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Okunseri CE, Hodgson B, Okunseri E, Garcia R, Visotcky A, Szabo A. Dental sealants and restorative treatment for first molars among Medicaid enrollees. Community Dent Oral Epidemiol 2020; 48:487-492. [PMID: 33020929 DOI: 10.1111/cdoe.12560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/06/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the association between dental sealant placement and subsequent restorative treatment of permanent first molars over time. METHODS We analysed Wisconsin Medicaid claims data from 2001 to 2009 for children aged 6-16 years. Children entered the study cohort at age 6 and were censored if Medicaid eligibility was lost for >31 days. A fixed effects analysis via a Cox proportional hazards model, stratified by individual, was used to estimate the time-averaged and time-dependent effects of sealant placement on dental treatment defined as any restorative, endodontic or surgical procedure. RESULTS A total of 185,262 children with permanent first molars who turned 6 years enrolled in Medicaid were examined. Sealant placement was higher for teeth #16 and 26 (5.42 and 5.46 per 100 person-years (100PY), versus 5.29 and 5.31/100PY for #36 and 46, respectively. The average rate for restorative treatments had the opposite pattern, with lower rate for teeth #16 and 26 (1.78 and 1.72/100PY) versus teeth #36 and 46 (2.14 and 2.12/100PY), respectively. In the fixed effects regression model, the hazard of dental treatment was substantially lower after sealant placement on a tooth, with time-averaged hazard ratio HR = 0.23 (95% CI 0.21-0.25, P < .001) versus before sealant. The largest effect was in the first year after sealant placement (HR = 0.13, 95% CI: 0.11-0.14), which decreased over time (HR = 0.50, 0.59 and 0.74 in years 2, 3 and 4, respectively), and was not statistically significant in later years. CONCLUSIONS This study demonstrates that permanent first molar sealant placement delayed subsequent dental treatments in children enrolled in Medicaid.
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Affiliation(s)
- Christopher E Okunseri
- Department of Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI, USA
| | - Brian Hodgson
- Department of Developmental Sciences, School of Dentistry, Marquette University, Milwaukee, WI, USA
| | - Elaye Okunseri
- Department of Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI, USA
| | - Raul Garcia
- Department of Health Policy & Health Services Research, Boston University Henry M. Goldman, School of Dental Medicine Massachusetts, Boston, MA, USA
| | - Alex Visotcky
- Institute of Health and Equities, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aniko Szabo
- Institute of Health and Equities, Medical College of Wisconsin, Milwaukee, WI, USA
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Fei X, Li Y, Weir MD, Baras BH, Wang H, Wang S, Sun J, Melo MAS, Ruan J, Xu HHK. Novel pit and fissure sealant containing nano-CaF 2 and dimethylaminohexadecyl methacrylate with double benefits of fluoride release and antibacterial function. Dent Mater 2020; 36:1241-1253. [PMID: 32571624 DOI: 10.1016/j.dental.2020.05.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 05/25/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Pit and fissure sealants with antibacterial and remineralization properties have broad application prospects in caries prevention. The objectives of this study were to: (1) develop a novel pit and fissure sealant containing CaF2 nanoparticles (nCaF2) and dimethylaminohexadecyl methacrylate (DMAHDM); and (2) investigate the effects of nCaF2 and DMAHDM on biofilm response and fluoride (F) ion release for the first time. METHODS Helioseal F was used as a control. Bioactive sealants were formulated with DMAHDM and nCaF2. Flow properties, enamel shear bond strength, hardness and F ion releases were measured. Streptococcus mutans (S. mutans) biofilms were grown on sealants. Biofilm metabolic activity, lactic acid production, colony-forming units (CFU), and pH of biofilm culture medium were measured. RESULTS Adding 5% DMAHDM and 20% nCaF2 did not reduce the paste flow and enamel bond strength, compared to control (p < 0.05). Hardness of sealants with 20% nCaF2 and DMAHDM was higher than control (p < 0.05). The F ion release from 20% nCaF2 was much higher than that of commercial control (p < 0.05). The sealant with DMAHDM reduced the S. mutans biofilm CFU by 4 logs. The pH in biofilm medium of the new bioactive sealant was much higher (pH 6.8) than that of commercial sealant (pH 4.66) (p < 0.05). SIGNIFICANCE The new bioactive pit and fissure sealant with nCaF2 and DMAHDM achieved high fluoride release and strong antibacterial performance. This novel fluoride-releasing and antibacterial sealant is promising to inhibit caries and promote the remineralizaton of enamel and dentin.
