ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Fissure Sealants Arrest Caries Progression in The Primary Dentition With Non-Cavitated Occlusal Caries
Clinical Question In a primary tooth with non cavitated dentinal occlusal caries, will applying a fissure sealant arrest caries progression?
Clinical Bottom Line Fissure sealants arrest caries progression in primary teeth with non cavitated occlusal caries. This is supported by a randomized controlled trial in which fissure sealants with total retention had the same clinical efficacy as composite resin in the primary dentition. This treatment is a non invasive alternative available to pediatric patients.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21718373Borges/2012Patient Group 30 school aged children with non cavitated dentinal occlusal lesions.Randomized Controlled Trial
Key resultsThe study consisted of 30 children, ages 5 though 9, observed for 1 year at 4 month intervals. Teeth chosen were primary molars diagnosed with non cavitated dentinal occlusal caries lesions extending from the dentin-enamel junction to the middle 1/3 of dentin. Any teeth with white spot lesions, cavitations on other tooth surfaces, or sensitivities were excluded. The control group consisted of 26 teeth treated with composite resin restorations. The experimental group also consisted of 26 teeth, but Fluoroshield sealant was applied to the occlusal surfaces instead of composite resin restorations. Both groups resulted in no caries progression both clinically and radiographically at the one year follow up (p=0.12). 23 of 26 primary teeth in the experimental group exhibited total retention, while the remaining 3 teeth were diagnosed with partial retention at the 1 year follow up and treated with composite resin restorations.
Evidence Search ("Tooth, Deciduous"[Mesh]) AND "Dental Caries"[Mesh]) AND "Pit and Fissure Sealants"[Mesh]
Comments on
The Evidence
Although 88% of the experimental group exhibited total retention, the small group size and 1 year length of the study must be taken into consideration. Total retention of sealants is an integral part of this treatment method and other studies have shown lower incidences of total retention with similar sealant treatments. Four subjects were loss during the study, but this was unlikely to alter the results since 26 of 26 teeth with total retention of sealant stopped caries progression. Both groups were similar at start, used blind analysis, and had adequate follow up. No statement concerning bias was found. The use of sealants in prevention of occlusal caries has been the subject of a number of systematic reviews in the Cochrane Data Base. A number of articles have been published by Mertz-Fairhurst and others showing ten year follow up on sealants placed over non-cavitated dentin caries lesions with no evidence of disease progression. This study shows the technique can be used in primary teeth with similar results.
Applicability This evidence can be used to provide an affordable non-invasive procedure for preventing caries progression in the pediatric patient with non cavitated occlusal lesions.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry)
Keywords Caries, Sealants, dentin
ID# 2451
Date of submission: 04/08/2013spacer
E-mail benito@livemail.uthscsa.edu
Author Brian Benito
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Joseph Connor, DDS
Faculty mentor/Co-author e-mail connorj@uthscsa.edu
Basic Science Rationale
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Comments on the CAT
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