Project USAP 2010: Use of Sedative Agents in Pediatric Dentistry-a 25-year Follow-up Survey

PURPOSE

A 25-year follow-up survey was conducted among members of the American Academy of Pediatric Dentistry (AAPD) to explore changes in the use of sedative agents.

METHODS

The survey was conducted in the winter of 2010 via an email LISTSERV of active members of the AAPD in the United States. The survey targeted demographics of participants and issues related to their use of sedation.

RESULTS

A total of 1,642 responded, representing a response rate of 44 percent. The majority was board certified (58 percent) and indicated that nitrous oxide was used for over 50 percent of patients. Restraint (protective stabilization) was used by 72 percent of respondents but had declined compared to previous surveys. The dominant route of sedative administration was oral (93 percent). Benzodiazepines and nitrous oxide represented the most frequently used sedatives.

CONCLUSIONS

Respondents and their patient pool characteristics are changing (e.g., there are proportionately more diplomates), benzodiazepines are the most frequently used sedative besides nitrous oxide (the use of which appears to be increasing), and protective stabilization among users is declining.

In vitro evaluation of the Spectra early caries detection system

OBJECTIVE

The goal of this study was to perform an in vitro evaluation of the Spectra, a new caries detector that uses light-induced fluorescence of healthy tooth structure and bacterial pigments to optically detect caries. The Spectra generates a storable color map image of examined tooth surfaces which shows areas of enamel and dentin caries. In this study, Spectra readings of occlusal surfaces were compared to clinical, radiographic, and histological assessments of caries.

METHODS

Two examiners evaluated 41 extracted molars. The teeth were radiographed and then visually assessed. The International Caries Detection and Assessment System (ICDAS) was used to classify the extent of caries. The teeth were then sectioned and assigned a histological score based on the extension of caries into enamel or dentin.

RESULTS

Teeth lacking radiographic caries had a mean Spectra reading of 1.5. Teeth having radiographic caries had a mean Spectra reading of 2.0. This difference was statistically significant. In general, higher ICDAS scores were associated with higher Spectra readings. Teeth with histologically evident deep dentin caries had significantly higher Spectra readings than intact teeth or teeth with superficial enamel demineralization. Spectra assessment of occlusal caries agrees with clinical and radiographic methods.

CONCLUSION

Spectra images illustrate the full spectrum of caries severity, from enamel demineralization to dentin decay. The Spectra is a promising technology for the diagnosis and for monitoring the progression of occlusal caries.

Attitudes of pediatric dentists toward parental presence during dental treatment of children

BACKGROUND

This study was performed to examine the current attitudes of pediatric dentists in the United States toward the presence of parents in the dental operatory during dental treatment for their children.

METHODS

E-mail letters were sent to the 1516 American pediatric dentists listed in the directory of the American Academy of Pediatric Dentistry. Respondents were directed to follow a hyperlink provided in the e-mail letter to a website containing survey questions. Answers were directly submitted via the internet into a database supported by the New Jersey Dental School.

RESULTS

905 acceptable surveys were received (60% response rate). Most practitioners (74%) generally allowed parental presence, although a majority (58%) felt that children would be less cooperative in the presence of parents. Initial examination had the highest frequency of parental presence allowed, whereas sedation had the lowest. When practitioners considered whether to allow parental presence, age and behavior were the two most important factors reported. Some demographic factors that had an effect on parental presence policy were region of the country (more parental presence was allowed in the Northeast and West), area of practice (more parental presence was allowed in suburban or urban areas), and type of practice (solo practitioners were more likely to exclude parents). Most practitioners reported a recent change to allow more parental presence because of changes in the expectation of parents (67%), and legal issues (66%).

CONCLUSIONS

Most American pediatric dentists allow parents in the dental operatory most of the time that children receive dental treatment.

CLINICAL IMPLICATIONS

Practitioners might wish to follow the findings of this study and allow parents into the treatment operatory whenever children receive dental treatment.

Effectiveness of two nitrous oxide scavenging nasal hoods during routine pediatric dental treatment

PURPOSE

This study compared the effectiveness of 2 nasal hoods (Porter/Brown and Accutron) in reducing waste nitrous oxide gas during conscious sedation for routine pediatric dental treatment.

