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Title School-Based Sealant Programs And caries Incidence
Clinical Question In elementary school children, are school-based sealant programs effective in decreasing caries incidence compared to children not receiving sealants?
Clinical Bottom Line School-based sealant programs are effective in decreasing caries incidence, however patient age and initial condition of tooth surfaces to be sealed directly affect sealant outcome. Also, pit and fissure sealants are best used as an adjunct to other caries preventative procedures. (See Comments on the CAT below)
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) 14761173van Wyk/2004Three age groups were selected; 119 six year olds, 139 twelve year olds, 127 fifteen year olds.Cohort Study
Key results“Pit and fissure sealants are an effective adjunct to other caries preventative procedures.” According to this article, the results showed that the dmft in the primary dentition in the six-year-old group did not differ significantly from the dmft of the control group.
#2) 19884392Gooch/2009Children and adolescent participants in school-based sealant programs.Practice guidelines/Expert opinion
Key resultsIt was noted that while sealants are effective in preventing the development of dental caries, differences between the recommendations for sealant use in clinical versus school settings is different. Clinicians must consider caries risk at the level of the school and community. Furthermore, the context for making decisions in clinical care and in School-based sealant programs differs due to the availability of diagnostic and treatment services.Based upon the guidelines updated by the expert work group, School-based sealant programs are supported such that they remain appropriate, feasible and based on the best scientific evidence.
#3) 18353204Azarpazhooh/2008Patients aged 0 to 18 years oldSystematic Review
Key resultsIt was found that sealant placement is highly recommended on children following eruption of molar teeth. Furthermore it was determined that resin-based sealants are more effective than glass-ionomer cements at preventing dental caries. Lastly, it is clear that following satisfactory placement of sealants, there is reduction of caries increments.
Evidence Search Search ("School Health Services"[Mesh] AND "Dental Caries"[Mesh]) AND "Pit and Fissure Sealants"[Mesh] Limits: Search ("School Health Services"[Mesh] AND "Dental Caries"[Mesh]) AND "Pit and Fissure Sealants"[Mesh]Search "School Health Services"[Mesh] AND "Dental Caries"[Mesh]
Comments on
The Evidence
1. Pubmed ID 14761173 This study design was a Cohort Study in which groups were similar at the start of the study. There was not a >90% completion rate. It was not stated whether or not the groups were treated the same. There was adequate follow-up. This was not a double-blind study. Compliance was adequate, recall bias was unlikely, and there were no identifiable competing interests.The dmft score in the six-year-old group was 1.74 compared to the control group which was 1.43 (p=0.49). The DMFT in the twelve-year-old group was 0.42 compared to the control group which was 1.07 (p=0.0384). The DMFT in the fifteen-year-old group was 0.59 compared to the control group which was 2.38 (p=.0001). 2. Pubmed ID: 19884392This study was considered an expert opinion that entailed a comprehensive detailed search for relevant trials. Individual studies were not assessed for validity. A total of twenty-eight studies were reviewed and patient number is unknown. A meta-analysis was performed.
Applicability The types of patients this information is most applicable to include school-aged children susceptible to dental caries. The use of dental sealants is applicable in the settings of both school-based programs as well as general dental providers. There are no potential harms as a result of dental sealants in school-aged children. Potential benefits include increased caries resistance following sealant placement. Factors that might limit the effectiveness of sealants in school-aged children include the quality dental materials used, and/or the methods by which sealants are placed.
Specialty/Discipline (Public Health) (Dental Hygiene)
Keywords Sealants, caries, Preventative dentistry
ID# 533
Date of submission: 05/10/2010spacer
E-mail fischerjc@livemail.uthscsa.edu
Author James Fischer
Co-author(s) e-mail
Faculty mentor/Co-author David Cappelli, DMD, MPH, PhD
Faculty mentor/Co-author e-mail CAPPELLI@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?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Michael Zhang, Johnny Trinh, Ross Williams (San Antonio, TX) on 01/07/2013
A PubMed search conducted 1/7/13 did not provide any new evidence on this specific clinical question.

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