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Pediatric Dentistry Sep 2023The purpose of this study was to review the in vitro literature on shear bond strength (SBS) and microleakage of pit and fissure sealant materials in contaminated... (Meta-Analysis)
Meta-Analysis
The purpose of this study was to review the in vitro literature on shear bond strength (SBS) and microleakage of pit and fissure sealant materials in contaminated (water, human, or artificial saliva) and non-contaminated conditions. PubMed, Web of Science™, Scopus, Embase™, and Cochrane Library databases were used as data sources. Of the 974 studies identified, 56 were considered eligible for full-text screening and 32 were selected for data extraction. The meta-analysis demonstrated that contaminated conditions decreased the SBS of the sealants by 4.33 MPa. In the contaminated subgroup analysis, both unfilled (Clinpro™, 3M™) and filled (FluroShield, Dentsply) resin-based sealants achieved a similar SBS (P=0.82). Regarding the outcome measurements, extensive methodological heterogeneity was found among the studies for SBS measurements (I 2 equals greater than or equal to 84 percent; P<0.001), whereas homogeneity was found for microleakage (I 2 equals 84 percent; P=0.85). When evaluating resin-based sealants, the level of microleakage in the contaminated and non- contaminated groups was not significantly different (P=0.1). Surface contamination decreases the bond strength between contaminated enamel and both unfilled and filled resin-based sealants, which affects the clinical effectiveness of sealants.
Topics: Humans; Pit and Fissure Sealants; Bisphenol A-Glycidyl Methacrylate; Dental Bonding; Saliva; Dental Enamel; Shear Strength; Materials Testing
PubMed: 37904265
DOI: No ID Found -
BMC Oral Health Oct 2023In South Africa, an estimated 85% of the population relies on the public sector for oral health services. With poor infrastructure and inadequate personnel, over 80% of...
BACKGROUND
In South Africa, an estimated 85% of the population relies on the public sector for oral health services. With poor infrastructure and inadequate personnel, over 80% of children with dental caries remain untreated. To reduce this burden of disease, one key goal is to promote good oral health and address oral diseases through prevention, screening, and treatment among children. While all policies have been proven to be effective in the control and prevention of dental caries, it is unclear which of those strategies provide value for money. This study evaluated five caries preventative strategies in terms of the cost and benefits among South African school children.
METHODS
The study uses a hypothetical South African population of school aged learners aged 5-15. The context and insights of the strategies utilized at the schools were informed by data from both grey and published literature. Using Markov modeling techniques, we conducted a cost-effectiveness analysis of Acidulated Phosphate Fluoride (APF) application, atraumatic restorative treatment (ART), sugar-reduction and fissure sealants. Markov model was used to depict the movement of a hypothetical patient cohort between different health states over time. We assessed both health outcomes and costs of various interventions. The health outcome metric was measured as the number of Decayed, Missing, Filled Tooth (DMFT). The net monetary benefit was then used to determine which intervention was most cost-effective.
RESULTS
The results showed that school-based caries prevention strategies are cost-effective compared to the status quo of doing nothing. The average cost per learner over the 10-year period ranged from ZAR4380 to approx. ZAR7300 for the interventions considered. The total costs (including screening) associated with the interventions and health outcome (DMFT averted) were: sugar reduction (ZAR91,380, DFMT: 63,762), APF-Gel (ZAR54 million, DMFT: 42,010), tooth brushing (ZAR72.8 million, DMFT: 74,018), fissure sealant (ZAR44.63 million, DMFT: 100,024), and ART (ZAR45 million, DMFT: 144,035). The net monetary benefits achieved for APF-Gel, sugar reduction, tooth brushing, fissure sealant and ART programs were ZAR1.56, ZAR2.45, ZAR2.78, ZAR3.81, and ZAR5.55 billion, respectively.
CONCLUSION
Based on the net monetary benefit, ART, fissure sealant and sugar-reduction appear to be the most cost-effective strategies for preventing caries in South Africa. In a resource-scarce setting such as South Africa, where there is no fluoridation of drinking water, this analysis can inform decisions about service packages for oral health.
