Natural History of Treatment Outcomes of Permanent First Molars

Resident: Swan

Article Title: Natural History of treatment outcomes of permanent first molars: A study of Sealant Effectiveness

Journal: JADA

Volume (Number): Vol. 136

Major Topic: Sealant Effectiveness

Type of Article: Retrospective Cohort Study

Main Purpose: Use insurance claims data to retrospectively assess the natural history and treatment outcomes of sealed and non-sealed teeth. Assist public health planners, dentists, and patients in clinical decision making and program planning.

Overview of method of research: Data was collected from eligibility and dental claims for children enrolled in the Iowa Medicaid program from ’96-2000. Children were enrolled in the study if they were six years old, enrolled continuously in Medicaid from ’96-2000, and were routine utilizers of dental services during this time (on preventive visit in 1996, one in 2000, and one other). 308 children met these criteria. The natural history (subsequent treatment history) of all first molars was evaluated by constructing Treatment Outcome Trees (TOT) to display all services provided over a four year period. First treatment node on TOT=whether tooth received sealant before any other treatment. Second node=whether teeth received further “restorative tx,” ie restorations, crowns, RCT, EXTs.

Findings: Sealed molars were less likely to receive further restorative treatment than were non-sealed (13% versus 29%). For teeth with sealants, about 87% of first molars did not receive restorative treatment during study period. Of teeth without sealants, about 70% of firsts did not receive further treatment. Few teeth in both groups received extensive treatment (crowns, endo, ext). 4% of the sealed teeth received another sealant. Of all teeth that received restorations, median time to restorative treatment was greater for sealed than non-sealed teeth.

Key Points/Summary: In this study sample of kids aged 6-10, permanent first molars with sealants were less likely to receive subsequent restorative treatment than were those without sealants. These results are consistent with different studies that have used different methodologies.

Assessment of Article: Good study, solid design. The preventive effect in this study (16%) may be exaggerated because the study started follow up based on age (six years) as opposed to after sealant placement, which has been done in other studies. The study period was 4 years--it would be nice to see the outcomes after a longer period, maybe 8-10 years.