Journal of Dental Research, Vol 76, 1862-1868, Copyright © 1997 by International & American Associations for Dental Research Online Journals
The relationship between clinical tooth status and receipt of sealants among child Medicaid recipients
V. A. Robison, R. G. Rozier, J. A. Weintraub and G. G. Koch
Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland 21205, USA.
This study investigated the association between caries status and sealant
need at a prior survey and subsequent sealant use in a Medicaid program.
Clinical data from a 1986-87 statewide epidemiological survey (N = 8026)
representative of North Carolina (NC) schoolchildren (grades K-12) were
linked with all NC Medicaid dental claims submitted during 1987-92,
yielding 570 children in the survey who had at least one dental visit
during 1987-1992. From the 570, 390 children were included: 71 who received
sealants (S) and 319 who received non-sealant care (NS). Children were
excluded based on age, having preexisting sealants, or having no
sealant-eligible molars or premolars. S and NS were compared on baseline
dfs, DMFS, and sealant need, controlling for the patient's age, number of
visits, and the provider's propensity to seal. At all ages, NS was twice as
likely to have had prior dfs or DMFS (OR = 2.04, 95% CI = 1.15, 3.70). The
association between sealant receipt and prior sealant need varied by age.
At 6 to 11 years, S and NS had equal likelihood of sealant need (OR = 1.41,
95% CI = 0.62, 3.18). At 12 to 15 years, NS had a greater likelihood of
sealant need (OR = 6.82, 95% CI = 1.60, 29.08). Caries-free status was
associated with subsequent sealant receipt. Prior sealant need caused
variability in dentists' decisions, depending on the child's age and past
caries experience. Sealants were used infrequently by most providers and
for a minority of patients. These findings are important for the Medicaid
program and for future non-randomized studies of sealant effectiveness.
