In their responses to Drs. Hays’ and Snaer’s November JADA letters to the editor criticizing their conclusions in the study related to early air abrasion treatment of suspect pits and fissures ("A Clinical Evaluation of Air-Abrasion Treatment of Questionable Carious Lesions: A 12-Month Report," June JADA), Dr. James C. Hamilton and colleagues rely heavily on a rationalization that "56 percent ... did not require treatment."
They responded that they would not seal the suspect pits and fissures in the older members since "age was negatively correlated with caries ... ." These are both statistically true statements that I am sure every dental insurance actuarial accountant wrote down as soon as they read them.
The following is also true: 44 percent of the sample teeth had decay into the dentin and a totally noninvasive procedure (sealants) can easily prevent pit and fissure decay in seniors, though it may be somewhat rarer than in 14-year-olds.
In some cost/benefit analysis of dentistry where we are trying to maximize public health for a given amount of money, or where others would be denied care because an "unnecessary filling" was done for someone else, I would give their research great weight. In this world where my patients ask me to take the best care of them as individuals, I have to give more weight to the latter statements.
If my patient wants me to get rid of all his or her dental infection (caries), the 56 percent of the suspect teeth cleaned with 
round bur, fissurotomy bur or air-abrasion handpiece and then filled (sealed) become the necessary dentistry done to locate the other 44 percent. If the standard of care is to leave 44 decay lesions in 100 teeth, we’d better get busy in the Department of Cariology.
