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Journal of the American Dental... Aug 2016National Health and Nutrition Examination Survey 2011-2012 data indicated that, in the United States, nearly one-fourth of children and over one-half of adolescents... (Review)
Review
Sealants for preventing and arresting pit-and-fissure occlusal caries in primary and permanent molars: A systematic review of randomized controlled trials-a report of the American Dental Association and the American Academy of Pediatric Dentistry.
BACKGROUND
National Health and Nutrition Examination Survey 2011-2012 data indicated that, in the United States, nearly one-fourth of children and over one-half of adolescents experienced dental caries in their permanent teeth. The purpose of this review was to summarize the available clinical evidence regarding the effect of dental sealants for the prevention and management of pit-and-fissure occlusal carious lesions in primary and permanent molars, compared with a control without sealants, with fluoride varnishes, or with other head-to head comparisons.
TYPE OF STUDIES REVIEWED
The authors included parallel and split-mouth randomized controlled trials that included at least 2 years of follow-up, which they identified using MEDLINE (via PubMed), Embase, LILACS, the Cochrane Central Register of Controlled Trials, and registers of ongoing trials. Pairs of reviewers independently conducted the selection of studies, data extraction, risk of bias assessments, and quality of the evidence assessments by using the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS
Of 2,869 records screened, the authors determined that 24 articles (representing 23 studies) proved eligible. Moderate-quality evidence suggested that participants who received sealants had a reduced risk of developing carious lesions in occlusal surfaces of permanent molars compared with those who did not receive sealants (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.08-0.27) after 7 or more years of follow-up. When the authors compared studies whose investigators had compared sealants with fluoride varnishes, they found that sealants reduced the incidence of carious lesions after 7 or more years of follow-up (OR, 0.19; 95% CI, 0.07-0.51); however, this finding was supported by low-quality evidence. On the basis of the evidence, the authors could not provide a hierarchy of effectiveness among the studies whose investigators had conducted head-to-head comparisons. The investigators of 2 trials provided information about adverse events, but they did not report any adverse events.
CONCLUSIONS AND PRACTICAL IMPLICATIONS
Available evidence suggests that sealants are effective and safe to prevent or arrest the progression of noncavitated carious lesions compared with a control without sealants or fluoride varnishes. Further research is needed to provide information about the relative merits of the different types of sealant materials.
Topics: Adolescent; Child; Dental Caries; Dental Fissures; Humans; Molar; Pit and Fissure Sealants; Randomized Controlled Trials as Topic; Tooth, Deciduous
PubMed: 27470524
DOI: 10.1016/j.adaj.2016.06.003 -
Journal of the American Dental... Mar 2008This article presents evidence-based clinical recommendations for use of pit-and-fissure sealants developed by an expert panel convened by the American Dental... (Review)
Review
BACKGROUND
This article presents evidence-based clinical recommendations for use of pit-and-fissure sealants developed by an expert panel convened by the American Dental Association Council on Scientific Affairs. The panel addressed the following clinical questions: Under what circumstances should sealants be placed to prevent caries? Does placing sealants over early (noncavitated) lesions prevent progression of the lesion? Are there conditions that favor the placement of resin-based versus. glass ionomer cement sealants in terms of retention or caries prevention? Are there any techniques that could improve sealants' retention and effectiveness in caries prevention?
TYPES OF STUDIES REVIEWED
Staff of the ADA Division of Science conducted a MEDLINE search to identify systematic reviews and clinical studies published after the identified systematic reviews. At the panel's request, the ADA Division of Science staff conducted additional searches for clinical studies related to specific topics. The Centers for Disease Control and Prevention also provided unpublished systematic reviews that since have been accepted for publication.
RESULTS
The expert panel developed clinical recommendations for each clinical question. The panel concluded that sealants are effective in caries prevention and that sealants can prevent the progression of early noncavitated carious lesions.
CLINICAL IMPLICATIONS
These recommendations are presented as a resource to be considered in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences. The evidence indicates that sealants can be used effectively to prevent the initiation and progression of dental caries.
