Occlusal Surfaces Of Permanent Molars Research Articles

Radiographic pattern of inactive occlusal enamel lesions and its relationship with caries progression over 4–5 years

ObjectiveTo assess the radiographic pattern of inactive enamel caries lesions (IECL) in the occlusal surfaces of permanent molars and to investigate whether the presence of radiolucency at baseline could predict lesion progression over 4–5 years. MethodsA prospective cohort study followed 193 schoolchildren from southern Brazil. At baseline, clinical and radiographic examinations were performed. After 4–5 years, clinical examination was repeated following the same protocol. Logistic regression models were used to investigate the relationship between the presence of radiolucency at baseline and caries progression. ResultsThis study included 916 permanent molars, classified as sound occlusal surfaces (n = 434), non-cavitated IECL (n = 438), or cavitated IECL (n = 44) at baseline. The proportion of lesions with radiolucency increased as lesion severity increased (p<0.001, chi-square test). The proportion of cases that progressed was significantly higher among teeth showing radiolucency at baseline than among teeth without radiolucency (p<0.001, chi-square test). The presence of radiolucency at baseline was found to be a predictor of caries progression (activity criteria, adjusted OR=3.37, 95%CI=1.66–6.82, p<0.001; severity criteria, adjusted OR=4.01, 95%CI=1.85–8.72, p<0.001). ConclusionOcclusal surfaces (either sound or with IECL) presenting radiolucency at baseline were more likely to progress over 4–5 years of monitoring and should be monitored more closely. Clinical relevanceBitewing radiographs, when available, may be used to identify which surfaces/lesions are more likely to progress and thus, to define proper recall intervals for patient monitoring.

Study protocol: A stepped-wedge, cluster-randomized trial of the effectiveness of a deliberative loop in identifying implementation strategies for the adoption of a dental sealant guideline in dental clinics

BackgroundThe American Dental Association (ADA) recommends dental providers apply dental sealants to the occlusal surfaces of permanent molars for the prevention or treatment of non-cavitated dental caries. Despite the evidence-based support for this guideline, adherence among general dentists is low, ranging from less than 5 to 38.5%. Thus, an evidence-to-practice gap exists, and it is unclear which implementation strategies would best support providers in adopting and implementing the evidence-based practice. One potential approach to selecting and tailoring implementation strategies is a deliberative loop process, a stakeholder-engaged approach to decision-making. This trial aims to test the acceptability, feasibility, and effectiveness of using a deliberative loop intervention with stakeholders (i.e., providers and staff) to enable managers to select implementation strategies that facilitate the adoption of an evidence-based dental practice.MethodsSixteen dental clinics within Kaiser Permanente Northwest Dental will be cluster randomized to determine the timing of receiving the intervention in this stepped-wedge trial. In the three-part deliberative loop intervention, clinic stakeholders engage in the following activities: (1) receive background information, (2) participate in facilitated small-group discussions designed to promote learning from each other’s lived experiences and develop informed opinions about effective clinic-level implementation strategies, and (3) share their informed opinions with clinic leaders, who may then choose to select and deploy implementation strategies based on the stakeholders’ informed opinions. The primary outcome of Reach will be defined as patient-level receipt of guideline-concordant care. Secondary outcomes will include the cost-effectiveness, acceptability, and feasibility of the deliberative loop process. Implementation strategies deployed will be catalogued over time.DiscussionThese results will establish the extent to which the deliberative loop process can help leaders select and tailor implementation strategies with the goal of improving guideline-concordant dental care.Trial registrationThis project is registered at ClinicalTrials.gov with ID NCT04682730. The trial was first registered on 12/18/2020. https://clinicaltrials.gov/ct2/show/NCT04682730

Microleakage Assessment of Two Different Pit and Fissure Sealants: A Comparative Confocal Laser Scanning Microscopy Study.