Topics: Child; Humans; Dental Caries; Cost-Benefit Analysis; South Africa; Pit and Fissure Sealants; Dental Atraumatic Restorative Treatment; Sugars
PubMed: 37898738
DOI: 10.1186/s12903-023-03474-1 -
BMC Oral Health Oct 2023Tooth decay is an infectious disease which, in its initial phase, leads to the formation of cavities in the teeth through decalcification of the enamel and local tissue... (Review)
Review
BACKGROUND
Tooth decay is an infectious disease which, in its initial phase, leads to the formation of cavities in the teeth through decalcification of the enamel and local tissue destruction. In addition to proper oral hygiene, prophylactic sealing of fissures and cavities with a sealant is a method of preventing the development of caries. The aim of this study is to summarise the effectiveness of fissure sealing of permanent teeth with fissure sealants compared to other preventive methods or no intervention.
METHOD
An umbrella review was carried out to achieve the purpose of our study. Searches were performed in Medline (via PubMed), Embase (via OVID), and Cochrane Library databases. Quality assessment of the included studies was performed using the AMSTAR2 tool. In addition, a manual search for recommendations/clinical practice guidelines on dental prophylaxis was performed.
RESULTS
204 publications were identified, of which 15 met the inclusion criteria. Based on the results of 3 systematic reviews, there was a statistically significant reduced odds of caries occurrence or development with prophylactic sealing of permanent teeth compared with no intervention - depending on the review and follow-up period odds ratio (OR) ranged from 0.06 [95%CI: (0.01-0.32)] to 0.28 [95%CI: (0.20-0.38)]. In the eight systematic reviews that analysed different sealants, there were no statistically significant differences between the types of materials used for prophylactic tooth sealing. For systematic reviews comparing the efficacy of fissure sealants with fluoride varnish, three reported no statistically significant difference in the efficacy of caries incidence, with only one systematic review based on 1 RCT finding a statistically significant difference in favour of fissure sealants.
CONCLUSION
Compared to the no intervention, dental sealing is an effective method for the prevention of dental caries. However, it is not possible to conclude conclusively which type of sealant and which of the available prophylactic methods is more effective in preventing caries.
Topics: Humans; Dental Caries; Dentition, Permanent; Fluorides; Pit and Fissure Sealants; Systematic Reviews as Topic
PubMed: 37891656
DOI: 10.1186/s12903-023-03499-6 -
BMC Oral Health Oct 2023Children aged 6-9 years are vulnerable to dental caries due to age-related limitations and a lack of adequate knowledge regarding oral health and hygiene practices. This...
The combined effect of pit and fissure sealant application and oral health education on oral health status of children aged 6-9 years: a 12-month follow-up study in Northeast China.
BACKGROUND
Children aged 6-9 years are vulnerable to dental caries due to age-related limitations and a lack of adequate knowledge regarding oral health and hygiene practices. This study aimed to establish a cohort of children aged between 6 and 9 years and conducted a 12-month follow-up to examine the combined effect of pit and fissure sealant (PFS) application and oral health education on their oral health status.
METHODS
A cohort study with 12-month follow-up was conducted in Liaoning province, China. A multi-stage stratified cluster sampling approach was employed in the study. The enrolled 6- to 9-year-old children were all from the selected primary schools, who had resided in the designated area for at least 6 months. Children who were unable to cooperate with the examiner or without informed consent from their guardians were excluded. Experienced dental professionals examined the oral health status of primary school children aged 6-9 years. All children and their guardians were mandated to complete a questionnaire (qualitative data) at the beginning of the study. In the experiment group, children underwent PFS application and chairside oral health education. Clinical examinations and questionnaire surveys were repeated at the 12-month follow-up. The chi-square test and binary logistic regression were conducted to investigate the potential risk factors associated with dental caries prevalence (dependent variable). Independent variables were items from the questionnaire (such as living place, parents' education level and children' birth weight). The significant variables identified in the chi-square tests were subsequently included in the binary logistic regression analysis.
