The effectiveness of sealant in the Boston University Dental Health Plan
Date
2005
DOI
Authors
Al-Semiery, Amany
Version
OA Version
Citation
Abstract
Background: Despite the decline in the prevalence and severity of caries in children, prevention aims are still motivated by policies that were established when caries was a more widespread public health concern. The use of sealant is on the increase, it is important to emphasize the appropriate use of this resource.
The purpose of the study: To use dental insurance claim data to Iook at the impact of dental sealants on the future likelihood of restorative treatment for sealed and unsealed teeth in a cohort of children enrolled in Boston University Dental Health Plan from 1996 to 2003.
Methods and Materials: This is a longitudinal retrospective cohort using BU Dental Health Plan claims from 1996 to 2003 as the primary data sources. Children were enrolled at age 5 years and followed until the end of the study. A tota1 2,734 children were enrolled: 1,540 with at least one sealant and 1,188 without any sealants; 1,231 males and 1,322 females: and l,751 treated at BU clinics and l,820 at non-BU clinics. Sealant effectiveness was analyzed by dividing the data into 4 prevention groups (the no-prevention, fluoride only, sealant only and sealant and fluoride group), 2 other groups were created the sealant group (no-prevention and fluoride only groups), and the no-sealant group (sealant only and sealant and fluoride groups). The primary outcomes were any-failure (restoration on occlusal surfaces of first and second permanent molars, crowns, endodontics or extraction treatment) and sealant reapplication. Three hypotheses were tested: I-Children who received sealant and those who did not are equivalent in their overall restorative care needs, II-Sealant application in conjunction with topical fluoride sealant will reduce restorative care needs, and III-Patients receiving reapplication of sealant will be more likely to receive a restoration compared to those who do not receive a reapplication. Patients and teeth were used as unit of analysis in bivariate and multivariate analyses.
Results: At the patient level analysis, the proportions of crowns, endodontics or extraction treatments than the no-sealant group with a significant difference between the groups (P[less than] 0.0001). At the tooth level analyses, there was no significant difference between the sealant only and the sealant and fluoride groups (p=0.3 and p=0.7) for any-failure and restorations respectively, although the sealant and fluoride group had higher proportions of failures. Also at tooth level analysis there was a significant relationship between any-failure/restoration and two or more sealant re-application.
Conclusion: 1-Sealant application had less protective effect than was expected in patient level analysis. 2-Fluoride application in conjunction with sealant did not seem to have added benefit over sealant application alone. 3-Sealant reapplication did not decrease the restorative care need and possibly only posponed the future restoration.
Description
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Thesis (D.Sc.D.)--Boston University, Henry M. Goldman School of Dental Medicine, 2000 (Public Health Dentistry).
Includes bibliographical references (leaves 75-80).
Thesis (D.Sc.D.)--Boston University, Henry M. Goldman School of Dental Medicine, 2000 (Public Health Dentistry).
Includes bibliographical references (leaves 75-80).
License
This work is protected by copyright. Downloading is restricted to the BU community. If you are the author of this work and would like to make it publicly available, please contact open-help@bu.edu.