Pit and fissure sealants in private practice and public health programmes: analysis of cost-effectiveness

Most studies of fissure sealants have concentrated on their ability to prevent caries of occlusal surfaces. The cost-effectiveness of the procedure has been generally ignored and even in those reports where values for the cost of sealant applications are given they tend to be overstated. In the majority of studies all sound teeth in one half of the subject's mouth were sealed, the other side acting as a control. Since only a proportion of the teeth sealed would have become carious this could be held to be wasteful and in a private practice where the caries profile of the subject was known, a more economical regimen could have been adopted. When sealants are applied by a dentist the cost appears likely to exceed the potential cost of restorations saved, but this could be altered if it were possible for the procedure to be carried out by auxiliaries. It is concluded that fissure sealants have a worthwhile contribution to make when used as an integral part of a total preventive regime which includes the use of professionally and self-applied fluorides. With their intelligent use it should be possible to preserve many more dentitions free of caries into adult life.