Natural History of Treatment outcomes of Permanent First Molars

Department of Pediatric Dentistry
Lutheran Medical Center
Date: 02/27/2009
Article title: Natural history of treatment outcomes of permanent first molars: A study of sealant effectiveness
Author(s): Bhuridej, Damiano, Kuthy, Flach, Kanellis, Heller, Dawson
Journal: Journal of Dentistry for Children
Volume (number): 136
Month, Year: Sept. 2005
Major topic: Sealant effectiveness
Minor topics: Caries
Type of Article: Retrospective review
Main Purpose: Compare natural progress of teeth without intervention with teeth treated with sealants.
Overview of method of research: Insurance claim data was reviewed and treatment outcome trees were generated. The source was IOWA medicaid claims from 1996-2000. The authors compared the treatments for 1st molars receiving sealant and 1st molars not sealed.
Findings:
40% of patients who routinely utilized medicaid for dental had sealants placed on their molars. 25% of all molars reviewed received some form of restorative treatment. Sealed molars were less likely to require further restorative treatment (13% vs 29%) Sealed molars had fewer endodontic treatments, crowns and extractions.

Key points/Summary :
Very few studies have utilized insurance data to retrospectively review treatment outcomes.
The Healthy People 2010 goal is to have 50% of high risk kids get sealants.
The Treatment Outcome Trees developed by the authors made for a graphical representation of the progression of teeth.
The more often a child utilizes the medicaid system, the more likely they are to receive sealants.
Not all unsealed molars required future restorative treatment (risk levels are different)
The authors suggest that outreach sealant programs could reduce restorative needs of high risk populations.
Inclusion criteria mandated that kids be enrolled in Medicaid during the entire study period and that they were seen at least 3 times during the study period.
The data can’t be generalized beyond a medicaid population.
Assessment of article: I think it’s universally accepted that sealants can reduce caries in high risk populations. The problem with this kind of research is that it quantifies the treatment--sealant, restorative, etc--into billing codes and doesn’t recognize subtle differences in treatment provided. This type of research is useful, but has a lot of limitations.