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Real-world effectiveness of national pit and fissure sealants program in Taiwan
Po-Yen Lin1, Le-Yin Hsu2, Hsuan-Lu Alicia Ko3
1Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Insights
The national pit and fissure sealants (PFS) program in Taiwan significantly reduced caries-related treatments by at least 10% in schoolchildren. Improved sealant retention could further enhance this protective effect against dental caries.
Area of Science:
- Dental Public Health
- Pediatric Dentistry
- Preventive Dentistry
Background:
- Dental caries remains a significant public health issue among children.
- Pit and fissure sealants (PFS) are a key preventive measure against occlusal caries.
- Evaluating the real-world effectiveness of national sealant programs is crucial for optimizing oral health strategies.
Purpose of the Study:
- To investigate the effectiveness of Taiwan's national population-based pit and fissure sealants (PFS) program.
- To assess the impact of sealant retention on caries prevention in schoolchildren.
Main Methods:
- Part 1: A large-scale analysis of 670,840 children participating in the PFS program (2015-2019) using multilevel Cox proportional hazards models.
- Part 2: Evaluation of sealant retention and its effect on caries in 1,561 children after 3 years.
- Propensity score matching was used to control for confounding factors in Part 1.
Main Results:
- Participation in the national PFS program was associated with a significant reduction in caries-related treatments (HR 0.90 for restoration, HR 0.42 for endodontic initiation, HR 0.46 for endodontic completion, HR 0.25 for extraction).
- Retained sealants showed a significant reduction in the risk of dental restoration (HR 0.70) compared to teeth without retained sealants.
- Overall, the program demonstrated at least a 10% reduction in caries-related treatment risk.
Conclusions:
- The national PFS program in Taiwan effectively reduced caries-related treatments in schoolchildren.
- Sealant retention plays a vital role, potentially offering an additional 30% risk reduction.
- Enhancing sealant retention rates is recommended to maximize the program's public health impact.
Objectives:
This study investigated the effectiveness of a national population-based pit and fissure sealants (PFS) program in Taiwan.
Methods:
Part 1 (effectiveness of national PFS program) involved children who had participated in the PFS program from 2015 to 2019. After propensity score matching, 670,840 children were selected for analysis until the end of 2019. During follow-up, the permanent first molars of the participants were assessed for caries-related treatments by employing multilevel Cox proportional hazards models. In Part 2 (effectiveness of retained sealants), which involved 1,561 children, sealant retention was evaluated 3 years after placement. A structured questionnaire was employed to collect information on family and individual factors. The endpoints were the same as in Part 1.
Results:
In Part 1, the adjusted hazard ratios (HRs) for caries-related treatments among participants in the PFS program were 0.90 (95% confidence interval [CI] = 0.89, 0.91) for dental restoration, 0.42 (95% CI = 0.38, 0.46) for initiation of endodontic treatment, 0.46 (95% CI = 0.41, 0.52) for completion of endodontic treatment, and 0.25 (95% CI = 0.18, 0.34, all Ps < 0.0001) for extraction. In Part 2, the adjusted HR for dental restoration of teeth with retained sealants was 0.70 (95% CI = 0.58, 0.85), significantly lower than that for teeth without retained sealants (P = 0.0002).
Conclusions:
Participation in the national PFS program was associated with a significant reduction of at least 10% in the risk of caries-related treatments, and an additional 30% risk reduction may have been attributed to sealant retention.
Clinical Significance:
In a real-world setting, schoolchildren in the national PFS program were associated with a significant reduction of at least 10% in the likelihood of caries-related treatments. The program provided moderate protection against caries for the study population and could be improved by increasing the sealant retention rate.
