Gerlach R W, Senning J H
Division of Dental Health, Vermont Department of Health.
ASDC J Dent Child. 1991 Jan-Feb;58(1):46-9.
The potential for overutilization of dental sealants is cited as one rationale for limitations in third-party coverage for such care. To evaluate the validity of these concerns, provider behavior was reviewed, using twelve months of claims data from one insured population with pre-existing coverage for dental sealants. A total of 13,512 procedures from Vermont's "Tooth Fairy" program for low-income children were reviewed for several variables; these related to provider, patient, procedure type, and tooth number. Although sealants were the third most frequently rendered service, only 10.5 percent of patients received sealants. Treatment was largely consistent with professional guidelines for targeting care according to patient age. The absence of excessive or unnecessary utilization, combined with evidence of caries development in older children, suggests that insurers should review the appropriateness of protocols for sealant coverage.
牙齿封闭剂使用过度的可能性被认为是第三方对此类护理保险覆盖范围受限的一个理由。为了评估这些担忧的合理性，我们利用来自一个已享有牙齿封闭剂预先保险的参保人群的十二个月理赔数据，对医疗服务提供者的行为进行了审查。我们审查了佛蒙特州针对低收入儿童的“牙仙子”项目中的总共13512例治疗程序的几个变量；这些变量与医疗服务提供者、患者、治疗程序类型和牙齿数量有关。虽然封闭剂是第三大最常提供的服务，但只有10.5%的患者接受了封闭剂治疗。治疗在很大程度上符合根据患者年龄确定护理目标的专业指南。没有过度或不必要的使用情况，再加上大龄儿童龋齿发展的证据，表明保险公司应该审查封闭剂保险方案的适当性。