METHODS

Thirty children, ages 3 to 8 years (mean=5.4 +/- 1.2 years), participated in this study. Fifteen randomly selected children started with the Porter/Brown mask, which was then switched to the Accutron mask, and the other 15 children used the reverse order of masks. Four measurements of ambient nitrous oxide were recorded with a Miran 205B Portable Ambient Air Analyzer 5 minutes after each of the following: (1) administration of nitrous oxide; (2) placement of the rubber dam; (3) change of the nasal hood; and (4) reduction of the vacuum. Samples were taken 8 inches above the nose of the patient and in the room 5 feet away from the patient.

RESULTS

Nitrous oxide levels were significantly lower (P<.05) with the Porter/Brown system (31 +/- 40 ppm for the patient and 8 +/- 10 ppm for the room) compared with the Accutron system (375 +/- 94 ppm for the patient and 101 +/- 37 ppm for the room). When the suction was reduced, there was an increase in nitrous oxide levels with the Porter/Brown nasal hood (169 +/- 112 ppm for the patient and 28 +/- 18 ppm for the room), whereas the levels with the Accutron nasal hood remained high (368 +/- 107 ppm for the patient and 121 +/- 50 ppm for the room).

CONCLUSIONS

This study demonstrated that removal of waste nitrous oxide was greater with the Porter/Brown device and that recommended suction levels must be used for optimum effectiveness.

Anxiolytic-like action in mice treated with nitrous oxide and oral triazolam or diazepam

Few animal studies have explored the interaction of nitrous oxide (N2O) with a benzodiazepine (BNZ) administered by the oral route, as used in clinical procedures involving "conscious sedation". The purpose of this study was to evaluate the relative "anxiolytic-like" and sedative effectiveness of N2O, oral triazolam (TRIAZ; Halcion) or oral diazepam (DIAZ; Valium), either alone or in various combinations of drugs and doses. One hundred and twelve Swiss Webster male mice, 35-45 days old, were assigned to 28 groups, each of which contained four mice. The mouse staircase test was used for the assessment of anxiety (number of rearings) and sedation (number of steps ascended). Three doses of oral TRIAZ (0.1, 0.3, 1.0 mg/kg) or DIAZ (2.0, 3.5, 5.0 mg/kg) were given in combination with room air, or N2O/O2 at a N2O concentration of 25, 50 or 75%. Each mouse was tested once. N2O alone did not reduce NR in any concentration, but caused a significant increase in locomotion. DIAZ without N2O reduced NR only with the middle and high doses, but the addition of N2O significantly enhanced the anxiolytic-like effect of all DIAZ doses. TRIAZ, alone, reduced NR only in the highest dose, but added N2O resulted in anxiolytic-like behavior with all three TRIAZ doses. The sedative effects of the BNZs were extremely variable. Only the middle dose of DIAZ plus 25% N2O unequivocally reduced the number of steps ascended, i.e., caused sedation. TRIAZ lacked the inverted U-shaped dose-response relationship with NR usually seen with DIAZ. TRIAZ, therefore, provides better dose control. This behavioral animal model indicates that the optimal combinations for reduction of anxiety-like behavior with minimal effects on sedation are 0.1 mg/kg oral TRIAZ with 25% N2O or 2.0 mg/kg oral DIAZ with 25% N2O.

Effect of primer solvent and curing mode on dentin shear bond strength and interface morphology

There is a need to study the main and interactive bonding effects of differences in solvent and curing mode used for adhesive monomers in dentin bonding systems.

OBJECTIVE

Two solvents (acetone and ethanol) and curing methods (light cure, dual cure) were evaluated on their effects on bond strength and interfacial morphology.

METHOD AND MATERIALS

The adhesives studied were based on two monomers, pyromellitate of glyceryl dimethacrylate (PMGDM) and 2-hydroxy ethyl methacrylate (HEMA). Four groups of eight teeth each were cut to expose planar dentin sections and treated with (a) light-cure system with acetone as solvent (LCA group); (b) light-cure system with ethanol as solvent (LCE group); (c) dual-cure system with acetone as solvent (DCA group); and (d) dual-cure system with ethanol as solvent (DCE group). The treated sections were tested for shear bond strength to composite discs and interfacial morphology.

RESULTS

The mean (standard deviation) of shear bond strength values (MPa) for the different groups were: LCA: 11.8 (2.3); LCE: 12.7 (2.7); DCA: 24.9 (9.3); and DCE: 21.6 (9.6). All bonded sections were characterized by a similar hybrid layer, resin tags, and overall interfacial morphology.

