The impact of recent changes in the epidemiology of dental caries on guidelines for the use of dental sealants: clinical perspectives

The use of dental sealants in adults: a long-neglected preventive measure

The consensus among the general public appears to be that dental sealants are intended to be used primarily with children whose teeth are in the early developmental stage, yet little attention is given to the preventive long-term aspects when applying them to adult permanent dentition. This article explores the rationale and substantiates the use of dental sealants among the adult population in reducing occlusal pit-and-fissure caries while accentuating a beneficial oral health lifestyle.

Natural history of treatment outcomes of permanent first molars

BACKGROUND

Few studies have used insurance claims data to retrospectively assess the natural history--a natural process or flow of events without any special interventions--and treatment outcomes of teeth with dental sealants.

METHODS

The authors constructed treatment outcome trees (TOTs) from the Iowa Medicaid claims and eligibility data (1996-2000) of continuously enrolled 6-year-old children who routinely used Medicaid dental services. The authors used the TOTs to compare the restorative treatments of sealed permanent first molars with those of nonsealed permanent first molars.

RESULTS

Forty percent of routine utilizers received a sealant during the four-year period. Overall, 25 percent of molars received at least one restoration. Sealed molars were less likely to receive further restorative treatment than were nonsealed molars (13 versus 29 percent). Sealed molars had fewer extensive restorative treatments (crowns, endodontic therapy and extractions) than did nonsealed molars. The median time to restorative treatment of the sealed molars also was greater than that of the nonsealed molars. All four first molars had comparatively similar patterns of subsequent care.

CONCLUSIONS

Permanent first molars with sealants received less subsequent restorative treatment than did those without sealants. TOTs are useful tools for identifying necessary outcome information needed for program evaluations.

CLINICAL IMPLICATIONS

Greater use of sealants could reduce the need for subsequent treatment and prolong the time until treatment may be necessary for permanent first molars.

Targeting dental sealants in school-based programs: evaluation of an approach

Several guidelines have been published in the United States to promote the appropriate use of sealants in both individual care and public health programs. Targeting sealants to children and teeth at high risk for dental caries has been accepted as a desirable strategy in school-based programs. However, there is little evidence to show that programs are complying with these guidelines. This report examined the extent to which sealants were targeted to high-risk children at 11 different school-based programs in New York State. Data on 3357 children ages seven to nine were analyzed. The percent of children receiving sealants ranged from 41% to 88%. While in two sites (St. Lawrence & Onondaga) fewer than 52% of the children received sealants; more than 73% received sealants in the remaining nine sites (P < 0.05). The results suggest that there was a wide variation in the implementation of the guidelines for sealant use. Some reasons for not adhering to the guidelines were: difficulty in assuring parents and local dentists that some children were not at risk for caries; lack of confidence in the risk-assessment method; uncertainty regarding what constitutes deep pits and fissures; fear of misclassifying children and requests by school administrators, parents and local dentists that all children should benefit from preventive measures.

Sealant use and placement techniques among pediatric dentists

BACKGROUND

Pit and fissure sealant use varies widely among dentists. The authors conducted a survey to determine the current variations and patterns of sealant placement among pediatric dentists.

METHODS

The authors mailed a 20-question survey to American Academy of Pediatric Dentistry members from six states, who represented one-third (1,210) of the membership, as well as to all 52 pediatric dentistry departments in U.S. dental schools. The authors examined selection criteria, placement techniques, evaluation methodologies, and the one- and three-year estimated success and reapplication rates of sealant placement.

RESULTS

The response rates were 70 percent for practitioners and 90 percent for dental schools. Approximately 80 percent of respondents said they sealed caries-free and questionable carious surfaces. Only 20 percent of the respondents said they sealed incipient carious surfaces; none said they would seal overt caries. Surface preparation was used always or sometimes by 87 percent of the respondents. The estimated one- and three-year sealant retention rates were 89 percent and 78 percent, respectively, for practitioners and 83 percent and 71 percent, respectively, for dental schools.

CONCLUSIONS

The survey demonstrated wide variations in selection criteria, placement techniques and evaluation methodologies, yet showed remarkable similarities between practitioners and dental schools. The reported retention rates were consistent with those reported in the literature.

PRACTICE IMPLICATIONS

The survey results suggested that pediatric dentists were searching for evidence-based selection criteria and a technique protocol for sealant placement that improved clinical success. The wide technique variations reported were likely a result of training diversity, diagnostic uncertainty, technique and material sensitivity, and an attempt to improve the success rate.

A comparison of sealant placement techniques and 12-month retention rates

OBJECTIVE

This study compared time required and 12-month retention for two methods of sealant placement: traditional acid-etch technique and air-abrasion technique without acid etch.

METHODS

Sealants were placed on the permanent first molars of 84 children in grades 1-4 who were randomly assigned to treatment groups. All sealants were placed in a school setting by the same clinician. Chair time required for sealant placement was recorded, and retention rates were determined for each technique 12 months after placement.

RESULTS

Mean chair time for placement of sealants on four first molars using the air-abrasion technique was significantly less than for the acid-etch technique (7:36 minutes vs 10:56 minutes). Fifty-eight children were available at 12-month follow-up; an examiner not involved in sealant placement and masked as to the technique used determined retention. Rates of complete retention for occlusal surfaces were not significantly different for the two techniques, although the rate for acid etch was higher than that for air abrasion (95% vs 87%). The complete retention rates for the acid-etch technique were significantly higher than air abrasion for buccal and distolingual surfaces. These rates were 65 percent and 58 percent, respectively, for acid etch and 6 percent and 28 percent, respectively, for air abrasion.

CONCLUSION

Although more research is needed to improve air-abrasion applications, it does not appear that air abrasion without acid etching offers a significant advantage over traditional sealant placement methods and, in fact, appears to be inferior to the acid-etch technique for use in public health settings.