RESULTS
A total of 4,085 children aged 6-9 years were included in the study, with 1805 participants assigned to the experiment group and 2280 to the control group. At baseline, the caries rates of the experimental and control group were 77.95% and 80.35%, respectively without any statistically significant differences. However, at the 12-month follow-up, the caries rate in the experimental group (83.65%) was significantly lower than that in the control group (86.62%) (P < 0.05). The results from the binary logistic regression analysis indicated that parents with a college degree and children in the experimental group exhibited lower caries rates. Conversely, higher caries rates were associated with the consumption of sweet beverages and foods more than once a day and a lack of knowledge regarding the causes of caries (P < 0.05).
CONCLUSIONS
In Liaoning, China, children aged 6 to 9 years exhibited a high prevalence of dental caries. Several factors, including the parent's education level, the frequency of consuming sweet beverages and foods, and the children's understanding of the cause of caries, significantly affected the caries prevalence rates. The implementation of PFS application and oral health education effectively reduce the caries rate among the surveyed children.
Topics: Humans; Child; Infant; Oral Health; Dental Caries; Follow-Up Studies; Pit and Fissure Sealants; Cohort Studies; Health Education, Dental; China
PubMed: 37891599
DOI: 10.1186/s12903-023-03467-0 -
BMC Oral Health Oct 2023Prevention and treatment services use is closely associated with socioeconomic factors, such as income. This study aimed to investigate the relationship between...
BACKGROUND
Prevention and treatment services use is closely associated with socioeconomic factors, such as income. This study aimed to investigate the relationship between implementing the sealant program and resin fillings restoration and to explore the role of income and frequency of dental visits in this relationship.
METHODS
This retrospective cohort study used the cohort database from the National Health Information Database of the National Health Insurance Service. The study population comprised 494,731 children born in 2007. A logistic regression model for the experience of resin fillings and a linear regression model for weighted utilization of them were used to identify the independent effects of dental sealants, income, and frequency of dental visits. All analyses were conducted using the SAS Enterprise Guide version 7.1 (SAS Institute Inc., Cary, NC, USA).
RESULTS
The ratio based on income level was almost proportional in all groups except the medical aid group, which had a rate as high as that of the wealthier group. Children without sealants were 1.05 times more likely to have resin fillings than others after adjusting for income level and frequency of visiting dental clinics in the final model. However, an opposite relationship between sealant experiences and resin fillings was observed in the previous model without dental visits. The gap in the weighted resin filling scores according to socioeconomic variables showed a similar tendency.
CONCLUSIONS
Income and frequency of dental visits might be confounding factors for the relationship between dental sealant and resin fillings. It is necessary to consider the complex relationship between socioeconomic indicators and service use while studying oral health inequality.
Topics: Child; Humans; Adolescent; Pit and Fissure Sealants; Dental Caries; Health Status Disparities; Retrospective Studies; Income
PubMed: 37891584
DOI: 10.1186/s12903-023-03387-z -
Community Dentistry and Oral... Aug 2024The sustainability of school-based oral health programs depends on the utilization of effective, efficient treatments and the availability of a trained clinical... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The sustainability of school-based oral health programs depends on the utilization of effective, efficient treatments and the availability of a trained clinical workforce. The objective of this study was to determine whether registered nurses are comparable to dental hygienists in the application and effectiveness of silver diamine fluoride (SDF) and fluoride varnish (FV) for the prevention of dental caries.
METHODS
CariedAway was a school-based study of SDF and FV versus dental sealants and atraumatic restorations. Within the SDF + FV arm, participants were treated by either a licensed dental hygienist or a registered nurse, both under the supervision of a paediatric dentist. Although initial treatment assignment in CariedAway was randomized, assignment to provider was not. The proportion of children who remained caries free after 2 years was assessed for non-inferiority using two-group proportion tests, adjusting for the clustering effect of schools.
