Efficacy of pit and fissure sealants for preventing dental decay in deciduous teeth
Level of evidence: C
Resin-based pit and fissure sealants may prevent new and progressed caries lesions in occlusal surfaces of deciduous molars more effectively than fluoride varnish.
Two RCT studies have shown that sealed (resin-based sealant) occlusal surfaces of primary molars have fewer new or progressed caries lesions than occlusal surfaces received only fluoride varnish «Honkala S, ElSalhy M, Shyama M ym. Sealant versus Fluoride in Primary Molars of Kindergarten Children Regularly Receiving Fluoride Varnish: One-Year Randomized Clinical Trial Follow-Up. Caries Res 201»1, «Bakhshandeh A, Ekstrand K. Infiltration and sealing versus fluoride treatment of occlusal caries lesions in primary molar teeth. 2-3 years results. Int J Paediatr Dent 2015;25:43-50 »2. The quality of evidence is downgraded due to limited number of studies and participants, high risk of bias (blinding of outcome assessment) «Honkala S, ElSalhy M, Shyama M ym. Sealant versus Fluoride in Primary Molars of Kindergarten Children Regularly Receiving Fluoride Varnish: One-Year Randomized Clinical Trial Follow-Up. Caries Res 201»1, relatively short follow-up time, and only borderline significance in one of the two studies «Bakhshandeh A, Ekstrand K. Infiltration and sealing versus fluoride treatment of occlusal caries lesions in primary molar teeth. 2-3 years results. Int J Paediatr Dent 2015;25:43-50 »2. Extrapolated evidence from a high quality meta-analysis of sealing permanent molars may confirm the evidence «Ahovuo-Saloranta A, Forss H, Walsh T ym. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database Syst Rev 2017;7:CD001830 »3. All in all, the quality of evidence is low.
Applicability of the evidence to the Finnish population is moderate.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| RCT = randomized controlled trial | |||||
| «Honkala S, ElSalhy M, Shyama M ym. Sealant versus Fluoride in Primary Molars of Kindergarten Children Regularly Receiving Fluoride Varnish: One-Year Randomized Clinical Trial Follow-Up. Caries Res 201»1 | RCT | 106 4-year-old children (the mean age 4.1 years), which had matched jaw quadrant pairs with molar surfaces with the same ICDAS code 0-4, from two kindergartens in Kuwait. Only children whose parents/guardians gave their written consent were included. Non-co-operative children or children who were absent from the school on the day of the intervention were excluded. | Pit and fissure sealant was compared to fluoride varnish. | Caries prevention on occlusal surfaces of primary molars. | High risk of bias because the dentist who measured the outcomes could see whether sealant had been used. Caries was diagnosed only visually, and thus it could not be confirmed whether the initial caries lesions had progressed under the sealant. The follow-up time was only 1 year. |
| «Bakhshandeh A, Ekstrand K. Infiltration and sealing versus fluoride treatment of occlusal caries lesions in primary molar teeth. 2-3 years results. Int J Paediatr Dent 2015;25:43-50 »2 | RCT | 50 children (mean age 6.51 years) from the public dental healthcare clinics in Nuuk, Greenland, were included. The main inclusion criteria was presence of at least three primary molars with initial caries lesions on occlusal surfaces in each child. Children with systemic disease or co-operating difficulties were excluded. | Intervention: Pit and fissure sealant + fluoride varnish Comparison: Fluoride varnish | Prevention of caries lesion progression on occlusal surfaces of primary molars. The outcome was assessed by pairwise analyze of baseline and final bitewing radiographs. | No specific high risk of bias. |
| Reference | Comments |
| «Honkala S, ElSalhy M, Shyama M ym. Sealant versus Fluoride in Primary Molars of Kindergarten Children Regularly Receiving Fluoride Varnish: One-Year Randomized Clinical Trial Follow-Up. Caries Res 201»1 | Participants of the study had a high caries risk |
| «Bakhshandeh A, Ekstrand K. Infiltration and sealing versus fluoride treatment of occlusal caries lesions in primary molar teeth. 2-3 years results. Int J Paediatr Dent 2015;25:43-50 »2 | 50 % of the participants had low caries risk, 23 % had moderate and 27 % high risk. |
Results
References
- Honkala S, ElSalhy M, Shyama M ym. Sealant versus Fluoride in Primary Molars of Kindergarten Children Regularly Receiving Fluoride Varnish: One-Year Randomized Clinical Trial Follow-Up. Caries Res 2015;49:458-66 «PMID: 26228621»PubMed
- Bakhshandeh A, Ekstrand K. Infiltration and sealing versus fluoride treatment of occlusal caries lesions in primary molar teeth. 2-3 years results. Int J Paediatr Dent 2015;25:43-50 «PMID: 24460688»PubMed
- Ahovuo-Saloranta A, Forss H, Walsh T ym. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database Syst Rev 2017;7:CD001830 «PMID: 28759120»PubMed