Factors affecting the cost of fissure sealants: a dental insurer's perspective.

The slow adoption of sealants into dental practice is attributed partly to the fact that few prepayment plans pay for sealants. An important concern of insurers is how a sealants benefit will affect premiums. In this analysis, caries rates for various surfaces and teeth, failure rates for both sealants and amalgam restorations, fees and copayments, interest rates, reimbursement policies for replacement and repair, and the passage of time were studied to assess the cost to an insurer of amalgam restorations versus sealants. The results indicate: Sealants as a covered benefit for molars may not cause premiums to increase if fees and copayment levels are properly balanced. If caries in children continues to decline, however, higher premiums may be required if a sealant benefit is provided. Sealants as a covered benefit for bicuspids are likely to require higher premiums. The level of dental caries in the population should be monitored closely, because a further substantial decline in caries prevalence could diminish the economic argument for sealants.