CONCLUSION

There was a significant difference in shear bond strength as a function of cure mode, but not of solvent. The mean bond strength was higher for dual-cure systems studied. Oxygen inhibition effects may account for the difference between light-cure and dual-cure types.

Project USAP 2000--use of sedative agents by pediatric dentists: a 15-year follow-up survey

PURPOSE

A national survey of members of the American Academy of Pediatric Dentistry was conducted to provide a 15-year update of information regarding the use of sedative agents by pediatric dentists.

METHODS

All 3,315 active members of the Academy were sent questionnaires regarding the frequency of their use of sedation and 1,778 responded. Practitioners were questioned regarding their use of sedative agents and the nature of their patients receiving sedation. In addition, they were questioned in regard to their use of restraints and reasons for change in their use of sedation during the past two years.

RESULTS

In regard to the use of nitrous oxide alone, 47% of practitioners responded that they use nitrous oxide less than 11% of the time. In regard to other types of sedative agents, most practitioners use little, if any, sedation. Eighty-two percent use sedation for less than 11% of their patients. Of the 1,778 respondents, 1,224 used drugs other than nitrous oxide. In a typical three-month period, they performed 77,112 sedations. Of that number, 61,662 (80%) were administered by only 478 practitioners who use sedation on the average of once or greater each day.

CONCLUSIONS

In comparison with previous surveys in 1985, 1991 and 1995, these results demonstrate an overall increased use of sedation by pediatric dentists. However, the increased use is due primarily to an increase in the numbers of practitioners who are heavier users of sedation (once or greater each day).

The effects of oral conscious sedation on future behavior and anxiety in pediatric dental patients

PURPOSE

This study investigated the relationship between oral conscious sedation and subsequent behavior in the dental setting.

METHODS

The sample consisted of 38 children between the ages of 39 to 71 months (mean=50 months) who had been treated with oral sedation 2 to 34 months(mean=13 months) previously, and a control group of 38 children, matched by age (mean=51 months) and gender, who had received dental treatment without conscious sedation or general anesthesia one week to 3 years previously. Subjects were matched by age and gender. All children received a standard recall examination and a prophylaxis, during which behavior and anxiety were measured. Independent variables included age at the time of sedation, present age, gender, time elapsed since sedation, effectiveness of sedation, parental scores on Corah's Dental Anxiety Scale and parent's answers to a questionnaire. The dependent variables were child behavior (rated with the 4-point Frankl scale) and self-reported anxiety ratings.

RESULTS

Both groups had mean behavior ratings of positive or very positive (experimental group mean=3.13; control group mean=3.34). There were no statistically significant differences between the groups and there was little correlation of independent and dependent variables.

CONCLUSIONS

There is no relationship between oral conscious sedation and the future behavior of children in the dental setting.

Prevalence of oral soft tissue lesions in HIV-infected minority children treated with highly active antiretroviral therapies

PURPOSE

This project studied the prevalence of oral soft tissue disease in HIV-infected children treated with highly active antiretroviral therapy (HAART).

METHODS

Thirty-eight HIV-infected children participated in the study. Twenty-three of these patients were treated with HAART while 14 received exclusively reverse transcriptase inhibitors (RTI) and served as controls. The children were examined three times at approximately one-month intervals while their health history and laboratory data were abstracted from medical charts. Analyses were performed to determine differences in lesion prevalence between treatment groups as well as between lesion and no lesion groups with regard to immune differences.

RESULTS

Thirty patients (79%) had oral lesions detected in at least one visit. There were no differences in specific lesion prevalence between HAART compared with RTI-treated children. However, a trend for more oral candidiasis in the latter group was observed. Subjects with oral soft tissue lesions had lower CD4 counts (P = 0.04) and percentage (P = 0.01) but similar viral loads when compared to patients without oral soft tissue disease.

CONCLUSIONS

HAART does not appear to significantly affect oral soft tissue disease prevalence in HIV-infected children. Presence of lesions was associated with decreased immunity and may signal advancing disease.

