An economic evaluation of pit and fissure sealants and fluoride varnishes in preventing dental caries: a systematic review
1Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, 710004 Xi’an, Shaanxi, China
2Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, Center of Oral Public Health, College of Stomatology, Xi’an Jiaotong University, 710004 Xi’an, Shaanxi, China
3State Key Laboratory of Oral Diseases, Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, 610041 Chengdu, Sichuan, China
DOI: 10.22514/jocpd.2023.048 Vol.47,Issue 5,September 2023 pp.4-11
Submitted: 28 December 2022 Accepted: 16 February 2023
Published: 03 September 2023
The aim was to systematically evaluate the cost-effectiveness of pit and fissure sealants (PFSs) compared with that of fluoride varnishes (FVs) in dental caries prevention. We searched four electronic databases including the Cochrane Oral Health Group’s Trials Register (till 03 June 2022), Web of Science (from 1945 to 03 June 2022), PubMed (from 1996 to 03 June 2022), and EMBASE via Ovid (from 1980 to 03 June 2022) to identify the cost and effectiveness of PFSs and FVs in decreasing dental caries incidence. Two researchers independently screened search results, extracted data from the included studies, and conducted the risk of bias assessments. The main characteristics of the included studies were extracted and analyzed. The initial search produced 874 articles. After removing duplicates and full-text review, 19 studies were included. In this study: nine studies were on PFSs comparison with control; five on PFSs comparison with FVs; and five on FVs comparison with control. Regarding the type of economic evaluation (EE), 13 studies conducted cost-effectiveness analysis, five conducted cost-utility analyses, and one conducted both cost-effectiveness analysis and cost-utility analyses. The cost-effectiveness evaluation of PFSs and FVs in the available studies was limited. The prevalence of dental caries, payers’ willingness to pay, length of follow-ups, delivery settings, retention rate of PFS, and application intervals of FV can affect the economic evaluation of these two methods for dental caries prevention. Therefore, more studies in the future are need to draw clear conclusions about which method is more cost-effective for the two preventive interventions in future.
Economic evaluation; Pit and fissure sealants; Fluoride varnishes; Dental caries; Systematic analysis
Bin Zhang,Min Zhao,Shaoying Duan,Jiangang Tian,Lei Lei,Ruizhe Huang. An economic evaluation of pit and fissure sealants and fluoride varnishes in preventing dental caries: a systematic review. Journal of Clinical Pediatric Dentistry. 2023. 47(5);4-11.
 Lam PP, Sardana D, Lo EC, Yiu CK. Fissure sealant in a nutshell. Evidence-based meta-evaluation of sealants’ effectiveness in caries prevention and arrest. Journal of Evidence Based Dental Practice. 2021; 21: 101587.
 Urquhart O, Tampi MP, Pilcher L, Slayton RL, Araujo MWB, Fontana M, et al. Nonrestorative treatments for caries: systematic review and network meta-analysis. Journal of Dental Research. 2019; 98: 14–26.
 Khouja T, Smith KJ. Cost-effectiveness analysis of two caries prevention methods in the first permanent molar in children. Journal of Public Health Dentistry. 2018; 78: 118–126.
 Du S, Zhang C, Wang W, Liu J, Yuan C, Yu Y, et al. The economic benefits of increased sugar-free chewing gum in China: a budget impact analysis. BMC Oral Health. 2021; 21: 436.
 Listl S, Galloway J, Mossey PA, Marcenes W. Global economic impact of dental diseases. Journal of Dental Research. 2015; 94: 1355–1361.
 Niessen LC, Douglass CW. Theoretical considerations in applying benefit-cost and cost-effectiveness analyses to preventive dental programs. Journal of Public Health Dentistry. 1984; 44: 156–168.
 Neidell M, Shearer B, Lamster IB. Cost-effectiveness analysis of dental sealants versus fluoride varnish in a school-based setting. Caries Research. 2016; 50: 78–82.
 Ahovuo-Saloranta A, Forss H, Hiiri A, Nordblad A, Mäkelä M. Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database of Systematic Reviews. 2016; 2016: CD003067.
 Bhuridej P, Kuthy RA, Flach SD, Heller KE, Dawson DV, Kanellis MJ, et al. Four-year cost-utility analyses of sealed and nonsealed first permanent molars in iowa medicaid-enrolled children. Journal of Public Health Dentistry. 2007; 67: 191–198.
 Dye BA, Tan S, Smith V, Lewis BG, Barker LK, Thornton-Evans G, et al. Trends in oral health status: United States, 1988–1994 and 1999–2004. Vital and Health Statistics. Series 11. 2007; 1–92.
 Marinho VC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews. 2013; CD002279.
 Bonetti D, Clarkson JE. Fluoride varnish for caries prevention: efficacy and implementation. Caries Research. 2016; 50: 45–49.
 Do L. Guidelines for use of fluorides in Australia: update 2019. Australian Dental Journal. 2020; 65: 30–38.
