Sealants for preventing and arresting pit-and-fissure occlusal caries in primary and permanent molars: A systematic review of randomized controlled trials-a report of the American Dental Association and the American Academy of Pediatric Dentistry

The influence factors on pit and fissure sealing behavior of 12-year-old children: a cross-sectional study in Zhejiang, China

BACKGROUND

In the 21st century, dental caries remains a global burden, particularly severely affecting the growth and quality of life of 12-year-old children. Fortunately, pit and fissure sealing (PFS) procedures can effectively prevent molars from caries. Hence, this study focused on the relationship between PFS and oral epidemiological factors in 12-year-old children.

METHODS

A cross-sectional survey was conducted in 12-year-old children from 11 cities in Zhejiang Province. Their dental conditions were collected through questionnaires, as well as basic information such as relevant family information, oral health knowledge and behavior. Then, logistic regression analysis was used to identify the influencing factors associated with PFS.

RESULTS

A total of 1204 children were included, with 252 in the PFS group and 952 in the non-PFS group. There were significant differences between the two groups in terms of decayed, missing and filled teeth (DMFT) score, first permanent molar DMFT score, residential area, educational level of parents, tooth-brushing frequency, use of dental floss, oral examination in a medical institution, having taken courses on oral health care, as well as having knowledge that tooth brushing could effectively prevent gingival inflammation, PFS could protect teeth, and oral disease may affect general health. According to further logistic regression analysis, the independent factors influencing PFS included use of dental floss [odds ratios (OR) = 1.672, 95% confidence intervals (CI) = 1.235-2.263, P = 0.001], having taken courses on oral health care (OR = 0.713, 95% CI = 0.515-0.988, P = 0.042), having knowledge that tooth brushing is effective in preventing gingival inflammation (OR = 0.627, 95% CI = 0.389-0.987, P = 0.044) and having knowledge that PFS can protect teeth (OR = 0.589, 95% CI = 0.438-0.791, P < 0.001).

CONCLUSION

PFS can reduce the mean DMFT score of 12-year-old children. Independent influencing factors of PFS consist of use of dental floss, having taken courses on oral health care, oral health behavior and knowledge level.

Sealing moderate caries lesions with bioactive glass-ionomer: A split-mouth clinical trial

Laboratory evidence has shown that 45S5 bioglass can help in dental remineralization, so its incorporation into resin-modified glass ionomer cement (RMGIC) has been studied. This randomized clinical trial aimed to determine the efficacy of RMGIC enriched with 10% 45S5 bioglass (RMGIC/45S5) in preventing the progression of moderate caries lesions. Sixty-six permanent molars with moderate caries lesions, were randomly sealed with RMGIC or RMGIC/45S5. After 1, 3-6 months, patients' oral health, material behavior, and caries evolution were evaluated. Chi-square and Fisher's exact test was employed. After one month, the RMGIC showed higher total retention and better clinical performance compared to RMGIC/45S5, both showed a predominance of sealed teeth or without caries progression. After 6 months, no materials retention, quality and caries progression difference was observed for both materials. Short-term clinical follow-up reveals worse retention and quality of RMGIC/45S5, only after 6 months no clinical/microscopic differences are observed between the materials.

Evaluation of direct restorations for pit-and-fissure caries using stamp combined with single-shade composite resin technique: A 12-month follow-up in vivo study

OBJECTIVES

To evaluate the clinical performance of direct restorations for pit-and-fissure caries in molars using stamp combined with single-shade composite resin (S/SCR) technique, and assess the effect of the number of stamp pressing on the trueness of S/SCR technique.

METHODS

Twenty molars of fifteen patients with pit-and-fissure caries but with an intact or micro-cavitated occlusal morphology were restored using S/SCR technique and were randomly divided into single pressing group (n = 10) and double pressing group (n = 10). Intraoral scans were obtained before treatment (scan 1), after filling (scan 2) and after polishing (scan 3). Deviation distribution maps of pairwise fitting were created including comparison 1 (scan1/scan 2), comparison 2 (scan1/scan 3), and comparison 3 (scan2/scan 3) using Geomagic Control X software. Root mean square (RMS) values were calculated to evaluate the trueness of restorations. Clinical performances including esthetic, functional, and biological properties of all restorations were evaluated according to FDI criteria after a 12-month follow-up. Analysis of variance, independent-samples T test and Wilcoxon rank-sum test were used for statistical analysis (α=0.05).

RESULTS

RMS values for comparison 1, comparison 2, and comparison 3 were 0.1243 ± 0.0151, 0.0966 ± 0.0136, and 0.0605 ± 0.0137 mm in single pressing group, while 0.0831 ± 0.0140, 0.0741 ± 0.0107, and 0.0475 ± 0.0099 mm in double pressing group, respectively. RMS value of single pressing group was higher than that of double pressing group in the same comparison (p ≤ 0.001). No statistically significant differences were observed between the two groups regarding esthetic, functional and biological properties (p > 0.05). For all properties, all restorations scored within 3, with over 80% scoring 1.

CONCLUSION

S/SCR technique presents satisfying clinical performances for pit-and-fissure caries in molars after a 12-month follow-up. Besides, double pressing can improve the trueness of restorations compared to single pressing.

CLINICAL SIGNIFICANCE

S/SCR technique is efficient in direct composite resin restoration for pit-and-fissure caries, with satisfying esthetic, functional and biological properties after a 12-month follow-up. Significantly, double pressing improves the trueness of S/SCR technique, reducing the need for occlusion adjustment.

Retention Rate of Hydrophilic and Hydrophobic Resin-Based Sealant under Field Conditions: A Split-Mouth Randomized Controlled Clinical Trial

OBJECTIVES

 The aim of this study was to evaluate and compare the clinical retention rate between hydrophilic and hydrophobic resin-based sealant placed under field setting and related factors.

MATERIALS AND METHODS

 Sixty-six children with 106 pairs of teeth in the same arch with matching International Caries Detection and Assessment System (ICDAS) scores ranging from 0 to 2 were recruited. This study was a split-mouth design with each tooth in the pair randomly assigned into either hydrophobic resin-based sealant group (Concise white sealant, 3M. EPSE, St. Paul, Minnesota, USA) or hydrophilic resin-based sealant group (UltraSeal XT hydro sealant, Ultradent Products, South Jordan, Utah, USA). A dental therapist performed all procedures in a field setting on a mobile dental unit with a mobile saliva ejector. The retention rate was evaluated by two calibrated dentists and classified as fully retained, partially retained, and total loss.

STATISTICAL ANALYSIS

 The outcomes were analyzed using McNemar's, chi-squared, and Fisher's exact test with a significance level of 0.05.

RESULTS

 After 12 months, 65 children with 105 pairs of teeth remained in this study. At 8-month follow-up, fully retained, partially retained, and total loss of material were found at 82.9, 15.2, and 1.9% in the hydrophobic group and 70.5, 26.7, and 2.9% in the hydrophilic group, respectively. At the 12-month follow-up, the outcomes were reduced, respectively, to 80, 17.1, and 2.9% in the hydrophobic group and 68.6, 27.6, and 3.8% in the hydrophilic group. There was no significant difference between the two groups (p > 0.05). Arch type was associated with the retention rate (p < 0.05), whereas ICDAS scores showed no correlation (p > 0.05).

CONCLUSION

 Both hydrophilic and hydrophobic resin-based sealant can be used under field conditions, with no significant difference in terms of retention rate.

Clinical effectiveness of pit and fissure sealants in primary and permanent teeth of children and adolescents: an umbrella review

PURPOSE

This umbrella review aimed to critically appraise the evidence published in systematic reviews (SRs) on the clinical effectiveness of sealants compared with each other/the non-use in primary/permanent teeth of children and adolescents with at least 12-month follow-up.

METHODS

A systematic literature search on 4 electronic databases was conducted up to January 18th, 2023. Following handsearching, two review authors independently screened retrieved articles, extracted data, and assessed the risk of bias (RoB) using the risk of bias in systematic reviews (ROBIS) tool. Based on a citation matrix, the overlap was interpreted by the corrected covered area (CCA).

RESULTS

Of 239 retrieved records, 7 SRs met the eligibility criteria with a moderate overlap among them (CCA = 7.4%). For primary molars, in 1120 1.5- to 8-year-old children, data on the clinical effectiveness of sealants were inconclusive. For permanent molars, 3 SRs found a significant caries risk reduction for sealants versus non-use (≤ 36-month follow-up). There was insufficient evidence to proof superiority of sealants over fluoride varnish for caries prevention (3 SRs), and to rank sealant materials according to the best clinical effectiveness in permanent molars. One study was rated at low and 6 at high RoB, which did not allow for a valid quantitative synthesis.

CONCLUSION

Considering the limitations of this umbrella review, sealants are more effective for caries prevention in children's permanent molars compared to no treatment. Future well-implemented RCTs are needed to draw reliable conclusions on the clinical effectiveness of sealants in primary and permanent teeth of children and adolescents.

