Partnering to Seal-A-Smile
2012
A report on the success of Wisconsin school-based dental sealant programs.
Partnering to Seal-A-Smile 2012
This report was developed by Children’s Health Alliance of Wisconsin and made possible
through a partnership and funding from Delta Dental of Wisconsin.
Delta Dental of Wisconsin is a not-for-profit dental service corporation that administers
and underwrites easy-to-use, cost-effective dental plans for employers and individuals
throughout Wisconsin. Delta Dental of Wisconsin is the largest dental benefits provider
in the state, covering more than 1 million employees and family members.
Delta Dental supports a significant number of charitable oral health initiatives focused
on improving access to dental care and raising awareness of the importance of proper
oral health.
The following individuals contributed to the preparation of this report:
• Matt Crespin, MPH, RDH, Children’s Health Alliance of Wisconsin
• Alex Eichenbaum, Children’s Health Alliance of Wisconsin
• Caroline Madormo, BSN, RN, CPN, Medical College of Wisconsin
Graphic design and layout, Tara Goris, Children’s Health Alliance of Wisconsin
2
Table of contents
Executive summary 4
Background 6
Methods 8
Key findings 10
Conclusion/recommendations 18
Sealant program profiles 20
• Adams County 20
• Ashland County 52
• Barron County 21
• Bayfield County 22
• Brown County 23

Partnering to Seal-A-Smile 2012
• Lincoln County 41
• Manitowoc County 42
• Marathon County n/a
• Marinette County 43
• Marquette County 20
• Menominee County n/a
• Milwaukee County 44, 45, 46, 47, 53
• Monroe County 48
• Oconto County 49
• Oneida County 60
• Outagamie County 50
• Ozaukee County n/a
• Pepin County n/a
• Pierce County n/a
• Polk County 21
• Portage County 51
• Price County 52
• Racine County 53
• Richland County n/a
• Rock County 54, 55
• Rusk County 25
• St. Croix County 21
• Sauk County 56
• Sawyer County n/a
• Shawano County 57
• Sheboygan County 58
• Taylor County 25
• Trempealeau County 59
• Vernon County n/a

denote school year, we reference the year of the fall semester. For example, 2010-11 is referred to as
the 2010 school year.
Key findings from the 2005-10 school years:
• The number of schools served by Wisconsin SAS increased from 135 to 406.
• The number of schools served by Wisconsin SAS with free and reduced lunch (FRL) rates of
greater than 50 percent increased from 48 to 229.
• The number of children and youth with special health care needs (CYSHCN) served by
Wisconsin SAS increased from 261 to 3,248.
• The overall average cost to deliver sealants increased from $89.37/child to $110.49/child.
• The average amount of Medicaid reimbursement received by programs increased from
$17.40/child to $59.94/child due in part, to the ability of dental hygienists to become
Medicaid providers.
• The number of children screened and sealed increased significantly.
• The percentage of children screened with untreated dental decay decreased from 40.8
percent to 35.4 percent.
• The number of children who received fluoride treatments in addition to dental sealants
increased from 3,304 to 23,499.
• The proportion of children with either Medicaid or SCHIP (BadgerCare Plus) insurance
coverage participating in Wisconsin SAS increased from 53.4 percent to 69.5 percent.
• The number of children who received oral health education quadrupled from 9,404 to 37,599.
• Sealant retention rates increased from 76.1 to 92.9 percent.
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Testimonial
"The value of Just Kids Dental (Douglas County) program is difficult to express. We
have many children in our school district who have never been to a dentist. Without
this great program and their ability to work with community resources, many of the
children who have received quality services would have never received oral health
care. The dental staff have a wonderful way of making our students feel comfortable
so each student remains positive about dental care. Our younger students even tease

Wisconsin 2008 Make Your Smile Count survey, the percentage of Wisconsin’s third grade children with
untreated decay decreased from 31 to 20 percent between 2001 and 2007.
The second Healthiest Wisconsin 2020 objective states that by 2020, the state will “assure appropriate
access to effective and adequate oral health delivery systems, utilizing a diverse and adequate workforce,
for populations of differing races, ethnicities, sexual identities and orientations, gender identities, and
educational or economic status and those with disabilities.” This objective can partially be measured by
the percentage of Wisconsin schools with a dental sealant program.
Nationally, Healthy People 2020 calls for the number of school-based dental sealant programs to
increase. Oral health objective number eight states the country will strive to “increase the proportion of
low-income children and adolescents who received any preventive dental service during the past year.”
Oral health objective number 12 calls for the “increase in the proportion of children and adolecents who
have received dental sealants.” The Wisconsin SAS program has increased both the number of high-risk
schools served, as well as the number of children receiving Medicaid or SCHIP (BadgerCare Plus)
assistance served.
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The Alliance manages state general purpose revenue (GPR) targeted to fund school-based sealant
programs. The dollars are subcontracted to the Alliance through DHS and subsequently awarded to
communities through a request for proposal process released each spring. Beginning in 2000, $60,000 of
GPR was allocated annually from the state budget. In 2005 this amount doubled to $120,000, as a result
of Governor Jim Doyle’s Kids First Initiative. However, due to budget cuts, GPR funding in 2011 was
reduced to $106,720.
In the 2006 school year, SAS funding again increased to approximately $200,000 due to Wisconsin
receiving a Health Resources and Services Administration (HRSA) three-year oral health workforce grant.
In 2009, HRSA funding increased to $241,000, which Delta Dental has matched annually. Beginning in the
2012 school year, HRSA funding will end and GPR funding will be increased by $250,000 to fill the void.
Delta Dental has agreed to match this funding for the 2012 school year.
Awards to community programs, as determined by a review committee, have ranged annually from
$1,000 to $75,000 depending on the needs of the individual program. The number of community
programs funded each year has increased from 12 to 42 with requests for dollars surpassing those