RESULTS
A total of 417 children with no untreated caries at baseline were analysed including 298 treated by hygienists and 119 by nurses. The proportion of children who remained caries free after 2 years was 0.81 and 0.80 for those treated by hygienists and nurses, respectively, for a difference of 0.01 (95% CI = -0.07, 0.098) and within the pre-determined non-inferiority margin.
CONCLUSIONS
Nurses may be effective in treating children with silver diamine fluoride and other fluoride varnishes in school-based oral health programs.
Topics: Humans; Silver Compounds; Fluorides, Topical; Dental Caries; Child; Quaternary Ammonium Compounds; Female; Male; Cariostatic Agents; School Dentistry; Dental Hygienists; Pit and Fissure Sealants; Nurses; School Health Services
PubMed: 37873685
DOI: 10.1111/cdoe.12925 -
Journal of the Indian Society of... 2023The cornerstone of preventative therapy is made up of pit and fissure sealants and fluorides. Resin sealants have been shown to help reduce fissure decay in both primary...
INTRODUCTION
The cornerstone of preventative therapy is made up of pit and fissure sealants and fluorides. Resin sealants have been shown to help reduce fissure decay in both primary and permanent teeth. Etching of primary molars is not effective due to prismless enamel, higher organic content, and diversity in fissure shape. Methods of pretreatment of pits and fissures have been hypothesized to promote microporosities in etched enamel and hence sealant adherence. Examining the etching pattern and surface roughness of the enamel surface can be used to gauge these.
OBJECTIVE
This study aimed to evaluate the effect of pretreatment with ozone gas and 5.25% sodium hypochlorite solution on pits and fissures of primary teeth to check for the etching pattern and surface roughness.
MATERIALS AND METHODS
Thirty noncarious primary molars were sectioned to retain the crowns, and randomly divided into three groups, sodium hypochlorite, ozone gas, and control. Each sample was pretreated with the agent, washed, followed by etching with 37% phosphoric acid. Samples were sectioned and subjected to scanning electron microscope analysis to evaluate the etching pattern and surface roughness.
RESULTS
Comparison of the etching pattern in three groups showed a statistically insignificant difference (P=0.364). Surface roughness was highest in the hypochlorite group followed by ozone and control which showed a statistically significant difference (P = 0.001). The surface area between the three groups showed a statistically insignificant difference.
CONCLUSION
Sodium hypochlorite is a better pretreatment agent compared to ozone gas and acid etching alone. However, as all results were not statistically significant further research must be carried out to prove the effectiveness of these agents.
Topics: Humans; Sodium Hypochlorite; Microscopy, Electron, Scanning; Acid Etching, Dental; Pit and Fissure Sealants; Tooth, Deciduous; Phosphoric Acids; Dental Bonding
PubMed: 37861642
DOI: 10.4103/jisppd.jisppd_352_23 -
Journal of the Indian Society of... 2023Well articulated by John Knowles - "Everything has to evolve or else it perishes." With the paradigm shift of emphasis toward the prevention of dental caries, it has...
Comparison of micromorphological changes in enamel using SEM analysis after conventional and erbium, chromium:yttrium, scandium, gallium, and garnet hard-tissue laser fissurotomy: An study.
BACKGROUND
Well articulated by John Knowles - "Everything has to evolve or else it perishes." With the paradigm shift of emphasis toward the prevention of dental caries, it has been proven that laser irradiation protects against both caries initiation and caries progression.
AIM
The aim of the study was to evaluate and compare the micromorphology of caries-free extracted premolars using a Scanning electron microscope (SEM) after fissurotomy by conventional fissurotomy bur and erbium, chromium: yttrium, scandium, gallium, and garnet (ER, CR: YSGG) hard-tissue laser.
METHODOLOGY
Sixty caries-free premolars extracted atraumatically for orthodontic treatment were included in the study. The samples were divided into two groups randomly (Group 1: fissurotomy by bur, n = 30, and Group 2: fissurotomy by hard-tissue laser, n = 30). Each sample was further divided into halves from the occlusal surface wherein one-half of the occlusal surface received fissurotomy procedure and the other half was control. Samples were analyzed by scanning electron microscopy (SEM) for micromorphological changes.
