Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents
Abstract
Background
Although pit and fissure sealants are effective in preventing caries, their efficacy may be related to the caries prevalence in the population.
Objectives
The primary objective of this review was to evaluate the caries prevention of pit and fissure sealants in children and adolescents.
Search methods
We searched the Cochrane Oral Health Group Trials Register, CENTRAL (The Cochrane Library 2007, Issue 3) and MEDLINE (to October 2007); EMBASE (to June 2007); SCISEARCH, CAplus, INSPEC, NTIS, PASCAL, DARE, NHS EED and HTA (to February 2008). There were no language or publication restrictions.
Selection criteria
Randomised or quasi‐randomised controlled trials of at least 12 months in duration comparing sealants with no sealant or sealants from different classes of materials for preventing occlusal caries in children and adolescents under 20 years. The primary outcome was the increment in the numbers of carious occlusal surfaces of premolars and molars.
Data collection and analysis
Two review authors independently screened search results, extracted data and quality assessed trials. Risk ratios (RR) were calculated for differences between intervention and control groups and in split‐mouth studies for differences of paired tooth surfaces being carious or not. The meta‐analyses were conducted using a random‐effects model.
Main results
Sixteen studies were included in the review; 7 studies provided data for comparison of sealant versus control without sealant and 10 studies for comparison of sealant versus sealant. Five split‐mouth studies and one parallel group study with 5 to 10 year old children found a significant difference in favour of second or third generation resin‐based sealants on first permanent molars, compared to a control without sealant, with a pooled RR of 0.13 (95% confidence interval (CI) 0.09 to 0.20), 0.22 (95% CI 0.15 to 0.34), 0.30 (95% CI 0.22 to 0.40), and 0.40 (95% CI 0.31 to 0.51) at 12, 24, 36 and 48‐54 months follow up, respectively. Further, one of those studies with 9 years of follow up found significantly more caries in the control group compared to resin sealant group; 27% of sealed surfaces were decayed compared to 77% of surfaces without sealant.
The results of the studies comparing different sealant materials were conflicting.
Authors' conclusions
Sealing is a recommended procedure to prevent caries of the occlusal surfaces of permanent molars. The effectiveness of sealants is obvious at high caries risk but information on the benefits of sealing specific to different caries risks is lacking.
PICOs
Plain language summary
Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents
Children who have their molar teeth covered by a sealant are less likely to have dental decay in their molar teeth than children without sealant.
Sealants are coatings applied by the dentist or by another person in dental care on the grooves of mainly molar teeth. These coatings are intended to prevent the growth of bacteria that promote decay in grooves of molar teeth. The review shows that after 4.5 years the sealed permanent molar teeth of children aged 5 to 10 had over 50% reduction in decay on biting surfaces compared to teeth without sealants. One study with longer follow up showed that after 9 years only 27% of sealed tooth surfaces were decayed compared to 77% of tooth surfaces without sealant.
