Effectiveness of sealant treatment over five years in an insured population

Evaluation of the success rate of pit and fissure sealants on first molars, 12 months follow-up study

INTRODUCTION

Dental caries by far is the most prevalent concern of the preadolescents and adolescents in dental clinics. Despite the provision of local fluoride, the occlusal surfaces of teeth are susceptible to dental caries. Pit and Fissure sealant therapy is a preventive method to decrease dental caries in permanent teeth. The present study aimed to evaluate the success of fissure sealant treatments of first molar teeth, at 3, 6, and 12 months follow-ups.

MATERIALS AND METHODS

Sixty five children were randomly selected. The subjects had already received fissure sealants in the department of public health dentistry. Demographic data, including age and gender, sealant failure and the type of failure were recorded in the relevant checklists. Feigal criteria were used to evaluate the success or failure of fissure sealant treatments.

RESULTS

Overall success rate was 74.3 % for one year. Evaluation of the failure rate showed that at the 3-month interval, 20.6% of the sealants exhibited failure (57.1% due to margin discoloration and 42.9% due to lack of margin adaptation). 28.6% of the sealants failed at the 6-month (75% due to marginal discoloration and 25% due to anatomic form) and 41.2% failed at the 12-month interval (57.1% due to marginal discoloration and 42.9% due to the lack of margin adaptation).

CONCLUSION

The total failure rate of fissure sealant failures after one year was 27.7%. The most frequent reason for the failure of fissure sealants was marginal discoloration.

Effectiveness of pit and fissure sealants on primary molars: A 2-yr split-mouth randomized clinical trial

The primary objective of this study was to evaluate the effects of sealants in preventing pit and fissure caries in primary molars. The secondary objective was to assess the sealant retention during a 2-yr study period. A 2-yr split-mouth randomized clinical trial including 90 3-7-yr-old children was conducted in the paediatric dental department of Montpellier hospital. The dentition of each included patient was divided into an experimental side and a control side, with annual follow-up visits. Caries increments, measured as the number of new occlusal cavitated lesions, were not different between the sealed (mean 0.23) and the control primary molars (mean 0.29). A multiple mixed-effects logistic regression showed that male gender, moderate/high caries risk, and a higher oral hygiene index score, had a statistically significant effect resulting in higher caries increments in the primary molars, than did female gender, low caries risk, and lower oral hygiene index scores. Sealing showed no statistically significant influence on the development of new caries lesions. After 2 yr, the percentages of partially or totally lost sealants were 22.7% and 32.0%, respectively. In this sample of children, the caries increment was not significantly different between the sealed and the unsealed molars. At the end of this 2-yr study, more than half of the sealants were totally or partially lost, which could explain the low sealant effectiveness.

Clinical success rate of fissure sealants: one-year follow-up

Purpose:

The aim of this study is to evaluate clinical success rate of resin-based fissure sealants applied at Istanbul University, Department of Pediatric Dentistry after 1 year of application.

Materials and methods:

Children with at least one pair of caries-free permanent first molars with deep pits and fissures were included in the study. The ages of children ranged from 7-13 (mean age: 9.2±1.22). Resin-based fissure sealant was applied to the 322 fissures of the first permanent molars in 100 children. 12 months after the application, children were recalled for examination. Recall examinations were carried out by the same dentist. Fissure sealants were evaluated at 12th month by using Ryge criteria: Retention (R), precence of caries (PC), marginal adaptation (MA), marginal discoloration (MD) and cracking (C).

Results:

12 months after the application, all of the children were recalled and fissure sealants were examinated. Our findigs are: R: Alpha 95 (29.5%), Bravo: 143 (44.4%), Charlie: 84 (26%); PC: Alpha 274, Bravo 48 (14.9%); MD: Alpha 322; MA: Alpha 279, Bravo 43 (13.3%); C: Alpha 321, Bravo 1 (0.3%).

Conclusion:

The preventive effects of the sealant are only maintained as long as it remains completely intact and bonded in place. After applying fissure sealants, patients must be recalled and sealants must be checked to provide retention and marginal adaptation.

Estimating the Cost Savings of Preventive Dental Services Delivered to Medicaid-Enrolled Children in Six Southeastern States

OBJECTIVE

To quantify the impact of multiyear utilization of preventive dental services on downstream dental care utilization and expenditures for children.

DATA SOURCES/STUDY SETTING

We followed 0.93 million Medicaid-enrolled children who were 3-6 years old in 2005 from 2005 to 2011. We used Medicaid claims data of Alabama, Georgia, Mississippi, North Carolina, South Carolina, and Texas.

STUDY DESIGN

We clustered each state's study population into four groups based on utilization of topical fluoride and dental sealants before caries-related treatment using machine learning algorithms. We evaluated utilization rates and expenditures across the four groups and quantified cost savings of preventive care for different levels of penetration.