 Marinho VC, Worthington HV, Walsh T, Chong LY. Fluoride gels for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews. 2015; 2015: CD002280.
 Smaïl-Faugeron V, Fron-Chabouis H, Courson F. Methodological quality and implications for practice of systematic Cochrane reviews in pediatric oral health: a critical assessment. BMC Oral Health. 2014; 14: 35.
 Zaror C, Muñoz-Millán P, Espinoza-Espinoza G, Vergara-González C, Martínez-Zapata MJ. Cost-effectiveness of adding fluoride varnish to a preventive protocol for early childhood caries in rural children with no access to fluoridated drinking water. Journal of Dentistry. 2020; 98: 103374.
 Ramamurthy P, Rath A, Sidhu P, Fernandes B, Nettem S, Fee PA, et al. Sealants for preventing dental caries in primary teeth. Cochrane Database of Systematic Reviews. 2022; 2: CD012981.
 Beresescu L, Kovacs M, Vlasa A, Stoica AM, Benedek C, Pop M, et al. Retention ability of a glass carbomer pit and fissure sealant. International Journal of Environmental Research and Public Health. 2022; 19: 1966.
 Lee I, Monahan S, Serban N, Griffin PM, Tomar SL. Estimating the cost savings of preventive dental services delivered to medicaid-enrolled children in six southeastern states. Health Services Research. 2018; 53: 3592–3616.
 Carvalho DM, Salazar M, Oliveira BH, Coutinho ES. Fluoride varnishes and decrease in caries incidence in preschool children: a systematic review. Brazilian Journal of Epidemiology. 2010; 13: 139–149. (In Portuguese)
 Mariño RJ, Khan AR, Morgan M. Systematic review of publications on economic evaluations of caries prevention programs. Caries Research. 2013; 47: 265–272.
 Morgan M, Mariño R, Wright C, Bailey D, Hopcraft M. Economic evaluation of preventive dental programs: what can they tell us?Community Dentistry and Oral Epidemiology. 2012; 40: 117–121.
 Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated health economic evaluation reporting standards (CHEERS) statement. Value in Health. 2013; 16: e1–e5.
 Chi DL, van der Goes DN, Ney JP. Cost-effectiveness of pit-and-fissure sealants on primary molars in medicaid-enrolled children. American Journal of Public Health. 2014; 104: 555–561.
 Atkins CY, Thomas TK, Lenaker D, Day GM, Hennessy TW, Meltzer MI. Cost-effectiveness of preventing dental caries and full mouth dental reconstructions among Alaska Native children in the Yukon-Kuskokwim delta region of Alaska. Journal of Public Health Dentistry, 2016; 76: 228–240.
 Palacio R, Shen J, Vale L, Vernazza CR. Assessing the cost-effectiveness of a fluoride varnish programme in Chile: the use of a decision analytic model in dentistry. Community Dentistry and Oral Epidemiology. 2019; 47: 217–224.
 Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine. 2009; 6: e1000097.
 Griffin SO, Griffin PM, Gooch BF, Barker LK. Comparing the costs of three sealant delivery strategies. Journal of Dental Research. 2002; 81: 641–645.
 Griffin S, Naavaal S, Scherrer C, Griffin PM, Harris K, Chattopadhyay S. School-based dental sealant programs prevent cavities and are cost-effective. Health Affairs. 2016; 35: 2233–2240.
 Zabos GP, Glied SA, Tobin JN, Amato E, Turgeon L, Mootabar RN, et al. Cost-effectiveness analysis of a school-based dental sealant program for low-socioeconomic-status children: a practice-based report. Journal of Health Care for the Poor and Underserved. 2002; 13: 38–48.
 Halasa-Rappel Y, Archibald J, Miller P, Frederick Lambert R, Hong M, Ng MW, et al. Pit-and-fissure sealants on primary molars are a cost savings. The Journal of the American Dental Association. 2021; 152: 832–841.e4.
 Espinoza-Espinoza G, Corsini G, Rojas R, Mariño R, Zaror C. The cost-utility of school-based first permanent molar sealants programs: a Markov model. BMC Oral Health. 2019; 19: 293.
 Chestnutt IG, Hutchings S, Playle R, Morgan-Trimmer S, Fitzsimmons D, Aawar N, et al. Seal or varnish? A randomised controlled trial to determine the relative cost and effectiveness of pit and fissure sealant and fluoride varnish in preventing dental decay. Health Technology Assessment. 2017; 21: 1–256.
 Schwendicke F, Splieth CH, Thomson WM, Reda S, Stolpe M, Foster Page L. Cost-effectiveness of caries-preventive fluoride varnish applications in clinic settings among patients of low, moderate and high risk. Community Dentistry and Oral Epidemiology. 2018; 46: 8–16.
 Nguyen TM, Tonmukayakul U, Warren E, Cartwright S, Liew D. A Markov cost-effective analysis of biannual fluoride varnish for preventing dental caries in permanent teeth over a 70-year time horizon. Health Promotion Journal of Australia. 2020; 31: 177–183.
