Use of the coatings in Medicaid children at high risk of dental problems also reduced costs to the Medicaid program, the research revealed. A report on the study appears in the November issue of the American Journal of Public Health.
Authors, all current or former faculty from UNC’s schools of public health and dentistry, include Drs. Jane A. Weintraub, Sally C. Stearns and R. Gary Rozier. Weintraub now is Lee Hysan professor of oral epidemiology and dental public health at the University of California, San Francisco. Stearns and Rozier are associate professor and professor of health policy and administration at UNC, respectively.
“We assessed what happened to the dental care of 15,438 North Carolina children between 1985 and 1992 and found the sealants definitely made an important difference,” Rozier said. “Not only did the children at highest risk for caries and extractions require fewer treatments, they also incurred fewer expenses for Medicaid.”
For a 9-year-old child, for example, sealant treatment led to a savings for Medicaid in 1990 dollars of almost $4 per tooth, he said.
Important potential benefits the researchers were unable to assess included less pain for the children from toothaches and fewer disruptions of school and home life, Rozier said.
The study involved dividing the N.C. children into two groups based on whether they had received sealant treatments, which fill grooves and pits in teeth, especially chewing surfaces on molars. The team reviewed subjects’ experiences over eight years.
Researchers analyzed what happened to the children’s teeth using information on costs of fillings and extractions in dentists’ claims filed for reimbursement. In high-risk children who did not get sealants, restorative dental treatments cost significantly more than the preventive sealant and restorative treatments combined cost in those who did. Researchers found no cost savings among children who were at lower risk of tooth decay.
“This study demonstrates that sealants are an important, cost-effective strategy for preventing cavities and tooth loss in high-risk children,” Rozier said. “Whether they are worthwhile to prevent a few cavities in low-risk children is a matter of opinion. When you can save money, however, and spare poor children at high risk a lot of pain from toothaches at the same time, sealants become an important preventive measure.”
The results also highlight the need for further research to find good ways to identify high-risk children to reduce overall costs of a sealant program to Medicaid, he said.
Although the research was confined to North Carolina, there is no reason to think they would differ in other states, Rozier said.
Strengths of the study include the large number of subjects, the relatively long follow-up period and the many factors controlled for in the analysis. Limitations were that it relied on claims data and that children were not randomly assigned to treatment and non-treatment groups, which would have been preferable.
The U.S. Agency for Healthcare Research and Quality supported the study.
Note: Rozier can be reached at (919) 966-7388 or gary_rozier@unc.edu. Weintraub can be reached at janew@itsa.ucsf.edu or through Twink Stern at UCSF, (415) 476-1045.
By DAVID WILLIAMSON
UNC News Services
Journal
American Journal of Public Health