Fluoride uptake by proximal surfaces from professionally applied fluorides: an in vitro study

This study was performed to examine the uptake of fluoride by mesial enamel surfaces of extracted teeth from different types of topical fluoride. Forty-eight extracted human molars and twelve premolars were randomly divided into four groups and mounted in twelve wax blocks with five teeth in proximal contact in each block. Each group was treated for four minutes with either 1.23 percent acidulated phosphofluoride conventional gel, thixotropic gel, or foam in lined trays, or 2 percent neutral sodium fluoride solution applied with a cotton tip applicator. Acid-etch biopsies were performed three times to indicate the amount of fluoride uptake at three different depths. The results demonstrated that there was a statistically significant increase in fluoride uptake in the surface layer with both gels and foam (1150, 1058 and 1120 ppm F), whereas there was an insignificant increase with the fluoride solution (27 ppm F). In the deepest layer, the thixotropic fluoride produced the greatest fluoride uptake (919 ppm F) in comparison with the uptake from conventional gel (383 ppm F), foam (297 ppm F), or solution (118 ppm F).

Caries experience and cariogenic markers in HIV-positive children and their siblings

The purpose of this cross-sectional, masked study was to compare the oral status of perinatally HIV-infected children with their uninfected siblings living in the same environment. A secondary purpose was to compare HIV-positive children for differences in oral health with respect to disease advancement. One hundred forty-seven children were examined in their homes and meeting places, using NIH criteria for caries diagnosis. Significant differences were found in the number of caries-free children (P < 0.05), past caries experience (P < 0.003), subsurface demineralizations (P < 0.0001), and caries-related bacteria (P < 0.05). However, differences in caries prevalence were not found in the 3- to 6-year-old subgroup. Caries prevalence (P < 0.001) and levels of caries-related flora in saliva were correlated to years since diagnosis (mutans streptococci P < 0.008, lactobacilli P < 0.02). Children with a more advanced disease stage had significantly more caries (P < 0.02). Among the HIV-infected children, the frequency of carbohydrate intake was clearly correlated to caries (P < 0.003) and to lactobacilli levels (P < 0.0001). It is concluded that children with perinatally acquired HIV are at greater risk for caries than their siblings, more so with advancing disease.

Mercury release from dental amalgams: an in vitro study under controlled chewing and brushing in an artificial mouth

The release of mercury vapor from class I amalgam restorations prepared in human molar teeth was studied during chewing simulations in an artificial mouth of a bi-axial servo-hydraulic mechanical test system. So that the total mercury released from the restoration over a fixed time could be determined, a closed chamber surrounded the envelope of chewing motion. In addition, the influence of sampling frequency on mercury release was corrected by the use of different sampling frequencies over a fixed time interval of mercury release measurement and extrapolation to zero sampling time. Thus, a combination of a closed environment and an extrapolation method to determine the mercury release under continuous sampling was used to determine the mercury released under normal breathing conditions. The measured mercury release rate data were used to calculate the potential daily mercury dose in a patient due to a single amalgam restoration, following the method previously outlined by Berglund. The mercury release from both a conventional and a high-copper amalgam was evaluated at different age intervals after the restoration was placed in the teeth. The results show that while the age of the amalgam and the amalgam type influence the extent of mercury release during the initial non-steady-state conditions, the steady-state value of mercury daily dose due to a single amalgam filling is 0.03 micrograms/day, which is well below the calculated threshold-limiting value (TLV) of 82.29 micrograms/day considered dangerous for occupational exposure in the United States.

Hypohidrotic ectodermal dysplasia: characteristics and treatment

Hypohidrotic ectodermal dysplasia is a rare congenital disease that affects several ectodermal structures. The disease is usually transmitted as an X-linked recessive trait in which the gene is carried by the female and manifested in the male. Manifestations of the disease differ in severity and may involve teeth, skin, hair, nails, and sweat and sebaceous glands. Most affected children require extensive dental treatment to restore their appearance and help the development of a positive self-image.

The effect of age on the behavioral responses of mice following diazepam and midazolam sedation in combination with nitrous oxide

This study examined the effects of age on the behavior of mice administered one of two benzodiazepines with and without nitrous oxide. Young (3 wk +/- 3 days) and adolescent (7 wk +/- 3 days) male DBA-2 mice were administered oral diazepam (2.0 or 3.5 mg/kg), midazolam (0.75 or 1.2 mg/kg), or a placebo in combination with 50% nitrous oxide/50% oxygen, or room air. The mouse staircase model was used, where the number of rears (NR) served as an index of anxiety, and the number of steps ascended (NSA) as an index of sedation. No significant differences in the responses between the ages were noted. Nitrous oxide seemed to increase the NR and NSA, whereas the benzodiazepines alone did not affect behavior. These DBA-2 mice may represent a strain that is less sensitive to the anxiolytic-sedative effects of the benzodiazepines than are other strains.

