Candice McMullan-vogel D.D.S., Dr. med. dent.
Sealing occlusal surfaces of permanent molars is effective in preventing caries for those at high caries risk.
This high quality review presents strong and consistent evidence of the clinical effectiveness of pit and fissure sealants.
Do pit and fissure sealants prevent dental decay in permanent molars of children and adolescents? Does the effectiveness of pit and fissure sealants vary among populations with different levels of caries risk? An additional objective was to compare the relative effectiveness of different types of sealant materials.
The authors selected randomized or quasi-randomized controlled trials (RCTs) with a duration of at least 1 year that compared sealant with no sealant or sealants of different materials in the prevention of caries in children and adolescents aged 20 years or younger. The primary outcome measure was caries increment of occlusal surfaces in permanent molars. The authors conducted an extensive all-language search of more than 12 electronic data bases (1950 to February 2008), hand searched reference lists from identified trials and review articles, and contacted selected authors and manufacturers of sealant materials to locate unpublished RCTs. Two review authors independently duplicated the selection of studies for inclusion, evaluation of study quality and data extraction. Where appropriate, the authors conducted random effects meta-analyses.
Sixteen studies were included in the review; 7 studies provided data for comparison of sealant versus control without sealant and 10 of them provided comparisons of sealant versus sealant (i.e. resin-based sealants were compared to glass ionomer sealants or poly-acid modified composite (compomer) sealants). Six studies found a highly significant difference between a resin-based sealant and control without a sealant. The reductions in caries ranged from 87% at 12 months to 60% at 48-54 months, with a pooled relative risk (RR) of 0.13 (95% CI, 0.09 to 0.20) and 0.40 (95% CI, 0.31 to 0.51) at 12 and 48-54 months follow up, respectively. One study that had a 9–year follow-up found significantly more caries in the control group, 77% of surfaces without sealant demonstrated caries as compared to 27% of sealed surfaces. The results of the studies comparing different sealant materials were conflicting.
Sealing occlusal surfaces of permanent molars effectively reduces caries in children and adolescents. Information on the benefit of sealants related to different levels of caries risk is lacking.
Source of Funding:
Finnish Office for Health Technology Assessment, Finland and School of Dentistry, The University of Manchester, UK.
Importance and Context:
Although a decline in dental caries in industrialized countries was noted during the 1970s and 1980s, caries prevalence may be increasing. Among school-age children most of this increase has been detected on the pit and fissure surfaces of permanent teeth. Sealants provide a physical barrier, blocking bacteria and food particles from collecting in the pits and fissures. Numerous studies have demonstrated the effectiveness of resin-based sealants, which depends on the longevity of sealant coverage. Glass ionomer sealants provide an alternative option in cases where achieving adequate moisture control is difficult. Fluoride release from glass-ionomer sealants may provide additional caries protection through fluoride release.
Strengths and Weaknesses of the Systematic Review:
The search criteria and methods described by the authors suggest that most relevant published studies would have been identified. The reviewers evaluated the data using appropriate, well-defined and clinically relevant methods.
Strengths and Weaknesses of the Evidence:
There is strong and consistent evidence for the effectiveness of sealants in caries reduction. There is insufficient information to conclude the effectiveness of different sealant materials at different caries levels; baseline caries prevalence was reported in only 5 of the 16 studies included in this review. Studies that compared different sealant materials were 1) not compared to control groups without sealants and 2) were primarily conducted in populations with low or moderate caries risk. Because the findings of these studies were inconsistent and contradictory, the authors could not draw any conclusion. This review did not evaluate sealant retention as a factor in caries prevention, nor did it evaluate factors important in the retention rate of different sealant materials. However, in studies where resin sealants provided better caries prevention results, the retention rate of resin sealant materials was reported as high. In studies where the retention rate of both sealant materials was low, glass ionomer sealants provided better caries prevention results.
Implications for Dental Practice:
The vast majority of carious lesions in children and young adults are found in the pits and fissures of permanent posterior teeth. Sealants have proven effective in reducing caries in children and adolescents. However, sealants are underused, particularly among populations at high caries risk. Resin sealants may be more effective than glass ionomer sealants when the material retention is high, but presently there is insufficient evidence to demonstrate the superiority of one type of sealant material over another.