Practice-based study of the cost-effectiveness of fissure sealants in Finland.

OBJECTIVE: To retrospectively analyze the cost-effectiveness of sealant treatment in two health centers with different caries preventive strategies in Finland using a practice-based research protocol. MATERIALS AND METHODS: The data of digital dental records were data-mined and analyzed retrospectively in the health center in Kemi where the preventive strategy was sealing selectively only high-caries risk patients, and in Vantaa where all patients were routinely sealed. Risk group determination in Kemi was based on the presence of Streptococcus mutans in dental plaque. Supervised use of xylitol was an additional caries preventive measure in Kemi. The subjects were divided into all-sealed and non-sealed groups in the beginning of the follow-up according to the sealant treatment status of their first permanent molars. The mean cumulative cost of restorations and sealing treatment was counted in children at 12 years of age. RESULTS: Sealing of risk children in Kemi resulted in a total cost of 185euro per child whereas the respective cost of routinely sealed children in Vantaa was 235euro. The cost of restorations was 76euro in Kemi and 150euro in 5 years in Vantaa. Risk determination and the use of xylitol did not affect significantly the total treatment cost in Kemi. CONCLUSION: The significant reduction in the cost of dental treatment can be achieved by leaving non-risk subjects unsealed and sealing only high-caries risk individuals.

Can Glass ionomer sealants be cost-effective?

Glass ionomer (GI), applied as a pit and fissure sealant, has been shown to be a promising method for caries prevention. It has also been suggested that when GI is used as a sealant material, it can prevent caries, even if partly or totally lost. As there is no need for resealing GI, it may be more cost-effective when compared to a resin-based (RB) sealant. This study evaluated the factors influencing the time needed to apply a sealant as a factor in determining the possible costs of the effectiveness of RB compared to GI sealants. To study this, children born between 1980 and 1983, who had their appropriate second molars sealed between 1993 and 1997, were assessed. The study was then based on a random sub-sample of this group, comprising 140 teeth: 86 sealed with RB (Delton) and 54 with GI (Fuji III). For a hygienist working alone, the whole procedure of applying a sealant, beginning with the cleaning of the tooth and ending with the finished sealant, took, on average, 344 (+/- 59) seconds with RB, and 599 seconds (+/- 89) with GI. This difference in time was found to be statistically significant at p < 0.01. No statistically significant difference existed in the mean time required to apply a sealant between the left (410 +/- 140 seconds) and the right (448 +/- 149 seconds) sides; however, the mandibular teeth required longer for application of the sealant than did the maxillary teeth (447 +/- 161 seconds vs. 408 +/- 125 seconds, respectively; p < 0.01). It was also found that a dentist, working with chairside assistance, took 20% less time to apply either sealant material than did the hygienist working alone. It was concluded that GI sealants, whether resealed or not, cannot be as cost-effective as RB sealants, when the expense of placement in time (and thus costs) is used as the basis of efficacy.