Fluoride exchange from glass ionomer preventive resin restorations

The purposes of this in vivo study were to determine if placing a sealant over a glass ionomer restoration modifies its fluoride release, and to examine the effect on glass ionomer of a 4-min application of topical fluoride. Fluoride release from glass ionomer preventive resin restorations placed in 21 bovine teeth was measured before and after removing their sealants. Fuji II, Ketac Silver, and Fuji LC were evaluated, representing the three generations of glass ionomers. Fluoride was extracted from the restorations by incubating the specimens in 5 ml deionized water and was measured by specific ion electrodes at 1 and 2 days, then once weekly for 7 weeks. The results indicated that fluoride release was not significantly different in pattern or quantity in the three types of ionomer (P > 0.05). A significant reduction in fluoride release occurred when the restorations were covered with a sealant when compared with control restorations of the same materials (P < 0.001). After removing the sealant from the glass ionomer preventive resin restorations, a significant release of fluoride occurred when compared with sealed restorations (P < 0.001). After 63 days in water, the unsealed restorations were subjected to a 4-min topical APF treatment and reimmersed in water for an additional 27 days to examine the ability of the various materials to absorb fluoride. The fluoride-depleted restorations treated with fluoride released significantly more fluoride than fresh, untreated ionomer restorations (P < 0.001) or amalgam restorations. As a result of fluoride release, the glass ionomer preventive resin restoration may afford chemical protection to the tooth if sealant loss occurs.

The preventive resin (composite resin/sealant) restoration: nine-year results

This study was performed to examine the 9-year success of the composite resin/sealant restoration, which uses "sealing for prevention" of fissure caries rather than "cavity extension for prevention." Three hundred thirty-two Class I restorations were placed in the occlusal surfaces of 240 permanent molar teeth in 114 children aged 6 to 14. Cavity preparations were made in occlusal surfaces, and caries was removed with no attempt to create any additional retention or remove undermined enamel. Exposed dentin was covered with Dycal and the cavity was restored with Radiopaque Adaptic, which was then covered with Delton fissure sealant. Incipient lesions confined to the enamel were restored only with Delton. After 9 years, 79 restorations in 28 subjects were examined for sealant retention, marginal staining, and the presence of dental caries. Forty-three restorations (54%) had completely retained sealants, 20 (25%) had sustained partial loss, and 16 (20%) of the restorations had lost all sealant. Dental caries occurred in 19 (25%) of the restorations that had sealant loss. An additional 16 teeth had proximal caries unrelated to the occlusal restoration. These findings demonstrated that the composite resin/sealant (preventive resin) restoration produced excellent long-term results.

Project USAP the use of sedative agents in pediatric dentistry: 1991 update

A national survey of members of the American Academy of Pediatric Dentistry was conducted to update information on the use of sedative agents by pediatric dentists. All 2532 members of the Academy were sent questionnaires regarding their use of sedation and 1497 responded. Practitioners were questioned regarding how frequently they used sedative agents and the nature of patients receiving sedation. In addition, they were questioned on reasons for change, if any, in their use of sedation during the past two years. A separate survey was conducted of directors of all 55 postdoctoral training programs in pediatric dentistry. Forty-six directors responded to questions concerning the type and frequency of sedation use in their programs. Both surveys demonstrated wide differences in sedation use between different training programs and between different practitioners. The heavier use of sedation by some practitioners or by some training programs, as compared with others, generally was not related to the percentage of handicapped patients who received sedation, nor to the type of training. Frequent users of sedation (more than once each day) were located more in the south/southeastern and western parts of the country and they tended to have been in specialty practice for more than 10 years.

Comparative clinical study of autopolymerized and light-polymerized fissure sealants: five-year results

The retention of autopolymerized and light-polymerized Delton fissure sealants was compared. Sealants were applied to 207 first permanent molars with 304 separate sites in 73 children 6-8 years old (mean age 6.3 years). After five years, there was complete retention in 59% of the autopolymerized and 48% of the light-polymerized sealants. The resulting 11% difference in retention rates was not statistically significant at P less than 0.05.