IntroductionPit and fissures of permanent dentition are considered to be highly vulnerable to the adhesion of cariogenic microorganisms and consequently result in caries formation. The main problem associated with sealant failure will be microleakage. Therefore, sealants can be considered to be an effective preventive procedure for dental caries, only if it strongly bonds to the tooth, and protect the pit and fissures from the oral bacterial environment.Aim and objectiveTo compare and assess the microleakage of two different pit and fissure sealants on permanent molars.Materials and methodsA total of 20 extracted third molars were randomly divided into two groups where group I is conventional sealant and group II is hydrophilic sealant. Occlusal surfaces of permanent molars were treated with 37% orthophosphoric acid before sealant placement. Tooth samples were subjected to 0.1% rhodamine dye immersion, thermocycling, and tooth samples were sectioned and evaluated under a confocal laser microscope for dye penetration. A non-parametric test (Mann–Whitney U) was performed to compare the mean microleakage score difference between the groups.ResultsGroup II (hydrophilic sealant) showed a minimum level of the microleakage score when compared to group I (conventional sealant) and was found to be statistically significant using the Mann-Whitney U test with a p value <0.05.ConclusionThe less the microleakage, the better will be the retention of the sealant for a longer duration and cariostatic action.How to cite this articlePrabakar J, Indiran MA, Kumar P, et al. Microleakage Assessment of Two Different Pit and Fissure Sealants: A Comparative Confocal Laser Scanning Microscopy Study. Int J Clin Pediatr Dent 2020;13(S-1):S29–S33.

Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents.

Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents.

Oral health status and caries trend among 12-year old Palestine refugee students: results from the UNRWA\u2019s oral health surveys 2011 and 2016

BackgroundIn 2016 the United Nation Relief and Work Agency for Palestine refugees in the Near East (UNRWA) commissioned a survey on oral health among 12-year-old students at UNRWA schools in five fields of operation (Jordan, Lebanon, Syria, Gaza Strip and West Bank), following World Health Organization guidelines. The survey aimed to determine the prevalence of dental caries and periodontal diseases among Palestine students attending UNRWA schools and how this has changed over time.MethodsA two-stage stratified cluster sample design was used. For each Field of operation, the sample size was calculated based on 95% confidence level, 80% power and margin of error of 4%. Clinical examination was carried out by trained Field Oral Health services Officers (FOHSOs) from the 5 fields. Teeth presence and condition, gingival bleeding and calculus and the presence of dental sealants in occlusal surfaces of permanent molars were recorded. Behavior information of students/parents were collected using a questionnaire that was self-completed by the child/parent under supervision. Results were compared with those from a previous survey carried out in 2011 with the same methodology.ResultsIn the two surveys the distributions of students who had caries experience in their permanent teeth were similar (73.1% in 2011 vs 72.8% in 2016, p = 0.83). In 2016 a significant increase of missing teeth (p < 0.01) and sealants (p < 0.01) was observed. Both surveys have identified behavioral determinants for dental caries, particularly dietary habits such as soft drinks consumption. Gingival health also showed statistical differences among the fields.ConclusionsThe prevalence of caries experience was very high in all fields and, with regard to main oral health indices, no trend of improvement was observed through 2011 and 2016. Surveys’ results advocates the need of a large-scale integrated preventive approach toward oral health and the emerging growth of Noncommunicable Diseases (NCDs), in line with the WHO recommendations.

Pit and fissure sealants for preventing dental decay in permanent teeth.

Pit and fissure sealants for preventing dental decay in permanent teeth.

Fissure seal or fluoride varnish?

Data sourcesCochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, the US National Institutes of Health Trials Register and the World Health Organization (WHO) Clinical Trials Registry PlatformStudy selectionRandomised controlled trials (RCTs) with at least 12 months follow-up, in which fissure sealants, or fissure sealants together with fluoride varnishes, were compared with fluoride varnishes alone for preventing caries in occlusal surfaces of permanent teeth of children and adolescents.Data extraction and synthesisTwo reviewers independently screened search results, extracted data and assessed risk of bias of included studies. Studies were grouped and analysed on the basis of sealant material type (resin-based sealant and glass ionomer-based sealant, glass ionomer and resin-modified glass ionomer) and different follow-up periods. Odds ratio were calculated for caries or no caries on occlusal surfaces of permanent molar teeth. Mean differences were calculated for continuous outcomes and data. Evidence quality was assessed using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methods.ResultsEight RCTs involving a total of 1747 children aged five to ten years of age were included. Three trials compared resin-based fissure sealant versus fluoride varnish. Results from two studies (358 children) after two years were combined. Sealants prevented more caries, pooled odds ratio (OR) = 0.69 (95%CI; 0.50 to 0.94). One trial with follow-up at four and nine years found that the caries-preventive benefit for sealants was maintained, with 26% of sealed teeth and 55.8% of varnished teeth having developed caries at nine years. Evidence for glass-ionomer sealants was of low quality. One split-mouth trial analysing 92 children at two-year follow-up found a significant difference in favour of resin-based fissure sealant together with fluoride varnish compared with fluoride varnish only (OR 0.30, 95% CI 0.17 to 0.55). The evidence was assessed as low quality. Three studies assessed but did not report any adverse effects.ConclusionsCurrently, scarce and clinically diverse data are available on the comparison of sealants and fluoride varnish applications; therefore it is not possible to draw clear conclusions about possible differences in effectiveness for preventing or controlling dental caries on occlusal surfaces of permanent molars. The conclusions of this updated review remain the same as those of the last update (in 2010). We found some low quality evidence suggesting the superiority of resin-based fissure sealants over fluoride varnish applications for preventing occlusal caries in permanent molars, and other low-quality evidence for benefits of resin-based sealant and fluoride varnish over fluoride varnish alone. Regarding glass ionomer sealant versus fluoride varnish comparisons, we assessed the quality of the evidence as very low and could draw no conclusions.

Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents.

Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents.

Association between two visual criteria in assessing non-cavitated caries lesion activity on occlusal surfaces of permanent molars.

This study aimed to evaluate the association between two visual criteria in assessing non-cavitated caries lesion activity on occlusal surfaces of permanent molars. Thirty-nine patients with at least one permanent molar with non-cavitated caries lesion on the occlusal surface were selected. Molars were assessed according to their activity status following two criteria: ICDAS-LAA and a qualitative criterion based on clinical characteristics. The results showed that the LAA criterion seems to overestimate caries activity. A weak association between both criteria in assessing caries lesion activity and low specificity for ICDAS-LAA was observed. The ICDAS-LAA criterion is not suitable to assess non-cavitated caries lesion activity on occlusal surfaces of permanent molars because it assesses the lesions to be active more frequently than the qualitative criterion. The determination of caries lesion activity is a key decision point in the treatment of caries disease. This study discusses the best option to assess the activity of non-cavitated occlusal caries lesions.

Clinical effectiveness and cost-effectiveness of fissure sealants in children and adolescents with a high caries risk.

In Germany, the application of resin-based pits and fissures sealants on the occlusal surfaces of permanent molars is part of individual prophylaxis for children and adolescents between six and 18 years. The individual prophylaxis is covered by the Statutory Health Insurance since 1993.The report addresses questions on medical effectiveness, cost-effectiveness, as well as ethical, social, and legal implications of pit and fissure sealants in preventing dental caries for children and adolescents at high caries risk. The results of the studies indicate a protective effect of pit and fissure sealants, particularly for children and adolescents at high caries risk. Additionally, the economic evaluation suggests a tendency for cost savings in this group. Nevertheless, a general expansion of the intervention cannot be recommended. All studies show a risk of bias in favour of pit and fissure sealing and a limited transferability to the German health care system. Studies included in the economic evaluation revealed methodological flaws. Both the economic models and primary studies do not provide reliable results.

Strong evidence for the effectiveness of resin based sealants

Cochrane Oral Health Group's Trials Register, CENTRAL, Medline via OVID, EMBASE via OVID; SCISEARCH, CAplus, INSPEC, NTIS and PASCAL via STN Easy and DARE, NHS EED, HTA (all to September/ November 2012) and ClinicalTrials.gov (to July 2012). There were no restrictions on language or date of publication. Randomised and quasi-randomised controlled trials of at least 12 months duration comparing no sealant with sealant, or different types of sealants, for preventing caries of occlusal or approximal surfaces of premolar or molar teeth in children and adolescents under 20 years of age. Screening of search results, data extraction and assessment of trial quality (using GRADE methods) were by two reviewers independently. There were 34 trials of children aged five to 16 years, with 12 trials (2575 participants) comparing sealants with no sealant, 21 trials (3202 participants) comparing one sealant with another and one trial (752 participants) comparing two types of sealant with no sealant.Resin sealants compared with no sealants prevented caries in the first permanent molars of children five to 10 years old (six trials at low risk of bias with two years follow up), (odds ratio (OR) 0.12, 95% confidence interval (CI) 0.07 to 0.19). At 48 to 54 months follow-up, the caries preventive effect was maintained (OR 0.21, 95% CI 0.16 to 0.28) although there were only four trials (two were at low and two at high risk of bias).No conclusions could be drawn as to whether glass ionomer sealants compared with no sealants prevented caries at 2 year follow-up. The mean difference in DFS was -0.18, 95% CI -0.39 to 0.03.The relative effectiveness of one type of sealant compared to a different type of sealant was inconclusive as there was great variation in comparisons, outcomes, times of outcomes and background fluoride levels in the 21 studies. There was insufficient evidence for the relative superiority of glass ionomer and resin sealants (very low event rate in many of the 15 trials). There were inconsistent results for resin-modified glass ionomer sealants compared with resin sealants. No difference in caries increments were found in the two small trials of polyacid-modified resin sealants compared with resin sealants. Sealants compared with no sealants, on the occlusal surfaces of permanent molars in children and adolescents, are effective at reducing caries up to 48 months. There is less evidence for longer term follow-up and little for the relative effectiveness of sealing in less high caries risk children. No conclusions could be drawn on the relative effectiveness of different types of sealants.

