On August 27, 2019, the AAPD and ADA wrote the Health Resources and Services Administration (HRSA) urging them not to replace the measure of Dental Sealants for Children Between 6-9 Years. This measure is utilized in HRSA’s oversight of its community health centers program. HRSA had requested public comment on a proposal to replace this measure with one titled Primary Caries Prevention Intervention as Offered by Primary Care Providers (CMS74v9).

The letter, signed by then-ADA President Jeffrey M. Cole, ADA Executive Director Kathleen T. O’Loughlin, AAPD President Kevin J. Donly, and AAPD Chief Executive Officer John S. Rutkauskas stated: “Research has shown that sealants are effective in preventing occlusal carious lesions in the molars of children when compared with controls without sealants.” The letter referenced the evidence-based clinical practice guideline released in 2016 by the ADA and AAPD that found sealants could minimize the progression of noncavitated occlusal carious lesions and effectively prevent and arrest pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes. The letter also stated:

“ . . .  there is in fact evidence to suggest the superiority of resin-based fissure sealants over fluoride varnishes applied to prevent decay in permanent molars.” 

“While both topical fluoride as well as dental sealants are important caries preventive modalities, we fail to see the agency’s rationale for removing the focus on improving sealant rates, especially given the improvement health centers have made.”

As reported by 1,362 HRSA-funded health centers, their performance improved more than 10 percentage points between 2015 –– when the sealant measure was first adopted –– and 2018. Nearly 53% of children 6 to 9 years old who are at an elevated risk for caries received the recommended sealants. Thirty-six states also performed better by at least 5 percentage points on the measure from 2015 to 2017. The AAPD-ADA letter indicated that a performance gap continues to exist and that now is not the time for HRSA to move away from a focus on this measure.

HRSA’s rationale was that the fluoride varnish measure would increase the target population from high-risk children who are 6 to 9 years old to children and adolescents as old as 20 and also include oral health preventative measures that health centers without dentists can employ. However, the AAPD-ADA letter pointed out that the fluoride varnish measure would track only one application of varnish during the measurement period, although topical fluoride should be applied every three to six months in children at an elevated risk for caries. It was further noted that the sealant measure was developed and tested by the Dental Quality Alliance (DQA), which maintains the measure through a periodic review process to align it with emerging science and implementation experience. The AAPD actively participates in the DQA as a member of its Executive Committee.

Click here for a copy of the letter.