Second molar sealants among US adolescents and their association with select sociodemographic factors and first molar sealants: A cross-sectional study using National Health and Nutrition Examination Survey data.

BACKGROUND: Caries is an important public health concern. Dental sealants are effective in preventing caries; however, their uptake is suboptimal and little is known about second molar (2M) sealants. The authors examined the prevalence of 2M sealants among US adolescents and investigated the factors associated with their presence. METHODS: The authors conducted a cross-sectional analysis of 2011-2016 National Health and Nutrition Examination Survey data on adolescents aged 12 through 19 years with complete sealant data (n = 3,636). Race and ethnicity, income, and first molar (1M) sealant were primary variables of interest. The logistic regression models were used to estimate the factors associated with 2M sealants. All analyses used survey weights and accounted for complex survey design. RESULTS: Only 34.6% of adolescents (95% CI, 31.2% to 38.0%) had 2M sealants. Approximately 89.0% of adolescents (95% CI, 86.1% to 92.0%) with 2M sealants and 19.6% (95% CI, 17.1% to 22.2%) without 2M sealants had 1M sealants. In the adjusted models, race and ethnicity were strongly associated with 2M sealant presence, but the association did not hold when 1M sealant was included in the model. 1M sealants were the most significant factor explaining the presence of 2M sealants (odds ratio, 0.03; 95% CI, 0.02 to 0.04). CONCLUSIONS: Two of 3 adolescents lacked 2M sealants, with considerable disparities in their presence. To improve adolescent oral health, clinical and community programs should increase delivery of 2M sealants. PRACTICAL IMPLICATIONS: Study findings highlight the need to evaluate adolescent sealant delivery programs to improve the uptake of 2M sealants.

Cost-Savings of Fluoride Varnish Application in Primary Care for Medicaid-Enrolled Children in Virginia.

OBJECTIVES: To determine the cost-benefit of fluoride varnish application during pediatric well-visits for the Medicaid/Children's Health Insurance Program population in Virginia (VA) from a Medicaid payer perspective. To provide initial cost estimates from the primary care provider (PCP) perspective. STUDY DESIGN: A systematic search of recent literature was completed to obtain input data for a Monte Carlo cost-benefit simulation and for the fluoride varnish application time, labor, and materials costs for PCPs. The analysis was conducted from a Medicaid perspective; costs and savings related to fluoride varnish application in primary dentition through 7.5 years were calculated for all Medicaid-eligible children up to 3 years of age in VA. Sensitivity analysis was performed to mitigate the effects of parameter uncertainty. RESULTS: Delivering fluoride varnish to all children <3 years old in VA who annually receive well-visits through Medicaid but did not receive fluoride varnish at those visits would reduce the percent of 7.5 year olds with decay from 63.2% to 39.8%. Accounting for averted restoration cost, PCP fluoride varnish application would save $75.32 per child, or a total population savings of almost $2 million/year for VA Medicaid. From the PCP perspective, the Medicaid reimbursement rate for fluoride varnish is 3.8-12.0 times the direct fluoride varnish application cost (labor and materials). CONCLUSIONS: Application of fluoride varnish by a PCP to children under 3 years of age is cost-saving in this study population. Costs to provide fluoride varnish from the PCP perspective are favorable compared with the Medicaid reimbursement, but additional studies on optimizing fluoride varnish application into the well-visit workflow are needed.

Evaluation of School-Based Dental Sealant Programs: An Updated Community Guide Systematic Economic Review.