RESULTS
Profile image of control samples revealed the disorganization of enamel surface at the junction of fissures forming a heterogeneous tissue and agglomeration of enamel with deep pit and fissure. On the contrary, the image of experimented samples (with laser fissurotomy) showed smooth enamel surface and homogeneous enamel subsurface with wider pit and fissure owing to self-cleansing ability.
CONCLUSION
On the grounds of the present study results, it could be concluded that the intervention of ER, CR: YSGG hard-tissue laser possesses self-cleansable pit and fissures for caries prevention and has the potential to irradicate the smear layer entirely for superior attachment of remineralizing agents.
Topics: Humans; Erbium; Scandium; Yttrium; Dental Caries; Chromium; Gallium; Dental Enamel; Lasers, Solid-State
PubMed: 37861641
DOI: 10.4103/jisppd.jisppd_214_23 -
The Journal of School Health Jan 2024School-based dental sealant programs are noted to increase sealant uptake among children, especially those from low-income families and those living in rural and...
BACKGROUND
School-based dental sealant programs are noted to increase sealant uptake among children, especially those from low-income families and those living in rural and underserved areas. However, nationally school-based dental sealant programs are substantially underutilized. This paper describes a partnership approach to a school-based dental sealant program for Title 1 public schools in Hawaii.
METHODS
The Hawaii Keiki: Healthy and Ready to Learn program partnered with the Hawaii Dental Service to develop and implement an interprofessional, school-based sealant program (SBSP). This article describes the development of key factors, such as partnerships, an interprofessional team, team roles, policies, and marketing tools to optimize program success.
RESULTS
The SBSP has completed over 3 academic years of implementation in Hawaii public schools. In its initial year (school year [SY] 2019-2020), which presented challenges due to the COVID-19 pandemic, it served 6 schools (106 students screened) on 1 island. It expanded to 14 schools on 1 island (193 students screened) in its second year (SY 2020-2021), 28 schools on 3 islands (653 students screened) in its third year (SY 2021-2022), and during the Fall of the fourth year, the program reached 50 schools on 3 islands (1821 students screened) and is projected to reach over 70 schools by the end of SY 2022-2023.
CONCLUSION
Taking advantage of strategic partnerships and key interprofessional team members, a school-based dental sealant program can help to improve the oral health of children in public schools by helping to decrease barriers to care.
Topics: Child; Humans; Hawaii; Pit and Fissure Sealants; Pandemics; Poverty; Schools
PubMed: 37857279
DOI: 10.1111/josh.13401 -
Materials (Basel, Switzerland) Sep 2023The scope of this paper is to compare different dental sealants and flow materials indicated for sealing pits and fissures considering their chemical formula. The... (Review)
Review
The scope of this paper is to compare different dental sealants and flow materials indicated for sealing pits and fissures considering their chemical formula. The narrative review aims to address the following questions: What is the essence of different dental sealants' activity, how does their chemical formula affect their mechanisms of caries prevention, and what makes a dental sealant efficient mean of caries prevention? Another vital issue is whether the sealants that contain fluoride, or any other additions, have potentially increased antimicrobial properties. An electronic search of the PubMed, Cochrane, Web of Science, and Scopus databases was performed. The following keywords were used: (dental sealants) AND (chemical composition). Additionally, information about composition and indications for clinical use provided by manufacturers were utilized. All of the considered materials are indicated for use both in permanent and primary dentition for sealing fissures, pits, and . The selection of suitable material should be made individually and adjusted to conditions of the sealing procedure and patient's needs. Cariostatic mechanisms increasing sealants' effectiveness such as fluoride release are desired in modern dentistry appreciating preventive approach. The review aims are to find crucial elements of sealants' composition which affect their cariostatic mechanisms.
PubMed: 37834590
DOI: 10.3390/ma16196453