The other day, out of curiosity, I googled “Do dental sealants save money long term?”. I wanted to see what my fellow dental folks had to say about the topic. I scanned the search results and found the following excerpts from two dental office websites, a dental insurance company website and an oral hygiene product manufacturer website.
Dental office website #1
“In almost every case, applying dental sealants early will cost less than pursuing corrective treatment later.”
Humana.com
“Dental sealants aren’t cheap, but they can be a good investment. The cost ranges from $30 to $60 per tooth, but can be more or less depending on your insurance plan. That may sound like a lot, but keep in mind that using sealants can save money over the long term and avoid the cost and inconvenience of repairing cavities with drilling, caps or crowns.”
Dental office website #2
“You will definitely save your money. It will be way cheaper to invest in dental sealants than in an expensive cavity treatment.”
Colgate.com
“Spending a little money upfront ensures neglected areas won’t result in costly dental procedures down the road…sealants can save you money down the line.”
I could have listed many more examples, but I think you get the picture. The general consensus in my industry seems to be this. Placing dental sealants will save “you” (individually or collectively) money over the long term.
As someone who has personally placed thousands of sealants in the last 12 years, I’ve always been a little skeptical of that claim. So let’s get into it.
How am I defining “dental sealants save money over the long term”?
This is my definition:
The total dollar cost of placing sealants (in the aggregate) is less than the total cost of restoring the teeth (in the aggregate) that the dental sealants would have prevented.
Assuming that’s a good definition, we now need to determine how many cavities sealants actually prevent, and how much sealants and fillings cost before we can crunch the numbers.
How many cavities do sealants actually prevent?
According to this highly referenced CDC study, “Over 4 years, sealing all four permanent first molars of low-income children is estimated to prevent 0.52 DFFM per child” (1)
That’s basically an 8 to 1 ratio. For every 8 sealants placed, 1 cavity is prevented.
How much do dental sealants cost?
National average = $53 (2)
MassHealth (Medicaid in my state of Massachusetts) = $41
School sealant program = $11.64 (3)
How much do amalgam (“silver”) fillings cost?
National average = $153* (2)
MassHealth average = $86*
What do the numbers tell us once crunched?
In the following scenarios, I’m assuming the placement of 1,000 dental sealants and 125 cavities / fillings prevented (based on the 8 to 1 ratio).
Scenario #1
1,000 sealants placed (average national fee) = $53,000
125 fillings prevented (average national fee) = $19,125
Overall dollar savings = – $33,875 dollars
Scenario #2
1,000 sealants placed (MassHealth fee) = $41,000
125 fillings prevented (average MassHealth fee) = $10,750
Overall dollar savings = – $30,250 dollars
Scenario #3
1,000 sealants placed (school sealant program) = $11,640
125 fillings prevented (average national fee) = $19,125
Overall dollar savings = + 7,485 dollars
Scenario #4
1,000 sealants placed (school sealant program cost) = $11,640
125 fillings prevented (average MassHealth fee) = $10,750
Overall dollar savings = – $890 dollars
Only one of the four scenarios above shows a positive dollar savings from using dental sealants. Mathematically, the 8 to 1 ratio is hard to overcome. For example, in scenario #1, the average national fee to place a dental sealant is $53. Just to break even, the fee would have to be reduced to $19. In scenario #2 the break even point would be even lower at $11.
Conclusion
Do dental sealants really save money? In most scenarios, in the real world. the answer seems to be a clear no. Does that mean we should stop placing sealants then? I don’t think so.
Dental sealants may not save monetary costs in most scenarios (we should probably stop saying that they do), but they do save non-monetary costs (e.g. pain, tooth loss, etc.) when done correctly.
Mark Frias, RDH
*It’s important to note that a dental sealant can potentially prevent a one or two surface cavity (occluso-lingual or occluso-buccal), so I averaged the cost of a one surface filling and a two surface filling to get a single number.
Resources
(1) Vital Signs: Dental Sealant Use and Untreated Tooth Decay Among U.S. School-Aged Children. https://www.cdc.gov/mmwr/volumes/65/wr/mm6541e1.htm?s_cid=mm6541e1_w
(2) ADA 2016 Survey of Dental Fees. https://ebusiness.ada.org/Assets/docs/32418.pdf
(3) Evaluation of School-Based Dental Sealant Programs: An Updated Community Guide Systematic Economic Review. https://pubmed.ncbi.nlm.nih.gov/27865653/
I googled “effectiveness of dental sealants “ and came up w this:
Once applied, sealants protect against 80% of cavities for 2 years and continue to protect against 50% of cavities for up to 4 years. Sealants can eliminate the need for expensive and invasive treatments like dental fillings or crowns.Oct 18, 2016
Dental Sealants Prevent Cavities – Vital Signs – CDC
The problem is that the reported percentage is the ratio of “patients to cavities prevented” as opposed to “number of sealants to cavities prevented”. In other words, it’s very misleading.
And this came up in the same search:
“ Applying sealants in school-based programs to the nearly 7 million children from low income households who don’t have them could save up to $300 million in dental treatment costs, the CDC reported.”
In this article: https://www.healthline.com/health-news/does-dental-sealant-protection-outweigh-risks#2
They will save “treatment” costs, but there’s no mention of the “prevention” costs.