title: Natural history of treatment outcomes of permanent first molars: a study of sealant effectiveness.
abstract: BACKGROUND
  Few studies have used insurance claims data to retrospectively assess the natural history--a natural process or flow of events without any special interventions--and treatment outcomes of teeth with dental sealants.
  
  
  METHODS
  The authors constructed treatment outcome trees (TOTs) from the Iowa Medicaid claims and eligibility data (1996-2000) of continuously enrolled 6-year-old children who routinely used Medicaid dental services. The authors used the TOTs to compare the restorative treatments of sealed permanent first molars with those of nonsealed permanent first molars.
  
  
  RESULTS
  Forty percent of routine utilizers received a sealant during the four-year period. Overall, 25 percent of molars received at least one restoration. Sealed molars were less likely to receive further restorative treatment than were nonsealed molars (13 versus 29 percent). Sealed molars had fewer extensive restorative treatments (crowns, endodontic therapy and extractions) than did nonsealed molars. The median time to restorative treatment of the sealed molars also was greater than that of the nonsealed molars. All four first molars had comparatively similar patterns of subsequent care.
  
  
  CONCLUSIONS
  Permanent first molars with sealants received less subsequent restorative treatment than did those without sealants. TOTs are useful tools for identifying necessary outcome information needed for program evaluations.
  
  
  CONCLUSIONS
  Greater use of sealants could reduce the need for subsequent treatment and prolong the time until treatment may be necessary for permanent first molars.
authors.affiliation: Department of Community Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand. patita.b@chula.ac.th
authors.forename: Patita
authors.initials: P
authors.lastname: Bhuridej
authors.forename: Peter C
authors.initials: PC
authors.lastname: Damiano
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Kuthy
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Flach
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kanellis
authors.forename: Keith E
authors.initials: KE
authors.lastname: Heller
authors.forename: Deborah V
authors.initials: DV
authors.lastname: Dawson
mesh_terms: D002648:Child; D003442:Crowns / Q000706:statistics & numerical data; D003731:Dental Caries / Q000517:prevention & control; D003793:Dental Restoration, Permanent / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007344:Insurance Claim Reporting; D007484:Iowa; D008297:Male; D008484:Medicaid / Q000191:economics; D008963:Molar / Q000473:pathology*; D010895:Pit and Fissure Sealants / Q000627:therapeutic use*; D012189:Retrospective Studies; D012390:Root Canal Therapy / Q000706:statistics & numerical data; D013997:Time Factors; D014081:Tooth Extraction / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States
chemical_list: D010895:Pit and Fissure Sealants