A change in the regional disparity based on the national insurance coverage of dental sealant in Korea

Hyo-Jin Lee; Kwang-Hak Bae

doi:10.11149/jkaoh.2014.38.3.165

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Lee and Bae: A change in the regional disparity based on the national insurance coverage of dental sealant in Korea

Original Article

J Korean Acad Oral Health 2014;38(3):165-169.

Published online: 12 September 2014

DOI: https://doi.org/10.11149/jkaoh.2014.38.3.165

A change in the regional disparity based on the national insurance coverage of dental sealant in Korea

Hyo-Jin Lee, Kwang-Hak Bae

Department of Preventive and Public Health Dentistry, Seoul National University School of Dentistry, Seoul, Korea

Corresponding Author: Kwang-Hak Bae Department of Preventive and Public Health Dentistry, Seoul National University School of Dentistry, 28 Yeongun-dong, Jongno-gu, Seoul 110-749, Korea Tel: +82-2-740-8747 Fax: +82-2-765-1722 E-mail: baekh@snu.ac.kr

Received 24 June 2014 Revised 26 August 2014 Accepted 1 September 2014

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

In 2002, the Ministry of Health and Welfare initiated a national sealant program (NSP) in public health centers in order to promote oral health among children in rural areas as well as among children with low socio-economic status in urban areas. However, this program was terminated in 2009 and substituted with the national insurance coverage of sealants (NICS). The aim of this study is to evaluate the impact of the change from NSP to NICS on regional inequality.

Methods

Based on data obtained from the 2010 and 2012 Korea National Oral Health surveys conducted, we analyzed the average number of permanent teeth with sealants (mean sealant) on the first molars and the prevalence of active dental caries in permanent teeth (D rate), segregated by region, in 8-year-old children. Analyses were performed using SPSS 21.0 (SPSS Inc., Chicago, IL, USA) after taking into consideration the complex design of the samples.

Results

The D rate of rural children was higher than that of those in metropolitan and city areas. Compared to the 2010 data on the mean sealants on the first molars, a 14.4% and 48.1% increase was observed in the mean sealants in children in the metropolis and in cities in 2012, respectively. However, this number decreased by 7.5% only in the rural areas.

Conclusions

Accessibility to dental services was limited in the rural areas as compared than in other areas; this result is based on the fact that the D rate in rural areas was higher than that in other areas. The NSP has decreased this regional inequality with regard to the accessibility to dental services. However, it was suggested that the mean sealant on the first molars was reversed due to a change from NSP to NICS.

Keywords: Dental sealants, Oral health inequality, Pit and fissure sealants, Socioeconomic factors

References

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Table 1.

The characteristics of the subjects in children aged 8 years

	2010		2012
	N	%	N	%
Total	5,732	100	4,379	100
Gender
Male	2,941	52.1	2,219	52.4
Female	2,791	47.9	2,160	47.6
Region
Metropolitan	2,516	45.2	1,724	42.9
City	2,376	41.6	2,057	51.5
Rural area	840	13.3	598	5.6

N, unweighted value; %, weighted value.

Table 2.

The prevalence of active dental caries for permanent teeth by region in children aged 8 years

	2010 (%)	2012 (%)
Total	7.6 (6.5-8.9)	3.4 (2.7-4.4)
Metropolitan	6.3 (5.0-7.9)	3.4 (2.4-4.7)
City	8.2 (6.2-10.9)	3.2 (2.1-4.9)
Rural area	9.8 (7.2-13.3)	5.5 (3.7-8.1)

Values expressed by weighted mean (95% confidence intervals).

Table 3.

The proportion of permanent teeth with sealant on the first molars by region in children aged 8 years

	2010 (%)	2012 (%)
Total	52.8 (49.9-55.6)	61.9 (59.0-64.7)
Metropolitan	52.7 (49.4-56.0)	58.0 (54.2-61.8)
City	49.4 (44.3-54.6)	65.6 (61.0-69.9)
Rural area	63.4 (54.2-71.7)	58.0 (48.4-67.0)

Values expressed by weighted mean (95% confidence intervals).

Table 4.

The average number of permanent teeth with sealant on the first molars by region in children aged 8 years

	2010 (a)		2012 (b)		Increase rate (%)
Total	1.43±0.05		1.79±0.05		25.2%
Metropolitan	1.46±0.06		1.67±0.06		14.4%
City	1.29±0.09	P*=0.046	1.91±0.07	P*=0.040	48.1%
Rural area	1.74±0.16		1.61±0.14		-7.5%

Values expressed by mean±standard error. Increase rate (%)={(b-a)/a}×100. *Determined by CSGLM.

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