Evidence-Based Clinical Recommendations for the Use of Pit-and-Fissure Sealants

Adoption and Effect of Sealants for Occlusal Noncavitated Caries in a Large Dental Network in the USA

INTRODUCTION

Dental sealants applied to occlusal pit-and-fissure surfaces have been shown to prevent caries and arrest occlusal noncavitated carious lesions (NCCLs). The American Dental Association (ADA) recommends that oral healthcare providers apply sealants on occlusal NCCLs. Though the evidence is clear that sealants are effective, few studies have examined the adoption of the ADA guideline by dentists and the duration of protection provided by sealants in a large real-world setting.

METHODS

This study used observational electronic health record (EHR) data from a network of dental clinics to follow teeth over a 2 year time period from when they were diagnosed as having an occlusal NCCL until either they were treated with a restoration or the time period ended with no restoration. The objectives of the study were to determine: (1) the degree to which dentists adopted the guideline, (2) whether the duration of protection was different for teeth that received a sealant from teeth that did not receive a sealant, and (3) whether dentists' experience placing sealants was associated with the duration of protection.

RESULTS

Overall, there were 7,299 teeth in the sample. Of those, dentists restored 591 teeth and applied sealants on 164. The sealant application rate for eligible teeth was 2.2%. Sealant application was associated with provider, with 1.9% of providers placing more than half of the sealants. By the end of the observation period, the proportion of teeth progressing to restorations was 8.2% for teeth that had not received a sealant and 3.0% for teeth that had received one (RR = 0.37; 95% CI: 0.16-0.88; p = 0.02). Multilevel survival analysis showed that teeth that had not received a sealant were restored sooner than teeth that had received a sealant (aHR = 0.11; 95% CI: 0.03-0.36; p < 0.01). Overall, teeth that received a sealant had an 89% reduced hazard of restoration within 2 years compared with teeth that did not receive sealants.

CONCLUSION

This study found that by arresting decay, the presence of sealants led to fewer restorations and delayed restorations compared with teeth not receiving a sealant or restoration in the 2 years following diagnosis of occlusal NCCL in clinical settings.

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.

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.

Clinical Evaluation of the Retention of Four Different Pit and Fissure Sealants on the First Permanent Molars - An Original Research

Objective

In this study, the retention rates of four different pit and fissure sealant materials on the first permanent molars were clinically assessed and compared.

Materials and Methods

A total of 120 kids aged 7 to 10 participated in a randomized controlled experiment. On their first permanent teeth, the subjects each got one of the four sealant materials (A, B, C, or D). Over the course of 24 months, the retention rates were evaluated every 6 months. The Chi-square test and Kaplan-Meier survival analysis were used for statistical analysis.

Results

At 6, 12, 18, and 24 months, the following retention rates were observed overall: A (85%, 78%, 65%, 52%), B (90%, 82%, 70%, 60%), C (78%, 70%, 55%, 42%), and D (95%, 88%, 75%, 62%). At each time point, the sealant materials showed significant variations in retention rates (P 0.05). While sealants A and C showed lower retention rates, sealant D showed the best retention rates, followed by sealant B.

Conclusion

This study shows that different materials have different retention rates for pit and fissure sealants on first permanent molars. Higher retention rates for sealants D and B suggest that they may be superior than sealants A and C. These results highlight how crucial it is to choose the right sealant materials to guarantee long-term retention and effectiveness in avoiding dental cavities.

Variation in General Dentists' Patterns of Sealant Use in Children with Elevated Caries Risk

INTRODUCTION

Strong evidence supports use of dental sealants to prevent tooth decay, and professional guidelines recommend use in children with elevated caries risk. However, not all children indicated for sealants receive this preventive intervention, even when they use routine dental care.

OBJECTIVE

The aim of this study was to explore the extent to which dentists' use of sealants varied in pediatric patients with elevated caries risk.

METHODS

Claims and enrollment data from a private dental program were used to identify a cohort of 6- to 17-y-olds with elevated caries risk (N = 27,677) and general dentists (N = 818) who provided services to the children. Children were identified as having elevated caries risk based on history of restorative treatment over a 5-y period (2010-2014). The 2 outcomes of interest were whether a dentist provided any sealants to children with elevated risk and, if so, the extent to which these were used during a 2-y observation period (2013-2014). A 2-stage hurdle model was used for multivariable analysis to identify dentist characteristics associated with sealant use.

RESULTS

Over the observation period, 13.3% (n = 109) of dentists did not provide any sealants to their elevated risk patients from the study cohort. Logistic regression found that female dentists were significantly more likely to have used sealants (odds ratio = 2.27); dentist age and practice in an isolated small rural town were negatively associated with any sealant use. However, among dentists who did place sealants (n = 709), female dentists, older dentists, dentists in solo practice, and those working full-time were significantly more likely to provide sealants to a child. Overall, substantial variation in practitioners' use of sealants was observed.

CONCLUSION

This is the first study to explore provider-level variation in sealant use, representing a critical step in future efforts to increase routine use of sealants by dentists and eliminate oral health disparities.

KNOWLEDGE TRANSFER STATEMENT

Findings from this study can be used to design targeted policy and behavioral interventions to increase sealant use by general dentists. This study provides foundational evidence for future research that explores motivation and barriers to routine use of preventive dental interventions by clinicians.

Effects of topical fluoride treatment on the bond strength of pit and fissure sealants: A systematic review

Background

This systematic review aimed to evaluate the available scientific evidence concerning the effects of topical fluoride treatment on the bond strength of pit and fissure sealants. Prevention of dental caries is one of the crucial issues in pediatric dentistry. Pit and fissure sealant and fluoride therapies are two caries prevention procedures that may be performed in one session. However, fluoride therapy may affect the bond strength of pit and fissure sealants.

Methods

An electronic search for in vitro studies published in English and Persian on topical fluoride therapy and the bond strength of pit and fissure sealants was performed via PubMed/ Medline, Web of Science, Google Scholar, Embase, and Scopus databases until May 2022. The articles were independently reviewed for quality by two reviewers. Textual data were analyzed manually, and the bond strength of sealants placed after fluoride application was compared with control groups.

Results

A total of 8482 articles were initially identified and reviewed by two independent reviewers, and 13 were selected for full-text evaluation. Finally, six articles were included in the systematic review. A total of 250 teeth were studied, 148 of which were in the case group (fluoride group) and 102 in the control group. Tensile and shear bond strengths were compared between groups in the studies.

Conclusion

In the studies in which the tooth surfaces were washed after applying fluoride, there was no change in the fissure sealant bond strength. However, in studies in which fluoride was not washed, the bond strength decreased significantly, independent of the fluoride type.

12-Month flexural mechanical properties of conventional and self-adhesive flowable resin composite materials

The aim of this study was to investigate the 12-month flexural mechanical properties of 23 flowable resin-based composites (FRBC) that included 5 self-adhesive FRBC materials. Specimens were evaluated following ISO 4049:2019 guidelines, but additionally stored in physiologic 0.2M phosphate buffered saline solution being tested at 24 h, 1 week, 1 month, and at 3-, 6-, 9-, and 12-months. While some deviation and degradation were noted at testing intervals, conventional FRBC materials overall demonstrated greater flexural strength than the self-adhesive and compomer materials. Three self-adhesive materials and the compomer were below recommended ISO 4049:2019 flexural strength values at 24 h with another after 6 months storage. Conventional FRBC materials, except at 1 month, overall demonstrated increased flexural modulus than the self-adhesive FRBC materials. Although results were material dependent, conventional FRBC materials demonstrated overall greater flexural mechanical properties as compared to the self-adhesive FRBC materials and the compomer evaluated.

Methods of Primary Clinical Prevention of Dental Caries in the Adult Patient: An Integrative Review

AIM

Preventive approaches to oral health diseases, mainly dental caries, require individual and collective policies. Thus, this review was conducted to identify the primary prevention methods of dental caries in adults to improve oral health at the clinical and community levels.

METHODS

This review followed the PICO strategy with the research question: "What are the methods of primary prevention of dental caries, in adults, for improving and maintaining oral health integrating clinical and community-based strategies?" Electronic screening was carried out by two independent reviewers in five databases (MedLine/PubMed, SciELO, Web of Science, Cochrane Library, and LILACS) to find relevant publications between 2015-2022. We applied eligibility criteria for selection of the articles. The following MeSH terms were used: "Primary Prevention"; "Adult"; "Oral Health"; "Dental Caries"; "Fluorides, Topical"; "Fluoride Varnishes"; "Pit and Fissure Sealants"; "Preventive Dentistry". Although the term "Prevention strategy" is not a MeSH descriptor, several correlated terms appeared and were used in the search engines: "Preventative Care", "Disease Prevention, Primary", and "Prevention, Primary". The tool provided by the JBI organization (Joanna Briggs Institute) was used to assess the quality of the included studies.