DATA EXTRACTION METHOD

We extracted all dental-related claims using CDT codes.

PRINCIPAL FINDINGS

In all states, Medicaid expenditures were much lower for children who received topical fluoride and dental sealants before caries development than for all other children, with a per-member per-year difference ranging from $88 for Alabama to $156 for Mississippi.

CONCLUSIONS

The cost savings from topical fluoride and sealants across the six states ranged from $1.1M/year in Mississippi to $12.9M/year in Texas at a 10 percent penetration level. Preventive dental care for children not only improves oral health outcomes but is also cost saving.

Effect of non-fluoride agents on the prevention of dental caries in primary dentition: A systematic review

Objective

To assess the effect of non-fluoride agents on the prevention of dental caries in primary dentition.

Materials and methods

Medline, Web of Science, Embase, Cochrane Library, CBM and CNKI databases were searched to identify all the relevant articles published prior to 16 December 2016. Grey literature was also searched. Randomized controlled human clinical trials in which non-fluoride agents were delivered by any method were considered.

Results

Of the 1,236 studies screened, 39 full articles were scrutinized and 14 selected for inclusion in the final sample. Five chemical agents, namely arginine, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), chlorhexidine, triclosan and xylitol were investigated in these included studies. The cariostatic effects of non-fluoride agents in vivo were evaluated in comparison with fluoride or placebos in randomized controlled trials. There is evidence that the use of certain doses of xylitol may be effective in arresting dental caries in primary dentition. However, quantitative synthesis could not be carried out because of the clinical and methodological heterogeneity of the included studies.

Conclusions

A study at low risk of bias indicated that daily use of xylitol wipes is a useful adjunct for caries control in young children, however, this conclusion should be interpreted with caution as this study had a very limited sample size. Chlorhexidine and CPP-ACP may be more effective than a placebo in managing caries in primary dentition, but their effectiveness is borderline when compared with fluoride. Arginine-containing mint confection and 0.3% triclosan varnish were found to reduce caries development in primary teeth but the evidence was at high risk of bias. High quality randomized controlled trials are needed in order to make a conclusive recommendation.

A Two-Year Clinical Evaluation of Fluoride and Non-Fluoride Resin-Based Pit-and-Fissure Sealants

The aim of this study was to evaluate and compare for 24 months, the retention and surface characteristics of two pit-and-fissure sealants: Helioseal Clear and Helioseal F (Ivoclar Vivadent). The correlation between the different stages of eruption and sealant retention was also verified. Fifty children aged 6 to 8 years participated in the study, totalizing 153 teeth divided into two groups: HC (Helioseal Clear) and HF (Helioseal F). After 6, 12, 18 and 24 months, a clinical examination was performed by previously calibrated examiners. The surface characteristics and the retention of the sealants (modified RYGE & SNYDER criteria) were assessed. Analyzing the occlusal surface, HC exhibited a statistically significant higher retention at 12 (p=0.0345) and 24 months (p=0.0076). Concerning the surface characteristics, only the superficial discoloration of HC was smaller than HF, during the entire studied period. For all the other characteristics, the results of the Mann-Whitney test were highly significant at different periods (p=0.0000 to 0.0421). The frequency of air bubbles within the sealant surfaces, determined by Chi-square test, was significantly higher in HF (p=0.000:12 and 18 months to p=0.002: 6 and 24 months). HC sealant material exhibited the best performance regarding the retention and surface characteristics on the occlusal surface.

Cost-effectiveness of pit-and-fissure sealants on primary molars in Medicaid-enrolled children

OBJECTIVES

We compared the incremental cost-effectiveness of 2 primary molar sealant strategies-always seal and never seal-with standard care for Medicaid-enrolled children.

METHODS

We used Iowa Medicaid claims data (2008-2011), developed a tooth-level Markov model for 10 000 teeth, and compared costs, treatment avoided, and incremental cost per treatment avoided for the 2 sealant strategies with standard care.

RESULTS

In 10 000 simulated teeth, standard care cost $214 510, always seal cost $232 141, and never seal cost $186 010. Relative to standard care, always seal reduced the number of restorations to 340 from 2389, whereas never seal increased restorations to 2853. Compared with standard care, always seal cost $8.12 per restoration avoided (95% confidence interval [CI] = $4.10, $12.26; P ≤ .001). Compared with never seal, standard care cost $65.62 per restoration avoided (95% CI = $52.99, $78.26; P ≤ .001).

CONCLUSIONS

Relative to standard care, always sealing primary molars is more costly but reduces subsequent dental treatment. Never sealing costs less but leads to more treatment. State Medicaid programs that do not currently reimburse dentists for primary molar sealants should consider reimbursement for primary molar sealant procedures as a population-based strategy to prevent tooth decay and reduce later treatment needs in vulnerable young children.