 Quiñonez RB, Downs SM, Shugars D, Christensen J, Vann WF. Assessing cost-effectiveness of sealant placement in children. Journal of Public Health Dentistry. 2005; 65: 82–89.
 Quiñonez RB, Stearns SC, Talekar BS, Rozier RG, Downs SM. Simulating cost-effectiveness of fluoride varnish during well-child visits for Medicaid-enrolled children. Archives of Pediatrics & Adolescent Medicine. 2006; 160: 164–170.
 Huang SS, Ruff RR, Niederman R. An economic evaluation of a comprehensive school-based caries prevention program. JDR Clinical & Translational Research. 2019; 4: 378–387.
 Yuan C, Wang XZ, Sun XY, Wang X, Feng XP, Tai BJ, et al. Oral health status of 12-year-olds from regions with and without coverage of the national oral health comprehensive intervention program for children in China. Chinese Journal of Dental Research. 2018; 21: 299–306.
 Holve S, Braun P, Irvine JD, Nadeau K, Schroth RJ. Early childhood caries in Indigenous communities. Paediatrics & Child Health. 2021; 26: 255–258.
 Bakhurji E, Hoaglin Cooper L. School-based fluoride varnish programs: a national survey. Journal of Public Health Dentistry. 2019; 79: 279–285.
 Turner S, Brewster L, Kidd J, Gnich W, Ball GE, Milburn K, et al. Childsmile: the national child oral health improvement programme in Scotland. Part 2: monitoring and delivery. British Dental Journal. 2010; 209: 79–83.
 Mathu-Muju KR, McLeod J, Walker ML, Chartier M, Harrison RL. The children’s oral health initiative: an intervention to address the challenges of dental caries in early childhood in Canada’s first nation and inuit communities. Canadian Journal of Public Health. 2016; 107: e188–e193.
 Bergström E, Davidson T, Moberg Sköld U. Cost-effectiveness through the dental-health FRAMM guideline for caries prevention among 12- to 15- year-olds in Sweden. Caries Research. 2019; 53: 339–346.
 Bertrand E, Mallis M, Bui NM, Reinharz D. Cost-effectiveness simulation of a universal publicly funded sealants application program. Journal of Public Health Dentistry, 2011; 71: 38–45.
 Skold L, Sundquist B, Eriksson B, Edeland C. Four-year study of caries inhibition of intensive Duraphat application in 11–15-year-old children. Community Dentistry and Oral Epidemiology. 1994; 22: 8–12.
 Vermaire JH, van Loveren C, Brouwer WBF, Krol M. Value for money: economic evaluation of two different caries prevention programmes compared with standard care in a randomized controlled trial. Caries Research. 2014; 48: 244–253.
 Pisarnturakit P, Detsomboonrat P. Comparison of two caries prevention programs among Thai kindergarten: a randomized controlled trial. BMC Oral Health. 2020; 20: 119.
 Bendinskaite R, Peciuliene V, Brukiene V. A five years clinical evaluation of sealed occlusal surfaces of molars. Stomatologija. 2010; 12: 87–92.
 Burt BA. Fissure sealants: clinical and economic factors. Journal of Dental Education. 1984; 48: 96–102.
 Hawkins R, Noble J, Locker D, Wiebe D, Murray H, Wiebe P, et al. A comparison of the costs and patient acceptability of professionally applied topical fluoride foam and varnish. Journal of Public Health Dentistry. 2004; 64: 106–110.
 Skinner J, Dimitropoulos Y, Rambaldini B, Calma T, Raymond K, Ummer-Christian R, et al. Costing the scale-up of a national primary school-based fluoride varnish program for aboriginal children using dental assistants in Australia. International Journal of Environmental Research and Public Health. 2020; 17: 8774.
 Morgan-Trimmer S, Chadwick BL, Hutchings S, Scoble C, Lisles C, Drew CJ, et al. The acceptability of fluoride varnish and fissure sealant treatments in children aged 6–9 delivered in a school setting. Community Dental Health, 2019; 36: 33–38.
 O’Neill C, Worthington HV, Donaldson M, Birch S, Noble S, Killough S, et al. Cost-effectiveness of caries prevention in practice: a randomized controlled trial. Journal of Dental Research. 2017; 96: 875–880.
 Stearns SC, Rozier RG, Kranz AM, Pahel BT, Quiñonez RB. Cost-effectiveness of preventive oral health care in medical offices for young medicaid enrollees. Archives of Pediatrics & Adolescent Medicine. 2012; 166: 945–951.
 Leskinen K, Salo S, Suni J, Larmas M. Comparison of dental health in sealed and non-sealed first permanent molars: 7 years follow-up in practice-based dentistry. Journal of Dentistry. 2008; 36: 27–32.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
PubMed (MEDLINE) PubMed comprises more than 35 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full text content from PubMed Central and publisher web sites.
Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.
Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.
JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.
Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.
BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Scopus: CiteScore 2.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.