The Placement of a Glass Ionomer Surface Protection Material on Permanent Molars of Special Olympics Athletes

Background: Healthy Athletes is a Special Olympics program that provides free health screenings in various health areas to Special Olympics athletes. The Special Smiles Program within that organization provides oral health screening and data collection for intellectually disabled special athletes participating in sports events. These athletes in many parts of the world have been reported to have poor oral health and high unmet treatment needs. Objective: The aim of this study was to examine the oral status of Turkish Special Olympics athletes, and to assess the quantity of untreated caries and dental restorative needs, using specifically dedicated screening forms designed to be helpful in motivating oral hygiene, and also to evaluate the clinical applicability of a high fluoride content glass ionomer sealant and surface protection material (Fuji TRIAGE®, GC Europe N.V.), on permanent molars of a group of Special Olympics athletes. Methods: Ninety-two Special Olympics athletes, aged 8-25, received oral examinations and evaluations by trained volunteers, using the standardized Special Smiles screening forms and protocol. Following the screening, the surface protection material was placed on surfaces of caries-free first permanent molars of athletes by the ART approach. Results: A total of 92 athletes aged 8 to 25 years, 43 (46.7%) females and 49 (53.2%) males, participated in the screening. Of the examined athletes, 34 (37%) cleaned their mouths once daily, 15 (16.3%) reported oral pain, 62 (67.4%) had untreated caries, 16 (17%) had fillings, 60 (65.2%) had gingival signs suggestive of periodontal disease, 38 (41.3%) needed urgent care, and 54 (58.6%) required nonurgent care. The surface protection material was placed on a total of 273 occlusal surfaces of permanent molars. Conclusion: Our findings offer an evaluation of the oral health of a group of Special Olympics athletes with intellectual disabilities in Turkey. Results showed high preventive and restorative oral health needs in the Special Olympics athletes. Therefore, offered in a fun, welcoming environment, effective and easily applied preventive protocols and treatments may be specifically designed for those athletes to be helpful in providing oral hygiene. The glass ionomer surface protection material could be used satisfactorily for caries prevention. The longer-term clinical performance of this material should now be assessed.

Influence of Eruption Stage and Biofilm Accumulation on Occlusal Caries in Permanent Molars: A Generalized Estimating Equations Logistic Approach

The aim of this study was to estimate the independent effects of biofilm accumulation and eruption stage on the occurrence of active caries lesions on occlusal surfaces of permanent molars. The sample consisted of 298 schoolchildren (6–15 years) who were examined by a calibrated examiner at a dental unit, using artificial light, a dental mirror and a WHO probe. The occurrence of visible biofilm on occlusal surfaces and the eruption stage of each permanent molar were recorded. After professional prophylaxis and air drying, the occlusal surfaces were classified as sound, caries-inactive or caries-active. To evaluate the association of eruption stage and biofilm accumulation with active caries lesions, a logistic regression model was used. Since data were clustered, odds ratios were obtained using generalized estimating equations with a logistic link function. 1,779 permanent molars were examined. All eruption stages were associated with active caries lesions. After adjustment for biofilm accumulation and type of molar, molars with occlusal surfaces partially exposed to the oral cavity were 63.6 times more susceptible to caries activity than molars with full occlusion (95% CI = 22.0–183.7). After adjustment for eruption stage and type of molar, teeth with a high degree of biofilm accumulation were 14.5 times more susceptible to caries activity than those without visible biofilm accumulation (95% CI = 6.5–32.4). No association between active caries and hardly detectable biofilm was found in this population. The present study found that the eruption stage of permanent molars is strongly associated with active caries lesions, adjusted for biofilm accumulation and type of molar.

