Fluoride‐releasing resin‐based sealants versus no sealants

Population: children with caries‐free (or non‐cavitated carious lesion) primary molars, aged 3–7 years

Settings: paediatric department, dental hospital (France)

Intervention: fluoride‐releasing resin‐based sealant

Comparison: no treatment

Development of ≥ 1 new carious lesion (caries incidence)

Follow‐up: 12 months

BB OR 1.21

(0.37 to 3.94)

88 children, 274 teeth

(1 RCT)

⨁⨁◯◯
Low^b

Development of ≥ 1 new carious lesion (caries incidence)

Follow‐up: 24 months

BB OR 0.76

(0.41 to 1.42)

85 children, 255 teeth

(1 RCT)

⨁⨁◯◯
Low^b

Progression of non‐cavitated enamel caries

Adverse events

*The basis for the assumed risk is the control group risk in the study. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
BB OR: Becker Balagtas odds ratio; CI: confidence interval; RCT: randomised controlled trial.

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

Glass ionomer‐based sealants versus no sealants

Population: children with caries‐free primary first molars with or without caries affecting other teeth, aged 1–5 years

Settings: paediatric clinic, dental school (India) and community dental setting (UK)

Intervention: glass ionomer‐based sealants

Comparison: no sealants

Development of at ≥ 1 new carious lesion (caries incidence)

Follow‐up: 12–30 months

OR 0.97 (0.63 to 1.49)

449 (1 RCT)

⊕⊕⊝⊝
Low^b

The evidence for this comparison is equivocal. In an additional trial randomising 107 children, the odds of developing a new carious lesion at 6‐ and 12‐month follow‐up were lower for the sealant group than the no‐sealant group at both time points (6 months: OR 0.031, 95% CI 0.002 to 0.601; 12 months: OR 0.033, 95% CI 0.007 to 0.149).^c

Progression of non‐cavitated enamel caries

Adverse events

*The basis for the assumed risk is the control group risk in the study. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; GIC: glass ionomer‐based sealants; OR: odds ratio; RCT: randomised controlled trial.

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

Glass ionomer‐based sealants versus resin‐based sealants

Population: 'healthy' children, with caries‐free second primary molars, aged 3–5 years

Settings: schools and kindergarten, India and China

Intervention: glass ionomer‐based sealants

Comparison: fluoride‐releasing or non‐fluoride‐releasing resin‐based sealants

Development of ≥ 1 new carious lesion (caries incidence)

Follow‐up: 6–24 months

N/A

200 (2 studies)

⊕⊝⊝⊝
Very low^a

Due to the methods of data collection, analysis and reporting we were unable to provide any quantitative estimates for this comparison.

Progression of non‐cavitated enamel caries

Sealant retention

Complete or partial retention of sealant

Follow‐up: 24 months^b

BB OR 0.20 (0.11 to 0.36)

100 children, 100 tooth pairs (1 RCT)

⊕⊝⊝⊝ Very low^a

We were unable to re‐analyse the results from an additional split‐mouth study (several tooth pairs) that failed to consider the split‐mouth nature of the data and the multiple teeth treated. The authors reported that, "At 6 month after pit and fissure seal, detachment rate was lower in the glass ionomer group compared with resin group (P = 0). At 18 months, detachment rate was lower in the glass ionomer group compared with resin group (P = 0.113)."

Adverse events

—

100 children (1 RCT)

⊕⊝⊝⊝ Very low^a

1 study reported adverse events as some discomfort such as nausea among some children. 1 child reported feeling uncomfortable and experienced a strong gag reflex following application of the glass ionomer‐based sealant while 8 children reported feeling uncomfortable after the fluoride resin‐based applications.

*The basis for the assumed risk is the control group risk. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
BB OR: Becker Balagtas odds ratio; CI: confidence interval; RCT: randomised controlled trial.

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

Fluoride‐releasing resin‐based sealants versus resin‐based sealants

Population: children with caries‐free second primary molars, aged 4–8 years

Settings: dental clinic, Turkey and Spain

Intervention: fluoride‐releasing resin‐based sealants

Comparison: resin‐based sealants

Development of ≥ 1 new carious lesion (caries incidence)

Follow‐up: 6–24 months

N/A

69 (2 studies)

⊕⊕⊝⊝
Low^a

Due to the different sealant materials evaluated, data reporting (split‐mouth studies reported as parallel‐group studies) and the very low number of tooth surfaces developing new carious lesions, we were unable to pool these data in a meta‐analysis.

Progression of non‐cavitated enamel caries

Sealant retention

Complete or partial retention of sealant

Follow‐up: 6–24 months

Effect estimate not calculable

69 (2 studies)

⊕⊝⊝⊝ Very low^b

Due to the different sealant materials evaluated, data reporting (split‐mouth studies reported as parallel‐group studies) and the very low number of sealants that were lost, we were unable to pool these data in a meta‐analysis.

Adverse events

*The basis for the assumed risk is the control group risk. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; N/A: not applicable.

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

Flowable resin composite versus resin‐based sealants

Population: children who were regular dental attenders with caries‐free first or second primary molars

Settings: Public Health service clinic in Brazil

Intervention: flowable resin composite

Comparison: resin‐based sealants

Development of ≥ 1 new carious lesion (caries incidence)

Progression of non‐cavitated enamel caries

Sealant retention

Complete or partial retention of sealant

Follow‐up: 12 months

Effect estimate

not calculable.

All sealants were completely or partially retained.

40 (1 RCT)

⨁⨁◯◯
Low^a

All sealants were retained or partially retained in both groups.

Adverse events

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RCT: randomised controlled trial.

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

Autopolymerised sealant versus light polymerised sealant

Population: children with sound primary molars, aged 2–4 years

Settings: municipal dental clinics or hospital paediatric clinics, Denmark

Intervention: autopolymerised sealant application

Comparison: light polymerised sealant application

Development of ≥ 1 new carious lesion (caries incidence)

Follow‐up: 24–36 months

OR 0.58

(0.15 to 2.19)

52 children, 52 tooth pairs

(1 RCT)

⊕⊝⊝⊝
Very low^a

Progression of non‐cavitated enamel caries

Sealant retention

Complete or partial retention of sealant

Follow‐up: 24–36 months

OR 0.68

(0.33 to 1.44)

52 children, 52 tooth pairs

(1 RCT)

⊕⊝⊝⊝
Very low^a

Adverse events

*The basis for the assumed risk is the control group risk. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; OR: odds ratio; RCT: randomised controlled trial.

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.