Seal a Smile Oral Health Needs

A Partnership of the Healthy Capital District Initiative and Whitney M. Young Jr. Health Services

Service Description

The Seal a Smile Program is an oral health prevention and screening program for low income children in Albany and Rensselaer Counties. Seal a Smile is a school-based program which provides oral health education, screenings, prophylactic measures, and sealants to children with parental consent. Services are provided by a licensed Hygienist and Dental Assistant on portable equipment in a room designated by the school and approved by the health department. The target population is elementary school children in 25 schools identified as having at minimum 35% participation in the federal school lunch program - an indicator of poverty, 5 Head Start programs, a public housing site and the Boys and Girls Club of Albany.

Each child is given a letter at the end of their visit providing their parents with information about the urgency of follow-up care with a dentist, the services provided to their child, the importance of brushing and fluoride, as well as our contact information and offer of assistance. Children are rewarded for their participation with a goody bag containing a toothbrush, toothpaste, timers for kindergarteners and stickers. Children in need of primary dental services are referred for further dental care and uninsured children’s parents are offered assistance in completing Child Health Plus applications.

Sealants are applied to healthy, mature molars which were found in 42% of participating children. Sealants are a critical prevention strategy because 90% of tooth decay in children is on surfaces that sealants protect. Sealants, according to the Center for Disease Control, have been shown to reduce decay by more than 70%. In our first half school year of service, we found 4% of the children had sealants. In 2006, this number improved to 11%, by the 2007 school year we had achieved a 33% sealant rate on students seen, but fell to 30% in 2008 when new schools were added to the program. Nationally 32% of 6-19 year-old children have dental sealants on their molar teeth.  The Healthy People 2010 goal is 50%.¹

Indications of Need

Tooth decay is the most prevalent childhood chronic disease; afflicting 5 times as many children as asthma.² Twenty-five percent of children receive their first dental care from a health professional in the emergency room. Nearly half of all children receiving emergency room oral health care have their decayed teeth extracted.²

Oral health problems disproportionately afflict children from low income families. Children from low-income families are twice as likely to have tooth decay⁴ and are much more likely to have untreated caries.^4,5 Untreated decay is 262% more prevalent in children from families with earnings below the Federal Poverty Line (FPL) than in children from families above 200% of the FPL.⁶ With more economically similar groups, the New York State Oral Health Surveillance demonstrated untreated caries rates 177% higher for those qualified for the federal free lunch program compared to all other children.⁵

Seal a Smile has found, during the past two years, 43% of the 5,500 children seen had untreated caries. In the past year, while serving children through fifth grade, untreated caries has risen to 48%. These children, with clear decay, averaged 3.75 carious teeth per child. Six percent (6%) of all children seen in the period required urgent care: One or more teeth had visible tooth decay that is accompanied by a draining abscess, swelling, and often discomfort when eating or drinking; or had portions of multiple teeth missing due to extensive dental decay. Parents of children who need care urgently, in addition to the Parent Report received a follow-up phone call, letter and outreach from school staff to emphasize the seriousness of the problem and to offer assistance with arranging a visit with a dentist.

Seal a Smile is positively impacting both the perceptions of oral health care and the preventative practices of the children we treat. Children’s oral health practices are most influenced by what they see and hear from their parents. In many cases, we are the first non-parent to provide them information on how to care for their teeth and the consequences of not doing so. One parent confided that she has had cavities in her teeth for years without pain and this is why she minimized the seriousness of dental decay experienced by her children. It is evident that many children have become accustomed to their parents missing teeth and expect the same to happen to them. These children associate dental care with tooth extractions.  We are teaching them that dental visits usually do not result in tooth extractions.

Seal a Smile findings demonstrate that children in their second visit are less likely to talk about pulling teeth but rather how they are not eating sweets, wondering whether particular foods cause cavities or looking for affirmation that they are making their smiles beautiful. All children receive a toothbrush after their visit, which makes brushing more appealing, and in some cases eliminates the need for sharing a toothbrush at home.

References

¹ Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis –United States, 1988-1994 and 1999-2002. MMWR, August 26,2005; 54 (No.SS-3).

² Edelstein BL. Ambulatory Pediatrics 2002; 2(2 Supplemental):141–2.

³National Center for Education in Maternal and Child Health, 1998. “The Cost of Caring: Emergency Oral Health Services.”

⁴US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institute of Health, 2000. “Oral Health in America: A Report of the Surgeon General.

⁵New York State Department of Health, 2005. “Oral Health Plan of New York State.”

Parent/Guardian Letter

Consent Form