The Effectiveness of Sealants in Managing Caries Lesions

A barrier to providing sealants is concern about inadvertently sealing over caries. This meta-analysis examined the effectiveness of sealants in preventing caries progression. We searched electronic databases for comparative studies examining caries progression in sealed permanent teeth. We used a random-effects model to estimate percentage reduction in the probability of caries progression in sealed vs. unsealed carious teeth. Six studies, including 4 randomized-controlled trials (RCT) judged to be of fair quality, were included in the analysis (384 persons, 840 teeth, and 1090 surfaces). The median annual percentage of non-cavitated lesions progressing was 2.6% for sealed and 12.6% for unsealed carious teeth. The summary prevented fraction for RCT was 71.3% (95%CI: 52.8%–82.5, no heterogeneity) up to 5 years after placement. Despite variation among studies in design and conduct, sensitivity analysis found the effect to be consistent in size and direction. Sealing non-cavitated caries in permanent teeth is effective in reducing caries progression.

[1]  J. Ramacciato,et al.  Evaluation of non-invasive treatment applied to occlusal surfaces. , 2001, ASDC journal of dentistry for children.

[2]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[3]  J. de Graaff,et al.  The effect of glass-ionomer cement on carious dentine: an in vivo study. , 1993, Caries research.

[4]  G. Schuster,et al.  Clinical progress of sealed and unsealed caries. Part I: Depth changes and bacterial counts. , 1979, The Journal of prosthetic dentistry.

[5]  Susan O Griffin,et al.  Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis--United States, 1988-1994 and 1999-2002. , 2005, Morbidity and mortality weekly report. Surveillance summaries.

[6]  Primosch Re,et al.  Sealant use and placement techniques among pediatric dentists. , 2001, Journal of the American Dental Association.

[7]  Michèle Muller-Bolla,et al.  Retention of resin-based pit and fissure sealants: A systematic review. , 2006, Community dentistry and oral epidemiology.

[8]  S L Normand,et al.  Meta-analysis: formulating, evaluating, combining, and reporting. , 1999, Statistics in medicine.

[9]  S. Handelman,et al.  Clinical radiographic evaluation of sealed carious and sound tooth surfaces. , 1986, Journal of the American Dental Association.

[10]  J. Bader,et al.  Systematic reviews of selected dental caries diagnostic and management methods. , 2001, Journal of dental education.

[11]  Gina Thornton-Evans,et al.  Trends in oral health status: United States, 1988-1994 and 1999-2004. , 2007, Vital and health statistics. Series 11, Data from the National Health Survey.

[12]  B. Burt,et al.  Longitudinal evaluation of sealing molars with and without incipient dental caries in a public health program. , 1995, Journal of public health dentistry.

[13]  Jeronimus Dj,et al.  Reduced viability of microorganisms under dental sealants. , 1975 .

[14]  J. Frencken,et al.  Three-Year Survival of One-Surface ART Restorations and Glass-Ionomer Sealants in a School Oral Health Programme in Zimbabwe , 1998, Caries Research.

[15]  M. J. Till,et al.  Reduced viability of microorganisms under dental sealants. , 1975, ASDC journal of dentistry for children.

[16]  M. Chapko.  A study of the intentional use of pit and fissure sealants over carious lesions. , 1987, Journal of public health dentistry.

[17]  Richardson As,et al.  Sticky fissure management. 30-month report. , 1980 .

[18]  James R. Lewis,et al.  When 100% really isn't 100%: improving the accuracy of small-sample estimates of completion rates , 2006 .

[19]  S. Normand,et al.  TUTORIAL IN BIOSTATISTICS META-ANALYSIS : FORMULATING , EVALUATING , COMBINING , AND REPORTING , 1999 .

[20]  S. Handelman,et al.  Effect of an autopolymerizing sealant on viability of microflora in occlusal dental caries. , 1980, Scandinavian journal of dental research.

[21]  H. Worthington,et al.  Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents. , 2008, The Cochrane database of systematic reviews.

[22]  C. Mulrow,et al.  Current methods of the US Preventive Services Task Force: a review of the process. , 2001, American journal of preventive medicine.

[23]  G. Gibson,et al.  Sticky fissure management. 30-month report. , 1980, Journal.

[24]  G. Schuster,et al.  Arresting caries by sealants: results of a clinical study. , 1986, Journal of the American Dental Association.

[25]  S. Griffin,et al.  The effect of dental sealants on bacteria levels in caries lesions: a review of the evidence. , 2008, Journal of the American Dental Association.

[26]  L. Haugh,et al.  Two-year clinical evaluation of a pit and fissure sealant. Part II. Caries initiation and progression. , 1976, Journal of the American Dental Association.

[27]  M Vaeth,et al.  Comments on a commentary: statistical evaluation of split mouth caries trials. , 1998, Community dentistry and oral epidemiology.