Prevalence of Noncavitated Occlusal Dentine Caries in Students in a City with a Low Prevalence of Caries

0 0 1 207 1184 FOP 9 2 1389 14.0 Normal 0 false false false PT-BR JA X-NONE Purpose : The aim of this study was to determine the prevalence of noncavitated occlusal dentine caries in permanent molars among students in a city with a low prevalence of caries. Combined radiographic and visual examinations were employed. Methods : The sample comprehended 1290 occlusal surfaces of permanent molars, in 179 students aged 12-15. The methods used were: visual inspection (VI), visual inspection with previous drying (VID) and Radiographic Examination (RE). For the statistic analysis, the DMFT and the DMFT modified (including RE, early lesions and microcaviteted lesions) indexes were used. Results : The mean DMFT was 2.3 (sd=2.5), and 32.5% of the students were free from caries on the VI. Of the 918 surfaces scored as clinically sound on VI, 241 demonstrated radiolucency in dentine on RE and the noncavitated occlusal dentine caries prevalence (per individual) was 56.4%. Of the 404 surfaces scored as clinically sound on VID, 75 (18.6%) demonstrated dentine radiolucency and the noncavitated occlusal dentine caries prevalence was 35.5%. Including dentine lesions on RE, the mean DMFT was 3.1 (sd=2.3), and 13.4% of the students were free from caries. Conclusions: The radiographic examination is effective in epidemiological surveys. However, new methods to replace this method should be evaluated, because the difficulty of transportation hinders its frequent use.

Microleakage of three different sealants on sound and questionable occlusal surfaces of permanent molars: An in vitro study

This was to evaluate the microleakage of 3 different sealants, applied on sound and questionably carious occlusal surfaces with and without a bonding agent. A total of 120 human molars were selected, photographed with a digital video microscope, and assigned by 3 independent examiners, according to the criteria of ICDAS II, in 2 groups of 60 teeth each. Group A: teeth with deep, clear, sound occlusal surfaces (ICDAS II, code 0). Group B: teeth with questionable occlusal surfaces, having deep, stained pits and fissures with probable incipient, but non-cavitated carious lesions (ICDAS II, codes 1 and 2). Each group was divided into 2 subgroups of 30 teeth each (bonding or no bonding) and then into 3 subgroups of 10 teeth each according to the type of sealant used: one conventional (Conseal) and 2 fluoridated (Conseal F and Teethmate F). After the application of the bonding agent and the sealant to the appropriate teeth, all specimens were subjected to thermal cycling and immersed in a 10% methylene blue dye solution for 4 hours. Average and summed microleakage for each sample were estimated from dye penetration scores on 3 mesiodistal sections of the tooth across the sealed occlusal surface. Non-parametric Friedman's 2-way ANOVA by ranks and Conover-Inman pair wise comparisons were used for differences at the 0.05 level of significance. According to Friedman's 2-way ANOVA by ranks analysis, although there were no significant differences between the different sealants (chi(2) = 0.048, df = 2, P = .976), there were significant differences between the sound and questionably carious occlusal surfaces (chi(2) = 24, df = 3, P = .000). Conover- Inman pair wise comparisons showed no differences between the groups using and not using bonding agents, on sound (SNB-SWB, P = .4561) or questionable occlusal surfaces (QNB-QWB, P = .0842). Sealant microleakage on questionably carious occlusal surfaces was statistically significantly higher than that of sound occlusal surfaces. Using a bonding agent or fluoridated FS did not influence microleakage significantly, either on sound or on questionable fissured surfaces.

Pit and Fissure Sealants: An Unused Caries Prevention Tool

ABSTRACTPit and fissure sealants along with fluoridation and good oral hygiene is an important tool for the prevention of dental caries in children and adolescents.RECOMMENDATIONSThe following recommendations are based on the evidence gathered: 1. Sealants should be placed on all permanent teeth without cavitation (i.e., teeth that are free of caries, teeth that have deep pit and fissure morphology, teeth with “sticky” fissures or teeth with stained grooves) as soon after eruption as isolation can be achieved. 2. Sealants should not be placed on partially erupted teeth or teeth with cavitation or caries of the dentin. 3. Sealants should be placed on the primary molars of children who are susceptible to caries (i.e., those with a history of caries). 4. Sealants should be placed on first and second molars within 4 years after eruption. 5. Resin-based sealants should be preferred, until such time as glass ionomer cements with better retention capacity are developed. 6. Sealants should be placed as part of an overall prevention strategy based on assessment of caries risk. Sealing is a recommended procedure to prevent caries of the occlusal surfaces of permanent molars. Though the effectiveness of sealants is obvious at high caries risk groups there is still some degree of latitudein operators preference for sealant placementand material selection.

