Objectives 1. To compare the prevalences of fissure sealants in simila
r groups of 14-15-year-old, regularly-attending patients treated under
fee-for-service in 1989 and capitation in 1994. 2. To calculate the e
ffect of including sealants in the restorative index on estimates of i
nterventional treatment carried out on 14-15-year-old regularly attend
ing patients treated by general dental practitioners in 1994. Design A
randomised epidemiological study. Setting Secondary schools in the Wy
combe, Doncaster and Hereford/Worcester areas. Method Random samples o
f 14-15-year-old, regularly attending patients treated by dentists pra
ctising under capitation in three contrasting areas of England were ex
amined in 1994 for the presence of decayed, missing and filled teeth a
nd fissure sealants. Restorative indices were calculated with and with
out the inclusion of sealants. The latter were compared with restorati
ve indices calculated without the inclusion of sealants on regularly a
ttending patients of the same age group when the dentists in the same
three areas were working under fee-for-service in 1989. Results The pr
evalence of fissure sealants increased between 1989 and 1994 from 16%
to 30% in Wycombe, from 13% to 50% in Doncaster and from 25% to 47% in
Hereford/Worcester. Without fissure sealants the restorative indices
fell between 1989 and 1994 from a range of 76.5-94.4 to 63.3-87.1. Whe
n sealants were included in the restorative indices for 1994, they ran
ged from 79.5-92.9. Conclusions There were increases in the prevalence
s of fissure sealants between 1989-1994. When these sealants were incl
uded in the calculation of restorative indices for 1994, the level of
restorative care provided by general dental practitioners remained rel
atively high since the introduction of capitation. Although there has
been some increase in the level of untreated disease, if the restorati
ve index is calculated without the inclusion of sealants then there is
a risk of underestimating the treatment provided by general dental pr
actitioners to control the carious process. Dentists appear to be redi
recting their efforts into newer treatment/preventive items.