Exploring Recent Decreases in First Molar Sealants among US Children

Analyses of National Health and Nutrition Examination Survey (NHANES) data suggested a significant decrease in sealant prevalence among children between 2011 to 2014 and 2015 to 2018. We explore whether this decrease could be associated with possible changes in 1) clinical sealant delivery, 2) dental materials (i.e., increased use of glass ionomer [GI] sealants resulting in an inability to detect sealant fragments that still provide preventive benefits or increased use of composite restorations leading to misclassifying sealants as restorations), and 3) examination sensitivity and specificity. We used NHANES data to estimate the prevalences of sealants, untreated caries, and restorations in ≥1 first permanent molar among children aged 7 to 10 y and used Medical Expenditure Panel Survey data to estimate the annual clinical delivery of sealants and fluoride treatments. We examined changes in outcomes between 2 periods (P < 0.05) controlling for selected sociodemographic characteristics. NHANES sealant examination quality was based on the reference examiner's replicate examinations. The adjusted prevalence of sealants decreased relatively by 27.5% (46.6% vs. 33.8%). Overall, untreated caries decreased. Untreated caries and restoration decreased among children without sealants. Annual clinical sealant delivery did not change, whereas fluoride treatment delivery increased. The decrease in sealant prevalence held when assessed for various age ranges and NHANES cycle combinations. While sealant examination specificity remained similar between the periods, sensitivity (weighted by the proportion of exams by each examiner) decreased relatively by 17.4% (0.92 vs. 0.76). These findings suggest that decreased sealant prevalence was not supported by decreased clinical sealant delivery nor increased use of composite restorations. Decreased examination sensitivity, which could be due to an increased use of GI sealants, could contribute to the decrease in sealant prevalence. The decrease in caries among children without sealants could suggest the increased use of GI sealants. However, we could not rule out that the decrease in caries could be attributable to increased fluoride treatment delivery.

The Assessment of Resin-Based Composite Sealants' Effectiveness in Arresting Non-Cavitated Dentin Carious Lesions (ICDAS 3)-A 12 Month Follow-Up Preliminary Study

Background and Objectives: The therapeutic management of carious lesions remains a significant focus for researchers, given their persistently high prevalence despite being largely preventable. This study aimed to compare the effectiveness of a composite resin-based sealant material in halting extended non-cavitated dentin carious lesions when used therapeutically versus preventively on caries-free teeth over a period of twelve months. Materials and Methods: out of the 236 children examined, 45 were excluded from the study due to non-compliance with the inclusion criteria. Thus, the study included 191 children aged 10-12 years, and 764 molars in total. Results: among these molars, 171 were caries-free (ICDAS II code 0), forming the Control group, while 180 molars were classified with an ICDAS II score of 3, forming the Study group. All molars were sealed and evaluated at 6- and 12-month follow-up intervals. Both intervals revealed statistically significant differences (p < 0.05) in sealant retention and carious lesion development between sound (ICDAS code 0) and decayed (ICDAS code 3) teeth. Conclusions: the findings did not support the effectiveness of sealants in halting non-cavitated dentin carious lesions classified as ICDAS II with code 3 compared to their preventive application in sound teeth classified as ICDAS II with code 0.

Detection of pit and fissure sealant microleakage using quantitative light-induced fluorescence technology: an in vitro study

This in vitro study aimed to evaluate the feasibility of quantitative light-induced fluorescence (QLF) technology for detecting the presence and severity of microleakage of pit and fissure sealants. The areas of interest (AOIs) were 160 pits and fissures of 40 extracted permanent teeth. Fluorescent images were acquired using a QLF device, and the maximum fluorescence loss ΔFmax of each AOI was analyzed. After staining and cross-sectioning of the teeth, histological dye penetration was scored on a scale of 0 to 3. The relationship between ΔFmax and microleakage depth was analyzed, and the areas under the curve (AUCs) were calculated. The │ΔFmax│ increased as microleakage depth increased. The ΔFmax values of microleakage areas showed a strong significant correlation with the histological scores of dye penetration (r = - 0.72, P = 0.001). AUC analysis showed a high diagnostic accuracy for microleakage depth (AUC = 0.83-0.91). The highest AUC of 0.91 was found when differentiating the outer half microleakage of the sealant (histological score 0 vs. 1-3). QLF technology is effective in assessing the presence and severity of microleakage, suggesting its potential for noninvasive detection and monitoring of sealant microleakage in clinical settings.

Micro-tensile bond strength of two pit and fissure sealants to intact enamel

Background

Sealing dental pits and fissures with resin-based sealants effectively prevents occlusal dental caries. The effectiveness of resin-based pit and fissure sealants relies on maintaining a strong bond between the sealant and the enamel.

Objective

This in-vitro study compared the micro-tensile bond strength (μTBS) of a conventional resin-based sealant (Clinpro™) and a hydrophilic resin-based sealant (Embrace™ WetBond™) when applied to intact, aprismatic human enamel.

Methods

Forty extracted permanent premolar and molar teeth were divided into two groups and paired by tightly approximating two buccal surfaces to create an artificial enamel groove (fissure). Fissure sealants (Clinpro™ and Embrace™ WetBond™) were applied to the artificial enamel 'grooves' in each group. The specimens were then cut into beams with a cross-sectional area of 1 mm2 and tested for the micro-tensile bond strength (μTBS). Fractured surfaces of samples were examined under a conventional microscope to identify the failure modes. Two specimens from each group were prepared and observed under a scanning electron microscope (SEM). Mann-Whitney U and Fischer-Freeman-Holton exact tests were used to test the statistical differences between the fissure sealants.

Results

The μTBS mean ± SD for Clinpro™ was 16.43 ± 7.08, and 10.57 ± 6.64 for Embrace™ WetBond™. There was a statistically significant difference in μTBS between Embrace™ WetBond™ and Clinpro™ (p < 0.001). There was no association between fissure sealant and failure modes (p = 0.922).

Conclusion

Clinpro™ showed higher μTBS to enamel than Embrace™ WetBond™. Further studies are needed to conclude the clinical effectiveness of these sealants.

Comparing the effectiveness of caries arrest by micro-operative treatment to operative treatment: A 2-year randomized controlled clinical trial

OBJECTIVES

To compare the effectiveness of caries arrest by micro-operative treatment (sealing) to operative treatment (flowable resin composite restoration) through a 2-year randomized controlled clinical trial.

MATERIALS AND METHODS

A prospective randomized controlled trial was conducted among 7-9-year-old children. At baseline, 630 subjects were screened and 92 children who had at least one carious lesion classified as ICDAS 3 on the pit and fissure of first permanent molar were included. Then they were randomly assigned to the sealant group (73 lesions) and the flowable resin composite group (76 lesions) to receive the corresponding intervention. Lesions status in each group was evaluated every 6 months up to 24 months. Clinical progression of dental caries and materials retention were the outcomes used for group comparisons at p-value < 0.05.

RESULTS

After 24 months, three lesions (4.1%) in the sealant group clinically progressed to dentin caries. No lesion in the flowable composite group was observed a progression. The results of Life-table survival analysis show that the cumulative caries arrest rate had no statistically significant difference between the two groups (p = 0.075). However, the cumulative retention rate was 57.5% in the sealant group and 92.1% in the flowable composite group, with significant differences (p < 0.001). The multilevel mixed model showed the sealant had higher risk of retention failure than the flowable composite (OR = 8.66, p < 0.001), while tooth position did not influence material retention (p = 0.083). In addition, the results of Fisher Exact test show that dentin lesions had more retention failure than enamel lesions in the sealant group (p = 0.026).

CONCLUSION

Although sealing microcavitated carious lesions of the first permanent molar achieved lower retention rate than resin composite restoration, both sealing and restoration effectively arrested caries progression for two years.

CLINICAL RELEVANCE

To preserving dental structure and delaying or eliminating the need for operative procedures, microcavitated carious lesion can be arrested by sealing.

TRIAL REGISTRATION

Registered at http://www.chictr.org.cn ; Feb 15th, 2020; No. ChiCTR2000029862.

Comparison of the Effect of Different Bonding Agents on the Microleakage of Two Hydrophilic Pit and Fissure Sealants: An Ex Vivo Study

Aim

To compare the impact of fifth- and seventh-generation bonding agents on the microleakage between Embrace WetBond sealants and Ionoseal.

Materials and methods

Forty extracted human premolar teeth were used for the study and grouped according to different sealants and bonding agents-group I: Embrace WetBond sealant with fifth-generation bonding agent; group II: Embrace WetBond sealant with seventh-generation bonding agent; group III: Ionoseal with fifth-generation bonding agent; group IV: Ionoseal with seventh-generation bonding agent. For microleakage evaluation, all the teeth were subjected to invasive sealant placement using the respective sealant materials in combination with bonding agents as specified. The treated teeth were stored at 37°C for 24 hours and then thermocycled for 100 cycles at temperatures of 5°C and 55°C with a dwell time of 30 seconds. In order to assess microleakage, the samples were immersed in 0.2% methylene blue dye for 24 hours, then sectioned in buccolingual direction, and evaluated under stereomicroscope.

Results

The mean microleakage scores in group III were highest at 0.90 ± 0.57, while the least was in group IV at 0.30 ± 0.68, indicating that Ionoseal with seventh-generation bonding agent was the most effective. However, when the mean microleakage scores of the four groups were compared using Kruskal-Wallis test, it indicated that the differences were not statistically significant.

How to cite this article

V R, P P, A A, et al. Comparison of the Effect of Different Bonding Agents on the Microleakage of Two Hydrophilic Pit and Fissure Sealants: An Ex Vivo Study. Int J Clin Pediatr Dent 2024;17(3):270-273.

The effect of preprocedural mouthrinses against COVID-19 before acid etching on the microleakage of a resin-based sealant in permanent molars: An in vitro experimental study

Aim

To determine whether rinsing with preprocedural mouthrinses against coronavirus disease before acid etching affects resin-based sealant microleakage.