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Affiliation(s)
- Xiuzhi Fei
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, and Department of Preventive Dentistry, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China; Department of Advanced Oral Sciences & Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| | - Yuncong Li
- Department of Prosthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Michael D Weir
- Department of Advanced Oral Sciences & Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| | - Bashayer H Baras
- Department of Advanced Oral Sciences & Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA; Department of Restorative Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Haohao Wang
- Department of Advanced Oral Sciences & Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA; State Key Laboratary of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Suping Wang
- Department of Advanced Oral Sciences & Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA; State Key Laboratary of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jirun Sun
- Volpe Research Center, American Dental Association Foundation, Frederick, MD 21704, USA
| | - Mary A S Melo
- Department of Advanced Oral Sciences & Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| | - Jianping Ruan
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, and Department of Preventive Dentistry, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China.
| | - Hockin H K Xu
- Department of Advanced Oral Sciences & Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA; Center for Stem Cell Biology & Regenerative Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Deep A, Thomas A, Singh N, Shaila. Parental knowledge and attitude toward pit and fissure sealants and fluoride therapy in children: A questionnaire study. CHRISMED JOURNAL OF HEALTH AND RESEARCH 2020. [DOI: 10.4103/cjhr.cjhr_121_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wells MH. Pit and Fissure Sealants. Pediatr Dent 2019. [DOI: 10.1016/b978-0-323-60826-8.00033-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cvikl B, Moritz A, Bekes K. Pit and Fissure Sealants-A Comprehensive Review. Dent J (Basel) 2018; 6:dj6020018. [PMID: 29895726 PMCID: PMC6023524 DOI: 10.3390/dj6020018] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/28/2018] [Accepted: 06/06/2018] [Indexed: 12/29/2022] Open
Abstract
Even in the 21st century, dental caries is considered a global burden, severely upsetting the health and quality of life of those affected. Apart from the usage of fluoride and regular oral hygiene, one of the most important prophylactic approaches against the occurrence of caries is the sealing of pits and fissures. However, the rapid progress of new materials and applications for sealing pits and fissures also raises new questions about their correct application. Recent literature on pit and fissure sealing, caries prevention, as well as caries risk assessment for both children and adults was reviewed. This report provides a general overview of pit and fissure sealing, the materials used for sealing occlusal surfaces, as well as indications and possible side effects. The conclusions are that sealing pit and fissures of primary and permanent teeth is an effective method for preventing and arresting caries. However, regular checkups must be conducted to avoid advanced tooth decay attributable to leakages in the sealing.
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Affiliation(s)
- Barbara Cvikl
- Department of Conservative Dentistry & Periodontology, School of Dentistry, Medical University of Vienna, A-1090 Vienna, Austria.
| | - Andreas Moritz
- Department of Conservative Dentistry & Periodontology, School of Dentistry, Medical University of Vienna, A-1090 Vienna, Austria.
| | - Katrin Bekes
- Department of Pediatric Dentistry, School of Dentistry, Medical University of Vienna, A-1090 Vienna, Austria.
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Mathu-Muju KR, Kong X, Brancato C, McLeod J, Bush HM. Utilization of community health workers in Canada's Children's Oral Health Initiative for indigenous communities. Community Dent Oral Epidemiol 2017; 46:185-193. [PMID: 29168578 DOI: 10.1111/cdoe.12352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/19/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The Children's Oral Health Initiative (COHI) is a federally funded community-based preventive dental programme implemented in geographically remote Canadian Indigenous communities. The study investigated the effect of the availability of local community health workers (COHI Aides) on access to the programme's preventive dental services for children. METHODS Twenty-five communities were continuously enrolled in the COHI during the 7-year study period. Communities were categorized as having uninterrupted (all 7 years), intermittent (≥4 years) or sporadic (<4 years) service from a community health worker. Four outcome variables measured longitudinal changes in access to preventive dental services: (i) the number of enrolments; (ii) the number of enrolled children with multiple fluoride varnishes delivered; (iii) the number of enrolled children with sealants placed; and (iv) the number of enrolled children receiving ART. RESULTS The general longitudinal trend for programme enrolment and each of the preventive dental service delivery outcomes was similar. Children in communities with uninterrupted service tended to have the highest rates of enrolment and service delivery, which remained constant over time. Children in communities with sporadic service tended to have persistently low rates of enrolment and service delivery over the study period. CONCLUSIONS Community health workers were beneficial in promoting programme enrolment, as well as facilitating and augmenting the delivery of preventive dental services.
