ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title The Continued Use of Dental Sealants for the Prevention of Dental Caries in the Permanent Teeth of Children and Adolescents
Clinical Question In children & adolescent patients with erupted permanent molars, do pit and fissure sealants actually reduce the rate of occlusal dental caries compared to identical populations without sealants? (See Comments on the CAT below)
Clinical Bottom Line Children and adolescent patients who have their erupted permanent molar teeth covered by a sealant are less likely to have dental decay in their molar teeth than patients without sealants, as sealants act to prevent the growth of bacteria that promote decay in grooves of molar teeth.
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) 18843625Ahovuo-Saloranta/2008Randomised or quasi-randomised controlled trials of at least 12 months in duration comparing sealants with no sealant or sealants from different classes of materials for preventing occlusal caries in children and adolescents under 20 years.Cochrane Systematic Review
Key resultsSixteen studies were included in the review; 7 studies provided data for comparison of sealant versus control without sealant and 10 studies for comparison of sealant versus sealant. Five split-mouth studies and one parallel group study with 5 to 10 year old children found a significant difference in favor of second or third generation resin-based sealants on first permanent molars, compared to a control without sealant, with a pooled RR of 0.13 (95% confidence interval (CI) 0.09 to 0.20), 0.22 (95% CI 0.15 to 0.34), 0.30 (95% CI 0.22 to 0.40), and 0.40 (95% CI 0.31 to 0.51) at 12, 24, 36 and 48-54 months follow up, respectively. Further, one of those studies with 9 years of follow up found significantly more caries in the control group compared to resin sealant group; 27% of sealed surfaces were decayed compared to 77% of surfaces without sealant. The results of the studies comparing different sealant materials were conflicting.
Evidence Search PubMed; Pit and Fissure Sealants;[Mesh] AND Dental Caries Susceptibility;[Mesh]) OR (Dental Caries Susceptibility/Prevention and Control&;[Mesh]) Limits: Meta-Analysis
Comments on
The Evidence
The evidence from this Cochrane Based Systematic Review is critical and timely, considering that more people are questioning the need for sealants with the increased rates of water fluoridization and generalized decreasing rates of dental caries. The review showed that after 4.5 years the sealed permanent molar teeth of children aged 5 to 10 had over 50% reduction in decay on biting surfaces compared to teeth without sealants. One study with longer follow up showed that after 9 years only 27% of sealed tooth surfaces were decayed compared to 77% of tooth surfaces without sealant. Since few studies reported the baseline caries prevalence in the population, it is not possible to examine the relationship between sealant effectiveness and baseline caries risk. Although sealants were shown to be effective in caries prevention, it is impossible to infer the magnitude at each level of caries risk.
Applicability Pit and fissure sealants continue to be recommended for the prevention of dental caries of permanent posterior teeth in children and adolescents (especially for those deemed at high risk for the development of caries). Such treatment is a simple, cost-effective procedure that is easily rendered in the general dental office.
Specialty/Discipline (Public Health) (General Dentistry) (Orthodontics) (Pediatric Dentistry)
Keywords Pit and Fissure Sealants, Dental Sealants, Dental Caries, Caries Prevention
ID# 288
Date of submission: 11/04/2009spacer
E-mail miklos@livemail.uthscsa.edu
Author Patrick Miklos, DDS
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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?)
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None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Zeena Alsalman (San Antonio, TX) on 04/05/2012
I conducted a pubmed search on this topic in April 2012 and found a more recent publication: PubMed ID 20068302. The RCT further supports the conclusions of this CAT.
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