Treatment outcomes of sealants on first permanent molars: Natural history, survivorship, and cost-utility analysis

Information on the economic efficiency and the effectiveness of providing sealants through private and public providers to children at a community level is inconclusive. Using Medicaid data, the treatment outcomes of first permanent molars of 6-year-olds were retrospectively evaluated from their approximate eruptive time through the time they were 10 years old. From all 12,404 six-year-olds, only 17% were utilizers who had a preventive visit at six and another dental exam afterwards. These utilizers that were white and had a higher family income were more likely to have more preventive visits.; There were 308 routine utilizers who continuously-enrolled in the program for 5 years and had at least three preventive visits in 1996, 2000, and once in between. Thirty-three percent of each first permanent molar of the routine utilizers received a sealant, as compared to 28% of the utilizers. Among the utilizers, sealants were more likely to be placed on first permanent molars of females and those who lived in a metro area, or those who had more than one preventive visit per year of enrollment. There was no difference of sealant status among left and right molars and mandibular and maxillary teeth.; Sealants are effective in preventing overall caries in first permanent molars. In the routine utilizers, sealed first permanent molars had fewer subsequent restorative treatment and extensive treatment. In the utilizers, sealed first permanent molars had greater 4-year survivorship and slightly greater utility than non-sealed molars. However, the costs of sealed molars were greater than the costs of non-sealed molars. Sealants are effective in improving the health states of first permanent molars, yet come at a price.; Children were more likely to receive sealants if they visited the dentist more often. The preventive effect of sealants is more evident in children who visited dentists less frequently. For the children who visited dentist more frequently, the effect of sealants is lower when the children are older. Sealed mandibular molars of children who had fewer preventive visits incurred the least cost.