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Affiliation(s)
| | - Xiaoli Kong
- College of Public Health, Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Candace Brancato
- College of Public Health, Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - James McLeod
- First Nations Inuit Health Branch, Winnipeg, MB, Canada
| | - Heather M Bush
- College of Public Health, Department of Biostatistics, University of Kentucky, Lexington, KY, USA
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Effect of Silver Nanoparticle-Added Pit and Fissure Sealant in the Prevention of Dental Caries in Children. J Clin Pediatr Dent 2017; 41:48-52. [PMID: 28052214 DOI: 10.17796/1053-4628-41.1.48] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the effects of pit and fissure sealant mixed with silver nanoparticles on dental caries, by means of monthly measurement of fluorescence with DIAGNOdent over six months. STUDY DESIGN This study was divided in two phases: experimental and clinical. In the experimental phase, the adhesion and microleakage of the pit and fissure sealant experiment were evaluated. Two groups of 10 teeth, without serious carious lesions, were included. Conventional (group A) and silver nanoparticles (group B) were added to the pit and fissure sealant. For the clinical phase, a split-mouth study was performed on 40 children aged 6-10 years old with healthy, erupted permanent first molars. A conventional pit and fissure sealant or a silver nanoparticle-mixed sealant was randomly placed. Repeated measures analysis was performed. RESULTS Conventional sealant presented an average microleakage of 30.6%, and the silver nanoparticle-mixed sealant showed 33.6% (P=NS). A three times greater reduction in fluorescence was found in the silver nanoparticles group compared to the conventional group (P<0.05). No sex- or age-based associations were found. CONCLUSIONS The silver nanoparticle-mixed sealant reduced tooth demineralization significantly and likely increased remineralization, compared to the conventional sealant.
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Qvist V, Borum MK, Møller KD, Andersen TR, Blanche P, Bakhshandeh A. Sealing Occlusal Dentin Caries in Permanent Molars: 7-Year Results of a Randomized Controlled Trial. JDR Clin Trans Res 2016; 2:73-86. [PMID: 30938648 DOI: 10.1177/2380084416680191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this study was to investigate the possibility of postponing restorative intervention of manifest occlusal caries in young, permanent dentition by non-invasive sealing. This RCT-designed study included 521 occlusal lesions in 521 patients aged 6 to 17 y. Based on clinical and radiographic assessments, all lesions required restorative treatment. After randomization (ratio 2:1), 368 resin sealings and 153 composite-resin restorations were performed by 68 dentists in 9 municipalities. The primary aims were to 1) analyze survival of sealings until replacement by restoration, 2) compare longevity of sealings and restorations until retreatments, and 3) compare effectiveness of sealings and restorations to halt caries progression in sealed lesions and beneath restorations. Furthermore, we aimed to identify factors influencing longevity and the effectiveness of sealings and restorations. Treatments were annually controlled, clinically and radiographically. After 7 y, the drop out rate was 8%, and 54% of the treatments were completed due to age. Of the sealings, 48% were retreated, including 31% replaced by restorations; 12% were still functioning. Of the restorations, 7% were repaired/renewed and 20% were still functioning. No endodontics was performed. Kaplan-Meier and Cox regression survival analyses were performed on 341 sealings and 152 restorations in first and second molar teeth. The 7-y survival was 37% (CI, 29% to 45%) for sealings and 91% (CI, 85% to 96%) for restorations (P < 0.001). The median survival time for sealings not replaced by restorations was 7.3 y (CI, 6.4 y to NA). Survival of sealings was increased in patients with low caries risk and/or excellent oral hygiene, second molars compared with first molars, and lesions not extending the middle one-third of the dentin. Survival of sealings was not influenced by municipality, sex, eruption stage or clinical surface cavitation. The results underline that it is possible to postpone or avoid restorative intervention of occlusal dentin caries lesions in young permanent teeth by non-invasive sealing. Knowledge Transfer Statement: The first restoration can ultimately be fatal for a young permanent tooth. A restoration may not be the final treatment but the start of an ongoing treatment with still more loss of tooth substance. The present study shows the possibility of treating occlusal dentin caries lesions with non-invasive resin sealings instead of conventional resin composite restorations in children and adolescents. Improved oral health can be expected.
