Trial shows caries reductions at one year in school-based sealant programme

Abstract

Pragmatic split-mouth randomised controlled trial. Children from low-income backgrounds were randomised to have one of each first molar tooth pairs sealed. Tooth pairs were excluded when a dental sealant or dentinal caries was present on one of the teeth. Clinical examinations took place at baseline and at one year. Caries risk status was assessed at baseline and included Streptococcus mutans (SM) and Lactobacillus counts. The primary outcome was new carious lesions (ICDAS code 3-6). Secondary outcomes included sealant status. 343 children consented, 253 (91.7%) of the 276 children who had sealants were seen at one-year giving 421 tooth pairs for analysis. The adjusted analysis showed that seared molars were less at risk of developing new caries compared with controls (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 = 0.25; 95% CI: 0.12-0.50) or with a high SM count (>105, OR = 0.20; 95% CI: 0.10-0.41) at baseline. Total retention was recorded in 52.7% (n = 222) of the treated teeth, with retention in the maxilla being significantly lower than in the mandible. The one-year effectiveness of the school-based program was demonstrated in low socio-economic areas. Selection of schoolchildren according to individual caries risk factors should be considered in school-based programmes.