Bonding agent underneath sealant: shear bond strength to oil-contaminated

This study evaluated in vitro the shear bond strength of a resin-based pit-and-fissure sealant (Fluroshield - F) associated with either an ethanol-based (Adper Single Bond 2 - SB) or an acetone-based (Prime & Bond - PB) adhesive system under conditions of oil contamination. Mesial and distal enamel surfaces from 30 sound third molars were randomly assigned to 2 groups (n=30): I - no oil contamination; II - oil contamination. Contamination (0.25 mL during 10 s) was performed after 37% phosphoric acid etching with an air/oil spray. The specimens were randomly assigned to subgroups, according to the bonding protocol adopted: subgroup A - F was applied to enamel without an intermediate bonding agent layer; In subgroups B and C, SB and PB, respectively, were applied, light-cured, and then F was applied and light-cured. Shear bond strength was tested at a crosshead speed of 0.5 mm/min in a universal testing machine. Means (+/- SD) in MPa were: IA-11.28 (+/-1.84); IIA-12.02 (+/-1.15); IB-9.73 (+/-2.38); IIB-9.62 (+/-2.29); IC-28.30 (+/-1.63); and IIC-25.50 (+/-1.91). It may be concluded that the oil contamination affected negatively the sealant bonding to enamel and the acetone-based adhesive system (PB) layer applied underneath the sealant was able to prevent its deleterious effects to adhesion.

A comparative study of fissure sealants Helioseal Clear Chroma and Delton FS(+): 3 year results

AIM

To evaluate the retention rates of a resin based colour changing fissure sealant (Helioseal Clear Chroma; Ivoclar Vivadent AG Schaan, Liechtenstein) compared with a coloured resin based fluoride fissure sealant (Delton FS(+); Dentsply De Trey GmbH,Konstanz,Germany).

METHODS

The fissure sealants (FS) were placed on all 4 caries-free first permanent molars of 31 children aged 6-9 years, using a half mouth experimental design by a paediatric dentist according to the manufacturers' instructions. A total of 121 FS were placed at baseline. Teeth were evaluated at 3 month intervals for 36 months where a preventive program including topical fluoride application was applied.

RESULTS

Retention rates for 36 months showed a differences between Delton FS(+) and Helioseal Clear Chroma that were statistically significant (p<0.05). Delton FS(+) had total retention rate of 30.4% for 36 months compared with Helioseal Clear Chroma at 10.8% for the same evaluation period. Although Delton FS(+) showed significantly better results than Helioseal Clear Chroma for the evaluation periods, there were no statistically significant differences between Delton FS(+) (90.7%) and Helioseal Clear Chroma (80.4%) with respect to caries incidence at 36 months(p>0.05).

CONCLUSION

Delton FS(+) showed a better complete retention rate for occlusal FS at one year. Both FS were aesthetically acceptable and easy to see during application and follow-up periods and gave significant protection from occlusal decay.

Bond strength of a pit-and-fissure sealant associated to etch-and-rinse and self-etching adhesive systems to saliva-contaminated enamel: individual vs. simultaneous light curing

This study evaluated in vitro the shear bond strength (SBS) of a resin-based pit-and-fissure sealant [Fluroshield (F), Dentsply/Caulk] associated with either an etch-and-rinse [Adper Single Bond 2 (SB), 3M/ESPE] or a self-etching adhesive system [Clearfil S3 Bond (S3), Kuraray Co., Ltd.] to saliva-contaminated enamel, comparing two curing protocols: individual light curing of the adhesive system and the sealant or simultaneous curing of both materials. Mesial and distal enamel surfaces from 45 sound third molars were randomly assigned to 6 groups (n=15), according to the bonding technique: I - F was applied to 37% phosphoric acid etched enamel. The other groups were contaminated with fresh human saliva (0.01 mL; 10 s) after acid etching: II - SB and F were light cured separately; III - SB and F were light cured together; IV - S3 and F were light cured separately; V - S3 and F were light cured simultaneously; VI - F was applied to saliva-contaminated, acid-etched enamel without an intermediate bonding agent layer. SBS was tested to failure in a universal testing machine at 0.5 mm/min. Data were analyzed by one-way ANOVA and Fisher's test (alpha=0.05).The debonded specimens were examined with a stereomicroscope to assess the failure modes. Three representative specimens from each group were observed under scanning electron microscopy for a qualitative analysis. Mean SBS in MPa were: I-12.28 (+/-4.29); II-8.57 (+/-3.19); III-7.97 (+/-2.16); IV-12.56 (+/-3.11); V-11.45 (+/-3.77); and VI-7.47 (+/-1.99). In conclusion, individual or simultaneous curing of the intermediate bonding agent layer and the resin sealant did not seem to affect bond strength to saliva-contaminated enamel. S3/F presented significantly higher SBS than the that of the groups treated with SB etch-and-rinse adhesive system and similar SBS to that of the control group, in which the sealant was applied under ideal dry, noncontaminated conditions.