Topics: Adolescent; Adult; Cariostatic Agents; Child; Dental Bonding; Dental Caries; Dental Fissures; Evidence-Based Medicine; Glass Ionomer Cements; Humans; Pit and Fissure Sealants; Resin Cements
PubMed: 18310730
DOI: 10.14219/jada.archive.2008.0155 -
Fogorvosi Szemle Aug 2008The aim of this review is to give an overview of 50 years experience of fissure sealing and draw conclusions about the applicability and effectiveness of the method.... (Review)
Review
The aim of this review is to give an overview of 50 years experience of fissure sealing and draw conclusions about the applicability and effectiveness of the method. Another purpose is to provide a summary of the relevant scientific evidence that will assist clinicians with their decision-making process. A fissure sealant is a material that is placed in the pits and fissures of teeth in order to prevent the development and/or to arrest of initial caries progression. Sealants, by providing a physical barrier, inhibit microorganisms and food particles from collecting in pits and fissures. Sealants are highly effective in preventing dental caries in pits and fissures of teeth when applied by trained operators. Sealant should be placed on pits and fissures of children's and adolescents' permanent teeth when it is determined that the tooth or the patient is at risk of developing caries. Fissure sealing can be recommended as a caries preventive measure. Whilst there is a good evidence to support the inclusion of fissure sealants as part of a preventive programme from the dental team, a number of related issues need to be considered. In areas of high caries prevalence it has been shown that treatment costs can actually be reduced by sealing susceptible surfaces, usually the occlusal surfaces of first permanent molars. Fissure sealing was introduced and first investigated in the years 1960-1970. During the past decades, evidence-based approaches have developed concerning the effectiveness of this primary and secondary preventive measure. It is generally accepted that the effectiveness of sealants for caries prevention depends on long-term retention. Resin-based sealants are the first choice of material for dental sealants. Glass-ionomer cement may be used as an interim preventive agent. Whilst cost-effectiveness is an important consideration, from an ethical standpoint the protection of oral health should not be viewed purely in economic terms. The oral health care professional should monitor and reapply sealants as needed to maximize effectiveness.
Topics: Adolescent; Child; Decision Making; Dental Caries; Dental Fissures; Dentition, Permanent; Disease Progression; Evidence-Based Medicine; History, 20th Century; History, 21st Century; Humans; Hungary; Pit and Fissure Sealants
PubMed: 19055129
DOI: No ID Found -
Operative Dentistry 2001
Review
Topics: Dental Caries; Dental Fissures; Humans; Outcome Assessment, Health Care; Risk
PubMed: 11504430
DOI: No ID Found -
Journal of Dental Research Sep 1995Sealants are highly effective in preventing dental caries in the pits and fissures of teeth when applied by trained operators in clinical trials and public health... (Clinical Trial)
Clinical Trial
Sealants are highly effective in preventing dental caries in the pits and fissures of teeth when applied by trained operators in clinical trials and public health programs. The effectiveness of fissure sealants when applied in dental practices is still not known. The purpose of this longitudinal study was to evaluate the effectiveness of fissure sealants applied in dental practices in preventing dental caries on occlusal surfaces of first permanent molars. In 1990, on the Island of Montréal, 911 randomly selected children, from 6 to 9 years of age, were examined; out of those, 816 and 733 were re-examined in 1991 and 1992, respectively. Only the 733 children with complete examination records were included in this evaluation. Sealant applications were either personally paid for or were paid for by private dental insurers. All children were covered for diagnosis and restorative care by a publicly financed and universal insurance program. Dental treatment records were provided by Quebec's health insurance board. In the epidemiological examination, the occlusal surfaces of first permanent molars, which are the only surfaces included in this analysis, were classified into: sound, non-cavitated and cavitated status, restored, and sealed. Sealants were evaluated for full or partial coverage of the occlusal surface and presence of dental caries. During the first and second years, 11.6% and 17.5% of the students had new sealants. The number of new sealants placed during the two years was 507. Children with caries-free status and whose parents had high school education or higher were significantly more likely to receive sealants during the study.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Binomial Distribution; Child; Cluster Analysis; Dental Care; Dental Caries; Dental Fissures; Humans; Logistic Models; Longitudinal Studies; Molar; Pit and Fissure Sealants; Private Practice; Quebec; Sampling Studies; Socioeconomic Factors
PubMed: 7560420
DOI: 10.1177/00220345950740091301 -
Journal of Dental Research Apr 2015For shallow or moderately deep pit-and-fissure lesions, various treatment options are available: (1) noninvasive treatments (e.g., fluoride application, antibacterial... (Meta-Analysis)
Meta-Analysis Review
For shallow or moderately deep pit-and-fissure lesions, various treatment options are available: (1) noninvasive treatments (e.g., fluoride application, antibacterial treatments, oral hygiene advice) avoid any dental hard tissue removal; (2) microinvasive treatments (e.g., sealing) remove only a few micrometers of hard tissues by etching; and minimally invasive methods (e.g., "preventive" resin/sealant restoration) remove carious dentin but avoid sacrificing sound tissues. We aimed at systematically reviewing and comparing these strategies for treating pit-and-fissure lesions in permanent teeth using network meta-analysis. Randomized or nonrandomized clinical trials investigating shallow or moderately deep primary caries lesions in fissured or pitted surfaces were included. We compared the risk of requiring invasive treatments or any retreatments in noninvasive, microinvasive, and minimally invasive treated lesions; untreated lesions were used as controls. Five electronic databases were systematically screened up to September 2013 and cross-referencing performed. Pairwise and network meta-analyses were performed and odds ratios and 95% confidence intervals (CI) calculated. Certainty of estimates was evaluated via GRADE criteria. From a total of 2,214 identified records, 14 studies representing 1,440 patients with 3,551 treated lesions were included. Pairwise meta-analysis found microinvasive and minimally invasive treated lesions to require less invasive retreatments than control lesions (odds ratios [95% confidence intervals]: 0.13 [0.07 to 0.26], 0.13 [0.03 to 0.50], respectively), whereas the estimate for noninvasively treated lesions remained nonsignificant (0.64 [0.39 to 1.06]). These findings were reflected in the strategy ranking stemming from network meta-analysis (first, minimally invasive; second, microinvasive; third, noninvasive). However, microinvasive treatment required significantly more total retreatments (including resealing) than minimally or noninvasive treatments. Due to limited study quality, the evidence was graded as low or very low. Clinical treatment decisions should consider the long-term sequelae and costs stemming from different therapies as well as their subjective impact on the patient. Available treatment options seem suitable for treating shallow or moderately deep pit-and-fissure lesions in permanent teeth; further conclusions are not possible.