Definition of At-Risk Occlusal Surfaces of Permanent Molars—A Descriptive Study

THE OBJECTIVE of this descriptive study was to define the at-risk occlusal surface to guide the practitioner in the decision of whether to seal or not. All dentists affiliated with the French Society of Pediatric Odontology (SFOP) and general practitioners (GP) registered in postgraduate courses in three French dental schools answered the same questionnaire illustrating four occlusal surfaces of permanent molars. It was focused on obtaining an optimal definition of an at-risk occlusal surface. The corresponding four molars were later sectioned to check the answers. Univariate logistic regression analyses and multivariate logistic regression models were tested to identify the factors associated with the at-risk occlusal surface. Eighty-six SFOP dentists and 136 GP filled in the form. Multivariate logistic regression models stratified by type of practice demonstrated that stained fissures (p =0.001) were only associated with at-risk occlusal surface among GP and the morphology of primary fissure (p=0.001) when considering SFOP dentists alone. The multivariate analyses demonstrated that stained fissures, and primary and secondary fissures were linked to the perception of an at-risk occlusal surface. An at-risk occlusal surface has narrow and deep primary fissures. Numerous secondary fissures could increase the risk. The coloration of fissures should not be used in the definition because it depends on tooth integrity.

Okklusalkaries – frühzeitige Diagnostik in den schulischen Reihenuntersuchungen

Concomitant to the general caries decline in children and adolescents, caries is mainly concentrated on occlusal surfaces of permanent molars. While occlusal cavities have been shifted to non-cavitated lesions, school-based visual tactile screenings on a cavity level based on the WHO standard (1997) are of limited value as evidence. To avoid cavities or extended restorations current dentistry targets at early prevention or minimal intervention. School-based visual screenings of non-cavitated lesions may support the preventive care strategies of dental practioners. A comparative diagnostic study in 8- to 12-year-olds in the Westfalian Ennepe-Ruhr district showed that occlusal surfaces scored as primarily sound under the WHO standard in fact revealed a high need for preventive (43%) and operative (30%) treatment after using additional visual and laser optical diagnostic measurements. Because of the limited information of the laser optical findings, laser fluorescence diagnostics should not be included in school-based dental screenings. Compromises are needed to introduce visual diagnostic examinations in school-based dental screenings.

Sealants recommended to prevent caries

Data sources Sources of studies were the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials, Medline, Embase, Scisearch, SIGLE (System for Information on Grey Literature in Europe) CAplus¥, INSPEC*, JICST-EPLUS♯, NTIS★, PASCAL⋆, Database of Abstracts and Reviews (DARE), the UK National Health Service Economic Evaluation Database and Health Technology Assessment database. Reference lists from included articles and review articles were searched for additional relevant publications. All relevant studies in most languages were considered and translated.Study selection Articles were selected for inclusion in the review if they were randomised or quasi-randomised controlled trials of at least 12 months in duration and if sealants were used for preventing caries in children and adolescents of under 20 years of age. Both parallel group and split-mouth study designs were included. The primary outcome was the increment in the numbers of carious occlusal surfaces of premolars and molars.Data extraction and synthesis In the first phase, two reviewers independently examined whether a given study was likely to be relevant on the basis of the title, keywords and abstract. In the second phase, four of the reviewers independently classified whether studies would be included in final analyses. Study authors were contacted for additional information. In the split-mouth studies, relative risk (RR) ratios were calculated for the paired differences of tooth surfaces being carious or not. In studies that compared resin-based sealant with no treatment, fixed-effect meta-analyses were used to combine the estimates of RR ratios. In one parallel-group study, the effect-estimate was calculated from data of occlusal surfaces of teeth included in the test and control groups.Results Eight trials were included in this review, of which seven were split-mouth studies and one a parallel-group study. Six studies provided data for comparing sealant with no treatment and three studies compared glass ionomers (GI) with resin-based sealants. The overall effectiveness of resin-based sealants in preventing dental decay on first molars was high. Based on five split-mouth studies with 5–10-year-old children there were significant differences in favour of the second-generation resin sealant compared with no treatment. Pooled RR values were 0.14, 0.24, 0.30 and 0.43 at 12, 24, 36 and 48–54 months, respectively. The reductions in caries therefore ranged from 86% at 12 months to 57% at 48–54 months. The 24-month parallel group study that compared second-generation resin sealant with control in 12–13-year old children also found significantly more caries in the control group children with a DFS of 0.65 (95% confidence interval, 0.47–0.83). Allocation concealment was classified as adequate in three of these six studies. The information on background levels of caries in the population, however, was insufficient to conduct further analyses that would allow an estimate of the effect of resin-based sealants related to baseline caries prevalence. Only one study provided data for the comparison of GI sealant and control. Based on this, there is not enough information to say whether GI sealants are effective or not. The results of three studies comparing resin sealants with GI sealants were conflicting and the meta-analyses were not carried out.Conclusions Sealing with resin-based sealants is recommended to prevent caries of the occlusal surfaces of permanent molars but we recommend that the caries prevalence level of both the individual and population should be taken into account. In practice, the benefit of sealing should be considered locally and specific guidelines for clinicians should be used. The methodological quality of published studies concerning pit and fissure sealants was poorer than expected.

Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents.

Fissure sealants used on occlusal tooth surfaces were introduced in the 1960s for protecting pits and fissures from dental caries. Although sealants have demonstrated to be effective in preventing caries, their efficacy may be related to the background caries prevalence in the population. The primary objective of this review was to evaluate the caries prevention of resin based pit and fissure sealants and glass ionomer cements or sealants in children and adolescents. We searched the Cochrane Oral Health Group's Trials Register (last update December 2002), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2002), MEDLINE via OVID (1966 to December 2002), EMBASE (1974 to February 2002), SCISEARCH, SIGLE, CAplus, INSPEC, JICST-EPLUS, NTIS, PASCAL (February 2002) and DARE, NHS EED, HTA (March 2002). Reference lists from included articles and review articles were searched for additional relevant articles. All relevant studies in most languages were considered and translated. Randomised or quasi-randomised controlled trials of at least 12 months in duration in which sealants were used for preventing caries in children and adolescents under 20 years of age were included. The primary outcome was the increment in the numbers of carious occlusal surfaces of premolars and molars. In the first phase, two reviewers independently examined whether a given study was likely to be relevant on the basis of the title, key words and abstract. In the second phase, four of the reviewers independently classified studies to be included in final analyses. Study authors were contacted for additional information. In the split-mouth studies relative risk ratios were calculated for the paired differences of tooth surfaces being carious or not. In studies comparing resin based sealant with no treatment, fixed effect meta-analyses were used to combine the estimates of relative risk ratios. In one parallel group study, the mean DFS data as continuous data, the effect estimate being the difference in mean DFS, was calculated from data of occlusal surfaces of teeth included in the test and control groups. Eight trials were included in this review of which seven trials were split-mouth studies and one a parallel group study. Six studies provided data for comparing sealant with no treatment and three studies for comparing glass ionomers with resin based sealants. The overall effectiveness of resin based sealants in preventing dental decay on first molars was high. Based on five split-mouth studies with 5 to 10 year old children there were significant differences in favour of the second-generation resin sealant compared with no treatment with pooled relative risk values of 0.14, 0.24, 0.30, 0.43 at 12, 24, 36 and 48 to 54 months respectively. The reductions in caries therefore ranged from 86% at 12 months to 57% at 48 to 54 months. The 24 month parallel group study comparing second-generation resin sealant with control in 12 to 13 year old children found also significantly more caries in the control group children with DFS = 0.65 (95% CI 0.47 to 0.83). Allocation concealment was classified adequate in three of these six studies. However the information on background levels of caries in the population was insufficient to conduct further analyses to estimate the effectiveness of resin based sealants related to baseline caries prevalence. Only one study provided data for the comparison between glass ionomer sealant and control. Based on this, there is not enough information to say whether ionomer sealants are effective, or not. The results of three studies comparing resin sealants with glass ionomer sealants were conflicting and the meta-analyses were not carried out. Sealing with resin based sealants is a recommended procedure to prevent caries of the occlusal surfaces of permanent molars. However, we recommend that the caries prevalence level of both individuals and the population should be taken into account. In practice, the benefit of sealing should be considered locally and specified guidelines for clinicians should be used. The methodological quality of published studies concerning pit and fissure sealants was poorer than expected.