Dental sealants are a thin, plastic coating that is painted on the top or biting surface of molar (back) teeth. Sealants block food and bacteria from causing tooth decay. Sealants are almost 100% effective if they stay on the tooth surface. While dental sealants have been available for more than 30 years, just 46% of Massachusetts 3 rd graders have at least one dental sealant on their permanent molar teeth.

The Massachusetts Department of Public Health supports the use of dental sealants, as well as school-based and school-linked sealant programs following guidelines developed by the Centers for Disease Control and Prevention (CDC); which includes the use of resin-based sealants.

According to the CDC, if 50% of children at high-risk participated in school sealant programs, over half of their tooth decay would be prevented and money would be saved on their treatment costs.

Updated Recommendations for School Sealant Programs are provided by the CDC for practitioners in school-based programs and are based on evidence:

  • Resin-based sealants are the first choice of material for dental sealants.
  • 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 published in JADA, March 2008.

For more information on school-based sealant programs go to Evidence Based Clinical Recommendations for Dental Sealants and Sealant Programs, and Other Sealant Program Resources and

The rules and regulations governing the practice of dentistry in the Commonwealth (August 20, 2010) allow for a registered dental hygienist practicing in a public health setting to provide dental hygiene services, including placement of sealants, without first having a dentist examine the patient, either pursuant to a written collaborative agreement that complies with requirements described in 234 CMR 5.08, or pursuant to a standing order under the general supervision of a dentist licensed pursuant to M. G. L. c. 112, § 45. (234 CMR 5.07(4))

Standing Order Template (PDF) pdf format of standing-order-template.pdf
doc format of                             standing-order-template.doc

Collaborative Agreement Template


The Office of Oral Health began implementing its school sealant program in 2007. Currently, the Program is serving school-aged children in several communities statewide with schools having greater than 40% to 50% student participation in the Free and Reduced School Lunch Program. Dental hygienists using portable dental equipment provide screenings, education, dental sealants and fluoride, as well as referrals to a dental home for children in need of restorative services. For more information on the SEAL Program or dental sealants email

Facts About Dental Sealants

This information is provided by the Oral Health within the Department of Public Health.