RESULTS

Nine studies were included. Overall, it was found that the main primary prevention methods applied in dentistry in adults are the application of pit and fissure sealants, topical application of fluoride performed in the dental clinic, use of fluoridated toothpaste, mouthwash with chlorhexidine at home, use of xylitol, the recommendation for regular appointments with the dentist, and the need to inform patients about the saliva buffer capacity and adoption of a non-cariogenic diet. For that purpose, preventive policies should be taken to prevent dental caries. These include three major challenges: providing the adult population with more knowledge regarding their oral health, empowering patients through adopting healthy lifestyles, and developing new preventive strategies and awareness campaigns aimed at the adult population to promote proper oral health habits.

CONCLUSIONS

A small number of studies were found whose participants were adult patients. There was some consistency regarding primary prevention methods in our studies. However, good quality randomized control studies are still required to define the best intervention strategies for adult caries prevention.

Perception of Minimum Interventional Dentistry among Dental Undergraduate Students and Interns

Background: The philosophy of minimum interventional dentistry (MID) is to integrate prevention, remineralization, and minimal intervention for the placement and replacement of restorations. All branches of dentistry play an important role in practicing MID, and their primary goal is to realize that any restoration is of less biological significance than the healthy original tissue Objectives: The objective of this study was to assess the perception of MID among dental undergraduate students and interns in terms of knowledge, attitude, and practice at the College of Dentistry. Materials and Methods: This cross-sectional study was conducted among undergraduate students and interns at the College of Dentistry, Qassim University, Saudi Arabia. A self-administered questionnaire was distributed, which included basic demographic profiles and questions about the knowledge, attitude, and practices toward MID. The data were tabulated in MS Excel, and all statistical analyses were performed using SPSS version 21. Results: A total of 163 dental students were recruited, with senior students comprising 73% and interns comprising 27%. Male students were slightly more prevalent (50.9%) than female students (49.1%). About 37.6% of participants received training about MID during educational courses, while 10.3% received it during their internship. A statistical test revealed that the prevalence of interns who were trained in performing MID was significantly higher (p < 0.001). Conclusions: The majority of the participants demonstrated proper knowledge, attitude, and practice in different aspects of MID. Interns reported a higher rate of knowledge, attitude, and practice in MID compared to undergraduate students. However, more education and hands-on training about MID concepts during the college curriculum are necessary to attain better knowledge, attitude, and practices that could be useful for more conservative clinical practice.

Effectiveness of applying proximal enamel caries with fluoride-releasing sealant and fluoride varnish on caries progression in permanent teeth: A 12-month split-mouth randomized clinical trial

BACKGROUND

Few studies report on managing initial proximal caries with sealants, and no reports focus on fluoride-releasing sealants.

AIM

To compare the effectiveness between applications of a fluoride-releasing sealant and fluoride varnish on proximal enamel caries to control caries progression in permanent teeth.

DESIGN

This was a split-mouth randomized controlled trial in forty-four 11- to 16-year-old children with radiographic caries in at least one contralateral pair of teeth with proximal enamel caries. The lesions were evaluated using DIAGNOdent and were also assessed visually after tooth separation. The lesions in each subject were randomly sealed with a fluoride-releasing sealant (Helioseal® F) or applied with fluoride varnish (Duraphat®). The fluoride varnish-treated lesion was reapplied at 3 and 6 months. Clinical examination, bitewing radiograph evaluation, and DIAGNOdent assessment were performed at 6 and 12 months. The caries progression outcome variables were regression, no change, and progression. The data were analyzed with the McNemar-Bowker test.

RESULTS

Radiographic examination and DIAGNOdent assessment demonstrated no significant differences in the percentages of regression, no change, or progression at the 12-month follow-up (p > .05).

CONCLUSION

Applications of a fluoride-releasing sealant and of fluoride varnish three times resulted in a nonsignificant difference in caries progression of initial proximal caries at the 12-month follow-up.

Evaluation of fissure sealant retention rates using Isolite in comparison with rubber dam and cotton roll isolation techniques: A randomized clinical trial

BACKGROUND

Clinical studies comparing retention rates of pit and fissure sealants placed under Isolite, rubber dam, and cotton roll combined have not been conducted until now.

AIM

To evaluate the retention rate of pit and fissure sealants (PFS) placed under three different isolation techniques (Isolite system [IS], rubber dam isolation [RDI], and cotton roll isolation [CRI]).

DESIGN

One hundred and forty-four teeth from 48 children aged 6-15 years attending paediatric dental clinics at King Saud University in Saudi Arabia were randomized to receive three PFS using three isolation techniques. The children that met the inclusion criteria were randomized by a simple block random allocation method. All PFS were placed by an operator and evaluated by a blinded evaluator. The evaluation scores were recorded at baseline and followed up over a period of 12-22 months.

RESULTS

The children's mean age was 8.58 ± 1.93 years. Seven patients were lost to follow-up. A total of 123 teeth were clinically evaluated; of these teeth, 22% had completely retained sealants, whereas approximately 66% had a partial loss of sealants, and approximately 12% had a complete loss of sealants. There were, however, no significant differences between the three isolation techniques on the retention rate of pit and fissure sealant.

CONCLUSION

The types of isolation had no impact on the retention rate of pit and fissure sealant.

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.

Incorporation of Nanomaterials in Glass Ionomer Cements-Recent Developments and Future Perspectives: A Narrative Review

Glass ionomer cements (GICs), restorative materials with commercial availability spanning over five decades, are widely applied due to their advantages (including bio-compatibility, fluoride release, or excellent bonding properties). However, GICs have shortcomings. Among the disadvantages limiting the application of GICs, the poor mechanical properties are the most significant. In order to enhance the mechanical or antimicrobial properties of these materials, the addition of nanomaterials represents a viable approach. The present paper aims to review the literature on the application of different types of nanomaterials for the enhancement of GICs' mechanical and antimicrobial properties, which could lead to several clinical benefits, including better physical properties and the prevention of tooth decay. After applying the described methodology, representative articles published in the time period 2011-present were selected and included in the final review, covering the modification of GICs with metallic nanoparticles (Cu, Ag), metallic and metalloid oxide nanoparticles (TiO₂, ZnO, MgO, Al₂O₃, ZrO₂, SiO₂), apatitic nanomaterials, and other nanomaterials or multi-component nanocomposites.

Acculturation and dental sealant use among US children

OBJECTIVES

Healthcare (including dental care) service use is influenced by predisposing, enabling and need factors. One area with limited research is the association of acculturation (defined as behavioural changes in the adaptation to another culture) as a predisposing factor for dental care preventive service use. Preventive service use is a primary objective of Healthy People, 2030. The purpose of this study was to determine the association of acculturation with the preventive dental service use of dental pit-and-fissure sealant placement, among children in the United States, ages 6-18 years.

METHODS

A cross-sectional, secondary data analysis study was completed using National Health and Nutrition Examination Survey (NHANES), 2013-2016 data. NHANES is a nationally representative survey of noninstitutionalized individuals across the United States. In the data set, children, ages 6-18 years, had been evaluated for pit-and-fissure dental sealant use. Information that served as proxies for acculturation was length of stay in the United States (a citizen at the time of the survey; not a citizen and in the country <5 years; or not a citizen and in the country ≥5 years) and whether English was spoken at home (yes; no). Data were analysed for descriptive statistics. Multivariable logistic regressions were used to examine strength of the associations. Odds ratios for pit-and-fissure sealants among groups were determined.

RESULTS

There were 2220 children participants whose data were used for this study. Less than half (45.5%) had received dental pit-and-fissure sealants. A majority (53.3%) were white and were ages 12-18 years (51.6%). The mean number of dental pit-and-fissure sealants among all children was 5.5. There was a lower percentage of children living in the United States <5 years who had received pit-and-fissure sealants than children who were citizens of the United States (22.2% vs 48.9%, respectively). The adjusted odds ratio was lower for dental pit-and-fissure sealants among children who were in the United States <5 years than children who were citizens of the United States (adjusted odds ratio, 0.38; 95% Confidence Interval: 0.24, 0.58).

CONCLUSIONS

In this study, children who had lived in the United States <5 years were less likely to have pit-and-fissure sealants than children who were citizens of the United States. There is a need to reach all children with preventive services to improve dental quality of life, reduce the need for dental restorations and decrease overall financial burden regardless of time in the United States.

The Assessment of Sealants' Effectiveness in Arresting Non-Cavitated Caries Lesion-A 24-Month Follow-Up

Dental sealants are excellent means to prevent pits and fissure caries. Nowadays, the application of sealants is extended to therapeutic use in arresting non-cavitated carious lesions. This relatively new concept still lacks evidence to support its routine use. The aim of this study was to evaluate the effectiveness of a resin-based sealant applied on first permanent molars with carious lesions (ICDAS 1−3), in comparison with its effectiveness when applied on sound surfaces (ICDAS 0). Included in the study were 114 children aged between six and eight years old, with a high caries risk (according to the CAMBRA system), with all four permanent molars erupted and with deep pits and fissures. A total number of 407 molars were sealed and assessed. A total of 49 were excluded (they had caries, which according to the ICDAS II classification were classified with code 4−6 or had older sealants or fillings). Out of these 407 molars, 213 were sound (code 0) and 194 had caries lesions as follows: 56 teeth classified as code 1, 79 teeth classified as code 2, and 59 teeth classified as code 3 according to the ICDAS II classification. The retention of the sealant and carious lesions were assessed clinically at 6, 12, 18, and 24 months. Regarding sealant retention, a statistically significant difference (p < 0.05) among the two types of sealed teeth, sound (ICDAS 0) and decayed (ICDAS 3), showed at 18- and 24-month follow-up intervals. Regarding caries lesions, a statistically significant difference (p < 0.05) showed between sound (ICDAS 0) and decayed (ICDAS 3) molars at 24-month follow-up. Our study results supported the resin-based sealant effectiveness in arresting incipient carious lesions, which according to the ICDAS II classification have received codes 1 and 2 but did not support sealant effectiveness in arresting caries lesions classified according to the same classification with code 3.

