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School-based dental sealant programs can improve the dental health of poor children at minimal cost

Poor and minority children have far more cavities than other children. However, a school-based dental sealant program could substantially improve the dental health of poor school-aged children at no cost or only slightly increased cost relative to ordinary dental care. That's the conclusion of a new study supported in part by a cooperative agreement between the Agency for Healthcare Research and Quality and the Health Resources and Services Administration's Bureau of Primary Health Care. The investigators did a cost-effectiveness analysis of a successful school-based dental sealant program for low-socioeconomic-status children in New York.

The program was set up in response to the observation that these children often did not keep their dental appointments due to their family situations and barriers they encountered in trying to access dental care. School program services offered at no cost to children ages 6 to 14 years included oral hygiene instruction, weekly fluoride rinses, dental sealants for permanent molars, and referrals to students' family dentists for comprehensive dental care. At the study's inception, these children had a 30 percent higher rate of dental cavities than similar children in surrounding communities and a high proportion (54 percent) of untreated dental cavities.

During the 5-year followup period, cavity incidence was 6.8 among matched control children in another school and 2.2 in the sealant group. Among the control group, 6 permanent teeth were lost. The sealant group had fewer decayed and filled surfaces than the control group (increase of 62 vs. 159) but more untreated cavities (78 vs. 66 percent). Total discounted costs of treatment in the control group during the 5-year study period amounted to $2,100 and $1,720 for the sealant group. Also, outcomes for the group given sealants were substantially better than for the control group. Even at private rates, the program would lead to substantially better outcomes at minimally increased cost.

More details are in "Cost-effectiveness analysis of a school-based dental sealant program for low-socioeconomic-status children: A practice-based report," by Georgina P. Zabos, D.D.S., M.P.H., Sherry A. Glied, Ph.D., Jonathan N. Tobin, Ph.D., and others, in the Journal of Health Care for the Poor and Underserved 13(1), pp. 38-48, 2002.

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