Materials and Methods

A presented in vitro experimental study was performed on 15 extracted permanent third molars. Samples were randomly allocated into five groups: Group 1-distilled water (control); Group 2-1% hydrogen peroxide; Group 3-1.5% hydrogen peroxide; Group 4-0.5% povidone-iodine; and Group 5-1% povidone-iodine. After the teeth were immersed in the assigned mouth rinses for 60 s, they were sealed with Concise™ white sealant. Subsequently, the teeth were thermocycled for 500 cycles, immersed in 2% methylene blue solution for 24 h, and sectioned with two parallel cuts in the buccolingual direction. Sixty surfaces (12 surfaces in each group) were examined for microleakage under a 40× light microscope and scored as described by Zyskind et al. Welch's one-way analysis of variance test and the Games-Howell test were used to analyze the results at a significance level of P < 0.05 for all tests.

Results

The intergroup comparisons indicated that the 0.5% povidone-iodine group and the 1% povidone-iodine group had significantly higher microleakage compared with the control group. The 1% and 1.5% hydrogen peroxide groups demonstrated no significant difference in mean microleakage scores compared with the control group. There was no significant difference between the povidone groups and the hydrogen peroxide groups.

Conclusions

Preprocedural rinsing with 0.5% and 1% povidone-iodine before acid etching caused higher microleakage of resin-based sealant, while hydrogen peroxide rinsing gave comparable microleakage compared with the control group.

Influence of incorporation of nanostructured silver vanadate decorated with silver nanoparticles on roughness, microhardness, and color change of pit and fissure sealants

Objective

The aim of this study was to evaluate the roughness, hardness, and color change of pit and fissure sealants of two commercial brands (Fluroshield ™ and Ultraseal XT ™) incorporated with nanostructured silver vanadate nanomaterial decorated with silver nanoparticles (β-AgVO3) in concentrations (0% - control, 2.5% and 5%).

Material and methods

Two commercial brands Fluroshield TM and Ultraseal XT ™ were used to make the samples with dimensions of 6 × 6 × 4 mm. The control group was made according to the manufacturer's instructions and in the groups with the addition of β-AgVO3, the nanomaterial was added proportionally by mass at percentages of 2.5% and 5%. Roughness properties were evaluated using a 3D Laser Confocal Microscope (n = 10), Knoop microhardness by Microdurometer (n = 10), and color change by Portable Color Spectrophotometer on the CIEDE2000 system (n = 10). Data were evaluated by one-way ANOVA with Bonferroni adjustment and Tukey's mean comparison test at a 5% significance level.

Results

Ultraseal XT ™ sealant roughness showed a significant difference between concentrations with the highest mean for the 5% group (P = 0.010). Regarding the hardness, both sealants showed no significant difference between the groups. Fluroshield ™ sealant showed a significant difference in ΔE00 between the control-2.5% 24.93 (3.49) and control-5% 28.41 (2.58).

Conclusion

It may be concluded that the incorporation of β-AgVO3 influenced the increase in roughness for Ultraseal XT ™ pit and fissure sealant, did not interfere with the microhardness of both sealants, and promoted a change in the color of Fluroshield ™ sealant within clinically acceptable limits.

Is there an acceptable surrogate for caries clinical trials? Evidence from a systematic review of primary studies

BACKGROUND

There is currently a lack of evidence supporting the use of valid surrogates in caries clinical trials. This study aimed at examining the validity of two surrogate outcomes used in randomized clinical trials for caries prevention, pit and fissure sealants and fluoridated dentifrices, according to the Prentice criteria.

METHODS

A systematic review was conducted in MEDLINE (PubMed), LILACS and Scopus databases up to 05 October 2022. The grey literature and the list of eligible studies' references were also screened. The search was conducted, selecting randomized clinical trials focussed on dental caries prevention using pit and fissure sealants or fluoridated dentifrices and with at least one surrogate endpoint for cavitated caries lesions. The risk of each surrogate endpoint and for the occurrence of cavitated caries lesions was calculated and compared. The association between each surrogate and the presence of cavitation was quantified, and each outcome was assessed graphically for validity according to the Prentice criteria.

RESULTS

For pit and fissure sealants, from 1696 potentially eligible studies, 51 were included; while for fluoridated dentifrices, of 3887 potentially eligible studies, four were included. Possible surrogates assessed were retention of sealants, presence of white spot lesions, presence of plaque or marginal discoloration around the sealants, oral hygiene index, radiographic and fluorescence caries lesion assessments. However, only the retention of sealants and the presence of white spot lesions could be evaluated for their validity according to the Prentice criteria.

CONCLUSION

Loss of retention of sealants and the presence of white spot lesions do not fulfil all of the Prentice criteria. Therefore, they cannot be considered valid surrogates for caries prevention.

Oral health knowledge, attitude, and performance of teachers and healthcare workers in special schools for the disabled children in Isfahan

Oral health is an important aspect of general health, and is of great importance, especially in disabled children. A school is an ideal place for the implementation of preventive programs. Considering the significance of the prevention of dental caries and periodontal disease in disabled children, and the important role of teachers in the oral health promotion of students, this study aimed to assess the oral health knowledge, attitude, and performance of teachers and healthcare workers in special schools for the disabled children in Isfahan. This descriptive-analytical study evaluated the oral health knowledge, attitude, and performance of 172 teachers and healthcare workers of special schools for disabled children in Isfahan using a questionnaire. The participants were selected using census sampling. Quantitative and qualitative data were analyzed using SPSS via the Chi-square test, t-test, and Pearson's correlation coefficient at P < 0.05 level of significance. The mean score of knowledge and attitude of teachers was 72.2% and 80.5%, respectively. The mean score of knowledge of healthcare workers was significantly higher than that of teachers (P = 0.007). Age had no significant correlation with the knowledge score (P = 0.41) but was significantly correlated with the attitude score (P = 0.01). Work experience had a significant correlation with the knowledge (P = 0.02) and attitude (P = 0.005) scores. In addition, the educational level had a significant correlation with the knowledge (P < 0.001) and attitude (P = 0.007) scores. The findings of this research showed that work experience had a significant correlation with the knowledge and attitude scores, which can be due to more contact of teachers with longer work experience with disabled children and their higher perception of hygienic needs and problems of these children.

Evaluation of the effectiveness of prophylactic sealing of pits and fissures of permanent teeth with fissure sealants - umbrella review

BACKGROUND

Tooth decay is an infectious disease which, in its initial phase, leads to the formation of cavities in the teeth through decalcification of the enamel and local tissue destruction. In addition to proper oral hygiene, prophylactic sealing of fissures and cavities with a sealant is a method of preventing the development of caries. The aim of this study is to summarise the effectiveness of fissure sealing of permanent teeth with fissure sealants compared to other preventive methods or no intervention.

METHOD

An umbrella review was carried out to achieve the purpose of our study. Searches were performed in Medline (via PubMed), Embase (via OVID), and Cochrane Library databases. Quality assessment of the included studies was performed using the AMSTAR2 tool. In addition, a manual search for recommendations/clinical practice guidelines on dental prophylaxis was performed.

RESULTS

204 publications were identified, of which 15 met the inclusion criteria. Based on the results of 3 systematic reviews, there was a statistically significant reduced odds of caries occurrence or development with prophylactic sealing of permanent teeth compared with no intervention - depending on the review and follow-up period odds ratio (OR) ranged from 0.06 [95%CI: (0.01-0.32)] to 0.28 [95%CI: (0.20-0.38)]. In the eight systematic reviews that analysed different sealants, there were no statistically significant differences between the types of materials used for prophylactic tooth sealing. For systematic reviews comparing the efficacy of fissure sealants with fluoride varnish, three reported no statistically significant difference in the efficacy of caries incidence, with only one systematic review based on 1 RCT finding a statistically significant difference in favour of fissure sealants.

CONCLUSION

Compared to the no intervention, dental sealing is an effective method for the prevention of dental caries. However, it is not possible to conclude conclusively which type of sealant and which of the available prophylactic methods is more effective in preventing caries.

The Impact of Minimal Intervention Dentistry on Patient-Reported and Observation-Based Outcomes in the Pediatric Population: A Systematic Review and Meta-Analysis

This review aimed to systematically investigate the effect of minimal intervention dentistry on patient-reported and observation-based outcomes of anxiety, pain and patient cooperation in the pediatric population. Microinvasive treatments (MITs) were compared to conventional treatments, home-based and professionally applied non-invasive treatments (NITs), and between MITs. Two reviewers independently screened studies from four electronic databases, extracted data, assessed the risk of bias and certainty of evidence with the GRADE approach. Ultimately, 26 studies were included for qualitative synthesis, with the data from 12 studies being incorporated into the meta-analysis. No statistically significantly differences in terms of anxiety were noted between MITs and conventional treatments, or between MITs from the meta-analyses. The treatment durations of MITs were not necessarily shorter than conventional treatments but varied with the use of local anesthesia, behavioral and clinical approach, and other confounding factors. The certainties of evidence were deemed low due to high risk of bias of the included studies. NITs evoked less anxiety and pain compared to MITs. Minimal intervention dentistry is an alternative treatment to manage dental caries among children and does not arouse different levels of dental anxiety and pain compared to other treatment modalities. However, further well-designed studies are required to draw an evidence-based conclusion.

Application Study of Novel Eggshell/Ag Combined with Pit and Fissure Sealants

Objective

The study aims to enhance the anti-caries performance of pit and fissure sealants through the synthesis of novel silver nanocomposites, and to evaluate their mechanical properties and biological safety in vitro and in vivo.

