Evaluation of a clinic-based sealant program

Exploring four-handed delivery and retention of resin-based sealants

BACKGROUND

To date, no trials have been published that examine whether four-handed delivery of dental sealants increases their retention and effectiveness. In the absence of comparative studies, the authors used available data to explore the likelihood that four-handed delivery increased sealant retention.

METHODS

The authors examined data regarding the retention of autopolymerized resin-based sealants from studies included in systematic reviews of sealant effectiveness. The explanatory variable of primary interest was the presence of a second operator. To examine the unique contribution of four-handed delivery to sealant retention, the authors used linear regression models.

RESULTS

Eleven of the 36 studies from systematic reviews met explicit criteria and were included in this analysis. The high level of heterogeneity among studies suggested that multivariate analysis was the correct approach. According to the regression model, the presence of a second operator increased retention by 9 percentage points.

CONCLUSIONS

For this group of studies, four-handed delivery of autopolymerized sealants was associated with increased sealant retention.

CLINICAL IMPLICATIONS

Using four-handed delivery to place resin-based sealants may increase retention.

Pit and fissure sealants: another major cornerstone in preventive dentistry

Despite dramatic reductions in caries in fluoridated communities, the disease continues to occur during childhood and adolescence and there is a sustained caries susceptibility of pits and fissures. Pit and fissure sealants have been available to the dental profession for the past two decades. Closely following community water fluoridation, this use of adhesive technology is now recognized as a major cornerstone of modern preventive dentistry. However, the technique appears to have been slow in implementation by the dental profession. Recent expanded utilization of sealants in the public sector, particularly in Victoria, has increased the awareness of the procedure amongst the public and is heightening demand. A review of the pertinent literature and current trends in utilization of sealants is presented. The case is made for expanded utilization of sealants in both the public and private sectors of dental health care delivery in Australia.

Evaluation after 4 years of the combined use of fluoride and dental sealants

This study evaluates the caries-preventive potential in permanent teeth of dental sealants when combined with an ongoing, school-based fluoride program. The investigation was designed as a sequential, cross-sectional comparison. Dental caries findings in 1987 for 416 children ages 7-11 and 14-17 who received dental sealants and fluorides were compared with corresponding data derived from 1983 baseline examinations of children who received fluoride therapy only. In addition, sealant retention status was determined. Overall mean DMFS scores in 1987 for children in two age groups combined were 51% lower than in 1983. Also, a surface-specific treatment effect was demonstrated in pit and fissures for both older and younger age groups. The overall proportion of sealants retained on occlusal surfaces of first molars after an average of 2 yr (92%) compared favorably with similar figures cited in the scientific literature. The results of this study suggest that pit and fissure sealants confer additional caries-preventive benefits beyond those of fluoride therapy alone.

Evaluation of Guamanian dental caries preventive programs after 13 years

OBJECTIVE

To address the high prevalence of dental caries in Guamanian children, a school-based fluoride mouthrinse program, a clinic-based pit and fissure sealant program, and community water fluoridation were phased in over a 13-year period. The purpose of this paper is to evaluate the impact of these programs on the prevalence of dental caries.

METHODS

Cross-sectional samples representative of schoolchildren in grades 1 through 8 were selected in 1976, 1979, 1984, 1986, and 1989. These years include the starting years for each of the three interventions and varying follow-up periods for each. About 1,000 children in each of the survey years were examined to derive DMF surface scores.

RESULTS

After eight years of fluoride mouthrinsing, DMFS scores were reduced by 25.4 percent in 6-14-year-olds. With two additional years of fluoride mouthrinsing and with pit and fissure sealants, overall DMFS scores declined an additional 44.4 percent. In 1989, three years after community water fluoridation was initiated on the island and continuation of the other two programs, there was a further decline in overall DMFS scores of 34.5 percent. Over the entire study period--during which there were 13 years of fluoride mouthrinsing in the schools, five years of sealant application, and three years of community water fluoridation--DMFS scores declined 72.8 percent overall (5.14 surfaces per child) and 71.9, 71.0, and 78.8 percent for occlusal, buccal-lingual, and proximal surfaces, respectively.

