Sealants recommended to prevent caries : Are pit and fissure sealants effective in preventing decay in children and adolescents who are at risk of caries?

Abstract

Data sources Sources of studies were the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials, Medline, Embase, Scisearch, SIGLE (System for Information on Grey Literature in Europe) CAplus¥, INSPEC*, JICST-EPLUS♯, NTIS★, PASCAL⋆, Database of Abstracts and Reviews (DARE), the UK National Health Service Economic Evaluation Database and Health Technology Assessment database. Reference lists from included articles and review articles were searched for additional relevant publications. All relevant studies in most languages were considered and translated.Study selection Articles were selected for inclusion in the review if they were randomised or quasi-randomised controlled trials of at least 12 months in duration and if sealants were used for preventing caries in children and adolescents of under 20 years of age. Both parallel group and split-mouth study designs were included. The primary outcome was the increment in the numbers of carious occlusal surfaces of premolars and molars.Data extraction and synthesis In the first phase, two reviewers independently examined whether a given study was likely to be relevant on the basis of the title, keywords and abstract. In the second phase, four of the reviewers independently classified whether studies would be included in final analyses. Study authors were contacted for additional information. In the split-mouth studies, relative risk (RR) ratios were calculated for the paired differences of tooth surfaces being carious or not. In studies that compared resin-based sealant with no treatment, fixed-effect meta-analyses were used to combine the estimates of RR ratios. In one parallel-group study, the effect-estimate was calculated from data of occlusal surfaces of teeth included in the test and control groups.Results Eight trials were included in this review, of which seven were split-mouth studies and one a parallel-group study. Six studies provided data for comparing sealant with no treatment and three studies compared glass ionomers (GI) with resin-based sealants. The overall effectiveness of resin-based sealants in preventing dental decay on first molars was high. Based on five split-mouth studies with 5–10-year-old children there were significant differences in favour of the second-generation resin sealant compared with no treatment. Pooled RR values were 0.14, 0.24, 0.30 and 0.43 at 12, 24, 36 and 48–54 months, respectively. The reductions in caries therefore ranged from 86% at 12 months to 57% at 48–54 months. The 24-month parallel group study that compared second-generation resin sealant with control in 12–13-year old children also found significantly more caries in the control group children with a DFS of 0.65 (95% confidence interval, 0.47–0.83). Allocation concealment was classified as adequate in three of these six studies. The information on background levels of caries in the population, however, was insufficient to conduct further analyses that would allow an estimate of the effect of resin-based sealants related to baseline caries prevalence. Only one study provided data for the comparison of GI sealant and control. Based on this, there is not enough information to say whether GI sealants are effective or not. The results of three studies comparing resin sealants with GI sealants were conflicting and the meta-analyses were not carried out.Conclusions Sealing with resin-based sealants is recommended to prevent caries of the occlusal surfaces of permanent molars but we recommend that the caries prevalence level of both the individual and population should be taken into account. In practice, the benefit of sealing should be considered locally and specific guidelines for clinicians should be used. The methodological quality of published studies concerning pit and fissure sealants was poorer than expected.