Methods

The antibacterial properties of synthetic eggshell/Ag were detected by bacterial inhibition zone, minimum bacteriostatic concentration, fluorescence staining and scanning electron microscopy. The synthetic products were then combined with pit and fissure sealants to prepare specimens, and their effects on mechanical properties, antibacterial properties and cytotoxicity were evaluated. Furthermore, an oral mucosal contact model of golden hamsters was established according to the ISO10933 standard to evaluate local stimulation and systemic effects.

Results

The novel nanocomposite eggshell/Ag was confirmed to exhibit strong broad-spectrum antibacterial activity, and that the eggshell/Ag-modified pit and fissure sealant had strong antibacterial properties against common dental caries bacterial biofilms, without any significant change in mechanical properties. The gradient dilution extract showed acceptable cytotoxicity, and in the golden hamster oral contact model, there were no visible abnormalities in local mucosal tissues, blood indices, or liver and kidney histopathology.

Conclusions

These findings suggest that eggshell/Ag combined with pit and fissure sealants has strong antibacterial activity and excellent biosafety in vitro and in vivo, making it a promising candidate for clinical applications.

Effectiveness of non-operative approaches in active enamel carious lesions: a retrospective longitudinal study

The aim of the study was to investigate the effectiveness of non-invasive and micro-invasive treatments in active enamel carious lesions in high-caries-risk children. Clinical records of children treated in a dental school setting were retrospectively screened for active enamel carious lesions treated non-invasively (topical fluoride applications, oral hygiene instruction, or dietary guidance) or micro-invasively (sealant). The control of active carious lesions was set as the main outcome established by the combination of inactivation and non-progression of the lesions based on Nyvad and ICDAS criteria, respectively. Individual and clinical factors associated with the outcome were analyzed by Poisson regression. The sample consisted of 105 high-caries-risk children with a mean age of 8.3 (± 2.4) years. From a total of 365 active enamel carious lesions, most lesions (84.1%) were active non-cavitated carious lesions (ICDAS scores 1 and 2) and only 15.9% presented localized enamel breakdown (ICDAS score 3). Of these, 72.6% were inactivated and 92.1% did not progress (mean time of 6.5 ± 4.1 months). The prevalence of controlled carious lesions was higher among children older than 6 years (PR:1.43; 95%CI:1.00-2.03; p = 0.04) and in those with better biofilm control (PR:0.99; 95%CI: 0.98-0.99; p = 0.03). Non-operative approaches are effective for controlling active enamel carious lesions. The majority of active enamel carious lesions became inactive and did not progress after treatment. Caries control was associated with older children and better biofilm control.

The revolutionary evolution in carious lesion management

Contemporary paradigms of dental caries management focus on the biological approaches to treating the disease and its principal symptom, the carious lesion. This narrative review traces the evolution of carious lesion management from the operative and invasive approaches of G. V. Black's era to the current period of minimally invasive biological approaches. The paper explains the rationale for adopting biological approaches to dental caries management and lists the five core principles of this management approach. The paper also details the aims, features, and the most recent evidence base for the different biological carious lesion management approaches. Based on current practice guidelines, collated clinical pathways for lesion management are also presented in the paper to aid clinicians in their decision-making. It is hoped that the biological rationale and evidence summarized in this paper will bolster the shift to modern biological carious lesion management approaches among dental practitioners.

Assessment of the Quality of Current American Dental Association Clinical Practice Guidelines

INTRODUCTION

The American Dental Association (ADA) defines evidence-based dentistry (EBD) as "an approach to oral healthcare that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences." Clinical practice guidelines (CPGs) are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. Therefore, ADA CPGs are the most rigorous examples of EBD to inform clinical practice. CPGs should be of the highest level of quality to ensure the appropriateness and timeliness of clinical recommendations.

OBJECTIVES

The aim of this study was to measure the methodological rigor and transparency of the ADA CPGs.

METHODS

Each ADA CPG was appraised by 4 independent assessors using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Quantitative quality scores were obtained for 6 domains and overall quality. In addition, assessors provided a qualitative analysis by providing comments for each item and an appraisal of the full recommendation.

RESULTS

A quality score of 75% was used as the threshold for high-quality guidelines. Using this metric, 6 of the current 10 current ADA CPGs were considered to be of high quality, 1 was slightly below the quality threshold, and 3 were considered marginal. Even among those evaluated to be high quality in overall assessment, certain domains did not reach the quality threshold of 75%.

CONCLUSION

Overall, the ADA CPGs collectively provide high-quality guidance for the clinician. While the AGREE appraisal guidelines have been used in CPG development since 2016, there is still room for improvement in certain domains (i.e., stakeholder involvement, rigor of development, applicability, and editorial independence).

KNOWLEDGE TRANSFER STATEMENT

The results of this study summarize the methodological rigor and transparency of the 10 current ADA clinical practice guidelines. Since adoption of AGREE standards (2016), CPGs have been uniformly of high quality. The quality of older CPGs was somewhat lower but overall deemed acceptable. Thus, ADA CPGs may be used with confidence to inform practitioners of treatment options supported by rigorous evidence-based dentistry standards. However, there is still room for improvement in methodological quality.

Dental caries status and its associated factors among schoolchildren aged 6-8 years in Hangzhou, China: a cross-sectional study

BACKGROUND

Dental caries prevalence reaches the first peak around 6 years old. It is necessary to take effective measures to prevent and treat caries at this stage. This study investigated the prevalence and associated factors of dental caries among schoolchildren aged 6-8 years in Hangzhou City, China.

METHODS

A cross-sectional survey was conducted in Hangzhou from October 2017 to May 2018. Oral health status of schoolchildren in 1st and 2nd grades of primary schools aged 6-8 years was examined by well-trained examiners according to the WHO criteria. Questionnaires about potential caries-related factors were distributed to their parents. ANOVA test and logistic regression were conducted for the statistical analyses (α = 0.05).

RESULTS

A total of 7959 pairs of schoolchildren and their parents were invited to participate, and 5595 were included in this study according to the eligible criteria (response rate: 70.3%). The overall prevalence and mean dmft/DMFT of dental caries in the investigated schoolchildren were 52.78% and 2.11. The prevalence and mean dmft/DMFT were 39.05% and 1.63 in the deciduous teeth, while these were 21.45% and 0.48 in the permanent teeth, respectively. For the first permanent molars (FPMs), the rate of fully eruption and pit and fissure sealing (PFS) were 79.09% and 6.60%, respectively. Multiple logistic regression showed that girl (OR = 1.12, 95% CI 1.01-1.25, p < 0.05), seldom or never brush teeth (OR = 2.36, 95% CI 1.08-5.44, p < 0.05), consuming sweet food or drink once or more time a day (OR = 1.14, 95% CI 1.00-1.29, p < 0.05; OR = 1.21, 95% CI 1.07-1.36, p < 0.05), dental visit experiences (OR = 1.58, 95% CI 1.35-1.86, p < 0.001) were positively and no tooth pain in the past 12 months (OR = 0.55, 95% CI 0.38-0.80, p < 0.05) were negatively associated with caries.

CONCLUSIONS

Dental caries was prevalent among schoolchildren aged 6-8 years in Hangzhou, and was associated with gender, frequency of toothbrushing, sweet food or drink consuming, tooth pain and dental visit experiences. A large number of fully erupted FPMs did not receive timely PFS.

In-vivo durability of Pro Seal in patients with fixed orthodontic appliances: A controlled clinical trial

BACKGROUND

This clinical trial aimed at studying the durability of an orthodontic sealant (Pro Seal) used on tooth surfaces for protection against white spot lesions.

METHODS

A total of 35 patients (18 females, 17 males; 17.57 ± 1.36 years) were recruited. Eligibility criteria included healthy patients of both sexes (age > 14 years), absence of labial caries, absence of defective enamel, absence of extensive restorations, and optimum oral hygiene. The participants received a single application of Pro Seal on the bonded teeth. The sealant covered the labial enamel surrounding the brackets. Participants were recalled monthly after sealant application, during which sealant layers were evaluated using an ultraviolet lamp. The assessment was realized using an index similar to the adhesive remnant index (ARI).

RESULTS

A total of 30 participants completed the trial. ARI values dropped significantly (P < 0.001) and reached <1.5 at T₁ on the index used. An ARI value of 2 was chosen as the threshold below which a tooth presented an insufficient sealant layer. The right and left sides of both jaws did not show any statistically significant difference (P > 0.05). ARI values of homolateral teeth revealed few statistically significant differences between upper and lower teeth. No statistically significant difference between the two sexes (P > 0.05) existed. No harm or disturbance was reported by any of the participants.

CONCLUSIONS

This study demonstrated that a single application of Pro Seal is effective for 4 weeks and should be renewed monthly. No interjaw, intrajaw, or intersex significant differences were found.

In vitro evaluation of fissure sealants' wear under erosive, abrasive and erosive/abrasive conditions

PURPOSE

To evaluate and compare the wear of selected resin-based fissure sealants with different compositions properties under erosive, abrasive, and erosive/abrasive conditions.

METHODS

Forty-five samples of the following resin-based fissure sealants were prepared: Fissurit (fluoride free), Fissurit F (with fluoride), Fissurit FX (55 wt.% filler content), Grandio Seal (70 wt.% nano-filler content) and bovine enamel. Fifteen samples from each material were randomly allocated into three groups according to the wear condition they would be subjected to as follows: erosive condition (citric acid, 1 min, pH 2.3), abrasive condition (120 brushing strokes at 2 N, toothpaste slurry RDA value = 69), and erosive/abrasive condition (combination of both). The wear challenges were repeated six times each day for 10 days. The material wear was measured using a stylus profilometer. Kruskal-Wallis and Conover's test was applied to compare the resulting material wear between the groups.

