School-based Dental Programs Prevent Dental Caries in Children at High Risk for Caries From Low Socioeconomic Backgrounds

Abstract

Subjects: The study population comprised 276 first- and second-graders, age 6–7 years, attending 16 elementary schools located in low socioeconomic zones in Nice, France. All children in the relevant class were invited to participate. Key Exposure/Study Factor: The key exposure was the placement of a resin-based dental sealant on the occlusal surface of one of a pair of mandibular and/or maxillary first permanent molars. The contralateral unsealed molar acted as control in this split-mouth study. A total of 457 pairs of permanent first molars in 276 children (133 girls and 143 boys) were included. Active caries in permanent or primary teeth, visible plaque, and Streptococcus mutans and Lactobacillus counts were recorded at baseline to assess individual caries risk. Main Outcome Measure: The main outcome measure was the occurrence of new caries (ICDAS code 3-6) at the 1-year follow-up. The secondary outcome was the sealant's status after 1 year of follow-up, specifically, total retention, partially lost, or fully lost. The sealant was considered partially lost if it did not cover all occlusal pits and fissures. Main Results: At 1-year follow-up, 253 children (421 tooth pairs) remained in the study. First permanent molars that received sealants were less at risk for developing new caries lesions after 1 year of follow-up compared with those from the control group (OR = 0.26, 95% CI: 0.14–0.49). The effect of the sealants was significant only when the analyses included subjects with active caries or a high S. mutans count at baseline. At the 1-year follow-up, total retention was recorded in 52.7% (n = 222) of the treated teeth. Conclusions: The 1-year effectiveness of a school-based dental sealant program in preventing dental caries was demonstrated in children from low socioeconomic areas. The selection of schoolchildren according to individual caries risk factors should be considered in such programs.