School-based Dental Sealant Programs Edward F. Zapert, D.M.D. Executive Dental Director Florida Department of Health Division of Community Health Promotion Bureau of Family Health Services November 18, 2014 To Protect, promote and improve the health of all people in Florida through integrated state, county and community efforts

Caries 2

Caries Type 3

Pit and Fissure ~ 85% Pit and Fissure ~ 85% Smooth Surface ~ 15% Smooth Surface ~ 15% 4

Smooth Surface 5

Pit And Fissure 6

What’s the problem? 7

Fissures ~ 0.1 mm Fissures ~ 0.1 mm 8

What’s the problem? Fissures ~ 0.1 mm Fissures ~ 0.1 mm Toothbrush bristle ~ 0.2 mm Toothbrush bristle ~ 0.2 mm 9

Do the math…. 10

Do the math…. Streptococcus Mutans ~ 0.75 microns Streptococcus Mutans ~ 0.75 microns 11

Do the math…. Streptococcus Mutans ~ 0.75 microns diameter Streptococcus Mutans ~ 0.75 microns diameter Tooth fissure 0.1 x 0.1 x 0.1 mm Tooth fissure 0.1 x 0.1 x 0.1 mm ~2.3 million bacteria ~2.3 million bacteria 12

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Sealants 14

Unsealed Tooth 15

Sealant Application 16

“Cleaning” 17

Acid Etch 18

Rinse 19

Dry 20

Material Application 21

Light Cure 22

Tooth With Sealant 23

Before And After 24

Chapter 466 (2) A dental hygienist licensed in this state may perform the following remediable tasks in a health access setting as defined in s without the physical presence, prior examination, or authorization of a dentist: (2) A dental hygienist licensed in this state may perform the following remediable tasks in a health access setting as defined in s without the physical presence, prior examination, or authorization of a dentist: (e) Apply dental sealants. (e) Apply dental sealants. 25

Title I Schools Most children covered by Medicaid Most children covered by Medicaid Highest caries risk Highest caries risk Reduces access to care barriers Reduces access to care barriers 26

Title I Schools State of Florida State of Florida 2442 Elementary Schools 2442 Elementary Schools Number of kids: ~ 2400 x.5 x 100 = 120,000 Number of kids: ~ 2400 x.5 x 100 = 120,000 27

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Funding? 29

Funding? Medicaid Rate Per Sealant $19.32 Medicaid Rate Per Sealant $ Sealants Per Hour = $ Sealants Per Hour = $

Funding? Medicaid Rate Per Sealant $19.32 Medicaid Rate Per Sealant $ Sealants Per Hour = $ Sealants Per Hour = $77.28 All plans cover School Based Sealants All plans cover School Based Sealants (Health Access Settings) (Health Access Settings) 31

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Escambia Santa Rosa Okaloosa Walton Holmes Washington Bay Gulf Jackson Calhoun Liberty Gadsden Leon Wakulla Franklin Madison Taylor Hamilton Suwannee Lafayette Columbia Gilchrist Dixie Levy Alachua Baker Union Nassau Bradford Clay St. Johns Putnam Flagler Marion Citrus Hernando Sumter Lake Volusia Seminole Orange Brevard Osceola Pasco Hillsborough Pinellas Polk Manatee Hardee Highlands Okeechobee Lake Okeechobee DeSoto Sarasota Charlotte Lee Glades Hendry Collier Indian River St. Lucie Martin Palm Beach Broward Dade Monroe Jefferso n Duval Alachua, Bay, Baker, Calhoun, Charlotte, Collier, Columbia, Desoto, Duval, Franklin, Highlands, Hillsborough, Indian River, Jackson, Lake, Leon, Marion, Miami-Dade, Nassau, Okaloosa, Orange, Palm Beach, Pasco, Polk, St. Johns, Taylor, Volusia, Wakulla, Washington Charlotte, Glades, Hendry, Highlands, Martin Regional School-based Sealant Pilot Project Existing School Based Services Programs Florida Department of Health School Based Pilot Programs

Escambia Santa Rosa Okaloosa Walton Holmes Jackson Washington Bay Gulf Franklin Calhoun Liberty Gadsden Leon Wakulla Jefferson Madison Taylor Hamilton Suwannee Lafayette Dixie Columbia Baker Nassau Duval Clay St. Johns Alachua Bradford Gilchrist Levy Putnam Marion Citrus Lake Sumter Hernando Flagler Volusia Seminole Orange Brevard Osceola Pasco Hillsborough Pinellas Polk Indian River Manatee Hardee Highlands Okeechobee St. Lucie Martin Palm Beach Sarasota DeSoto Charlotte Glades Lee Hendry Collier Broward Monroe Dade Union Legend -County without a Fixed CHD Dental Clinic Site (21 counties; 31.3% of the state) -County with at least one Fixed CHD Dental Clinic Site Counties Without Fixed CHD Dental Clinics SFY

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Statewide School-based Sealant Program Expand school-based sealant programs from current total of twenty-nine (29) programs in 31 counties to having school-based programs in all 67 counties. Pursue dental hygienist workforce model in Title I schools. Exploring additional funding options for school-based preventive dental programs.

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Future Expansion of School-based Programs Seven additional counties are interested in developing school- based programs in 2015 (Alachua, Brevard, Holmes, Osceola, Okeechobee, Putnam, Sumter). Identifying areas where regional programs are needed due to health professional shortages. Develop a statewide database for reporting sealant program data.

Workforce (Innovation) Dental Hygienists with school age children Dental Hygienists with school age children Stay at home moms Stay at home moms Work school year / school hours Work school year / school hours DOH / OPS employees DOH / OPS employees 36

Winners !!! 37

Winners !!! State of Florida (out of last place…) State of Florida (out of last place…) 38

Winners !!! State of Florida (out of last place…) State of Florida (out of last place…) MMAs (increased utilization rates) MMAs (increased utilization rates) 39

Winners !!! State of Florida (out of last place…) State of Florida (out of last place…) MMA plans (increased utilization rates) MMA plans (increased utilization rates) Kids in Florida (85% reduction in cavities ) Kids in Florida (85% reduction in cavities ) 40

Contact Information Edward F. Zapert, D.M.D To Protect, promote and improve the health of all people in Florida through integrated state, county and community efforts 41