RESULTS

Under erosive conditions, Grandio Seal and Fissurit FX showed statistically significantly the least material wear. Under abrasive and erosive/abrasive conditions, Grandio Seal showed statistically significantly the least material wear. Fissurit F showed statistically significantly the highest material wear under abrasive and erosive/abrasive conditions, after dental enamel (p < 0.05).

CONCLUSION

Higher filler content in sealants leads to better wear resistance. Incorporating fluoride into sealants seems to reduce their wear resistance at similar filler contents.

"The pediatric dentist is different": A qualitative study of young children's caregivers' experiences of oral health care in the Galapagos Islands

BACKGROUND

Little is known about factors influencing children's access to and use of oral healthcare services in the Galapagos Islands, a resource-limited setting.

AIM

We sought to understand caregivers' experiences and factors influencing their children's use of dental services on San Cristobal Island in the Galapagos Archipelago.

DESIGN

A community-based qualitative interview study was carried out among 25 caregivers of children aged 6 months to 10 years. Participants were recruited via a random walk door-to-door approach in 10 neighborhoods, and interviews were conducted by a trained research assistant who is native of the Galapagos Islands. We employed a grounded theory-based qualitative data analysis based on inductive coding to identify and report major emerging themes and illustrative participant quotes.

RESULTS

Two major themes emerged related to children's oral health care. Participants expressed their preference for care provided by paediatric versus general dentists and recognized the important role of school-based dental care programs, acknowledging their strengths and weaknesses.

CONCLUSIONS

Participants' lived experiences were informative and helped improve our understanding of factors influencing children's use of dental services in the Galapagos Islands. Above and beyond their local relevance, these themes and insights are likely applicable to other global communities that experience similar barriers of access to oral healthcare services.

A concise review of dental sealants in caries management

This concise review provides an update of the use of dental sealants. Dental sealants protect a tooth from caries development by providing a physical barrier to microorganism colonisation and creating a favorable environment for patients to clean. Some sealants release fluoride ions to promote remineralization. Dental sealants can be applied on pits and fissures of primary and permanent teeth to prevent and arrest early enamel caries. They are effective in caries prevention. The preventive fraction of resin sealant is up to 61% after 5 years. Dental sealants can be classified as resin, glass ionomer and hybrid (compomer or giomer) according to the material. Recent studies from 2012 to 2022 showed resin sealant has a high retention rate of up to 80% after 2 years, whereas glass ionomer sealants is 44%. Chemical etching with 37% phosphoric acid is the standard of care, whereas laser or air-abrasion cannot does not increase the sealant retention rate. Moist control is critical and studies found the use of rubber dam and cotton rolls had similar success for sealant retention. The longevity of dental sealant is also associated with clinical operative factors, including approaches of moisture control, enamel pretreatment, selection of dental adhesive, and time of acid etching.

A novel application of a bioactive material as a pit and fissure sealant: in vitro pilot study evaluating the sealing ability and penetration

PURPOSE

To compare the sealing ability and penetration of a bioactive material used as pit and fissure sealant to those of glass ionomer sealant.

METHODS

This was an in vitro experimental study conducted on 20 permanent teeth. For Group I of ten teeth, ACTIVA BioACTIVE-Base/Liner was applied as a sealant on pits and fissures, and the remaining ten teeth of Group II were sealed using glass ionomer cement. After thermocycling, the apex of the teeth was sealed using composite resin and they were immersed in 1% methylene blue solution, buffered at pH 7 for 24 h. Longitudinal sections were obtained from each tooth for evaluating the sealing ability and penetration, using a binocular light microscope at 4 × magnification. The obtained data were subjected to analysis using the Chi-square test and independent t test.

RESULTS

The comparison of the sealing ability and sealant penetration, between the two groups, showed statistically no significant difference (p = 0.104 and p = 1.0, respectively).

CONCLUSION

Bioactive material as a pit and fissure sealant, performed on par with glass ionomer sealant in terms of tested properties like sealing ability and penetration.

COVID-19 Pandemic Impact on US Childhood Caries and Potential Mitigation

Non-Hispanic Black (NHB) and Hispanic and low-income US children have a higher prevalence of untreated caries than their higher-income and non-Hispanic White (NHW) counterparts. Due to the COVID-19 pandemic, many dental offices and school sealant programs closed beginning March 2020. We examine the effect of reduced access to restorative care and sealants on the oral health of children from low-income households overall and by race/ethnicity and how increased sealant delivery in September 2022 could mitigate these effects. We used Markov chain Monte Carlo simulation to model COVID-19's impact on first permanent molar (1M) caries incidence and loss in quality of life (disability-adjusted life years [DALYs]) due to time lived with 1M untreated caries. Our model followed a cohort of children aged 7 y in March 2020 until February 2024. Model inputs were primarily obtained from published studies and nationally representative data. Excess DALYs per 1,000 children attributable to reduced access to care during the pandemic were 1.48 overall and greater for Hispanic (2.07) and NHB (1.75) children than for NHW children (0.94). Excess incidence of 1M caries over 4 y was 2.28 percentage points overall and greater for Hispanic (2.63) and NHB (2.40) children than for NHW (1.96) children. Delivering sealants to 50% of eligible 1Ms in September 2022 would not completely mitigate COVID-19's health access impact: overall excess DALYs would decrease to 1.05, and absolute disparities in excess DALYs between NHW children and Hispanic and NHB children would remain but decrease by 0.38 and 0.33, respectively. Sealing 40% of eligible 1Ms, however, would bring overall 4-y caries incidence down to pre-COVID-19 levels and eliminate the differential effect of the pandemic on children from minority groups. The pandemic's negative impact on the oral health of children from low-income households and increased disparities could be partially mitigated with increased sealant delivery.

Oral Hygiene Habits and Use of Fluoride in Developmental Age: Role of Parents and Impact on their Children

Introduction

In healthcare, the need to pay more attention to the achievement of two objectives within the society arises: health promotion and prevention in terms of nutrition, good education, sport, and health education. Scientific evidence shows that adequate health standards must be learned since childhood through the help of parents and appropriate school projects. Parental intervention must be appropriate to support the responsibility of their children's health. In oral health, it has been established for many years that there is a correlation between parental behaviors and lifestyles and children's attitude. The aim of this study is to verify the close relation between behaviors, habits, lifestyles, and the knowledge of parents about their oral health and, consequently, their focus and care for their own children's oral health. Furthermore, the awareness of parents about the importance and use of fluorine was to be determined.

Materials and Methods

The study lasted 15 months and was conducted from April 2018 to July 2019: an anonymous 29-question questionnaire was administered to all parents who accompanied their children (aged between 3 and 12 years) going under treatment in the Pediatric Dentistry Unit of the University Hospital Policlinico Umberto I, Rome. Anamnestic data, sociodemographic context (e.g., educational level and occupation), oral health habits, and prevention of parents and children and fluoride knowledge were investigated. The study received ethical approval. 204 questionnaires were collected. The data gathered were recorded with a specifically designed computer program and collected and analyzed using a Microsoft Excel 10 database. Data were evaluated using standard statistical analysis software; descriptive statistics including mean ± SD values and percentage were calculated for each variable. The relationship between the age of parents, between mother or father and the parents' degree of education levels, and the knowledge for their own children's oral health was explored using the chi-square test of homogeneity and Fisher's exact test (P value of < 0.05 considered as statistically significant).

Results

From the acquired data, it is possible to deduce that the major respondents were mothers aged from 36 to 45, while only a small part were fathers aged above 45 years. Questions related to parents' oral hygiene habits were included in the questionnaire, and from the sample taken into consideration, it emerges that 64.7% of the respondents (67.1% mothers and 57.7% fathers) periodically attend a dental office for a checkup, 20.9% tend to postpone the treatment, and 15.2% go there just for emergency. Some of the questions showed that 80% of the interviewed subjects use fluoride toothpaste for their child's oral hygiene.

Conclusion

Prevention in childhood, in addition to being synonymous with monitoring the oral health of the child, means first of all to pay attention to parents who are the main behavioral reference. It emerged that there is no adequate knowledge about fluorine, especially when the subjects have a low educational level. A role of fundamental importance for the diffusion of adequate concepts in the field of oral hygiene is covered, according to the data received from the study carried out, by the dentist and dental hygienist.

Penetration and Adaptation of the Highly Viscous Zinc-Reinforced Glass Ionomer Cement on Contaminated Fissures: An In Vitro Study with SEM Analysis

Objective: To evaluate the penetration and adaptation of highly viscous zinc-reinforced glass ionomer cement (ZRGIC), using a scanning electron microscope (SEM), when applied under various contaminated conditions on grooves and fissures of primary second molars. Materials and Methods: A total of 40 extracted human primary second molars were randomly assigned into five groups (8 teeth each), with different surface conditions (conditioned with 40% polyacrylic acid, dry condition, water contamination, saliva contamination, or saliva contamination and air-drying) on the occlusal surface before placement of zinc-reinforced highly viscous glass ionomer cement with the finger-press technique. After sectioning the teeth, they were subjected to SEM analysis, where four in each group underwent aging by thermocycling and the other four were without aging. ANOVA tests, post hoc analysis, and unpaired t-tests were used for statistical analyses. Results: There was a significant statistical difference in the sealant penetration in the non-aging group, but in the aging group, there was no significant statistical difference in the sealant penetration. On other hand, a significant statistical difference was found in the adaptation between all the groups (p < 0.05). Highly viscous zinc-reinforced glass ionomer fissure sealants have better fissure penetration and more intimate adaptation under fissures conditioned with 40% polyacrylic acid and dry surface fissures with no contamination. However, the best penetration and retention after aging were under contaminated fissures with a shiny layer of saliva. Conclusions: The ZRGIC is a highly viscous fluoride-releasing cement, effectively seals fissures by interfering with food lodgment and protecting teeth from caries. It is advisable to restore the fissures with the minimal technique of sensitive fluoride-releasing GIC, particularly in young, uncooperative children, rather than leaving a caries-prone environment.

