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Is there a risk of harm or toxicity in the placement of pit and fissure sealant materials? A systematic review

Azarpazhooh A, Main PA . J Can Dent Assoc. 2008;74(2):179-83

BACKGROUND: Recently, there has been increased interest in the in vivo release of dental sealant components, such as bisphenol A (BPA), which has the potential to bind the estrogen receptors of relevant cells at subtoxic concentrations in vitro, impairing the development, health and reproductive systems of wildlife. The purpose of this systematic review was to investigate whether the placement of pit and fissure sealant materials causes toxicity, and thus harms patients. METHODS: The literature search (from the earliest record up to March 2007) for relevant articles was done with Ovid MEDLINE, CINAHL and other bibliographic databases. RESULTS: A total of 377 articles were identified by the literature search; relevance was determined by examining the title and abstract of the articles. Eleven original studies met the inclusion criteria. These articles were read in full and scored independently by 2 reviewers. RECOMMENDATIONS: The evidence suggests that patients are not at risk for exposure to BPA from the use of dental sealants. To reduce the potential, if any, for BPA toxicity from sealants, dental providers should use a mild abrasive, such as pumice, either on a cotton applicator or in a prophy cup; have older children and adolescents gargle with tepid water for 30 seconds; or wash the sealant surface for 30 seconds with an air-water syringe while suctioning fluids and debris from a child"s mouth.

Sealants: minimal evidence to prove toxicity of BPA in dental sealants

Analia Veitz-Keenan DDS .


Systematic Review Conclusion

Patients are not at risk of toxic exposure to bisphenol A (BPA) in dental sealants.

Critical Summary Assessment

A narrative assessment of a systematic search provides little evidence to resolve the issue.

Evidence Quality Rating

Limited Evidence

Structured Abstract

Clinical Questions:

Does the placement of pit and fissure sealants cause toxicity, and thus harm patients?

Review Methods:

The authors conducted a comprehensive database search in English through March 2007. Working independently, they identified 377 potential articles, of which a total of 11 in vitro and in vivo studies were selected for review.

Main Results:

The authors divided the studies into two groups. In one group, a total of eight in vitro and in vivo studies reported “no significant levels of BPA” after sealant placement. In the other group, a total of six in vivo and in vitro studies reported that detectable levels of BPA were found after sealant placement.


Based on these studies the authors indicate that patients are not at risk for toxic exposure to BPA after sealant placement. To reduce potential for BPA toxicity exposure, the authors recommend procedures to clean the surface of the new sealant and eliminate any uncured resin.

Source of Funding:

Not stated.


Importance and Context:

BPA is widely used in the manufacture of many consumer plastic products. Laboratory testing in animals suggests that BPA may affect reproduction and development. Concerns exist that some polymers used in dental sealants or composites may contain trace amounts of BPA.

Strengths and Weaknesses of the Systematic Review:

An extensive and comprehensive search informed the review. However, the review failed to present an explicit search strategy or inclusion and exclusion criteria. The review failed to present an evidence table and it did not critically appraise the identified articles for evidence level or validity. The search identified 11 studies, but the narrative portion of the manuscript included 15 studies. Also, the authors did not stratify the studies by study type, and instead grouped them by in vivo and in vitro trials.

Strengths and Weaknesses of the Evidence:

The limited evidence from the included studies did not offer a clear conclusion. Only three human studies were identified in the review, but the review was not specific about the methodology and the quality of the research used by each included study.

Implications for Dental Practice:

Based on these findings, the amount of human exposure to BPA from dental sealants appears small and currently there is minimal evidence of a health risk.

Critical Summary Publication Date:


These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association © 2019