An In Vitro Study of Three Types of Pit and Fissure Sealants for Viscosity, Resin Tag, and Microleakage: A Scanning Electron Microscope Study

Introduction

One of the important techniques for prevention of dental caries is the application of pit and fissure sealants. The sealant success depends on not only adhering firmly to the enamel surface, but also isolation of pits and fissures from the rest of the oral environment.

The study was conducted to evaluate and compare three pit and fissure sealant materials for viscosity, microleakage, and resin tag length.

Materials and methods

Sixty premolars were selected for the study. The teeth were randomly divided into three groups. Group I: type VII GIC, group II: Delton FS, group III: Delton. Teeth were prepared by pumice prophylaxis and etched with 37% phosphoric acid. The respective pit and fissure sealants were applied. Teeth were stored in 1% methylene blue dye and sectioned mesiodistally into two halves. The microleakage was assessed using stereomicroscope and resin tag length using scanning electron microscope (SEM). Brookfield's viscometer was used to measure the viscosity.

Result

Viscosity was lowest for Delton and highest for type VII GIC. Microleakage was seen least with the Delton (0.0%) sealant, followed by Delton FS (20.0%), and highest in Type VII GIC (85.0%) in the scoring criteria of 3 and 4 and the mean length of the resin tags was least for Type VII GIC was 3.79 ± 2.58 µm, followed by Delton FS was 5.60 ± 2.12 µm, and highest for Delton was 7.27 ± 3.43 µm. The relation between viscosity, resin tag length, and microleakage was negative. As the viscosity gets lower, the more long the resin tags formed and the microleakage decreased. Delton pit and fissure sealant had lowest viscosity and microleakage scores while longest resin tag lengths.

Conclusion

Delton with the lowest viscosity and microleakage appears to be a more suitable pit and fissure sealant compatible with residual moisture and ideal for use in children, where isolation is a problem.

How to cite this article

Singh R, Lakhanam M. An In Vitro Study of Three Types of Pit and Fissure Sealants for Viscosity, Resin Tag, and Microleakage: A Scanning Electron Microscope Study. Int J Clin Pediatr Dent 2022;15(3):304-310.

Clinical Evaluation of the Retention of Self-adhering Flowable Composite as Fissure Sealant in 6&ndash;9-year-old Children: A Randomized Controlled Trial

Aim

To evaluate the retention rate of self-adhering flowable composite as fissure sealant in comparison with the unfilled resin sealant on first permanent molars of 6–9-year-old children.

Materials and methods

A 2-arm, split-mouth randomized controlled trial included 100 children of age 6–9 years with completely erupted mandibular first permanent molars. A total of 200 teeth were randomly divided into two groups, group I: self-adhering flowable composite; group II: unfilled resin sealant. Sealants were placed on the mandibular first permanent molars and the children were recalled at 6, 12, and 18 months intervals to evaluate the retention rate. Chi-square test was used to analyze the data.

Results

Self-adhering flowable composite has shown a complete retention rate of 67%, 47%, and 46% at 6, 12, and 18-month intervals, respectively, whereas unfilled resin sealant has shown 41%, 8%, and 5% retention rate at 6, 12, and 18-month intervals, respectively. The difference in the complete sealant retention rates between the groups is found to be statistically highly significant at all the follow-up intervals (p = 0.0004, 0.0001, and 0.0001 at 6, 12, and 18-month intervals, respectively). In both groups, maximum sealant loss occurred between 6 and 12-month intervals. Retention rates were higher at 6 months intervals which were significantly reduced over 18 months intervals.

Conclusion

Self-adhering flowable composite has shown a higher retention rate compared to unfilled resin sealant at all the time intervals. The retention rate of both materials decreased with time. However, the loss of sealant was more with unfilled resin sealant.

Clinical significance

In pediatric dental practice, the elimination of a step in restorative dentistry protocol makes a big difference as time is a critical factor in obtaining children's cooperation. The use of self-adhering materials eliminates the step of bonding agent application, which simplifies the restorative protocol and makes the clinical practice effective. Therefore, these self-adhering flowable composite resin materials can be considered fissure sealants in routine clinical practice.

How to cite this article

Bhuvaneswari P, Vinay C, Uloopi KS, et al. Clinical Evaluation of the Retention of Self-adhering Flowable Composite as Fissure Sealant in 6–9-year-old Children: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2022;15(3):322-326.

Effect of nano-hydroxyapatite incorporation on fluoride-releasing ability, penetration, and adaptation of a pit and fissure sealant

BACKGROUND

Dental caries is one of the most common multifactorial oral diseases and can be prevented using pit and fissure sealants.

AIM

To evaluate the effect of nano-hydroxyapatite (nanoHAP) incorporation on fluoride-releasing ability, penetration, and adaptation of a pit and fissure sealant.

DESIGN

This was an in vitro study with two groups: conventional sealant and nanoHAP-incorporated sealant. Sealant penetration and adaptation were assessed using stereomicroscope and scanning electron microscope (SEM) (15 and 10 samples per group, respectively). Fluoride release was analyzed using ion-selective electrode (15 samples per group). The chi-square test was used to compare penetration and adaptation between the 2 groups, and an independent Student t test was used to compare fluoride release.

RESULTS

The nanoHAP group showed significantly more samples with no bubbles (P = .001) and no debris (P < .001). SEM analysis showed a significantly greater percentage of adequate fissures in the test group (P = .007). The fluoride release was significantly higher in test samples with p values of .001 and .016 on day 1 and day 60, respectively.

CONCLUSION

The incorporation of nanoHAP into the conventional pit and fissure sealant improved its penetration and adaptation properties along with fluoride release.

Microtensile Bond Strength of Bioactive Pit and Fissure Sealants Bonded to Primary and Permanent Teeth

Background: Sealing occlusal pits and fissures is an effective preventive measure against dental caries. Pit and fissure sealants (PFS) should be strongly bonded to the teeth to prevent partial or complete loss of the sealant, which may limit its preventive effect. Objective: The objective of the study was to compare the microtensile bond strength (μTBS) of bioactive resin-based sealants (Bio-RBS) and resin-based sealants (RBS), with and without the use of a bonding agent, to the enamel of primary and permanent teeth. Methods: One hundred and twenty caries-free primary molar specimens and 120 permanent molar specimens were divided to eight groups (30 specimens per group), both primary and permanent teeth were sealed with a Bio-RBS BioCoat^TM (Premier^®, Plymouth Meeting, PA, USA) or with a RBS Clinpro^TM (3M ESPE, Saint Paul, MN, USA), with or without the use of a bonding agent (Prime & Bond NT; Dentsply, Inc., Charlotte, NC, USA). Half the specimens were aged with 5000 thermal cycles, and all specimens were tested for the μTBS and failure mode. Results: The mean μTBS of aged Bio-RBS was higher in permanent teeth than primary teeth, and the aging process reduced the μTBS of RBS more than that of Bio-RBS. Moreover, the addition of a bonding agent improved the μTBS of aged RBS in permanent teeth. Conclusion: We concluded that Bio-RBS exhibit superior μTBS than RBS when applied to permanent teeth.

Sealants for preventing dental caries in primary teeth

BACKGROUND

Pit and fissure sealants are plastic materials that are used to seal deep pits and fissures on the occlusal surfaces of teeth, where decay occurs most often in children and adolescents. Deep pits and fissures can retain food debris and bacteria, making them difficult to clean, thereby causing them to be more susceptible to dental caries. The application of a pit and fissure sealant, a non-invasive preventive approach, can prevent dental caries by forming a protective barrier that reduces food entrapment and bacterial growth. Though moderate-certainty evidence shows that sealants are effective in preventing caries in permanent teeth, the effectiveness of applying pit and fissure sealants to primary teeth has yet to be established.

OBJECTIVES

To evaluate the effects of sealants compared to no sealant or a different sealant in preventing pit and fissure caries on the occlusal surfaces of primary molars in children and to report the adverse effects and the retention of different types of sealants.

SEARCH METHODS

An information specialist searched four bibliographic databases up to 11 February 2021 and used additional search methods to identify published, unpublished and ongoing studies. Review authors scanned the reference lists of included studies and relevant systematic reviews for further studies.

