Analyses of National Health and Nutrition Examination Survey (NHANES) data suggested a significant decrease in sealant prevalence among children between 2011 to 2014 and 2015 to 2018. We explore whether this decrease could be associated with possible changes in 1) clinical sealant delivery, 2) dental materials (i.e., increased use of glass ionomer [GI] sealants resulting in an inability to detect sealant fragments that still provide preventive benefits or increased use of composite restorations leading to misclassifying sealants as restorations), and 3) examination sensitivity and specificity. We used NHANES data to estimate the prevalences of sealants, untreated caries, and restorations in ≥1 first permanent molar among children aged 7 to 10 y and used Medical Expenditure Panel Survey data to estimate the annual clinical delivery of sealants and fluoride treatments. We examined changes in outcomes between 2 periods ( P < 0.05) controlling for selected sociodemographic characteristics. NHANES sealant examination quality was based on the reference examiner’s replicate examinations. The adjusted prevalence of sealants decreased relatively by 27.5% (46.6% vs. 33.8%). Overall, untreated caries decreased. Untreated caries and restoration decreased among children without sealants. Annual clinical sealant delivery did not change, whereas fluoride treatment delivery increased. The decrease in sealant prevalence held when assessed for various age ranges and NHANES cycle combinations. While sealant examination specificity remained similar between the periods, sensitivity (weighted by the proportion of exams by each examiner) decreased relatively by 17.4% (0.92 vs. 0.76). These findings suggest that decreased sealant prevalence was not supported by decreased clinical sealant delivery nor increased use of composite restorations. Decreased examination sensitivity, which could be due to an increased use of GI sealants, could contribute to the decrease in sealant prevalence. The decrease in caries among children without sealants could suggest the increased use of GI sealants. However, we could not rule out that the decrease in caries could be attributable to increased fluoride treatment delivery.

中文翻译：

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探索美国儿童第一磨牙封闭剂的近期减少

对国家健康和营养检查调查 (NHANES) 数据的分析表明，2011 年至 2014 年以及 2015 年至 2018 年期间，儿童密封剂流行率显着下降。我们探讨这种下降是否与 1) 临床密封剂输送、2) 方面可能发生的变化有关。牙科材料（即玻璃离聚物 [GI] 密封剂的使用增加导致无法检测仍具有预防作用的密封剂碎片，或复合修复体的使用增加导致将密封剂错误分类为修复体），以及 3) 检查敏感性和特异性。我们使用 NHANES 数据来估计 7 至 10 岁儿童中密封剂、未经治疗的龋齿和 ≥1 个第一恒磨牙修复体的患病率，并使用医疗支出小组调查数据来估计密封剂和氟化物治疗的年度临床交付量。我们检查了两个时期之间结果的变化（P < 0.05），并控制了选定的社会人口统计学特征。NHANES 密封剂检查质量基于参考检查员的重复检查。调整后的密封剂使用率相对下降了 27.5%（46.6% vs. 33.8%）。总体而言，未经治疗的龋齿数量有所减少。未使用密封剂的儿童中，未经治疗的龋齿和修复会减少。每年临床密封剂的交付量没有变化，而氟化物治疗的交付量有所增加。对不同年龄范围和 NHANES 循环组合进行评估时，密封剂流行率仍然下降。虽然各时期之间密封剂检查的特异性保持相似，但敏感性（按每位检查者的检查比例加权）相对下降了 17.4%（0.92 vs. 0.76）。这些发现表明，临床密封剂输送量的减少和复合修复体使用的增加并不支持密封剂流行率的下降。由于胃肠道密封剂的使用增加，检查灵敏度降低，这可能导致密封剂流行率的下降。没有密封剂的儿童中龋齿的减少可能表明胃肠道密封剂的使用有所增加。然而，我们不能排除龋齿减少可能归因于氟化物治疗的增加。