Sealants Are the Key to Successful Preventive Pediatric Services



Low-income children face the greatest risks of tooth decay, prompting many government and charitable organizations to offer preventive dental visits (PDVs). Yet these services may not be effective in reducing the need for later care unless they include sealants, according to a study of data from ALL Kids, which is part of the Children’s Health Insurance Program in Alabama.

“Parents frequently do not get preventive services for a wide range of reasons, ranging from lack of access to not having the time or interest in getting it, mostly because they may be unclear of the benefits of such services,” said Bisakha (Pia) Sen, PhD, professor of healthcare organization and policy at the school of public health with the University of Alabama at Birmingham, and one of the study’s authors.

ALL Kids covers basic diagnostic and preventive services, such as dental exams twice a year, dental x-ray exams, fluoride treatments twice a year, space maintainers, and routine cleanings twice a year. Preventive services also including sealants on teeth Nos. 2, 3, 14, 15, 18, 19, 30, and 31, with one application per tooth each calendar year. Restorative, surgical, prosthetic, and periodontic benefits are available as well.

The researchers looked at enrollee data from 1998 to 2012 and conducted separate analyses of children up to 4, between ages 4 and 9, and older than age 9. First, the researchers wanted to see if those children younger than 4 had at least one PDV before the age of 3. Next, they investigated whether the older children had regular PDVs and claims for a sealant during each of their first 3 years.

Outcomes including restorative and emergency dental services and costs were measured in the children’s fourth year. The researchers found that only sealants were associated with a reduced likelihood of using restorative and emergency services and costs. Whether PDVs without sealants reduce restorative or emergency services is questionable, the researchers concluded, and further studies are necessary.

“While sealants appear to be beneficial, we are not seeing any evidence that PDV per se is beneficial. In fact, it often has positive associations with using more restorative services,” said Sen. “However, based on our results, we think ALL Kids needs to see whether access is an issue with enrollees being able to get sealants and whether programs where sealant services are provided in other settings such as schools and health fairs at churches might be helpful.”

The study, “Preventive Dental Care and Long-Term Dental Outcomes Among ALL Kids Enrollees,” was published by Health Services Research.

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