Mind Your Decisions

Should I Get a Dental Sealant to Prevent Cavities (and Save Money)?

Image source: yomi955 via flickr

I’m an adult now, but for the first time in my life, my dentist found cavities. I didn’t understand it, as I religiously follow all of the American Dental Association’s guidelines for oral hygiene (brush twice, floss, eat balanced meals, visit dentist regularly).

Why did I get the cavities? My dentist told me “sometimes food particles get stuck” and hinted these things just happen. After he filled my teeth, he suggested I consider a dental or tooth sealant as a preventative measure.

As I understand, dental sealants are plastic resins that fill in the pits and fissures of teeth to create a smooth cleaning surface. This allows toothbrush bristles to remove food particles, especially in hard to reach places in the back teeth, like the molars.

My dentist left me the job of deciding. What thoughts are running through my mind?

The Appeal

Dental sealants appear to work, anecdotally at least. My friend tells me how he didn’t have cavities years after he got a dental sealant. In fact, his next cavity happened when the sealant wore off (about 10 years).

Sealants are also highly recommended by the American Dental Association, even for some adults. They write in their FAQ about sealants, “Ask your dentist about whether sealants can put extra power behind your prevention program” [my emphasis].

It was not pleasant getting my cavities filled. Staring at a bright light, getting my saliva sucked out of me, and getting drilled was among the most painful experiences in recent memory. I would certainly pay something to avoid a repeat. So that brings me to the next question of value.

Are dental sealants cost effective?

The Numbers

Preventative measures, like dental sealants, are worthwhile if the benefits can justify the costs. A careful analysis is necessary to avoid excessive effort. For instance, exercising for longevity, a common pursuit, might be a misleading goal—the longevity benefits roughly equal the exercise time cost, as I wrote about before.

To analyze sealants, I’ll consider the cost of the procedure versus the savings in getting fillings for cavities, relative to insurance.

No dental insurance

This is the case where you’d have to pay for everything. Sealants appear to be a good deal.

From my research, I found that dental sealants cost about $25 to $50 per tooth (source 1, source 2). This is compared to getting non-mercury cavity fillings that can cost $150 to $200 (source).

Since sealing a tooth costs less than filling a cavity, the procedure would seem to make sense.

With dental insurance

Many times sealants and fillings are covered by insurance. In this case, cost isn’t really an out of pocket expense. This distorts incentives and might make dentists trigger happy to suggest or not suggest sealants, depending on how they make money (I have no clue about this).

Take note of the dentists’ position. I’m sure many dentists do give honest advice, but as an economist, I know that incentives matter.

The risks

It would be short-sighted to stop the analysis here. I need to consider the risks and the full impact of getting a dental sealant. This is the area where I let myself be a full skeptic. I’m motivated by three main questions.

• Does the procedure hurt?

The procedure should not hurt much, according to the American Academy of Pediatric Dentistry page on sealants. They describe it as a single visit where the dentist cleans the tooth, and then conditions and dries it under a special light. One can eat right after the appointment.

• What are the long-term health impacts?

The long-term health impacts bother me, despite what the authorities says. I’ve skimmed about 50 articles from dentists and government websites that all say there is no evidence dental sealants are unsafe. But absence of evidence is not evidence of absence.

But I haven’t found any compelling arguments on why dental sealants are unsafe either. Some sealants contain bisphenol-A, a plastic that appears to be damaging. Studies at the University of Granada in Spain and the Boston University are not necessarily conclusive, and some still question the use of sealants. The American Dental Association says dental sealants are appropriate.

• Do I want plastic on my teeth?

This seems like a very unnatural state, at a minimum. Sealants require some kind of binding agent, and they ultimately wear off. Do I want to be slowly ingesting whatever plastic is there?

I am worried about these questions and I don’t have answers. But there is one option I’m considering.

What’s missing: lifestyle changes

Let’s recap my visit with the dentist. He found I had two cavities. I told him I followed good oral hygiene. He filled my cavities, suggested cavities happen, and then suggested a sealant.

Isn’t there anything else I can do?

I didn’t have time to ask this question, but I doubt I would have gotten a positive answer. The way my dentist answered, he said cavities just happen as food gets stuck. In fact, that’s the consensus of the American Dental Association.

Why was I given the advice to get plastic put over my teeth before I was suggested lifestyle changes to address the cause of cavities?

Perhaps my dentist has seen too many patients and knows that people don’t change. They don’t floss or brush or avoid sugary foods, no matter what he tells them.

I, like many people I know, are more disciplined and care about these things. We will change. What should we do?

Three possible changes

I already follow the mainstream American advice on oral hygiene, so perhaps it’s time to do something different.

Three things I might try:

• clean teeth after every meal
• avoid potato chips
• avoid brushing until an hour after meals

The first step is obvious. I brushed twice a day, but I was not cleaning after lunch. If food particles getting stuck are the problem, I can easily eliminate that.

The second change is a surprise to me. I had heard that sugary foods caused cavities, but I never ate them so it didn’t matter. No one told me about other starchy foods like potato chips, one of my few indulgences. According to the Mayo Clinic, this is a big deal:

For instance, although candy bars, jelly beans and caramels are sticky and sugary, they’re easily washed away by saliva, making them less of a threat than are potato chips, which stubbornly stick to your teeth.

Potato chips are probably not good for my health anyway, so I’m going to start eating some alternative snacks.

The final change is a shocker. I had always heard it was best to brush right after meals to avoid food buildup. But it looks like I was brushing too soon, according to the British Dental Health Foundation

Eating and drinking naturally weakens the enamel on your teeth, and brushing straight afterwards can cause tiny particles of enamel to be brushed away. It is best not to brush your teeth until at least one hour after eating.

This one sounds very strange to me, so if you know better, please share in the comments.

My conclusion: proceed with caution

Regardless of cost, I would like to avoid putting plastic on my teeth. I don’t know about the health impacts, and it’s not a reversible procedure.

I’m going to try these lifestyle changes and see how things look at my next dentist appointment.

What’s your take? Have you gotten a dental sealant? Did it work? Is it safe? Did your insurance cover it?