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Public Health Dental Hygienist Toolkit: Clinical recommendations for dental sealants and sealant programs

Evidence based clinical recommendations for dental sealants and sealant programs, and other sealant program resources

Table of Contents


These recommendations provide the most up-to-date evidence on dental sealant use, material choice, and tooth preparation for a public health dental hygienist implementing a school-based sealant program.

1. Preventing Dental Caries Through School-based Sealant Programs

Preventing Dental Caries Through School-based Sealant Programs: Updated Recommendations and Reviews of Evidence (JADA, November 2009)

Abstract: Background. School-based sealant programs (SBSPs) increase sealant use and reduce caries. Programs target schools that serve children from low-income families and focus on sealing newly erupted permanent molars. In 2004 and 2005, the Centers for Disease Control and Prevention (CDC), Atlanta, sponsored meetings of an expert work group to update recommendations for sealant use in SBSPs on the basis of available evidence regarding the effectiveness of sealants on sound and carious pit and fissure surfaces, caries assessment and selected sealant placement techniques, and the risk of caries' developing in sealed teeth among children who might be lost to follow-up. The work group also identified topics for which additional evidence review was needed. Types of Studies Reviewed. The work group used systematic reviews when available. Since 2005, staff members at CDC and subject-matter experts conducted several independent analyses of topics for which no reviews existed. These reviews include a systematic review of the effectiveness of sealants in managing caries. Results. The evidence supports recommendations to seal sound surfaces and non-cavitated lesions, to use visual assessment to detect surface cavitation, to use a toothbrush or handpiece prophylaxis to clean tooth surfaces, and to provide sealants to children even if follow-up cannot be ensured.

2. The Effectiveness of Sealants in Managing Caries Lesions

"The Effectiveness of Sealants in Managing Caries Lesions" (J Dent Res, February 2008)

Abstract: Background. A barrier to providing sealants is concern about inadvertently sealing over caries. This meta-analysis examined the effectiveness of sealants in preventing caries progression. Methods. 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). Results. 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: 2.8%-82.5, no heterogeneity) up to 5 years after placement. Conclusions. 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.

3. The Effect of Dental Sealants on Bacteria Levels in Caries Lesions

"The Effect of Dental Sealants on Bacteria Levels in Caries Lesions" (JADA, March 2008)

Abstract: Background. Concern about inadvertently sealing over caries often prevents dentists from providing dental sealants. The objective of the authors' review was to examine the effects of sealants on bacteria levels within caries lesions under dental sealants. Methods. The authors searched electronic databases for comparative studies examining bacteria levels in sealed permanent teeth. To measure the effect of sealants on bacteria levels, they used the log 10 reduction in mean total viable bacteria counts (VBC) between sealed and not-sealed caries and the percentage reduction in the proportion of samples with viable bacteria. Results. Six studies-three randomized controlled trials, two controlled trials and one before-and-after study-were included in the analysis. Although studies varied considerably, there were no findings of significant increases in bacteria under sealants. Sealing caries was associated with a 100-fold reduction in mean total VBC (four studies, 138 samples). Sealants reduced the probability of viable bacteria by about 50.0 percent (four studies, 117 samples). Conclusions. The authors found that sealants reduced bacteria in carious lesions, but that in some studies, low levels of bacteria persisted. These findings do not support reported concerns about poorer outcomes associated with inadvertently sealing caries.

4. Evidence-based Clinical Recommendations for the Use of Pit-and-Fissure Sealants

"Evidence-based Clinical Recommendations for the Use of Pit-and-Fissure Sealants" (JADA, March 2008)

Abstract: Background. This article presents evidence-based clinical recommendations for use of pit-and-fissure sealants developed by an expert panel convened by the American Dental Association Council on Scientific Affairs. The panel addressed the following clinical questions: Under what circumstances should sealants be placed to prevent caries? Does placing sealants over early (non-cavitated) lesions prevent progression of the lesion? Are there conditions that favor the placement of resin-based versus. glass ionomer cement sealants in terms of retention or caries prevention? Are there any techniques that could improve sealants' retention and effectiveness in caries prevention? Types of Studies Reviewed. Staff of the ADA Division of Science conducted a MEDLINE search to identify systematic reviews and clinical studies published after the identified systematic reviews. At the panel's request, the ADA Division of Science staff conducted additional searches for clinical studies related to specific topics. The Centers for Disease Control and Prevention also provided unpublished systematic reviews that since have been accepted for publication. Results. The expert panel developed clinical recommendations for each clinical question. The panel concluded that resin-based sealants are effective in caries prevention and that sealants can prevent the progression of early non-cavitated carious lesions.

5. A Comparison of the Effects of Toothbrushing and Handpiece Prophylaxis on Retention of Sealants

"A Comparison of the Effects of Toothbrushing and Handpiece Prophylaxis on Retention of Sealants" (JADA, January 2009)

Abstract: Background. Tooth surface cleaning before acid etching is considered to be an important step in the retention of resin-based pit-and-fissure sealants. Methods. The authors reviewed and summarized instructions for cleaning tooth surfaces from five manufacturers of 10 unfilled resin-based sealants marketed in the United States. The authors also searched electronic databases for studies that directly compared the effects of different surface-cleaning methods on sealant retention and for systematic reviews of the effectiveness of sealants. They explored the association between surface-cleaning methods and sealant retention in the studies included in the systematic reviews. They calculated the summary weighted retention rates for studies that used either a handpiece or toothbrush prophylaxis. Results. All of the sealant manufacturers' instructions for use (IFU) recommended cleaning the tooth before acid etching. None of the IFU directly stated that a handpiece was required to perform the cleaning, but five IFU implied the use of handpiece prophylaxis. None of the IFU recommended surface-altering procedures in caries-free teeth. Direct evidence from two clinical trials showed no difference in complete sealant retention between surfaces cleaned mechanically with pumice or prophylaxis paste and those cleaned with air-water syringe or dry toothbrushing. Indirect evidence from 10 studies found that weighted summary retention by year after sealant placement in studies that used toothbrush prophylaxis was greater than or equivalent to values for studies that used handpiece prophylaxis. Conclusions. Levels of sealant retention after surface cleaning with toothbrush prophylaxis were at least as high as those associated with hand-piece prophylaxis.

6. Caries Risk in Formerly Sealed Teeth

"Caries Risk in Formerly Sealed Teeth" (JADA, April 2009)

Abstract: Background. The authors examined the risk of caries development in teeth with partially or fully lost sealant (formerly sealed [FS] teeth) relative to the risk in teeth that never have received sealants (never-sealed [NS] teeth). Methods. The authors searched the population of studies used in five reviews of sealant effectiveness as established in split-mouth design studies involving resin-based sealants with no reapplication of lost sealant. They required included studies to contain sufficient data to estimate the risk of caries in FS teeth relative to that in NS teeth and its 95 percent confidence interval (CI). To estimate the mean RR by year since sealant placement, they used a weighted bivariate model and tested for heterogeneity using the quantity I 2. Results. The weighted mean RR was 0.998 (95 percent CI, 0.817-1.220) one year after placement (four studies, 345 tooth pairs) and 0.936 (95 percent CI, 0.896-0.978) at four years (five studies, 1,423 tooth pairs). Conclusions. Teeth with fully or partially lost sealant were not at a higher risk of developing caries than were teeth that had never been sealed.

Additional Resources