Comparative Assessment of Retention and Caries Protective Effectiveness of a Hydrophilic and a Conventional Sealant-A Clinical Trial

Sealants are highly efficient and the most secure method for the prevention of caries lesions from pits and fissures in recently erupted permanent teeth. The aim of this study is to clinically assess and compare the retention and evolution of caries of a moisture-tolerant resin-based sealant with a conventional hydrophobic resin-based sealant. Material and method: We have included in the study 28 children with between 6 and 8 years old. For each child we sealed 4 permanent molars (a total of 112 teeth). The study group was divided into two subgroups: the Embrace Group—consisting of 56 first permanent molars that underwent dental sealing with moisture-tolerant resin-based fissure sealant (Embrace™ WetBond™ Pulpdent, Watertown, MA, USA) and the Helioseal Group—represented by the same number of 56 first permanent molars that were sealed with conventional hydrophobic resin-based sealant (Helioseal F™, Ivoclar Vivadent Schaan, Liechtenstein). The retention and the incidence of new carious lesions of each sealant were assessed clinically at 6, 12, 18, and 24 months. Results: The 12-month follow-up assessment showed perfect integrity in 50 molars (89.28%) sealed with moisture-tolerant resin-based material (Embrace Group), and in 51 molars (91.07%) with conventional resin-based sealant (Helioseal Group). At the 24-month recall, the retention was maintained in 44 molars (78.57%) in the Embrace Group and in 45 molars (80.35%) in the Helioseal Group, respectively. The follow-up assessments showed no statistically significant differences (p > 0.5) between the two materials regarding sealant retention. First evidence of new carious lesions was present at 12 months on two molars sealed with Embrace WetBond and on one molar sealed with Helioseal. At the 24-month evaluation, the prevalence of caries in the Embrace Group was 7.14% (four caries) and 3.56% (two caries) in the Helioseal Group. Moreover, there were no statistically significant differences (p > 0.05) between the two materials regarding new caries development at any of the follow-up assessments. Conclusions: Moisture-tolerant resin-based sealant was effective in terms of retention and caries prevention.

Caries Management in Special Care Dentistry

The objective of this article is to provide a summary of the current evidence-based recommendations for caries management in patients with special health care needs (SHCNs). Considerations regarding caries risk assessment and preventive measures are also discussed with the goal of helping clinicians to manage the caries disease process using a person-centered approach and risk-based interventions. Importantly, most of the evidence is still based on the general population, because the evidence for those with SHCNs is still limited.

Risk factors for and prevention of caries and dental erosion in children and adolescents with asthma

There are many studies and reviews of the relationship between the asthma disease in young individuals on the one hand and caries and dental erosion on the other. The causes of caries and dental erosion might be related to the asthmatic drugs, low pH and the sweeteners that the inhaled drug contains and perhaps even the lifestyle of children and adolescents with asthma. The main focus of this review is therefore to describe various preventive strategies, based on long experience of preventive dental care in Sweden. Two fact boxes are presented, one on fluoride toothpaste as a population-based intervention for different ages and one on diet counselling in children and adolescents with asthma. The most important thing is to introduce fluoride toothpaste early in the child's life and that the parents brush the child's teeth twice a day, in the morning after breakfast and at night before bedtime, up to the age of 10. Moreover, a high-risk approach with an additional fluoride supply at home is presented, together with the application of fluoride varnish at the clinic. Regarding diet counselling, it is important to make sure that the child has regular meals during the day, maximum five to six times a day, to allow the teeth to rest between meals and restrict sweets and soft drinks to once a week. It is important to identify children and adolescents with asthma as early as possible and to refer them to a dental team for preventive treatment.

Effectiveness of the ICCMS caries management system for children: a 3-year multicentre randomised controlled trial

OBJECTIVE

This 3-year multicentre randomised controlled trial compared, in 6-7-year-old Colombian children, the effectiveness of the ICCMS (International Caries Classification and Management System) with a conventional caries-management system (CCMS) in terms of individual caries-risk, caries lesions, and secondarily, oral-health-related knowledge/attitudes/practices, and number of appointments.

MATERIAL AND METHODS

With ethical approval, 240 6-7-year olds from six Colombian clinics were recruited. Trained examiners conducted the following baseline/follow-up assessments: Caries risk (Cariogram-ICCMS); caries severity/activity staging (ICDAS-merged combined radiographic/visual); sealants/fillings/missing teeth, and oral-health-related knowledge, attitudes and practices. Children received their randomly allocated (ICCMS/CCMS) care from dental practitioners. Outcomes: caries-risk control (children); caries-progression control (tooth surfaces); oral-health-related knowledge/attitudes/practices improvement (parents/children), and appointments' number (children). Descriptive and non-parametric/parametric bivariate analyses were performed.

RESULTS

Three-year-follow-up: n = 187 (77.9%; ICCMS: n = 92; CCMS: n = 95) disclosed a baseline-to-3-year overall high-caries-risk children decrease (ICCMS: 60.9-0%, p < .001; CCMS: 54.7-5.3%, p < .001) (p > .05). ICCMS versus CCMS showed: fewer tooth-surface caries progression (6.2% vs 7.1%, p = .010) and fewer active-caries lesions (49.8% vs. 59.1%, p < .05); higher proportion of children with ≥2/day fluoride-toothpaste tooth-brushing practice (p < .05); similar mean number of appointments (10.9 ± 5.9 vs. 10.0 ± 3.8, p = .15).

CONCLUSION

Both caries-management systems showed similar effectiveness in caries-risk control, with ICCMS more effectively controlling tooth-surface caries progression and improving toothbrushing practices.

Minimally Invasive Therapies for the Management of Dental Caries—A Literature Review

In recent years, due to a better understanding of the caries pathology and advances in dental materials, the utilization of non-invasive and minimally invasive techniques that delay/obviate the need for traditional restorations has started gaining momentum. This literature review focuses on some of these approaches, including fluoride varnish, silver diamine fluoride, resin sealants, resin infiltration, chemomechanical caries removal and atraumatic restorative treatment, in the context of their chemistries, indications for use, clinical efficacy, factors determining efficacy and limitations. Additionally, we discuss strategies currently being explored to enhance the antimicrobial properties of these treatment modalities to expand the scope of their application.

Sealant Utilization and its Influence on Caries Reduction in First Permanent Molars in Saudi Female School Children

Purpose:

This study aimed to assess the utilization of fissure sealants and their influence on caries reduction in first permanent molars (FPMs) among 6-9 years old female schoolchildren in Dammam, Eastern Province of Saudi Arabia.

Materials and Methods:

First to fourth grade female children from public schools in Dammam participated in this cross-sectional study. Dental caries and fissure sealants in FPMs were examined clinically using the World Health Organization guidelines. In addition, the parents of the participants responded to a self-reported questionnaire.

Results:

The study analyzed the data of 449 children. Almost 44.3% of the participants had at least one FPM affected with caries. There were 8.7% of the participants who had fissure sealants in at least one FPM, and out of these, only 2.2% had four FPMs filled with sealants. A significantly greater proportion of participants with sealed FPMs had no caries than the lower proportion of participants without sealants who had caries (P=<0.05). The use of sealants increased significantly from first grade (10.3%) to second grade (30.8%), third grade (38.5%), and fourth grade (20.5%) (P=0.006). High monthly family income (P= 0.047) and having insurance (P=0.017) were significantly associated with increased sealant application. Nearly 21.9% of participants’ parents were aware of caries protective effects of dental sealants.

Conclusion:

The application of sealants was significantly associated with reduced caries in FPMs. Class year, monthly family income, and insurance were significantly associated with having sealants. Caries prevention programs for children should incorporate sealant application.

The efficacy of dental sealant used with bonding agent on occlusal caries (ICDAS 2-4): A 24-month randomized clinical trial

BACKGROUND

Bonding before sealant application enhances retention on saliva-contaminated sound teeth; however, there are few studies of bonding's efficacy on sealant retention on occlusal caries.

AIM

To evaluate a bonding agent's efficacy on sealant retention on occlusal caries and caries transition.

DESIGN

One hundred twenty pairs of first permanent molars with occlusal caries (ICDAS 2-4) from 98 children aged 7.3-9.9 years were included. One molar was randomly selected to use bonding (Adper™ Single Bond 2, 3M ESPE) applied before sealant application (Helioseal^® clear, Ivoclar Vivadent). Bonding was not used on the contralateral tooth. Retention was determined using Simonsen's criteria; caries transition was evaluated using ICDAS scores, DIAGNOdent values, and bitewings at baseline, 6, 12, and 24 months. Data were analyzed with McNemar's and Fisher's exact tests.

