Occlusal dental caries incidence and implications for sealant programs in a US college student population

Given the decline in dental caries incidence in preteens and young teenagers in the United States, a study of the incidence of dental caries in young adults (17-23 years) was conducted to provide a descriptive epidemiologic picture of this "new" natural history of dental caries in the late and post-teenage years. A retrospective study was performed analyzing the detailed dental records of the four-year college experience in the class of 1989, US Coast Guard Academy. Occlusal caries incidence, in the absence of associated proximal caries, was shown to be moderately common in molars (11.9%) and rare in premolars (0.8%). In contrast to previous studies' findings, demographic indicators, socioeconomic status indicators, and prior caries experience were poor predictors of occlusal caries incidence; targeting a universal sealant policy in this population therefore would be done best by tooth type rather than patient type. A preliminary cost-comparison model, projected over a 40-month period, suggests that the cost of initiating a universal molar sealant policy in this population would be 92 cents per year per student greater than the cost of restoring occlusal caries in the presence of sound proximal surfaces. This cost comparison suggests that it would be advantageous to initiate such a policy.