SELECTION CRITERIA

We included parallel-group and split-mouth randomised controlled trials (RCTs) that compared a sealant with no sealant, or different types of sealants, for the prevention of caries in primary molars, with no restriction on follow-up duration. We included studies in which co-interventions such as oral health preventive measures, oral health education or tooth brushing demonstrations were used, provided that the same adjunct was used with the intervention and comparator. We excluded studies with complex interventions for the prevention of dental caries in primary teeth such as preventive resin restorations, or studies that used sealants in cavitated carious lesions.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened search results, extracted data and assessed risk of bias of included studies. We presented outcomes for the development of new carious lesions on occlusal surfaces of primary molars as odds ratios (OR) with 95% confidence intervals (CIs). Where studies were similar in clinical and methodological characteristics, we planned to pool effect estimates using a random-effects model where appropriate. We used GRADE methodology to assess the certainty of the evidence.

MAIN RESULTS

We included nine studies that randomised 1120 children who ranged in age from 18 months to eight years at the start of the study. One study compared fluoride-releasing resin-based sealant with no sealant (139 tooth pairs in 90 children); two studies compared glass ionomer-based sealant with no sealant (619 children); two studies compared glass ionomer-based sealant with resin-based sealant (278 tooth pairs in 200 children); two studies compared fluoride-releasing resin-based sealant with resin-based sealant (113 tooth pairs in 69 children); one study compared composite with fluoride-releasing resin-based sealant (40 tooth pairs in 40 children); and one study compared autopolymerised sealant with light polymerised sealant (52 tooth pairs in 52 children). Three studies evaluated the effects of sealants versus no sealant and provided data for our primary outcome. Due to differences in study design such as age of participants and duration of follow-up, we elected not to pool the data. At 24 months, there was insufficient evidence of a difference in the development of new caries lesions for the fluoride-releasing sealants or no treatment groups (Becker Balagtas odds ratio (BB OR) 0.76, 95% CI 0.41 to 1.42; 1 study, 85 children, 255 tooth surfaces). For glass ionomer-based sealants, the evidence was equivocal; one study found insufficient evidence of a difference at follow-up between 12 and 30 months (OR 0.97, 95% CI 0.63 to 1.49; 449 children), while another with 12-month follow-up found a large, beneficial effect of sealants (OR 0.03, 95% CI 0.01 to 0.15; 107 children). We judged the certainty of the evidence to be low, downgrading two levels in total for study limitations, imprecision and inconsistency. We included six trials randomising 411 children that directly compared different sealant materials, four of which (221 children) provided data for our primary outcome. Differences in age of the participants and duration of follow-up precluded pooling of the data. The incidence of development of new caries lesions was typically low across the different sealant types evaluated. We judged the certainty of the evidence to be low or very low for the outcome of caries incidence. Only one study assessed and reported adverse events, the nature of which was gag reflex while placing the sealant material.

AUTHORS' CONCLUSIONS

The certainty of the evidence for the comparisons and outcomes in this review was low or very low, reflecting the fragility and uncertainty of the evidence base. The volume of evidence for this review was limited, which typically included small studies where the number of events was low. The majority of studies in this review were of split-mouth design, an efficient study design for this research question; however, there were often shortcomings in the analysis and reporting of results that made synthesising the evidence difficult. An important omission from the included studies was the reporting of adverse events. Given the importance of prevention for maintaining good oral health, there exists an important evidence gap pertaining to the caries-preventive effect and retention of sealants in the primary dentition, which should be addressed through robust RCTs.

Molar space closure: To do or not to do?

Missing or compromised permanent molars can complicate orthodontic treatment planning and mechanics. Molar extraction should be considered in appropriate situations, but clinicians must decide between closing and regaining the edentulous space. Several factors should be taken into consideration to achieve appropriate molar space management, such as the need for space, asymmetry, periodontal status, sinus pneumatization, and the terminal molar position. Herein, three sample cases are reported to demonstrate the treatment options for molar space closure and maintenance with these factors taken into consideration during treatment planning. The understanding of mechanics played a crucial role in anchorage preparation and side effect prevention. If the third molar substitution was managed in advance and adequate space between the ramus and third molar was obtained via second molar protraction, the tooth spontaneously erupted in a favorable position without requiring further treatment. This case series can aid clinicians in molar space management. Regardless of whether the space is to be closed or regained, the treatment plan should conform to the patient’s expectations and improve occlusion with minimal side effects and treatment duration.

Using bonding agent prior to pits and fissure sealant application enhances the microtensile bond strength and the interface morphology

Background

A pits and fissures sealant is an effective method for preventing dental caries. Using a bonding agent before applying the sealant may increase its retention. This study aimed to compare the microtensile strength (µTBS) of a fissure sealant with and without a bonding agent and to characterize the enamel-sealant interface using confocal laser scanning microscopy (CLSM). The null hypothesis was that the use of a bonding agent before fissure sealant application would not change the microtensile strength or the enamel-sealant interface.

Materials and methods

Twenty caries-free premolars were used. Each tooth was divided into four parts. The first two parts were assigned to the bonded group, where a bonding system was used before sealant application. The remaining two parts were treated only with a fissure sealant (i.e., the nonbonded group). In each group, the µTBS was examined after 24 h (n = 20) and after a 3-month aging period (n = 20). Five other caries-free extracted premolars were used to assess the enamel-sealant interface using CLSM. Two-way analysis of variance (ANOVA) and Pearson chi-square statistical analysis tests were used to analyze the µTBS and the enamel-sealant interface, respectively.

Results

The mean µTBS for the bonded group was significantly higher (p = 0.001) in the immediate group (36.87 ± 14.95 MPa) and the aged group (31.08 ± 15.88 MPa) than in the respective nonbonded groups (19.77 ± 9.67 MPa and 19.52 ± 14.14 MPa). The µTBS was not significantly different in either group after aging (p = 0.46 [bonded group] and p = 0.98 [nonbonded group]). In addition, using a dental adhesive, before applying a fissure sealant resulted in a significantly higher (53%) resin penetration into the enamel with the continuous integrity of the resin.

Conclusion

The use of a bonding agent before the application of fissure sealant resulted in superior microtensile bond strength immediately and after aging. In addition, the enamel-sealant interface characteristics were improved.

Intelligent pH-responsive dental sealants to prevent long-term microleakage

OBJECTIVES

Microleakage is a determinant factor of failures in sealant application. In this study, DMAEM (dodecylmethylaminoethyl methacrylate), a pH-responsive antibacterial agent, was incorporated into resin-based sealant for the first time. The objectives of this study were to: (1) investigate the long-term performance of DMAEM-modified sealants against oral microbial-aging; and (2) investigate the long-term preventive effect of DMAEM-modified sealants on microleakage.

METHODS

Depth-of-cure and cytotoxicity of DMAEM-modified sealants were measured. Then, an aging model using biofilm derived from the saliva of high caries experience children was conducted. After aging, microhardness and surface roughness were measured. Biofilm activity, lactic acid production and exopolysaccharide (EPS) production were measured. 16S rRNA gene sequencing were also performed. The effects of DMAEM on microleakage were tested using an in vitro microleakage assessment.

RESULTS

The addition of DMAEM with a mass fraction of 2.5-10% did not affect depth-of-cure values and cytotoxicity of sealants. Adding 2.5-10% DMAEM did not affect the surface roughness and microhardness after aging. Compared to control, adding 2.5-10% DMAEM reduced biofilm metabolic activity by more than 80%. The lactic acid production and EPS production were reduced by 50% in DMAEM groups. DMAEM-modified sealants maintained the microbial diversity of biofilm after aging, they also inhibited the growth of lactobacillus. The 5% and 10% DMAEM groups exhibited a significant reduction in microleakage compared to control.

SIGNIFICANCE

The long-term antibacterial activities against oral microbial-aging and the long-term microecosystem-regulating capabilities enabled DMAEM-modified sealant to prevent microleakage in sealant application and thus prevent dental caries.

Anti-bacterial and anti-microbial aging effects of resin-based sealant modified by quaternary ammonium monomers

OBJECTIVES

Pit and fissure sealant is used in the prevention of dental caries. However, commercial pit and fissure sealant lacks persistent antibacterial properties. Dimethylaminododecyl methacrylate (DMADDM) was added to pit and fissure sealants to give it sustainable antibacterial properties and anti-microbial aging properties.

METHODS

Resin-based sealant was used as a control. Novel sealants were made with DMADDM. Atomic force microscope observation, curing depth, cytotoxicity, lactic acid measurement, hardness and microleakage were measured. Saliva-derived biofilms were grown on sealants. Biofilm metabolic activity, lactic acid production and biomass accumulation were measured.

RESULTS

Incorporating DMADDM did not increase the cytotoxicity or change the physical properties when the mass fraction of the DMADDM was 2.5-10%. The modification decreased the amount of bacterial biofilm, metabolic activity, lactic acid production and exopolysaccharide (EPS) in the saliva biofilms. It also provided anti-microbial aging properties.

CONCLUSION

The incorporation of DMADDM improved the antibacterial and anti-microbial aging effects of the material. It demonstrated a sustained antibacterial effect. The antibacterial and anti-microbial aging modification might be a potential choice for future clinical applications to inhibit dental caries, especially for children at high caries risk.

