Economic Evaluation of a School-based Combined Program with a Targeted Pit and Fissure Sealant and Fluoride Mouth Rinse in Japan

Shihoko Sakuma1, *, Akihiro Yoshihara1, Hideo Miyazaki1, Seigo Kobayashi2
1 Division of Preventive Dentistry, Department of Oral Health Science, Graduate School of Medical and Dental Science, Niigata University, Japan
2 Department of Community Oral Health, Nihon University School of Dentistry at Matsudo, Japan

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© Sakuma et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Division of Preventive Dentistry, Department of Oral Health Science, Graduate School of Medical and Dental Science, Niigata University, 2-5274 Gakkocho-dori Chuo-ku Niigata City, 951-8514 Japan; Tel: 025-227-2858; Fax: 025-227-0807; E-mail:



In Niigata prefecture, Japan, a system has been developed based on a school-based fluoride mouth rinse program as follows; students with caries susceptible teeth are screened in a school dental examination, and encouraged to receive sealant placement in local dental clinics. However, the cost-effectiveness of sealant application in the public health has been questioned. The aim of this study was to estimate of the cost-effectiveness and cost-benefit ratio for a school-based combined program with fluoride mouth rinse and targeted fissure sealant in children residing in non-fluoridated areas in Japan.


The analysis was based on comparing an intervention group with two cohorts in the 8-year-old (n=66) and 11-year-old (n=58) participating in the combined program for four and seven years, respectively, with a control group of the same grades (n=43 and n=54 respectively).


The study measured mean differences in number of decayed and filled teeth (DFT) between the study groups and a combined program cost per child during study periods. The cost-effectiveness ratio was expressed as an individual annual program cost per DFT averted. In the cost-benefit ratio the mean difference in treatment cost between groups (program benefit) was compared to program cost.


The mean reduced DFT differences between groups were 1.44 in 8-year-old and 3.17 in 11-year-old children. The cost-effectiveness ratio was ¥ 493 in the 8-year-old and ¥ 202 in the 11-year-old, respectively. The cost-benefit ratio was 1.84 in 8-year-old children and 2.42 in 11-year-old.


This combined program indicated acceptable cost-effectiveness and cost –benefit ratio.

Key Words: Cost-effectiveness, Cost-benefit ratio, Fluoride mouth rinse, Targeted fissure sealant.