2012
Annual Wisconsin SAS funding
HRSA funding
Delta Dental funding
GPR funding
School year
8
Methods
The SAS logic model found on page 70 shows funding sources, activities, outputs and outcomes that
have assisted with the design of this report. The following outcomes were evaluated:
• Number of schools served and the FRL rates of those schools.
• Number of CYSHCN served.
• Number of students screened and sealed.
• Number of children with untreated decay and severity of disease.
• Insurance status of children participating.
• Proportion of children retaining sealants placed by Wisconsin SAS programs.
• Number of students receiving oral health education.
In 2003-04, the Centers for Disease Control and Prevention (CDC) developed the Sealant Efficiency
Assessment for Locals and States (SEALS) electronic data collection tool. Wisconsin programs were
used as a model for the creation of SEALS. Wisconsin DHS, the Alliance and nine community
programs worked intensely to retroactively collect data from the previous three years of the SAS
program. SEALS software has been marketed as a user-friendly tool to standardize sealant data
collection throughout the nation.
SEALS calculates cost-effectiveness, efficiency measures, disease burden and demographic
information. Wisconsin communities collect this information and forward it electronically to the
Alliance. The data assists in policy development and evaluation of programming.
SEALS data was used to evaluate the outcomes identified for this report. Data from non-funded
programs also was collected through self-reporting by individual program managers. The Alliance
continues to work with non-funded programs, in an attempt to integrate SEALS into their programs.
Some non-funded programs have agreed to utilize SEALS, allowing continuity in data collection

Key finding 1
The number of schools served by Wisconsin SAS with FRL rates greater than 50 percent
increased by 477 percent, between 2005 and 2010.
Between 2005 and 2010, the Wisconsin SAS program increased the total number of schools served
from 135 to 406. A significant increase in schools with FRL rates of greater than 50 percent also was
achieved. The figure increased from 48 schools in 2005, to 229 in 2010. Wisconsin SAS staff has
actively engaged oral health partners in communities lacking school-based services in high-risk (FRL
≥ 35 percent) schools to implement new programs. SAS funding is dedicated to serve schools
identified as high-risk. Some private and charter schools do not participate in the FRL program and
are labeled as “no FRL” in the graph above. Targeting specific communities, coupled with increased
funding and expanded programming, has contributed to noticeable increases in the number of high-
risk schools being served. This increase also demonstrates a dedication to reaching a greater number
of low-income and uninsured children.
Partnering to Seal-A-Smile 2012
0
50
100
150
200
250
300
350
400
450
2005 2006 2007 2008 2009 2010
No FRL
FRL <35%
FRL = 35-50%
FRL <50%
FRL >50%

3,000
3,500
2005 2006 2007 2008 2009 2010
CYSHCN served
School year
12
Key finding 3
The overall average cost per child to deliver sealants increased from $89.37 in 2005 to $110.49
in the 2010 school year.
Key finding 4
The average amount of Medicaid reimbursement each program received per child increased
from $17.40 in 2005 to $59.94 in the 2010 school year.
An increase in overall program cost is noted between 2005 and 2010. This can be attributed to the
large number of new programs and additional equipment purchased in the last two to three years,
which drives up the initial overall program cost. In addition, newer programs may not be as efficient
as those having been operational for longer periods of time. Overall program costs were not
collected in 2007. Since then, Wisconsin SAS has implemented a policy requiring all funded
programs to collect and report this data annually.
Aside from grant funding, Medicaid revenue continues to be the key tool in program sustainability.
Since 2007, when dental hygienists were able to become certified Medicaid providers, a significant
increase in Medicaid billing can be seen by programs statewide.
The SAS cost per child has remained steady over the past several years with little fluctuation. This
reflects the actual grant dollars per child utilized statewide in the program. Inkind support at the
program level fills the gap between Medicaid/grant funding and overall program cost.
Partnering to Seal-A-Smile 2012
$0.00
$20.00
$40.00
$60.00
$80.00