CLINICAL SIGNIFICANCE

The antibacterial and anti-microbial aging modification might be a potential choice for future clinical applications to prevent dental caries, especially for individuals at high caries risk.

Early Childhood Caries in Indigenous Communities

The oral health of Indigenous children of Canada (First Nations, Inuit, and Métis) and the United States (American Indian and Alaska native) is a major child health disparity when compared with the general population of both countries. Early childhood caries (ECC) occurs in Indigenous children at an earlier age, with a higher prevalence, and at much greater severity than in the general population. ECC results in adverse oral health, affecting childhood health and well-being, and may result in high rates of costly surgical treatment under general anesthesia. ECC is an infectious disease that is influenced by multiple factors, but the social determinants of health are particularly important. This policy statement includes recommendations for preventive and clinical oral health care for infants, toddlers, preschool-aged children, and pregnant women by primary health care providers. It also addresses community-based health-promotion initiatives and access to dental care for Indigenous children. This policy statement encourages oral health interventions at early ages in Indigenous children, including referral to dental care for the use of sealants, interim therapeutic restorations, and silver diamine fluoride. Further community-based research on the microbiology, epidemiology, prevention, and management of ECC in Indigenous communities is also needed to reduce the dismally high rate of caries in this population.

Effect of a chlorhexidine-encapsulated nanotube modified pit-and-fissure sealant on oral biofilm

The purpose of this study was to characterize a chlorhexidine-encapsulated nanotube modified pit-and-fissure sealant for biofilm development prevention. HS (commercial control); HNT (HS+15wt%Halloysite^®-clay-nanotube); CHX10% (HS+15wt% HNT-encapsulated with chlorhexidine 10%); and CHX20% (HS+15wt% HNT-encapsulated with CHX20%) were tested. Degree-of-conversion (DC%), Knoop hardness (KHN), and viscosity were analyzed. The ability of the sealant to wet the fissures was evaluated. Specimens were tested for zones of inhibition of microbial growth. S. mutans biofilm was tested by measuring recovered viability. Data were statistically analyzed (p<0.05). DC% was significantly higher for the HNT-CHX groups. For KHN, CHX10% presented a lower mean value than the other groups. Adding HNT resulted in higher viscosity values. The biofilm on CHX10% and CHX20% sealants presented remarkable CFU/mL reduction in comparison to the HS. The experimental material was able to reduce the biofilm development in S. mutans biofilm without compromising the sealant properties.

Redesign of an informed consent form to increase participation in a school-based dental program

OBJECTIVES

The study aimed to determine if modifications to the design of a consent form and consenting process increased participation rates in the Indiana University School of Dentistry's Mobile School-Based Dental Program (Seal Indiana).

METHODS

Kaizen methodology was followed to identify problem areas in the consenting process. Additionally, stakeholders were invited to participate in focus groups and fill out surveys to identify issues preventing participation in the Seal Indiana program (N = 48) and later to evaluate the changes made (N = 48). The redesigned form and process were then used in a pilot study at 14 sites to determine the impact that changes had on levels of participation as measured by the number of consent forms completed and returned.

RESULTS

There was a statistically significant increase in the number of consent forms returned. The measured change represented a 32 percent increase in program participation (P value = 0.035). A statistically significant increase was observed in how participants viewed the attractiveness of the form and how easy it was to read and comprehend.

CONCLUSIONS

In order to increase consenting rates, our results indicate modifications to the consent form should be focused on the following characteristics: esthetics, ease of reading and comprehending information, and making the Health Insurance Portability and Accountability Act of 1996 (HIPPA) privacy regulations easier to read and comprehend.

Identifying heterogeneity in the risk factors of dental caries status in Chinese adolescents using Poisson mixture regression

OBJECTIVE

The purpose of this study was to cluster individuals into groups with different dental health characteristics and make statistical inferences on the effect differences among different groups simultaneously to identify the heterogeneity of risk factors in Chinese adolescents by analysing the data from the 4th Chinese National Oral Health Survey.

METHODS

For decayed, missing and filled permanent teeth (DMFT), mean values were statistically analysed for their relationships with different categories of all involved variables. As DMFT scores only have discrete values, Poisson mixture regression was adopted to model the heterogeneity and complex patterns in the association and to detect the subgroup. The Bayesian information criterion (BIC) was used to determine the optimal number of subgroups. A series of Wald tests were used to explore the relationship between risk factors including the interaction effects and the number of DMFT.

RESULTS

A total of 100 986 individuals aged 12-15 years old were analysed. The model clustered different individuals into three subgroups and built three submodels for detailed statistical inference simultaneously. The number of individuals in the three subgroups were 52 576 (52.1%), 41 969 (41.5%) and 6441 (6.4%), respectively. The mean (SD) of DMFT of the three subgroups was 0.50 (1.05), 0.99 (1.21), 5.59 (2.50). The model fitting results indicated that the effects of all risk factors on DMFT appear to be different in three subgroups. Controlling the confounding effects, our analysis implied that the regional inequality was the main contributing factor to dental caries among adolescents in Chinese mainland.

CONCLUSIONS

The risk factors of dental caries exhibited heterogeneity in groups with different characteristics. The Poisson mixture regression model could cluster individuals into groups and identify the heterogeneous effects of risk factors among different groups. The findings support the need for different targeted interventions and prevention measures in groups with different dental health characteristics.

Laser Tooth Preparation for Pit and Fissure Sealing

Objectives: Various approaches are available for pit and fissure sealing, including: the use of sealants, with or without mechanical preparation; the use of etching, with or without bonding; and the use of lasers as an alternative to mechanical preparation. The objective of this study is to evaluate pit and fissure sealing by comparing the retention and microleakage of sealants, between mechanical and Er:Yag laser enamel preparation. Methods: Sixty extracted sound third molars are classified into six groups: A, bur mechanical preparation and sealant application; B, bur mechanical preparation, etching and sealant; C, bur mechanical preparation, etching, bonding and sealant; D, laser mechanical preparation and sealant; E, laser mechanical preparation, etching and sealant application; F, laser mechanical preparation, etching, bonding, and sealant. Statistical analysis methods include Fisher’s exact test, a general linear model for one-way analysis of variance (ANOVA) of multiple comparisons, and Bonferroni multiple comparison tests. Results: All the groups showed dye microleakage beneath the sealants. Less microleakage was observed for those that used bur rather than laser, 41 versus 44 specimens, respectively. The number of specimens without microleakage decreased as follows: group E (24), group A (18), groups B and F (17), group C (14), and group D (5). Retention was 100% in all groups except group D. Conclusion: Mechanical preparation increases retention of sealants, especially when etching material is used; additionally, bonding can help the retention. The best technique is mechanical preparation via laser and subsequent use of etching, without bonding prior to application of the dental sealant.

Measuring sealant placement in children at the dental practice level

Background.

Although sealants are an established and recommended caries-preventive treatment, many children still fail to receive them. In addition, research has shown that existing measures underestimate care by overlooking the sealable potential of teeth before evaluating care. To address this, the authors designed and evaluated 3 novel dental electronic health record–based clinical quality measures that evaluate sealant care only after assessing the sealable potential of teeth.

Methods.

Measure I recorded the proportion of patients with sealable teeth who received sealants. Measure II recorded the proportion of patients who had at least 1 of their sealable teeth sealed. Measure III recorded the proportion of patients who received sealant on all of their sealable teeth.

Results.

On average, 48.1% of 6- through 9-year-old children received 1 or more sealants compared with 32.4% of 10- through 14-year-olds (measure I). The average measure score decreased for patients who received sealants for at least 1 of their sealable teeth (measure II) (43.2% for 6- through 9-year-olds and 28.4% for 10- through 14-year-olds). Fewer children received sealants on all eligible teeth (measure III) (35.5% of 6- through 9-year-olds and 21% of 10- through 14-year-olds received sealant on all eligible teeth). Among the 48.5% who were at elevated caries risk, the sealant rates were higher across all 3 measures.

Conclusions.

A valid and actionable practice-based sealant electronic measure that evaluates sealant treatment among the eligible population, both at the patient level and the tooth level, has been developed.

Practical Implications.

The measure developed in this work provides practices with patient-centered and actionable sealant quality measures that aim to improve oral health outcomes.

Retention of pit and fissure sealants versus flowable composites in permanent teeth: A systematic review

OBJECTIVE

To summarize the available clinical evidence on the relative effectiveness of retention of resin-based pit and fissure sealants (PFS) with that of flowable composites on occlusal surfaces of permanent teeth when evaluated in clinical trials.

SOURCES

Electronic searches were performed in PubMed and Cochrane Library for the identification of relevant studies, from their inception until February 2020 and an additional search was done with the reference lists of included articles.

STUDY SELECTION

The review protocol followed the PRISMA guidelines and was registered in PROSPERO (CRD42018112805). The risk of bias of the studies was independently appraised using the revised Cochrane Risk of Bias tool (RoB 2.0).