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Affiliation(s)
- V Qvist
- 1 Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - M K Borum
- 2 Public Dental Health Service, Aarhus, Denmark
| | - K D Møller
- 3 Public Dental Health Service, Gentofte, Denmark
| | - T R Andersen
- 4 Public Dental Health Service, Hørsholm, Denmark
| | - P Blanche
- 5 Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - A Bakhshandeh
- 1 Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Ney JP, van der Goes DN, Chi DL. Economic modeling of sealing primary molars using a "value of information" approach. J Dent Res 2014; 93:876-81. [PMID: 25056993 PMCID: PMC4213251 DOI: 10.1177/0022034514544299] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 05/25/2014] [Accepted: 06/29/2014] [Indexed: 11/17/2022] Open
Abstract
The objective was to evaluate 2 primary molar sealant strategies for publicly insured children using an "expected value of perfect information" (EVPI) approach. We converted a 10,000-observation tooth-level cost-effectiveness simulation model comparing 2 primary molar sealant strategies - always seal (AS) and standard care (SC) - with a 1,250-observation child-level model. Costs per child per restoration or extraction averted were estimated. Opportunity losses under the AS strategy were determined for children for whom SC was the optimal choice. We determined the EVPI by multiplying mean opportunity losses by the projected incident population of publicly insured 3-year-olds in the US over 10 years with costs discounted at 2%. All analyses were conducted under assumptions of high and low intrachild correlations between at-risk teeth. The AS strategy cost $43.68 over SC (95% CI: -$5.50, $92.86) per child per restoration or extraction averted under the high intrachild correlation assumption and $15.54 (95% CI $7.86, $23.20) under the low intrachild correlation. Under high intrachild correlation, mean opportunity losses were $80.28 (95% CI: $76.39, $84.17) per child, and AS was the optimal strategy in 31% of children. Under low correlation, mean opportunity losses were $14.61 (95% CI: $12.20, $17.68) and AS was the optimal strategy in 87% of children. The EVPI was calculated at $530,813,740 and $96,578,389 (for high and low intrachild correlation, respectively), for a projected total incident population of 8,059,712 children. On average, always sealing primary molars is more effective than standard care, but widespread implementation of this preventive approach among publicly insured children would result in large opportunity losses. Additional research is needed to identify the subgroups of publicly insured children who would benefit the most from this effective and potentially cost-saving public health intervention.
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Affiliation(s)
- J P Ney
- University of Washington, Department of Neurology, Box 359455, Seattle, WA 98195, USA
| | - D N van der Goes
- University of New Mexico, Department of Economics, 1915 Roma Ave. NE 1019, Albuquerque, NM 87131, USA
| | - D L Chi
- University of Washington, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA
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Chi DL, van der Goes DN, Ney JP. Cost-effectiveness of pit-and-fissure sealants on primary molars in Medicaid-enrolled children. Am J Public Health 2014; 104:555-61. [PMID: 24432941 PMCID: PMC3953771 DOI: 10.2105/ajph.2013.301588] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared the incremental cost-effectiveness of 2 primary molar sealant strategies-always seal and never seal-with standard care for Medicaid-enrolled children. METHODS We used Iowa Medicaid claims data (2008-2011), developed a tooth-level Markov model for 10 000 teeth, and compared costs, treatment avoided, and incremental cost per treatment avoided for the 2 sealant strategies with standard care. RESULTS In 10 000 simulated teeth, standard care cost $214 510, always seal cost $232 141, and never seal cost $186 010. Relative to standard care, always seal reduced the number of restorations to 340 from 2389, whereas never seal increased restorations to 2853. Compared with standard care, always seal cost $8.12 per restoration avoided (95% confidence interval [CI] = $4.10, $12.26; P ≤ .001). Compared with never seal, standard care cost $65.62 per restoration avoided (95% CI = $52.99, $78.26; P ≤ .001). CONCLUSIONS Relative to standard care, always sealing primary molars is more costly but reduces subsequent dental treatment. Never sealing costs less but leads to more treatment. State Medicaid programs that do not currently reimburse dentists for primary molar sealants should consider reimbursement for primary molar sealant procedures as a population-based strategy to prevent tooth decay and reduce later treatment needs in vulnerable young children.
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Affiliation(s)
- Donald L Chi
- Donald L. Chi is with the Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle. David N. van der Goes is with the Department of Economics, College of Arts and Sciences and the Robert Wood Johnson Foundation Center for Health Policy, University of New Mexico, Albuquerque. John P. Ney is with the Department of Neurology, School of Medicine, University of Washington
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Simonsen RJ, Neal RC. A review of the clinical application and performance of pit and fissure sealants. Aust Dent J 2011; 56 Suppl 1:45-58. [DOI: 10.1111/j.1834-7819.2010.01295.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Leskinen K, Salo S, Suni J, Larmas M. Comparison of dental health in sealed and non-sealed first permanent molars: 7 years follow-up in practice-based dentistry. J Dent 2008; 36:27-32. [DOI: 10.1016/j.jdent.2007.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Revised: 10/01/2007] [Accepted: 10/09/2007] [Indexed: 11/25/2022] Open
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