Title	Sealants are More Effective in Preventing Dental Caries Than Periodically Applying Fluoride Varnish to a Child’s First Molars
Clinical Question	On children’s first molars, are dental sealants more effective in preventing dental caries than applying a fluoride varnish periodically?
Clinical Bottom Line	Sealants are more effective than periodic fluoride treatments. There were fewer accounts of dental caries on subject’s first molars if they received sealants. Data showed that if fluoride treatments were discontinued then the effectiveness would eventually discontinue as well.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 16304443 Bravo/2005 Adolescents under the age of 20 years. Randomized Controlled Trial Key results Research showed that children with sealant and fluoride treatments had a reduction in occlusal caries on their permanent first molars by 65.4% and 23.7%, respectively compared to the control group. The study was completed over 4 years with an additional 5 years of discontinuation. 20238319 Hiiri/2010 Adolescents under the age of 20. Systemic Review Key results Four studies were chosen to be part of this review because of their high quality. Each study showed that pit and fissure sealants work better than fluoride treatments. Risk ratios (RR) were calculated in order to show the differences between the intervention group and the control group. The risk ratios in the split-mouth studies showed the differences between the “paired tooth surfaces being carious or not.” One low risk of bias split-mouth study and one moderate to high risk of bias cluster randomized study gave results that showed pit and fissure sealants were statistically significantly higher than a fluoride varnish application. The split-mouth study gave a RR of 0.74, 95% confidence interval (CI) 0.58 to 0.95 after applying fluoride varnish ever 6 months on the first molars for 23 months. At 4 and 9 years, the cluster randomized study gave a RR of 0.42, 95% CI 0.21 to 0.84 and RR of 0.48, 95% CI 0.29 to 0.79. A moderate to high risk of bias small parallel group study did not find any difference between sealants and applying fluoride varnish. A low risk of bias split-mouth study had an RR of 0.36, 95% CI 0.21 to 0.61 and found fewer caries on surfaces that had been treated with sealants and fluoride than fluoride varnish alone.
Evidence Search	“Sealant vs Fluoride Treatment”
Comments on The Evidence	The quality of Bravo’s research seems to be well done based on the study being double-blind, long-term, and randomized trial. The study had great follow up by seeing the subjects 5 years after the treatments were complete. However, there was a risk of bias because 51.1% of the children that began the study could not be examined at the end of the 9 years. Hiiri’s systemic review involved four studies. Each study qualified to be apart of the review, but there remained to be a risk of bias in each of the four studies. Hiiri expresses, “current scarce data limit recommendations on whether to apply pit and fissure sealants or fluoride varnishes on occlusal surfaces.” It seems as though more research needs to be completed on this topic. Although Hiiri expressed neither fluoride or pit and fissure sealants could be recommended because of scarce data, Hiiri also concludes that there is some evidence leaning toward pit and fissure sealants being more successful in preventing occlusal caries. Bravo’s randomized controlled study appears to show valid and applicable data that applying sealants on pit and fissures is more beneficial in stopping occlusal caries than applying a fluoride varnish alone. Sealants on occlusal surfaces are also recommended by ADA from evidence-based research.
Applicability	If a patient comes into a dental office with deep pits and fissures on their posterior teeth, sealants would be a cost effective way to prevent occlusal caries.
Specialty	(General Dentistry) (Pediatric Dentistry) (Dental Hygiene)
Keywords	Sealant, Fluoride, Dental Caries, Pediatric Dentistry
ID#	2633
Date of submission	04/04/2014
E-mail	whitesj@livemail.uthscsa.edu
Author	Shantal White
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Kevin J. Donly, DDS, MS
Faculty mentor e-mail	donly@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available