DATA

Ten articles were considered relevant for qualitative synthesis. The data extracted from two of the included articles showed statistically significant difference between the two materials based on their retention potential, of which one article favored superior retention of flowable composites and one article favored higher retention of PFS and the other eight studies showed no significant difference between the two materials.

CONCLUSION

The current review has shown evidence suggesting the effective retention of resin-based pit-and-fissure sealants and flowable composites when applied to prevent occlusal caries in permanent molars, however, this evidence is of low quality. Carefully designed long-term clinical trials are required to support the results of this review.

CLINICAL SIGNIFICANCE

This is an important topic that would be of significant interest in the field of preventive dentistry, where sealants are the primary recommended method to prevent caries. The clinical efficacy of sealants is directly linked to their potential to retain and this systematic review focuses on comparing the relative effectiveness of resin-based pit-and-fissure-sealants with flowable composites in permanent teeth.

Implementation science and periodontal practice: Translation of evidence into periodontology

The advent of evidence-based practice in the 1990s led to the development of processes and resources to support the use of high-quality research in the provision of health care. As the evidence-based approach to health care continues to evolve, it has become apparent that mere creation and access to scientific knowledge is not sufficient to facilitate its routine adoption in health care. Throughout any health care system, there are inherent barriers preventing the adoption and routine use of new evidence in patient care. These barriers include provider-level factors, such as knowledge and access to new evidence, as well as each provider's attitudes and beliefs around adopting and applying the evidence with their patients. Importantly, there are also health care system-level barriers that, even among willing providers, prevent the easy adoption of new evidence and routine application in patient care. In addition to barriers, there are facilitators that help promote adoption of evidence into practice. Understanding and addressing barriers and facilitators to promote adoption of evidence into practice has led to the growth of a new field known as implementation science. Successful application of implementation science in all areas of health care, including periodontology, will help bridge the gap between what are known from clinical research to be effective treatments and what treatments should be applied routinely in clinical practice. This article reviews key concepts in implementation science and how its application in periodontology can facilitate the translation of high-quality evidence into routine periodontal practice and improved patient outcomes.

Fissure caries inhibition with a CO2 9.3-μm short-pulsed laser-a randomized, single-blind, split-mouth controlled, 1-year clinical trial

OBJECTIVES

The objective of this randomized, single-blind, split-mouth controlled, clinical trial was to evaluate whether the use of a short-pulsed 9.3-μm CO₂ laser increases the caries resistance of occlusal pit and fissures in addition to fluoride therapy over 12 months.

MATERIALS AND METHODS

A total of 60 participants, average age 13.1 years, were enrolled. At baseline, second molars were randomized into test and control, and assessed by ICDAS, SOPROLIFE, and DIAGNOdent. An independent investigator irradiated test molars with a CO₂ laser (wavelength 9.3 μm, pulse duration 4 μs, pulse repetition rate 43 Hz, beam diameter 250 μm, average fluence 3.9 J/cm², 20 laser pulses per spot). Test molars received laser and fluoride treatment, control teeth fluoride alone. Fluoride varnish was applied at baseline and at 6 months. After 6 and 12 months, teeth were again assessed.

RESULTS

A total of 57 participants completed the 6-month and 51 the 12-month recall. Laser-treated surfaces showed very slight ICDAS improvements over time with ICDAS change - 1 in 11% and 8%, no changes (ICDAS change 0) in 68% and 67%, and slightly worsened (ICDAS change 1) in 19% and 24% at 6- and 12-month recalls, respectively, and worsened by two scores in 2% at both recall time points. Control teeth showed significantly higher ICDAS increases, with 47% and 25% showing ICDAS change 0, ICDAS change 1 in 49% and 55%, and ICDAS change 2 in 4% and 20% at 6- and 12-month recalls, respectively. Differences in ICDAS changes between the groups were statistically significant (P = 0.0002 and P < 0.0001; Wilcoxon's signed-rank test, exact). A total of 22% of the participants developed ICDAS 3 scores on the control teeth.

CONCLUSIONS

Microsecond short-pulsed 9.3-μm CO₂ laser irradiation markedly inhibits caries progression in pits and fissures in comparison with fluoride varnish alone.

CLINICAL RELEVANCE

The 9.3-μm CO₂ laser irradiation of pits and fissures enhances caries resistance.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02357979.

Dental Decision Simulation (DDSim): Development of a virtual training environment

PURPOSE

Case-based simulations are powerful training tools that can enhance learning and drive behavior change. This is an overview of the design/development of Dental Decision Simulation (DDSim), a web-based simulation of an electronic dental record (EDR). The purpose was to use DDSim to train dentists to make evidence-based treatment planning decisions consistent with current evidence. This simulated EDR provides case-based information in support of a set of defined evidence-based learning objectives.

METHODS

The development of this complex simulation model required coordinated efforts to create several components: identify behavior changes, case authoring mechanism, create virtual patient visits, require users to make treatment plan decisions related to learning objectives, and a feedback mechanism to help users recognize departures from those learning objectives. This simulation was evaluated in a 2-arm, clinic-randomized, controlled pilot study examining the extent to which DDSim changed dentists' planned treatment to conform to evidence-based treatment guidelines relative to change in dentists not exposed to DDSim. Outcomes were measured by comparing preintervention and postintervention patient EDR treatment data.

RESULTS

Changes in behavior over time did not favor intervention or control clinics.

CONCLUSION

DDSim provides a standardized learning platform that cannot be achieved through the use of live patients. Both live patients and case-based simulations can be used to transfer knowledge and skill development. DDSim offers the advantage of providing a platform for developing treatment planning skills in a low-risk environment. However, further research examining behavior change is needed.

The forgotten merits of GIC restorations: a systematic review

Objective

To reevaluate proven strengths and weakness of glass ionomer cements (GICs) and to identify agreement versus conflicting evidence in previous reports regarding the transition between GIC and the tooth, and the existence of an “interphase”.

Materials and methods

Relevant electronic databases (PubMed, Embase via Ovid and Medline via Web of science) were searched for publications of evidence relating to the transition zone at the GIC-tooth interphase. Studies were examined and grouped according to characteristics of GIC-tooth attachment area quantified by X-ray and optical microscopy techniques in 2D and 3D.

Results

Inclusion criteria comprised of in vitro studies that showed images of the conventional GIC-tooth substrate attachments using at least one of the following techniques: SEM, CLSM, or μCT. The search identified 419 studies, from which 33 were included. Ten studies demonstrated the existence of an interphase layer and five studies quantified the layer thickness (1–15 μ). Twenty-nine publications studied different failure modes of the GIC-tooth interphase. Eleven studies described discontinuities inside the GIC bulk.

Conclusion

The GIC-tooth interphase attributes evolve with time. Good attachment is evident even under compromised surface preparation. The GIC-tooth attachment area is resistant to acidic dissolution as compared to both tooth and GIC bulk. In general, studies revealed mostly intact GIC-tooth interphases with only some cracked interphases.

Clinical significance

GIC bonds to the tooth structure and forms an acid resistant attachment zone that might enhance caries inhibition. Due to fluoride release and ease of use, GIC provides a cost effective treatment, ideal for low income or high caries populations.

Knowledge and opinions of French dental students related to caries risk assessment and dental sealants (preventive and therapeutic)

OBJECTIVES

A national questionnaire study was performed to document knowledge and opinions of French dental students (FDSs) about minimal intervention (MI) in dentistry especially caries risk assessment (CRA) and dental sealants (DSs).

MATERIALS AND METHODS

A questionnaire was administered to the fifth-year dental FDSs (n = 1370) from the 16 French dental schools. Descriptive and statistical analyses were performed.

RESULTS

The response rate was 84.5%. A large majority of respondents (87.8%) linked MI with minimally invasive dentistry and 77.4% considered MI as a concept based on prevention. About 80% stated they use CRA in clinical practice, mostly without any specific form. If 80.4% of the respondents would base their treatment plans on CRA, only 55.1% would regularly plan preventive regimens according to individual risk level. However, while 96.6% declared they perform preventive DSs, only 44.3% considered therapeutic sealants as a routine treatment. Although 75.1% of FDSs stated that they had sufficient learning and training related to CRA, 55.9% thought that they need further education about preventive and therapeutic DSs.

CONCLUSION

Although FDSs seem to be aware of the importance of CRA and preventive strategies, this study shows the need to harmonize the teaching in cariology according to the latest European recommendations.

CLINICAL RELEVANCE

A national questionnaire study showed variability towards knowledge and opinions of FDSs related to MI in cariology. This may impact care provisions in their future professional life showing the urgent need to harmonize the teaching of MI in cariology in France.

Meta-analysis of the longevity of commonly used pit and fissure sealant materials

OBJECTIVE

This systematic literature review and meta-analysis compared the clinical retention of primed or adhesively bonded sealants to that of conventional sealant materials.

METHODS

A search of the MEDLINE, EMBASE and CENTRAL databases identified 3707 abstracts published prior to 12/31/2017, of which 335 clinical publications were analysed in detail. A total of 67 studies included information about sealant retention after 24, 36, or 60 months of follow-up. A meta-analysis using a random effects model was conducted to calculate the pooled estimate of the retention rates for the five groups of sealants. Subgroup moderator analysis was performed to compare the pooled retention rate estimate (RRE) of primed sealants against those of the other groups.

