Targeting school-based dental sealant programs: who is at "higher risk?"

Objectives: To assess the effect of various school-level Free and Reduced Price Meal Program (FRPMP) enrollment-based risk thresholds on the ability of school-based sealant programs (S-BSPs) to reach higher risk children. Methods: We used data from a statewide third grade oral health survey to compare: a) prevalence of dental caries for higher-risk children, using three different sets of child risk criteria based on social determinants; and b) dental caries and other access-related indicators for children at higher-risk schools based on four FRPMP-based thresholds (>= 60 percent of children FRPMP-enrolled, >= 50 percent, >= 40 percent, >= 30 percent). In addition, we used school enrollment and FRPMP enrollment data to compare the percentages of eligible schools and of higher-risk children resulting from the various thresholds. Results: The prevalence of caries experiences and untreated caries were not significantly different for higher risk children categorized by the respective child caries risk criteria. Regardless of school-level risk threshold, children at higher risk schools were more likely to have caries experience, untreated caries, and no recent dental visit and less likely to have private dental insurance than children at lower risk schools. For these measures, children at higher risk schools were similar to each other regardless of risk threshold and were similar to higher risk children at all schools. The number of additional higher risk children per additional higher risk school showed a large decline between the 40-49 percent and 30-39 percent FRPMP enrollment tiers. Conclusions: Targeting higher risk schools to reach higher risk children is a practical and effective approach for increasing sealant prevalence through S-BSPs.