20,000
25,000
30,000
35,000
2005 2006 2007 2008 2009 2010
Children screened
Children with
untreated decay
Children sealed
Children with urgent
treatment needs
Seal-A-Smile annual ndings
Children
School year
14
Key finding 8
The number of children who received topical fluoride treatments increased from 3,304 in 2005,
to 23,499 in 2010.
The number of children who received fluoride as part of the SAS program increased substantially. In
2009, Wisconsin SAS implemented a policy requiring all funded programs to provide 2-3 fluoride
varnish applications to all participating children. This policy, coupled with the expansion of the SAS
program, contributed to the significant increase in children receiving topical fluoride treatments in
the last two years.
Partnering to Seal-A-Smile 2012
0
5,000
10,000
15,000
20,000
25,000

Insurance status
16
Key finding 10
The number of children who received oral health education through the SAS program has
increased nearly four times since the 2005 school year.
Most oral health education is provided chairside and tailored to individual patient needs. Therefore,
the increased number of children who received education correlates with the overall increase in
children served. Additionally, some programs provide classroom education to all children, regardless
if they receive preventive services or not.
Partnering to Seal-A-Smile 2012
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
2005 2006 2007 2008 2009 2010
Children receiving oral health education
School year
Partnering to Seal-A-Smile 2012
Key finding 11
Sealant retention rates for programs increased from 76.1 percent in 2005 to 92.9 percent in 2009.
Sealant retention rates have significantly increased from 2005-09. Rates for 2010 will be available in
fall 2012.
In 2008, a policy regarding the use of self-etch material was implemented as a result of the new
American Dental Association and CDC recommendations for school-based sealant programs.
Programs are no longer able to use self-etch products and have implemented tooth selection and

integrity and evaluate performance.
Recommendations
• The state of Wisconsin maintain or increase the amount of SAS funding available through
GPR in future biennial budgets.
• The state of Wisconsin increase dental Medicaid reimbursement rates to help programs
achieve sustainability and increase access for restorative services.
• Programs continue to develop relationships with dentists to help serve children in need of
restorative care, following their participation in school-based programs.
• Programs increase early intervention strategies to reduce rising decay rates.
• Programs determine if recommended follow-up care was obtained.
• Programs use best practices to improve overall retention rates of sealants.
• Programs explore implementing a broader range of services that may include restorative
services.
• Programs continue providing services to an increased number of schools with high FRL rates.
• Programs continue reaching out and providing services to CYSHCN.
• Programs continue reducing the cost per child to deliver sealants by using best practices and
improving efficiency.
• Programs continue Medicaid billing efforts to maximize reimbursement.
• Programs continue to increase the number of children receiving oral health education both
in the classroom and chairside.
Partnering to Seal-A-Smile 2012
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Testimonial
“I had a young patient come in to our clinic who had received sealants through the
Wisconsin Seal-A-Smile program. The sealants looked great, secondary grooves and
everything! Her mother was happy she received this care and that follow-up
information was sent home. Her mother also shared with me that her child came
home and was teaching her about teeth and was very excited to use the new
toothbrush she was given. I have had countless children and teachers come through
the clinic and say what a great program this is. I think this is one of the best programs

44
38
46
Findings (2010-11)
Untreated decay
Urgent needs
Retention rate
95.5%
17.4%
47.8%
0
10
20
30
40
50
60
2005 2006 2007 2008 2009 2010
Oral exams
Sealants
School year
Children served
1
4
Schools served (2010-11)
<35%
35-50%
>50%
FRL status
No FRL

9.1%
44.1%
Oral exams
Sealants
School year
Children served
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000
2005 2006 2007 2008 2009 2010
<35%
35-50%
>50%
FRL status
No FRL
Schools served (2010-11)
8
22
20
3
22
Bayfield County

Oral exams
Sealants
School year
Children served
0
20
40
60
80
100
120
140
160
2005 2006 2007 2008 2009 2010
Schools served (2010-11)
1
3
<35%
35-50%
>50%
FRL status
No FRL
Brown County
Program title
Brown County Oral Health Partnership Sealant Program
Program inception
1996
Fiscal agent
Brown County Oral Health Partnership (BCOHP)
Program notes

200
400
600
800
1,000
1,200
2005 2006 2007 2008 2009 2010
Schools served (2010-11)
1
14
<35%
35-50%
>50%
FRL status
No FRL
24
Buffalo County
Program title
Buffalo County Seal-A-Smile Program
Program inception
2009
Fiscal agent
Buffalo County Department of Health and Human Services
Program notes
The program is coordinated by a dental hygienist contracted by the local public health department.
The coordinator provides oral exams, sealants, fluoride varnish applications and oral health
education. The program targets all children in second and fifth grade at one area school. The Buffalo
County SAS program was developed in collaboration with an existing SAS program in Eau Claire and
Trempealeau Counties. Due to its small size, the program collaborates with neighboring counties to
utilize portable dental equipment.

<35%
35-50%
>50%
FRL status
No FRL