RESULTS

Bonding agent use significantly increased sealant retention rates (P < .001). Bonded (B) sealants had a higher retention rate (83.3%) than non-bonded (NB) sealants (53.7%). The difference in the caries-transition rate was not significant between the groups (P > .05). Three teeth (1.4%; NB:B = 2:1) were restored due to radiographic dentin-caries progression.

CONCLUSIONS

Using a bonding agent before applying sealant on permanent molar occlusal caries (ICDAS 2-4) significantly enhanced sealant retention. Caries progression was rarely detected at the 24-month follow-up.

Dental Caries and Associated Factors in 3-5-Year-Old Children in Guizhou Province, China: An Epidemiological Survey (2015-2016)

Objective: This study aimed to explore the factors influencing dental caries among 3-5-year-old children in Guizhou Province and the interrelationship between these factors using structural equation modeling, while providing theoretical references to improve the prevention and control strategy. Materials and Methods: A total of 1,291 children aged 3-5 years in Guizhou Province were selected by a multistage stratified and whole group random sampling to examine the caries prevalence in whole-mouth deciduous teeth crowns, and parents were surveyed with questionnaires to analyze the caries-related factors. IBM SPSS Statistics v 23.0 software (IBM, Armonk, NY, USA) was used for statistical analysis. Results: The caries prevalence of children aged 3-5 years in Guizhou Province was 63.1%, the mean decayed-missing-filled teeth was 3.32, the caries filling rate was 0.5%, and there was no statistically significant difference between urban and rural areas and among genders in each age group; results of logistic regression analysis showed that the caries risk increased with the following factors: age, brushing frequency <2 times per day when parents did not take their children to the dentist, and with parents poor evaluation of the oral condition of their children. The higher the education of the parent, the lower the risk of children suffering from caries in deciduous teeth. Conclusions: With an overall poor situation about oral hygiene habits, oral healthcare attitude of the parents, and behavior transformation, the prevalence of dental caries in the deciduous teeth of children aged 3-5 years in Guizhou Province is high, and their caries status was severe, with more than 99% of the caries cases that were untreated. Therefore, prevention and treatment measures of caries in preschool children need strengthening through the improvement of public awareness and the enhancement of the management of oral health habits of their children.

Ecological determinants of effect of a free pit and fissure sealant program in Shanxi, China, 2017-2018

BACKGROUND

The aim of this study is to explore the spatial heterogeneity of the retention of PFS in children aged 7-9 years in Shanxi Province, North China and investigate the risk factors associated with PFS retention.

METHODS

In this study, 937 children aged 7-9 years from Shanxi Province, China were randomly selected, all of whom had at least one first permanent tooth sealed with PFS in 2016. The children were surveyed after 12 months (in 2017) and 24 months (in 2018). The Geo-detector model was used to explore the spatial heterogeneity of the retention rate of PFS and analyze the influence and interactions of the ecological factors on PFS.

RESULTS

3299 teeth from 937 children were analyzed. The PFS full retention rates after 12 months (in 2017) and 24 months (in 2018) were 81.6% and 75.1%, respectively. The incidence of caries of the first molar was 2.1% after 12 months and 5.4% after 24 months. The spatial heterogeneity of the PFS retention rate after 24 months was significant, which was shown as the retention rate of PFS increased from north to south after 24 months. Remarkably, the natural environmental factors exerted greater influence than the socioeconomic and medical resources factors after 12 months, where the interaction of fluorine in water (FW) had the strongest explanatory power of 52% (P < 0.05). The medical resources were important ecological factors after 24 months, and the percentage of medical technicians (PMT) had the strongest explanatory power of 70% (P < 0.05).

CONCLUSION

The natural environmental factors and medical resources factors are important ecological factors determining the spatial pattern. The government should strengthen medical and technician construction in North China, comprehensively control fluoride in water, optimize the allocation of medical resources, and promote the balanced development of regional medicine.

Study protocol: A stepped-wedge, cluster-randomized trial of the effectiveness of a deliberative loop in identifying implementation strategies for the adoption of a dental sealant guideline in dental clinics

BACKGROUND

The American Dental Association (ADA) recommends dental providers apply dental sealants to the occlusal surfaces of permanent molars for the prevention or treatment of non-cavitated dental caries. Despite the evidence-based support for this guideline, adherence among general dentists is low, ranging from less than 5 to 38.5%. Thus, an evidence-to-practice gap exists, and it is unclear which implementation strategies would best support providers in adopting and implementing the evidence-based practice. One potential approach to selecting and tailoring implementation strategies is a deliberative loop process, a stakeholder-engaged approach to decision-making. This trial aims to test the acceptability, feasibility, and effectiveness of using a deliberative loop intervention with stakeholders (i.e., providers and staff) to enable managers to select implementation strategies that facilitate the adoption of an evidence-based dental practice.

METHODS

Sixteen dental clinics within Kaiser Permanente Northwest Dental will be cluster randomized to determine the timing of receiving the intervention in this stepped-wedge trial. In the three-part deliberative loop intervention, clinic stakeholders engage in the following activities: (1) receive background information, (2) participate in facilitated small-group discussions designed to promote learning from each other's lived experiences and develop informed opinions about effective clinic-level implementation strategies, and (3) share their informed opinions with clinic leaders, who may then choose to select and deploy implementation strategies based on the stakeholders' informed opinions. The primary outcome of Reach will be defined as patient-level receipt of guideline-concordant care. Secondary outcomes will include the cost-effectiveness, acceptability, and feasibility of the deliberative loop process. Implementation strategies deployed will be catalogued over time.

DISCUSSION

These results will establish the extent to which the deliberative loop process can help leaders select and tailor implementation strategies with the goal of improving guideline-concordant dental care.

TRIAL REGISTRATION

This project is registered at ClinicalTrials.gov with ID NCT04682730. The trial was first registered on 12/18/2020. https://clinicaltrials.gov/ct2/show/NCT04682730.

Diagnosis and Management Approaches for Non-cavitated Carious Dental Lesions- A Narrative Review

Background:

Dental caries is one of the most prevalent diseases. Its detection and management should start with a comprehensive treatment plan, with the goals of the elimination of cariogenic bacteria, the reduction of plaque acidogenicity, the encouragement of tooth remineralization, and the repair of damaged teeth.

Objectives:

The aim of this paper was to review the literature regarding the latest updates on the diagnosis and management approaches of non-cavitated carious dental lesions.

Methods:

Studies regarding the diagnosis and management of non-cavitated carious dental lesions were included.

Results:

The subclinical non-cavitated carious lesion might progress to an early enamel lesion, develop into an established dentin lesion, or sometimes end up with a lesion reaching the pulp. The detection and management of caries should be patient-centered, risk-based, and evidence-supported, and should consider the dentists’ expertise and the patients’ needs and preferences. The visual-tactile and radiographic detection of non-cavitated carious lesions are greatly helped by the advances of non-invasive detection tools such as DIAGNOdent, fiber-optic transillumination, quantitative light-induced fluorescence, and DIAGNOcam.

Conclusion:

Accordingly, non-cavitated carious lesions can be arrested by several non-invasive techniques, which are preferred over the invasive options. The clinicians can use sealants plus fluoride varnish on occlusal surfaces, fluoride varnish or resin infiltration on proximal surfaces, and resin infiltration,fluoride gel, or varnish alone on facial or lingual surfaces to manage non-cavitated carious lesions.

Common Dental Issues in Pediatrics

This article reviews common issues in pediatric dental health, including normal development, developmental issues, infections, trauma, and preventative care.

Management of dental caries lesions in Latin American and Caribbean countries

Caries management at the lesion level is dependent on the lesion activity, the presence of a cavitation (either cleanable or non-cleanable), and lesion depth as evaluated via radiographic examination. A variety of non-invasive, micro-invasive, and minimally invasive treatment (with or without restoration) options are available for primary and permanent teeth. Non-invasive strategies include oral hygiene instructions, dietary counseling, and personal as well as professional use of fluoridated products that reduce demineralization and increase re-mineralization. Micro-invasive procedures include the use of occlusal resin sealants and resin infiltrants, while minimally invasive strategies comprise those related to selective removal of caries tissues and placement of restorations. Deep caries management includes indirect pulp capping, while exposed pulp may be treated using direct pulp capping and partial or complete pulpotomy. The aim of the present study was to review available evidence on recommended preventive and restorative strategies for caries lesions in Latin American/Caribbean countries, and subsequently develop evidence-based recommendations for treatment options that take into consideration material availability, emphasize ways to adapt available treatments to the local context, and suggest ways in which dentists and health systems can adopt these treatments.

COMPLIANCE OF RANDOMIZED CLINICAL TRIALS ON DENTAL CARIES PREVENTION METHODS WITH THE CONSORT STATEMENT: A SYSTEMATIC REVIEW

OBJECTIVE

Reporting of randomized controlled trials (RCTs) in dentistry remains suboptimal. Considering the positive impact of the Consolidated Standards of Reporting Trials (CONSORT) guidelines on the quality of evidence in RCTs, the main objective of this systematic review was to determine whether RCTs on dental caries prevention conform to these guidelines. The secondary objective was to assess the association between CONSORT adherence and the year and impact factor of the journal in which the study was published.

