Can Glass ionomer sealants be cost-effective?

Abstract

Glass ionomer (GI), applied as a pit and fissure sealant, has been shown to be a promising method for caries prevention. It has also been suggested that when GI is used as a sealant material, it can prevent caries, even if partly or totally lost. As there is no need for resealing GI, it may be more cost-effective when compared to a resin-based (RB) sealant. This study evaluated the factors influencing the time needed to apply a sealant as a factor in determining the possible costs of the effectiveness of RB compared to GI sealants. To study this, children born between 1980 and 1983, who had their appropriate second molars sealed between 1993 and 1997, were assessed. The study was then based on a random sub-sample of this group, comprising 140 teeth: 86 sealed with RB (Delton) and 54 with GI (Fuji III). For a hygienist working alone, the whole procedure of applying a sealant, beginning with the cleaning of the tooth and ending with the finished sealant, took, on average, 344 (+/- 59) seconds with RB, and 599 seconds (+/- 89) with GI. This difference in time was found to be statistically significant at p < 0.01. No statistically significant difference existed in the mean time required to apply a sealant between the left (410 +/- 140 seconds) and the right (448 +/- 149 seconds) sides; however, the mandibular teeth required longer for application of the sealant than did the maxillary teeth (447 +/- 161 seconds vs. 408 +/- 125 seconds, respectively; p < 0.01). It was also found that a dentist, working with chairside assistance, took 20% less time to apply either sealant material than did the hygienist working alone. It was concluded that GI sealants, whether resealed or not, cannot be as cost-effective as RB sealants, when the expense of placement in time (and thus costs) is used as the basis of efficacy.