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SPECIAL ISSUE ARTICLE

COVID-19 impact on school-based dental sealant programs: De-implementation, re-implementation, challenges, and adaptations

Eiman E. AlEissa1* ,  Joseph A. Catania1
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1 Department of Health Promotion and Health Behavior, School of Nutrition and Public Health, College of Health, Oregon State University, Corvallis, Oregon, United States of America
JCTR, 00074 https://doi.org/10.36922/jctr.24.00074
Received: 27 November 2024 | Revised: 14 May 2025 | Accepted: 21 May 2025 | Published online: 13 June 2025
(This article belongs to the Special Issue Challenges in Dental Public Health)
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Background: The COVID-19 crisis significantly affected school-based dental sealant programs (SBDSPs). Nationwide mitigation efforts, including school closures, led to the de-implementation of SBDSPs by default. Aims: We examined how COVID-19 crisis management planning by SBDSPs, or lack thereof, influenced: (i) de-implementation-related adaptations, (ii) re-implementation processes, (iii) workforce capacity required for re-implementation, (iv) the role of organizational resources in early re-implementation, and (v) overall school reach. Methods: We conducted an embedded multiple case study using a stratified random sample of organizations delivering SBDSPs in Oregon. Semi-structured interviews were conducted with program personnel (n = 10) from the six organizations. We performed quantitative (e.g., counts and percentages) and qualitative (i.e., directed content analysis, within, and across case study analysis) analyses to identify crisis management efforts, de-implementation adaptations, re-implementation timelines, and related challenges. Results: A universal absence of proactive crisis management during SBDSP de-implementation was observed and resulted in challenges for re-implementation. SBDSPs initiated different adaptations (e.g., mobile dental vans) to reach their targeted population. Re-implementation timeline varied (i.e., partial, intermediate, and full) and followed different rates (i.e., full rapid, full gradual, and intermediate slow). Challenges with workforce capacity, organizational resources, program policies, schools’ response, and inter-organizational communication influenced re-implementation. Re-implementation occurred more rapidly for SBDSPs that: (i) formed “crisis management teams” and quickly rebuilt their workforce and (ii) operated within well-sourced organizations that retained staff during de-implementation. However, school responses and COVID-19-related policies often created complex approval systems that limited re-implementation and overall school reach. Results suggested that COVID-19 crisis management planning largely overlooked dental public health programs (i.e., SBDSPs). Conclusion: Public health and school-related organizations must develop proactive crisis management plans that support the continuity of dental public health programs during the crises. Relevance for patients: School reach is foundational to SBDSPs’ implementation processes. Addressing barriers to re-implementation during crises is essential to ensure continued dental care access for the target population.

Keywords
School-based dental sealant programs
COVID-19 crisis
De-implementation
Re-implementation
Dental public health
Implementation research
Funding
This work was supported through the National Institutes of Health grant (MH120512; Drs. Dolcini and Catania).
Conflict of interest
The authors declare that they have no competing interests.
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