Caries-preventive effect of resin-based and glass ionomer sealants over time: a systematic review

INTRODUCTION

The difference in preventing dentine lesion development between resin-based and glass ionomer sealant materials is unclear. Two recently published reviews were unable to conclude on the difference because the comparison was an exclusion criterion in one review and there were statistical shortcomings in the relevant papers in the other (Cochrane) review.

OBJECTIVES

The aim of the present investigation was to carry out a systematic review on the caries-preventive effect of these two types of sealant materials under more liberal exclusion criteria concerning the statistical presentations in the publications.

METHODS

Based on five exclusion criteria, the literature search in the electronic libraries PubMed and MEDLINE and the publications retrieved in the Cochrane review, revealed 12 eligible publications for analyses. A variety of glass ionomers and resin-based sealant materials had been applied in the included studies. Attributable risk (AR) was chosen rather than relative risk (RR), as used in the Cochrane review, because RR is very instable in a low caries population.

RESULTS

There was no consistent pattern observed with respect to the caries-preventive effect of either resin-based or glass ionomer sealants. Therefore, it was impossible to calculate an overall AR.

CONCLUSIONS

There is no evidence that either resin-based or glass ionomer sealant material is superior to the other in preventing dentine lesion development in pits and fissures over time.

Treatment decisions and conservation of tooth structure

New technology is becoming available to help establish an early diagnosis of incipient and hidden pit and fissure caries, and microdentistry techniques are being developed to follow the principles of minimal intervention. Following the accurate diagnosis of suspected lesions, early intervention can be in the form of chemotherapeutics to promote remineralization or conservative intervention to minimize tooth structure loss. Patient risk factors should have a role in developing and individualized treatment program. The life cycle of a restored molar is used in this article to illustrate the long-term value of early diagnosis, preventive therapy, and conservative intervention to preserve tooth structure and to extend the retention of healthy teeth.

Assessing cost-effectiveness of sealant placement in children

OBJECTIVE

The lack of cost-effectiveness information regarding sealant placement strategies is thought to have influenced reimbursement policies and subsequent sealant utilization in dental practice. This study compared three strategies for managing the occlusal surfaces of first permanent molars: seal all (SA), risk-based (RBS), and seal none (SN).

METHODS

A decision tree was developed for various possible outcomes following each of the above strategies. Due to the complexity of the decision tree, a Markov model was used to allow for the construction of a chain of events representing the natural history of sealant retention, caries formation, and their associated health states. The outcome measures were the incremental cost per month gained in a cavity-free state over a ten-year period.

RESULTS

Our theoretical model showed that RBS strategy improved clinical outcomes, in the form of cavity-free months, and saved money over SN. The strategy of sealing both high and low risk teeth (SA) further improved outcomes but at an additional cost compared to RBS. However, the cost was small, .08 dollars for each additional cavity-free month gained per tooth. Further, minor changes in the baseline assumptions resulted in the SA strategy being the dominant strategy.

CONCLUSION

This study provides evidence that sealing children's first permanent molars can improve outcomes and save money by delaying or avoiding invasive treatment and the destructive cycle of caries. In a time of limited funds for dental services, these results can assist payers in establishing more rational sealant reimbursement policies.

Caries prevalence 1987–1998 in 12-year-olds in France

OBJECTIVE

To describe caries morbidity in 12-year-old French schoolchildren 1987-1998.

MATERIALS AND METHODS

Three cross-sectional surveys from the WHO Global Oral Data Bank that were conducted at national level in France in 1987, 1993, 1998. The surveys involved a representative sample of 1,000 12-year old children in 1987, 1,331 in 1993, and 6,000 in 1998.

RESULTS

An important decline of the caries focused in the first period - 22.8% vs. 4.5% in the period 1993-1998. All components in the DMFT Index decreased although they followed different patterns. The mean number of filled teeth consistently dropped over the entire 11 years in a context where the mean number of untreated carious teeth reached its lowest point in 1993 and increased thereafter. The four first molars accounted for the vast majority of the caries, 73.7% in 1998. In 1998 year, 44.9 % of children had caries-free first molars as opposed to 38.8 % in 1993 and 14.0 % in 1987.

CONCLUSION

The influence of this caries evolution on the oral health system is discussed. Suggestions are advanced to integrate dentistry in a public health concept especially focused on the reduction of inequality.

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.