摘要：Objectives. This retrospective cohort analysis of children enrolled in the North Carolina Medicaid program compared the likelihood of restorative treatments and associated cumulative Medicaid expenditures for teeth with or without dental sealants. Methods. We assessed the dental experience of the cohort of 15 438 children from 1985 to 1992 on the basis of enrollment and claims files. We conducted regression analyses for outcomes (caries-related services involving the occlusal surface [CRSOs] of permanent first molars) and cumulative expenditures, controlling for characteristics of the child, the treating dentist, and the child's county of residence. Results. Overall, 23% of children received at least 1 sealant and 33% at least 1 CRSO. Sealants were effective in preventing CRSOs, although the degree of effectiveness was highest for children with the greater levels of CRSOs before sealant placement. Estimated cumulative Medicaid expenditures indicated expenditure savings from sealants within 2 years of application for children with 2 or more prior CRSOs. Conclusions. Sealant placement was associated with expenditure savings to Medicaid for certain high-risk children, so Medicaid and, more broadly, society will benefit by providing for sealant placement in these children. Dental sealants, placed primarily on occlusal molar surfaces to prevent dental caries (tooth decay), have been commercially available since 1971. 1 Since then, several generations of improved and highly effective products have followed, 2, 3 but the proportion of children receiving sealants has remained low. Data collected as part of the 1988–1994 National Health and Nutrition Examination Survey (NHANES-III) show that only 23% of 8-year-olds had received sealants, 4 compared with the national oral health objective of 50%.5 Since the invention of sealants, it has become clear that some children and some teeth are more at risk for dental caries than others. Evidence strongly indicates that children of low-income families are at greater risk than other children, and occlusal surfaces of molars are at greater risk than other tooth surfaces. 6, 7 Medicaid and State Children's Health Insurance Program (S-CHIP) recipients are assumed to be at high risk for caries because low family income is usually required for eligibility. All states now include sealants as a dental benefit for children enrolled in their dental Medicaid programs, 8 and all but 3 states have S-CHIPs that either include sealants in their preventive dental services or are expansions of the Medicaid Early and Periodic Screening, Diagnosis and Treatment coverage that already includes sealant benefits. 9 Although the clinical efficacy of sealants is well established, the effectiveness and costs of this procedure in a statewide Medicaid population treated in private practice have not been evaluated. A smaller study assessed the cost-effectiveness of dental sealants in a low-income population in Flint, Mich. 10 The purpose of this larger study is to analyze the impact of dental sealants on the likelihood of restorative treatment and net expenditures for first permanent molars in a cohort of children enrolled in the North Carolina Medicaid Program from 1985, when the sealant benefit was initiated, until 1992.
