Evaluation of the fissure sealant program among Jerusalem school children

Background: Since 1994 the Jerusalem municipality has operated a school-based fissure sealant program. Using mobile dental units, dentists seal first permanent molars of children in first through fourth grades. Objectives: To estimate caries experience in fourth-graders in Jerusalem, to determine retention rate of sealants, to measure parent's satisfaction. Methods: A stratified cluster random sample of 450 children was chosen. 303 (67%) completed a parental consent form and participated. Results: Mean caries experience (permanent and deciduous teeth) was 3.61 teeth, and DMF of first permanent molars was 1.04 teeth per child. Caries experience and incidence of untreated caries was higher among children from low socio-economic status, larger families, orthodox sector and males. Less caries was observed among children with higher number of sealants. After an average of 2.6 years, complete sealant retention rate was 52%. 18% and 10% were partially retained or totally missing without any evidence of caries, respectively. 19% of previously sealed teeth were carious or restored. Sealant retention rate was not associated with socio-economic status, family size or religious sector, but was associated with gender, subjects' age, the dentist placing the sealant and the sealant being placed in upper or lower molars. Only 57% of subjects agreed to participate in the program. Participation was higher in orthodox sectors and in lower socio-economic status. Parents to children who received sealants within the program showed higher satisfaction scores when compared with parents of children who received sealants elsewhere. Conclusion: Retention rate of sealants provided by this program compared favorably with similar international studies. Results demonstrate that school-based preventive fissure sealant programs contribute to a reduction in the prevalence of caries, especially in lower socio-economic layers, but require higher participation in order to achieve its full potential.