CONTEXT: A recently updated Community Guide systematic review of the effectiveness of school sealant programs (SSPs) still found strong evidence that SSPs reduced dental caries among schoolchildren. This follow-up systematic review updates SSP cost and benefit information from the original 2002 review. EVIDENCE ACQUISITION: Using Community Guide economic review methods, the authors searched the literature from January 2000 to November 20, 2014. The final body of evidence included 14 studies-ten from the current search and four with cost information from the 2002 review. Nine studies had information on SSP costs; six on sealant benefit (averted treatment costs and productivity losses); four on SSP net cost (cost minus benefit); and three on net cost to Medicaid of clinically delivered sealants. The authors imputed productivity losses and discounted costs/outcomes when this information was missing. The analysis, conducted in 2015, reported all values in 2014 U.S. dollars. EVIDENCE SYNTHESIS: The median one-time SSP cost per tooth sealed was $11.64. Labor accounted for two thirds of costs, and time to provide sealants was a major cost driver. The median annual economic benefit was $6.29, suggesting that over 4 years the SSP benefit ($23.37 at a 3% discount rate) would exceed costs by $11.73 per sealed tooth. In addition, two of four economic models and all three analyses of Medicaid claims data found that SSP benefit to society exceeded SSP cost. CONCLUSIONS: Recent evidence indicates the benefits of SSPs exceed their costs when SSPs target schools attended by a large number of high-risk children.

School-Based Dental Sealant Programs Prevent Cavities And Are Cost-Effective.

Untreated cavities can have far-reaching negative consequences for people's ability to eat, speak, and learn. By adolescence, 27 percent of low-income children in the United States will have untreated cavities. School-based sealant programs typically provide dental sealants (a protective coating that adheres to the surface of molars) at little or no cost to students attending schools in areas with low socioeconomic status. These programs have been shown to increase the number of students receiving sealants and to prevent cavities. We analyzed the cost-effectiveness of school sealant programs using data (from school programs in fourteen states between 2013 and 2014) on children's cavity risk, including the effects of untreated cavities on a child's quality of life. We found that providing sealants in school programs to 1,000 children would prevent 485 fillings and 1.59 disability-adjusted life-years. School-based sealant programs saved society money and remained cost-effective across a wide range of reasonable values.

Balancing investments in Federally Qualified Health Centers and Medicaid for improved access and coverage in Pennsylvania.

Two common health disparities in the US include a lack of access to care and a lack of insurance coverage. To help address these disparities, healthcare reform will provide $11B to expand Federally Qualified Health Centers (FQHCs) over the next 5 years. In 2014, Medicaid rules will be modified so that more people will become eligible. There are, however, important tradeoffs in the investment in these two programs. We find a balanced investment between FQHC expansion and relaxing Medicaid eligibility to improve both access (by increasing the number of FQHCs) and coverage (by FQHC and Medicaid expansion) for the state of Pennsylvania. The comparison is achieved by integrating multi-objective mathematical models with several public data sets that allow for specific estimations of healthcare need. Demand is estimated based on current access and coverage status in order to target groups to be considered preferentially. Results show that for Pennsylvania, FQHCs are more cost effective than Medicaid if we invest all of the resources in just one policy. However, we find a better investment point balancing those two policies. This point is approximately where the additional expenses incurred from relaxing Medicaid eligibility equals the investment in FQHC expansion.

Public health sealant delivery programs: optimal delivery and the cost of practice acts.

BACKGROUND: The greatest unmet health need for US children is dental care. School-based sealant programs target low-income, high-risk second graders and are effective in preventing caries for as long as the sealant material remains in place. However, it is not clear whether such programs make efficient use of available resources and staffing. METHODS: The authors used discrete event simulation to determine the optimal combinations of staffing levels and sealant stations for school-based sealant programs. Using data provided by state programs and the literature, they modeled different-sized programs under different practice act constraints and determined times and associated costs. A detailed economic analysis was done for Wisconsin. RESULTS: For general, direct, or indirect supervision, it is optimal to have only 1 dentist or no dentists for no supervision. For general supervision, it is optimal to have the dentist and dental assistant to come on separate days to screen. The cost savings for adding an assistant and chair averaged over all of the program sizes and travel distances ranged from 4.50% (SE= 0.89) to 10.94% (SE= 0.56). Significant cost savings also result from reducing the required supervision level (8.72% [SE = 1.61] to 29.96% [SE= 1.67]). The cost of the practice act for the state of Wisconsin for 2003 was from USD 83,041 to USD 346,156, significantly more than its annual budget. CONCLUSIONS: States could save money by relaxing restrictions on the type of personnel who can deliver sealants in public health settings and by productivity gains through proper consideration of staffing. The savings could be used to improve access to sealant programs and further reduce disparities in oral health.