RESULTS

Primed sealants had a 2-year pooled RRE of 43.2% (95% CI: 30.5-55.8), which was significantly inferior to those of auto-polymerizing (80.8%, 95% CI: 72.2-89) and light-polymerizing sealants (68.4%, 95% CI: 60.2-76.7). Fluoride-releasing and light-polymerizing sealants had the highest 3-year pooled RREs (86.4%, 95% CI: 73.4-99.3 and 83.1%, 95% CI: 75.6-90.7, respectively).

SIGNIFICANE

The results of this meta-analysis suggest that primed sealants cannot be fully recommended for clinical practice due to their moderate survival rates. Auto-polymerizing, light-polymerizing and fluoride-releasing sealants continue to be considered the reference standards for pit and fissure sealants. However, future generations and developments of primed sealant materials may change this position.

Comparison and Evaluation of the Retention, Cariostatic Effect, and Discoloration of Conventional Clinpro 3M ESPE and Hydrophilic Ultraseal XT Hydro among 12-15-year-old Schoolchildren for a Period of 6 Months: A Single-blind Randomized Clinical Trial

Introduction

Pit and fissures are more prone to caries as compared to smooth surfaces. Sealing the pit and fissures with sealants is considered to be highly effective in the prevention of pit and fissure caries. Hydrophobic sealants are technique sensitive in nature. Ultraseal XT Hydro sealant is moisture tolerant which incorporates the benefits of both hydrophilic and hydrophobic sealants into one unique chemistry. Hence, the study was conducted to compare and evaluate the retention, cariostatic effect, and discoloration of conventional Clinpro™ 3M™ ESPE™ and hydrophilic Ultraseal XT Hydro sealants among 12–15-year-old schoolchildren for 6 months.

Materials and methods

It was a single-blinded, randomized split-mouth clinical trial. Schoolchildren aged 12–15 years were recruited in this clinical trial. Clinpro sealant and Ultraseal XT Hydro were placed in the right and left quadrant molars, respectively, and were assigned as group I and II. The sample size arrived was 60 teeth per group and at 30 patients based on the computer-generated random sequence. Sealant coverage between the two sealants was compared using Mann–Whitney test and Z test for proportions.

Results

After 6 months, it was seen that 10 teeth out of 44 (22.72%) with Clinpro had the sealant covering all the fissures compared to Ultraseal XT Hydro which was only 9%. Fifty-nine percent of retention rate was seen with Clinpro compared to Ultraseal XT Hydro sealant (27.27%). Caries incidence was higher in the case of group II. No difference was observed with regard to the discoloration of the sealants.

Conclusion

It was concluded that for a longer follow-up period conventional Clinpro™ 3M™ ESPE™ was better than Ultra XT Hydro seal in terms of retention and cariostatic effect.

How to cite this article

Mohapatra S, Prabakar J, Indiran MA, et al. Comparison and Evaluation of the Retention, Cariostatic Effect, and Discoloration of Conventional Clinpro 3M ESPE and Hydrophilic Ultraseal XT Hydro among 12–15-year-old Schoolchildren for a Period of 6 Months: A Single-blind Randomized Clinical Trial. Int J Clin Pediatr Dent 2020;13(6):688–693.

Retrospective analysis of utilisation of the Australian Child Dental Benefit Scheme

Objective The Child Dental Benefit Scheme (CDBS), which provides dental services for targeted children in Australia, was implemented in 2014. Currently there is no information available on the cost and utilisation patterns of this publicly funded scheme. This study aimed to analyse the pattern of dental visits under the CDBS, as well as the cost of the CDBS over the first 2 years of operation. Methods This study was a retrospective descriptive analysis, using data from Medicare Statistics (an Australian Government website) from two calendar years (2014 and 2015). Results Nationally, the number of CDBS patients declined by 16.3% after the first year, and patients were predominantly aged 5–14 years. Preventive services were the most used service, and contributed to approximately 30% of total expenditure. Conclusion The utilisation of CDBS is considered to be low. What is known about the topic? Previous government dental schemes in Australia resulted in inequalities in utilisation of the scheme by targeted groups. The CDBS was implemented with an extension of eligibility criteria and services offered as a means to improve access to dental care. What does this paper add? There is no information available on the utilisation and cost patterns of the CDBS; hence, this study analysed the pattern of utilisation and the cost of the CDBS over the first 2 years of operation. What are the implications for practitioners? It is important that practitioners promote the scheme among those eligible to enable targeted populations access to the scheme and to ultimately improve child oral health.

The cost-utility of school-based first permanent molar sealants programs: a Markov model

BACKGROUND

Evidence of the cost-effectiveness of school-based first permanent molar sealants programs is not yet fully conclusive. The aim of this study was to determine the incremental cost-utility ratio (ICUR) of school-based prevention programs for the application of sealants in molars of schoolchildren compared with non-intervention.

METHODS

A cost-utility analysis based on a Markov model was carried out using probability distribution. The utility was measured in quality-adjusted tooth years (QATY). The assessment was carried out from the public payer's perspective with a six-year time horizon. Costs and benefits were discounted at 3% per year. Only direct costs were evaluated, expressed in Chilean pesos (CLP) at 7th May at 2019 values (exchange rate USD = CLP 681.09). Univariate deterministic sensitivity analysis and probabilistic analysis were carried out.

RESULTS

After a six-year follow up, the cost of sealing all first permanent molars was found to be higher than non-intervention, with a mean cost difference of USD 1.28 (CLP 875) per molar treated. The "seal all" strategy was more effective than non-intervention, generating 0.2 quality-adjusted tooth years more than non-intervention. The ICUR of the "seal all" strategy compared to non-intervention was USD 6.48 (CLP 4,412) per quality-adjusted tooth years. The sensitivity analysis showed that the increase in caries was the variable which most influenced the ICUR.

CONCLUSIONS

A school-based sealant program is a cost-effective measure in populations with a high prevalence of caries.

Clinical Evaluation of the Retention of Resin and Glass Ionomer Sealants Applied as a Part of School-Based Caries Prevention Program

BACKGROUND:

Using of sealant on pits and fissures is likely one of the most generally well-known strategies by the new cavity-prevention systems.

AIM:

The purpose of this research is to measure the retentiveness of sealants of resin-modified ionomer glass cement (GIC) and resin pits and fissures, on the first permanent molars of special patients as a part of caries prevention program in schools.

METHODS:

The sample was comprised by 60 molars. Resin-based sealants on one side and glass-ionomer sealant on the contralateral side of the mouth. The molars were examined in three and six months after application for retention with three standards: TR: Totally Retained; PR: Partially Retained; and CL: Completely Lost.

RESULTS:

by the end of the study 60% of resin sealant was present. While 55% of GIC were retentive after 6 months.

CONCLUSION:

Resin sealants are more retentive than glass ionomer sealants in school-based carries prevention program.

Fluorinated Montmorillonite Composite Resin as a Dental Pit and Fissure Sealant

Molar pits and fissures tend to be affected by caries due to cleaning difficulties. As such, the filling of pits and cracks with sealants is common to deter the onset of caries. However, current clinical practices rely on sealants that lack the ability to release and recharge fluoride ions. Thus, we herein report the development of a fluoride-montmorillonite nanocomposite resin that has the potential to provide sustained release of fluoride due to the strong adsorption of fluoride by montmorillonite. X-ray diffractometry, thermogravimetric analysis, and Fourier-transform infrared spectroscopy were employed to confirm the successful insertion of the polymer into the interlayer structure. The mechanical properties (viscosity, hardening depth, hardness, diametral tensile strength, flexural strength, and wear resistance) of the developed composite resin were then examined, and simulation of the oral environment demonstrated a good fluoride ion release and recharge ability for the effective prevention of dental caries. Finally, we demonstrated the non-cytotoxic nature of this material using the water-soluble tetrazolium salt (WST-1) test. We expect that the described fluoride-containing composite resin may become a new clinical option in the near future.

The anticaries effects of pit and fissure sealant in the first permanent molars of school-age children from Guangzhou: a population-based cohort study

BACKGROUND

Analyses of the effects of pit and fissure sealant have been based on small samples and lack large-scale field evaluation data in China. The aim of this study was to understand the effect of pit and fissure sealant in preventing caries in the first permanent molars (FPMs) of children in Guangzhou.

METHODS

We conducted a population-based cohort study using the database of the pit and fissure sealant program of Guangzhou. The carious status and sealant retention of the FPMs were assessed in 4,822 school children who received pit and fissure sealant 3 years prior to the study. The control group included 4,396 children who had indications for receiving pit and fissure sealant but were not treated and were matched according to sex, age and school.