Report of project USAP: the use of sedative agents in pediatric dentistry

Project USAP was performed to examine the use of sedation in pedodontics; part one studied the use of sedative agents by pediatric dentists, and part two examined the use of sedation in postgraduate teaching programs. In part I all 2,040 members of the American Academy of Pediatric Dentistry were sent questionnaires in 1985 concerning their use of sedation, and 1,105 responded. In regard to their use of nitrous oxide alone, 55 percent of practitioners responded that they used nitrous oxide less than 10 percent of the time. In regard to other types of sedative agents, most practitioners used little, if any sedation; 88 percent of practitioners used sedation for less than 10 percent of their patients. In a typical three-month period, the 1,105 respondents performed 33,465 sedations. Of that number, almost half (14,802) were administered by only 64 practitioners. Compared with other geographic areas, there appeared to be greater use of sedation in the south/southeast and west regions of the United States. The heavier use of sedation by some practitioners was not related to the percentage of their handicapped patients who received sedation. In part II, all 59 postgraduate programs in pediatric dentistry were surveyed during 1985 to examine the use of sedation by postgraduate students. There were wide differences in frequency and type of experience of students with different drugs. It is concluded that when a healthy child receives a sedative agent for dental treatment, the type of drug and drug dosage depend more on the biases of the individual practitioner, than on the requirements of the patient.

Effects of chloral hydrate on nitrous oxide sedation of children

This study was conducted to examine the effects of chloral hydrate on nitrous oxide sedation of young children for dental treatment. Nineteen children, ranging in age from 19 to 41 months (mean 30 months), participated in this double-blind study. The subjects were assigned randomly to receive either a placebo or chloral hydrate (50 mg/kg) for the first visit with the alternate regimen administered during the second appointment. In addition, all subjects received inhalation nitrous oxide/oxygen at a concentration of 50%, and were restrained in a Papoose board (Olympic Medical Group; Seattle, WA) with head restraint. Seventy-four per cent of sedations were classified as very good or excellent when chloral hydrate was administered with nitrous oxide compared with only 26% when the placebo was administered.

The retention of fissure sealants using twenty-second etching time: three-year follow-up

The retention of a self-polymerized fissure sealant applied after twenty seconds etching time was evaluated after three years. From the original 100 molars that were sealed, seventy-one teeth with 105 sites were available. The sealants were totally retained in 91 percent of the cases, after three years. The findings demonstrate that the retention rates of fissure sealants using twenty seconds etching time are comparable to those reported with the more conventional sixty seconds.

Autopolymerized versus light-polymerized fissure sealant

This study found that 31 months after placement of a sealant, no significant difference was seen in the clinical performance and retention between the visible light-polymerized and autopolymerized materials. Practitioners can use either material without compromising efficacy.

Pharmacological methods and research issues in the management of child patients

A review of the current use of sedative agents by pediatric dentists indicates that agents other than nitrous oxide have rather limited use, in that less than 10% of patients treated by pediatric dentists receive sedative agents. However, a small but significant number of practitioners use sedation with more than 10% of their patients, and 8% of practitioners account for almost half of sedations administered. Practitioners use a variety of agents which probably reflect the training programs that teach the use of a variety of techniques. There appears to be no general agreement on dosage levels or methods for monitoring. There is a need for research to establish dosage levels for drugs and proper methods to monitor patients treated with sedation.

Occlusal composite restorations: 4-year results

A study was performed to determine the success of a conservative cavity preparation using the principle of sealing for prevention rather than cavity extension for prevention. A total of 332 restorations were placed in 240 teeth of 110 subjects, aged 6 to 14, with a mean age of 8 years. After 4 years, 205 restorations were examined. Caries appeared in 13 teeth and sealant wear occurred in 14 restorations. Complete sealant loss was observed in eight restorations and partial loss in 38, leaving 156 restorations with complete retention of the sealant. These preliminary results show that conservative cavity preparation with sealing for prevention is a successful technique that conserves valuable tooth structure.

Occlusal restoration using fissure sealant instead of "extension for prevention"

This study was conducted to determine the success of a conservative cavity preparation using the principle of "sealing for prevention" rather than cavity "extension for prevention". Three hundred and twenty one restorations were placed in 234 teeth of 110 subjects, ages six to fourteen, with a mean age of eight years. After three years, 273 restorations were examined. Caries appeared in ten teeth and sealant wear occurred in sixteen restorations. Complete sealant loss was observed in two restorations and partial loss in thirty-nine, leaving 224 restorations with complete retention of the sealant. These preliminary results demonstrate that conservative cavity preparation with sealing for prevention is a successful technique which conserves valuable tooth structure.