Topics: Cariostatic Agents; Dental Atraumatic Restorative Treatment; Dental Enamel; Dental Fissures; Humans; Pit and Fissure Sealants; Risk Factors; Treatment Outcome
PubMed: 25710951
DOI: 10.1177/0022034515571184 -
Journal of the American Dental... Jun 2008
Topics: Cariostatic Agents; Decision Making; Dental Caries; Dental Fissures; Disease Progression; Evidence-Based Medicine; Humans; Pit and Fissure Sealants; Treatment Outcome
PubMed: 18519982
DOI: 10.14219/jada.archive.2008.0233 -
Journal of the Mechanical Behavior of... Jan 2016The principle of minimal intervention dentistry (MID) is to limit removal of carious tooth tissue while maximizing its repair and survival potential. The objective of...
The principle of minimal intervention dentistry (MID) is to limit removal of carious tooth tissue while maximizing its repair and survival potential. The objective of this study is to explore the fracture resistance of a permanent molar tooth with a fissure carious lesion along with three clinical restoration procedures, namely one traditional and two conservative approaches, based upon MID. The traditional restoration employs extensive surgical removal of enamel and dentine about the cavity to eliminate potential risk of further caries development, while conservative method #1 removes significantly less enamel and infected dentine, and conservative method #2 only restores the overhanging enamel above the cavity and leaves the infected and affected dentine as it was. An extended finite element method (XFEM) is adopted here to analyze the fracture behaviors of both two-dimensional (2D) and three-dimensional (3D) modeling of these four different scenarios. It was found that the two conservative methods exhibited better fracture resistance than the traditional restorative method. Although conservative method #2 has less fracture resistance than method #1, it had significantly superior fracture resistance compared to other restorations. More important, after cavity sealing it may potentially enhance the opportunity for remineralization and improved loading bearing capacity and fracture resistance.
Topics: Dental Fissures; Dental Restoration, Permanent; Finite Element Analysis; Mechanical Phenomena; Molar
PubMed: 26298801
DOI: 10.1016/j.jmbbm.2015.08.010 -
Journal of Dental Education Oct 1998
Review
Topics: Dental Caries; Dental Caries Activity Tests; Dental Fissures; Electric Conductivity; Fluorescence; Humans; Light; Risk Assessment
PubMed: 9847881
DOI: No ID Found -
Caries Research 2012Carious lesions are distributed nonuniformly across tooth surfaces of the complete dentition, suggesting that the effects of risk factors may be surface-specific.... (Comparative Study)
Comparative Study
Carious lesions are distributed nonuniformly across tooth surfaces of the complete dentition, suggesting that the effects of risk factors may be surface-specific. Whether genes differentially affect caries risk across tooth surfaces is unknown. We investigated the role of genetics on two classes of tooth surfaces, pit and fissure surfaces (PFS) and smooth surfaces (SMS), in more than 2,600 subjects from 740 families. Participants were examined for surface-level evidence of dental caries, and caries scores for permanent and/or primary teeth were generated separately for PFS and SMS. Heritability estimates (h(2), i.e. the proportion of trait variation due to genes) of PFS and SMS caries scores were obtained using likelihood methods. The genetic correlations between PFS and SMS caries scores were calculated to assess the degree to which traits covary due to common genetic effects. Overall, the heritability of caries scores was similar for PFS (h(2) = 19-53%; p < 0.001) and SMS (h(2) = 17-42%; p < 0.001). Heritability of caries scores for both PFS and SMS in the primary dentition was greater than in the permanent dentition and total dentition. With one exception, the genetic correlation between PFS and SMS caries scores was not significantly different from 100%, indicating that (mostly) common genes are involved in the risk of caries for both surface types. Genetic correlation for the primary dentition dfs (decay + filled surfaces) was significantly less than 100% (p < 0.001), indicating that genetic factors may exert differential effects on caries risk in PFS versus SMS in the primary dentition.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Appalachian Region; Child; Child, Preschool; Cohort Studies; DMF Index; Dental Caries; Dental Caries Susceptibility; Dental Enamel; Dental Fissures; Dental Restoration, Permanent; Female; Genetic Predisposition to Disease; Genetic Variation; Humans; Infant; Male; Middle Aged; Models, Genetic; Phenotype; Population Surveillance; Quantitative Trait, Heritable; Tooth Loss; Tooth, Deciduous; Young Adult
PubMed: 22286298
DOI: 10.1159/000335099