RESULTS

In the sealant group, the rate of sealant retention in the FPMs was 72.2%. Children in the sealant group had a 37% decreased risk of dental caries compared with the control group (adjusted HR = 0.63 [95% confidence interval (CI), 0.57-0.69], P < 0.001). Compared to no sealant use, the use of pit and fissure sealants reduced the risk of developing dental caries by 44% after 3 years in the FPMs of children from rural areas, reflecting a greater reduction than that among urban children (35%) during the same period (urban: adjusted hazard ratio (HR) = 0.65 [95% CI, 0.58-0.72]; rural: adjusted HR = 0.56 [95% CI, 0.45-0.70], P < 0.001). The mean number of decayed, missing, or filled permanent teeth (DMFT) in the control group was higher than that in the sealant group, and the difference was statistically significant regardless of sex.

CONCLUSIONS

Pit and fissure sealant has a significant preventive effect against dental caries in the FPMs, especially for children in rural areas; thus, this sealant represents an effective technique for preventing and controlling dental caries.

Dental caries lesions in primary teeth without obvious cavitation: Treatment decision-making process

BACKGROUND

Dental caries diagnosis and management have changed over time.

AIM

To identify the treatment decision-making process performed by paediatric dentists, after caries detection using CAST instrument (Caries Assessment Spectrum and Treatment), for enamel (CAST 3) and non-cavitated dentin caries lesions (CAST 4) before and after analysing radiographic images.

DESIGN

Seventy-four paediatric dentists were invited to participate. Twelve clinical cases were presented online, and treatment decisions before and after the analysis of bitewing radiographs were evaluated.

RESULTS

Sixty-one specialists answered the questionnaire. The necessity for radiographs was significantly associated with the presence and depth of the caries lesion (P < 0.0001). CAST 3 lesions were preferentially monitored before and after the radiographic assessment. For CAST 4 lesions limited to the outer half of dentin, treatments indicated before and after radiographic analysis were sealant (33%) and restoration (40%). For the lesions in the inner half of dentin, restoration was the most cited before (45%) and after (84%) radiographs. The radiographic depth was the only significant independent variable when "change in the treatment option" was analysed by the regression model (P < 0.001).

CONCLUSIONS

Enamel lesions were treated through less invasive treatments. Radiographs influenced the decision, especially for the lesions that involved the inner half of dentin.

Retention and remineralization effect of moisture tolerant resin-based sealant and glass ionomer sealant on non-cavitated pit and fissure caries: Randomized controlled clinical trial

INTRODUCTION/OBJECTIVES

Pit and fissure sealants are an essential part of preventive dentistry and should be adopted as a crucial part of the minimally invasive dentistry due to their profound benefit to our patients.

METHODS

The study design is a single-blind, split-mouth, randomized controlled clinical trial. Forty patients between age 6-9 were selected. First permanent molars' occlusal surfaces with scores of 1, or 2 according to the International Caries Detection and Assessment System II (ICDAS II) and with scores between 14-30 by using DIAGNOdent device (Kavo®, Biberach, Germany) were selected and readings recorded. One side of the mouth was randomly chosen to have either the moisture tolerant resin sealant or the glass ionomer sealant placed, and then the second material was placed on the other side. The retention of these materials was analyzed at 3 and 6 months. The sealants were then removed and DIAGNOdent readings were subsequently taken.

RESULTS

After three months, full retention was found in 38/40 (95%) teeth in Group A (Embrace™ WetBond™) and 35/40 (87.5%) teeth in Group B (Fuji TRIAGE®). Additionally, no sealant suffered a total loss in group A, whereas, three sealants were totally lost (7.5%) in group B. The difference in sealant retention in two groups in this period was not found to be statistically significant (P >  0.05). At six months, full retention was found in Group A 34/40 (85%) and 25/40 (62.5%) in Group B. Also, the partial loss in Group A was 2/40 (5%) whereas in Group B 7/40 (17.5%). Also, the total loss was 4/40 (10%) and 8/40 (20%) in Group A and B, respectively. The difference in sealant retention in two groups after six months follow-up was found statistically significant (P < 0.05). The initial mean values of DIAGNOdent readings were 22.42 and 22.8 in Group A and Group B, respectively. After six months, DIAGNOdent mean values revealed a drop in both groups, and this difference was statistically significant. Nevertheless, when Group A was compared to Group B in terms of remineralization effect, the differences were found not to be statistically significant (p > 0.05).

CONCLUSIONS

Within the limitation of this study, we affirmed that occlusal caries lesions, which is restrictive to enamel and in need of surgical intervention, can be arrested clinically by sealing the lesion with both a hydrophilic resin sealant and glass ionomer sealant materials. Embrace™ WetBond™ showed superiority over the glass ionomer sealant tested in retention after six months follow up.

The Efficacy of Different Sealant Modalities for Prevention of Pits and Fissures Caries: A Randomized Clinical Trial

Objectives

This clinical trial evaluates the efficacy of different pit and fissure sealant modalities as a caries prevention tool.

Materials and Methods

Forty-four children aged 6-8 years with completely erupted first permanent molars participated in sealant placement randomized clinical trial. Split-mouth technique used and each child received four treatment modalities (ICON, Seal It, GCP glass seal, ICON/Seal It combination). Caries progression and sealant retention monitored over a period of 24 months.

Results

Seal It and combination modalities had the highest efficacy in the prevention of pits and fissures caries, whereas the ICON had the lowest efficacy. Regarding retention, there were no significant differences among the four modalities during the 1, 3, and 6 months follow-up intervals. However, at 12, 18, and 24 months, the retention of Seal It and combination modalities were better than ICON and better than GCP, but the differences were not statistically significant. In addition, the retention of combination modality was better than Seal It, but the difference was not significant. At the end of the trial, the caries incidence was the highest in ICON group (20 lesions) followed by GCP group (13 lesions), Seal It group (3 lesions) and the lowest observed in combination group (2 lesions).

Conclusions

Both Seal It and combination modalities are highly effective in the prevention of pits and fissures caries, GCP has acceptable effect while the use of ICON alone was not effective. The Seal It and ICON combination improves their clinical efficacy in caries prevention.

Bioactive glass ceramic can improve the bond strength of sealant/enamel?

AIM

Evaluate the influence of enamel pre-treatment using Biosilicate, associated or not to other treatments; on the bond strength (BS) of pit-and-fissure sealant, with or without saliva contamination.

METHODS

Ninety slices (4 mm × 4 mm) were obtained from 30 bovine incisors. Each slice was embedded in acrylic resin with their buccal surface exposed and polished to obtain a flat enamel surface. Half of them were contaminated with human saliva. All specimens were randomly divided into five groups (n = 9) according to the surface pre-treatment tested: acid etching (AE); AE + Biosilicate (B); AE + B + total-etch adhesive (Ad); Biosilicate; control (no treatment). Then, a 1 mm layer of sealant (Clinpro XT Varnish, 3M ESPE) was applied; and to provide support, a composite resin (Opallis, FGM) block was built up over it. Samples were thermocycled (500 cycles/5-55 °C) and sectioned obtaining sticks (1 × 1 × 10 mm) for microtensile BS testing (0.5 mm/min). Data were analysed with two-way ANOVA, Bonferroni test, p < 0.05. Failure patterns were evaluated using a stereomicroscope.

RESULTS

There was no difference among contaminated and non-contaminated groups, and between non-contaminated groups (p > 0.05). When contaminated, AE + B + Ad Group showed the highest BS values, differing (p < 0.05) from B Group and Control; similar between them (p > 0.05). Cohesive fractures were found in AE + B + Ad Group, submitted or not to contamination.

CONCLUSIONS

Since a surface pre-treatment was used, whether Biosilicate was applied or not, the sealant/enamel BS was the same in saliva-contaminated or non-contaminated enamel.

Tooth Decay Prevention: Knowledge and Practices Survey of Dental Students

OBJECTIVES

This study aimed to assess the level of knowledge, attitudes, and practices fissure sealants among undergraduate Saudi dental students.

METHODS

A modified questionnaire consisted of 24-items was distributed among 226 undergraduate dental students, males and females of different years at Al-Farabi Colleges, Riyadh, Saudi Arabia. Chi-square/Fisher's exact tests were used for descriptive statistical analyses.

RESULTS

The response rate was 100%. Most of the respondents were male (60.2) and (39.8%) were female. With regard to the level of study, 20.8% were in the fourth year, 43.8% in the fifth year, and 16.8% were in the sixth year. The respondents showed a sensible level of learning about sealants, with the majority (88%) believed that there is strong scientific evidence about fissure sealants effectiveness and around 90% showed a good understanding of sealant placement instructions. Furthermore, respondents demonstrated inadequate learning about sealants clinical practice.

CONCLUSION

Despite a high proportion of undergraduate dental students' showed sufficient knowledge about dental sealant, following guidelines and standardized procedures in clinical practice is lacking. The findings suggest an urgent need of dental colleges to additionally and/or update their curriculum regarding fissure sealants to reflect advance dental education that concentrates on evidence-based practice (EBP) in Pediatric Dentistry and Dental Public Health need for regular continuing education courses for the dental professional.

HOW TO CITE THIS ARTICLE

Al-Sabri FA, Ba-Salamah M, et al. Tooth Decay Prevention: Knowledge and Practices Survey of Dental Students. Int J Clin Pediatr Dent 2019;12(2):92-95.