METHODS

A systematic search was conducted in different databases using appropriate terms to retrieve RCTs that assessed the caries-preventive effect of at least 2 of the following materials-fluoride varnish, resin-based fissure sealants, and ionomer-based fissure sealants-on the occlusal surfaces of permanent molars. Since the first CONSORT statement was published in 1996, a time frame from 1997 to 2020 was established for the identification of studies. Selected articles were assessed according to their adherence to the CONSORT statement, risk of bias (Cochrane risk of bias tool, RoB 2.0), and journal impact factor based on the InCites Journal Citation Reports. The year of publication and other relevant data were also recorded. SPSS (SPSS Statistics 25.0, IBM©) was used to perform the linear correlation analyses to determine the relationship between the article CONSORT score (previously determined) and the year of publication and journal impact factor. A significance level of 5% was established for all analyses.

RESULTS

Of 3196 references retrieved, 30 articles were selected and evaluated. Using RoB 2.0, 8 studies were classified as having a high risk of bias, 16 as having some concerns about the risk of bias assessment, and 6 as having a low risk of bias. Concerning CONSORT adherence, 77% of the studies adequately reported the intervention domain, since the methodology for the application of fluoride varnish or sealant materials was thoroughly described. However, the participants' setting and location, random sequence generation, randomization, and the flowchart description of the losses/exclusions domains were poorly reported. Meanwhile, the allocation concealment process was not reported in 83% of the articles. Correlation analyses indicated a positive relationship between CONSORT adherence and the year of publication, as well as the journal impact factor.

CONCLUSION

When assessing clinical trials on the prevention of occlusal caries, most RCTs examined followed the CONSORT statement. However, some methodological domains remain poorly reported, demonstrating the need to improve CONSORT compliance in these RCTs.

Stunting Malnutrition Associated with Severe Tooth Decay in Cambodian Toddlers

Background: The persistently high prevalence of undernutrition in Cambodia, in particular stunting or chronic malnutrition, calls for innovative investigation into the risk factors that affect children’s growth during critical phases of development. Methods: Secondary data analysis was performed on a subgroup of children who were present at two time points within the Cambodian Health and Nutrition Monitoring Study (CAHENMS) and who were less than 24 months of age at the nominated baseline. Data consisted of parent interviews on sociodemographic characteristics and feeding practices, and clinical measures for anthropometric measures and dental status. Logistic regression modelling was used to examine the associations between severe dental caries (tooth decay)—as indicated by the Significant Caries Index—and the presence of new cases of stunting malnutrition at follow-up. Results: There were 1595 children who met the inclusion criteria and 1307 (81.9%) were followed after one year. At baseline, 14.4% of the children had severe dental caries, 25.6% presented with stunted growth. 17.6% of the children transitioned from healthy status to a low height-for-age over the observation period. Children with severe dental caries had nearly double the risk (OR = 1.8; CI 1.0–3.0) of making that transition. Conclusion: Severe caries experience was associated with poorer childhood growth and, as such, could be an underinvestigated contributor to stunting.

Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents

BACKGROUND

Most of the detected increment in dental caries among children above the age of six years and adolescents is confined to occlusal surfaces of posterior permanent molars. Dental sealants and fluoride varnishes are much used to prevent caries. As the effectiveness of both interventions in controlling caries as compared with no intervention has been demonstrated previously, this review aimed to evaluate their relative effectiveness. It updates a review published originally in 2006 and updated in 2010 and in 2016.

OBJECTIVES

Our primary objective was to evaluate the relative effectiveness of dental sealants (i.e. fissure sealant) compared with fluoride varnishes, or fissure sealants plus fluoride varnishes compared with fluoride varnishes alone, for preventing dental caries in the occlusal surfaces of permanent teeth of children and adolescents. Our secondary objectives were to evaluate whether effectiveness is influenced by sealant material type and length of follow-up, document and report on data concerning adverse events associated with sealants and fluoride varnishes, and report the cost effectiveness of dental sealants versus fluoride varnish in caries prevention.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 19 March 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2020, Issue 2), MEDLINE Ovid (1946 to 19 March 2020) and Embase Ovid (1980 to 19 March 2020). We searched the US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. There were no restrictions on the language or date of publication.

SELECTION CRITERIA

We included randomised controlled trials with at least 12 months of follow-up comparing fissure sealants, or fissure sealants plus fluoride varnishes, versus fluoride varnishes, for preventing caries in the occlusal surfaces of permanent posterior teeth (i.e. premolar or molar teeth), in participants younger than 20 years of age at the start of the study.

DATA COLLECTION AND ANALYSIS

At least two review authors independently screened search results, extracted data from included studies and assessed their risk of bias. We attempted to contact study authors to obtain missing or unclear information. We grouped and analysed studies on the basis of sealant material type: resin-based sealant or glass ionomer-based sealant (glass ionomer and resin-modified glass ionomer sealant), and different follow-up periods. We calculated the odds ratio (OR) for risk of caries on occlusal surfaces of permanent molar teeth. For trials with a split-mouth design, we used the Becker-Balagtas OR. One cluster-randomised trial provided precise estimates in terms of risk ratio (RR), which we used. For continuous outcomes and data, we used means and standard deviations to obtain mean differences (MD). For meta-analysis, we used the random-effects model when we combined data from four or more studies. We presented all measures with 95% confidence intervals (CIs). We assessed the certainty of the evidence using GRADE criteria.

MAIN RESULTS

We included 11 trials with 3374 participants aged five to 10 years when trials started. Three trials are new since the 2016 update. Two trials did not contribute data to our analysis. Sealant versus fluoride varnish Resin-based fissure sealants versus fluoride varnishes Seven trials evaluated this comparison (five contributing data). We are uncertain if resin-based sealants may be better than fluoride varnish, or vice versa, for preventing caries in first permanent molars at two to three years' follow-up (OR 0.67, 95% CI 0.37 to 1.19; I² = 84%; 4 studies, 1683 children evaluated). One study measuring decayed, missing and filled permanent surfaces (DMFS) and decayed, missing and filled permanent teeth (DMFT) increment at two years suggested a small benefit for fissure sealant (DMFS MD -0.09, 95% CI -0.15 to -0.03; DMFT MD -0.08, 95% CI -0.14 to -0.02; 542 participants), though this may not be clinically significant. One small study, at high risk of bias, reported a benefit for sealant after four years in preventing caries (RR 0.42, 95% CI 0.21 to 0.84; 75 children) and at nine years (RR 0.48, 95% CI 0.29 to 0.79; 75 children). We assessed each of these results as having very low certainty. Glass ionomer-based sealants versus fluoride varnishes Three trials evaluated this comparison: one trial with chemically cured glass ionomer and two with resin-modified glass ionomer. Studies were clinically diverse, so we did not conduct a meta-analysis. In general, the studies found no benefit of one intervention over another at one, two and three years, although one study, which also included oral health education, suggested a benefit from sealants over varnish for children at high risk of caries. We assessed this evidence as very low certainty. Sealant plus fluoride varnish versus fluoride varnish alone One split-mouth trial analysing 92 children at two-year follow-up found in favour of resin-based fissure sealant plus fluoride varnish over fluoride varnish only (OR 0.30, 95% CI 0.17 to 0.55), which represented a clinically meaningful effect of a 77% reduction in caries after two years; however, we assessed this evidence as very low certainty. Adverse events Five trials (1801 participants) (four using resin-based sealant material and one using resin-modified glass ionomer) reported that no adverse events resulted from use of sealants or fluoride varnishes over one to nine years. The other studies did not mention adverse events.

AUTHORS' CONCLUSIONS

Applying fluoride varnish or resin-based fissure sealants to first permanent molars helps prevent occlusal caries, but it has not been possible in this review to reach reliable conclusions about which one is better to apply. The available studies do not suggest either intervention is superior, but we assessed this evidence as having very low certainty. We found very low-certainty evidence that placing resin-based sealant as well as applying fluoride varnish works better than applying fluoride varnish alone. Fourteen studies are currently ongoing and their findings may allow us to draw firmer conclusions about whether sealants and varnish work equally well or whether one is better than the other.

Dental sealants and restorative treatment for first molars among Medicaid enrollees

OBJECTIVES

To assess the association between dental sealant placement and subsequent restorative treatment of permanent first molars over time.

METHODS

We analysed Wisconsin Medicaid claims data from 2001 to 2009 for children aged 6-16 years. Children entered the study cohort at age 6 and were censored if Medicaid eligibility was lost for >31 days. A fixed effects analysis via a Cox proportional hazards model, stratified by individual, was used to estimate the time-averaged and time-dependent effects of sealant placement on dental treatment defined as any restorative, endodontic or surgical procedure.

RESULTS

A total of 185,262 children with permanent first molars who turned 6 years enrolled in Medicaid were examined. Sealant placement was higher for teeth #16 and 26 (5.42 and 5.46 per 100 person-years (100PY), versus 5.29 and 5.31/100PY for #36 and 46, respectively. The average rate for restorative treatments had the opposite pattern, with lower rate for teeth #16 and 26 (1.78 and 1.72/100PY) versus teeth #36 and 46 (2.14 and 2.12/100PY), respectively. In the fixed effects regression model, the hazard of dental treatment was substantially lower after sealant placement on a tooth, with time-averaged hazard ratio HR = 0.23 (95% CI 0.21-0.25, P < .001) versus before sealant. The largest effect was in the first year after sealant placement (HR = 0.13, 95% CI: 0.11-0.14), which decreased over time (HR = 0.50, 0.59 and 0.74 in years 2, 3 and 4, respectively), and was not statistically significant in later years.

CONCLUSIONS

This study demonstrates that permanent first molar sealant placement delayed subsequent dental treatments in children enrolled in Medicaid.