The recommendations were developed by a work group of experts in the fields of caries prevention and treatment, oral epidemiology, and evidence-based reviews. The work group also included representatives from professional dental organizations.

The expert work group examined new evidence on:

• The effectiveness of sealants in preventing new decay and progression of early decay
• Methods to assess decay
• Sealant placement techniques
• Scientific reviews of program practices

Based on this evidence, the following recommendations are provided for practitioners in school-based programs:

• Seal pit-and-fissure tooth surfaces that are sound or have early decay, prioritizing first and second permanent molars.
• Use visual assessment to differentiate surfaces with the earliest signs of tooth decay from more advanced lesions.
• X-rays are not needed solely for sealant placement.
• A toothbrush can be used to help clean the tooth surface before acid etching.
• When resources allow, have an assistant help the dental professional place sealants.
• Provide sealants to children even if follow-up examinations for every child cannot be guaranteed.

These recommendations are designed to guide practices of state and community public health programs for planning, implementing, and evaluating school-based sealant programs, as well as to complement the American Dental Association Council on Scientific Affairs’ evidence-based clinical recommendations for sealant use* (PDF–245K) published in 2008.

Preventing Dental Caries Through School-Based Sealant Programs: Updated Recommendations and Review of Evidence,”* Journal of the American Dental Association, November 2009, provides guidance to school-based sealant programs.