.  This drops to 38.7% among low-income children.  Use of sealant is highest among White, better educated families with higher incomes.


The use of sealants has increased from 2004 to 2014 from 31.1 to 43.6%.  The increase was greatest among families with low incomes (16.2% increase) compared higher-income children (8.8% increase).  There was a corresponding decrease in tooth decay, which decreased 4.9% in low income children.  It remained about the same with higher-income children.


While sealants helped both low and high income children, only 60% of low-income children receive the treatment.  This leaves around 6.5 million children untreated.  These untreated children are three times more likely to develop significant decay in their first molars.


Sealants are cost-effective and the positive economic consequences become apparent within two years.  This results in Medicaid savings as well as benefits from reduced absenteeism and improved learning.  Sealants must be placed by a licensed dental professional, although not necessarily a dentist.  Failure to undergo regular dental check plays a negative role.  Low literacy levels, especially among non-English speaking households, also negatively affect dental care, especially sealant use.


School programs, while effective, are far from universal.  Where available, they mostly use cost-saving dental hygienists or other paraprofessionals to place the sealants rather than dentists.  Fluoridation of water also prevents tooth decay.  That, too, requires a community commitment to such programs, which are sometimes opposed by vocal activists.  Fluoridation and sealants have synergistic positive effects, especially since sealants have the greatest effect on the back teeth.


Children and parents need to understand the importance of dental hygiene, regular dental visits, and the use of sealants.  Adequate dental providers, insurance coverage, and the use of school-based sealant programs with dental paraprofessionals all increase the use of sealants with their positive short and long-term benefits.