10 Questions: Tammi Byrd, RDH

01 Can you describe your organization, Health Promotion Specialists?

Health Promotion Specialists (HPS) is a school-based dental prevention program. We currently serve 42 school districts in the state of South Carolina and provide services to over 20,000 children a year.

02 How does your role as CEO/Clinical Director for HPS give you a unique perspective on the way that sealant use is helping children?

HPS is in our eleventh year serving children in South Carolina. During this time we have seen the number of children receiving dental sealants increase dramatically in the districts we serve. This has also led to decreased children with urgent needs and more children entering high school with their first and second molars being caries free.

03 In Nov. 2006, you wrote an article for us on the efficacy of sealants and roadblocks to making them the standard of care. Have we made progress in the last 5 years?

Yes, there has been tremendous progress made. But, we still have a long way to go in having the private practitioner read the research and apply it to practice.

04 The delivery model for sealants was also something you were passionate about. What forward steps do you think we’ve taken in recent years?

I believe there are more communities utilizing dental sealant programs than ever before. This enables many children to receive dental sealants who would have otherwise ended up in an ER or at a dental office once the molars had decayed, abscessed, and become too painful to bear. The increased visibility of the dental sealant research and the third party “report cards” have helped overcome the ignorance related to sealants. This, in turn, has made it easier to educate non-dental professionals of the benefits of dental sealants and has increased the ability to provide them in settings outside the traditional dental office. Utilizing dental hygienists without the necessity for an exam by a dentist is a much more cost effective delivery model.

05 What organizations have been most helpful in dealing with the opposition to school-based sealant programs?

The United States Centers for Disease Control and the Pew Foundation have been the most instrumental in bringing validity to the placement of dental sealants and the increase in programs. I greatly appreciate their knowledge and perseverance. The ADA was gracious in publishing much of the research and the CDC updated recommendations.

06 In our survey, of the hygienists who said they don’t use sealants on pediatric patients, 55% said it was not a mutual decision between them and their dentist. Does that surprise you?

No, it does not surprise me at all. Most private practitioners were not educated on the vast amount of research supporting dental sealants in dental school. Their time was dedicated to becoming proficient in the area of restorative dentistry. After graduating, their focus continues to evolve toward their restorative and cosmetic dentistry practices. The March 2008 issue of JADA was devoted to dental sealants. I was very excited to see it published. But, from my continued opposition supported by inaccurate information from some private practitioners, it is apparent that many of them did not read the research.

07 In what ways are dentists and hygienists finding common ground?

The initial fear that a school-based program would pull people from their practices has been replaced by data showing that there has actually been a 37% increase in the number of children presenting to offices since we started providing care in the schools. Water fluoridation is another strong common ground as well as earlier visits for children to a practice.

08 How do the “scares” over BPA impact your advocacy for sealants?

Most of our encounters on this issue have risen when a school district is considering the use of our program and a local dentist raises the issue to bring doubts about sealants in an effort to stop the district from partnering with us. These few inquiries have been answered with research, an explanation of our sealant procedures, the type of sealants we use and the realization that “tooth-colored” fillings are the same material, just more of it.

09 If a hygienist wants to encourage sealant use, how should she start that conversation?

In a casual conversation or staff meeting ask if he/she has read the latest guidelines related to dental sealants and go from there.

10 And what would you encourage her to look for in the sealant to bring into the practice?

An unfilled resin based sealant and a good acid etchant. The choice of clear or opaque is optional.