CONCLUSIONS

An intensified preventive dentistry program introduced on an island with high caries prevalence twice that of the US mainland was successful, and contributed to a reduction in the prevalence of caries to a level equivalent to that of the United States at the end of the study period.

Community-based sealant programs in the United States: results of a survey

The appropriate use of pit and fissure sealants could reduce substantially the majority of occlusal caries among US school-aged children. The 1986-87 national oral health survey conducted by the NIDR showed that less than 8 percent of the children 5-17 years of age had sealants on their teeth. The purpose of this national study was to document the current status of community-based sealant programs and to identify general program characteristics. Data were gathered through a mail survey to all state dental directors and site visits to four selected comprehensive community-based programs. Twenty-nine states were currently conducting sealant programs. The vast majority of these programs had formal quality assurance systems and companion health education components. Eight states indicated that sealant programs had been terminated within the last two years. Medicaid reimbursement for sealants was available in 42 states, with a mean reimbursement rate of $10.71 per sealant. Reimbursement rates ranged from $3.00-$20.00 per sealant. State practice acts almost uniformly permitted the placement of sealants by dental hygienists (n = 48), but less frequently by dental assistants (n = 15). Approximately 43 percent of state practice acts did not require a dentist to be present physically when auxiliaries place sealants in public/community sealant programs. All respondents indicated that there was a need for additional programs in their state. No structural factors--for example, level of Medicaid reimbursement for sealants or state practice act requirements for auxiliary supervision--were found to be associated with the presence of community-based sealant programs. Nationally, only a small percentage of children appeared to be receiving sealants in community programs.

Evaluation of a school-based fluoride mouthrinsing and clinic-based sealant program on a non-fluoridated island

For many years the children of Guam have experienced a high prevalence of dental caries. Surveys conducted on the fluoride-deficient island found that caries levels were double those of US mainland children. In 1976 a school-based fluoride mouthrinse program was initiated involving over 22,000 children in grades kindergarten through eight in weekly rinses with 0.2% neutral NaF. A clinic-based dental pit and fissure sealant program was added in 1984 to the fluoride mouthrinse program. Over 15,000 children participated annually in the sealant program where more than 75,000 teeth were sealed the first year. After 8 yr of fluoride mouthrinsing (1976-1984) mean DMFS scores were 1.79 surfaces per child lower compared to baseline, a decrease of 0.22 DMFS per child per year. During this period proximal DMFS scores decreased 61%, buccal-lingual surfaces 31%, and occlusal surfaces 7%. After 2 yr of fluoride mouthrinsing and sealant application combined overall DMFS scores decreased an additional 2.34 surfaces per child, a reduction of 1.17 DMFS per child per year. Most of this decline took place on pit and fissure surfaces. For the 10-yr period a reduction of 4.13 DMFS per child was seen--a decline from 7.06 DMF at baseline to 2.93 DMF surfaces per child in 1986. This long-term evaluation indicates that dental sealants when used in combination with fluoride mouthrinse were particularly effective in lowering the prevalence of dental caries. Schoolchildren in participating grades on Guam now have dental caries rates close to those of US schoolchildren.

The effectiveness of pit and fissure sealants

This review addresses two major issues related to the use of pit and fissure sealants. First, the epidemiology of occlusal caries for children and adults is examined to determine if there is a basis for administering sealant programs to different age groups. Second, the effectiveness of pit and fissure sealants in fluoridated and non-fluoridated communities is compared. Changes in effectiveness of sealant over time are evaluated in terms of percent effectiveness, complete retention, caries incidence, and reapplication rates. Based on epidemiologic evidence, sealant programs can be justified for children and young adults, but not for older age groups. Based on the literature reviewed, following one application of autopolymerized or visible-light-cured sealant, the median percent effectiveness declines from 83 percent after one year to 55 percent after seven years. Similarly, the median complete retention declines from 92 percent after one year to 66 percent after seven years. Conversely, the median percent of sealed first molars becoming carious and/or restored increases from 4 percent after one year to 31 percent after seven years. Large differences in sealant effectiveness are not apparent between studies performed in fluoridated and fluoride-deficient communities.