Dental Sealant Program

Free Dental Sealant Program

Protect your child's teeth from decay!

The Washington County Health Department participates in the Dental Sealant Program funded by the Ohio Department of Health. This program brings dental personnel into qualified schools in Washington, Noble, Morgan, Belmont, and Monroe Counties to apply dental sealants to second and sixth-graders at NO CHARGE to the families. Children are re-checked in the third and seventh grades for retention.

For more information: Contact 740-374-2782 ext. 3351 Stephani Brown, RDH, the Dental Sealant Program Coordinator

What is Dental Sealant?

Sealant is a plastic coating that keeps food and germs out of the chewing surfaces of the back teeth and protects them from cavities. Sealants are safe; they work and are easy to apply. There are no drills or needles involved! This will save money on future dental visits for fillings.

I would like for my child to get sealants.

First, print and fill out a dental sealant form (PDF) (must be read and signed by a guardian) and have your child give this form to their teacher. OR Fill out the electronic version below. You can also get sealants at your family dentist's office if you prefer.  

Privacy Policy

Dental Sealant Permission Form

  1. Please complete the full form.
  2. Race:

    Please check all that apply.

  3. Has your child had any serious health problems?
  4. Does your child have any of the following allergies?
  5. Coverage

    No payment is required of you for this program.  However, the value of this service is more than $150 per child and we rely on insurances such as Medicaid or Healthy Start to help cover the costs.  If you child is covered by Medicaid/Health Start, please check the name of their Managed Care Plan.

  6. Insurance
  7. Leave This Blank:

  8. This field is not part of the form submission.