Effectiveness of Sealants in Adolescents with High and Low Caries Experience

Abstract

The aim of this 3-year longitudinal study was to analyze caries increment and the caries-preventive effect of sealants in adolescents in the setting of the German national health system. 434 pupils (193 male, 241 female) took part in compulsory school examinations at age 12 (mean 12.3 ± 0.4 years) and 15 (mean 15.6 ± 0.3 years) according to WHO criteria, including the examination of sealants. Mean DMFT increased from 1.78 (± 2.15) to 3.97 (± 3.68), mean DMFS from 2.79 (±4.07) to 6.94 DMFS (± 8.34), respectively. Logistic regression analysis showed that high caries incidence at the individual level was mostly associated with the type of school (’Gymnasium’, RR = 0.3), gender (female, RR = 2.08) and high baseline DMFS (RR = 1.2 per surface), but not with the number of sealants. In an interaction model, adolescents with high baseline DMFS values had an even higher risk of caries increment with an increasing number of sealants compared to adolescents with fewer sealants (p = 0.047). At the tooth level, this effect was detected for first permanent molars, while sealants in premolars and second permanent molars did not result in a statistically significant caries-preventive effect due to the low caries incidence on these surfaces. Thus, sealants on occlusal surfaces of first permanent molars were only protective in individuals with low or moderate caries activity (p = 0.006), which indicates the need for other measures to reduce caries activity in high risk adolescents. In addition, rates of 19% lost sealants and 18% carious or filled surfaces in 3 years suggest a discrepancy between sealant retention under real-life conditions and the results of controlled clinical trials.

Sealants in Dentistry: Outcomes of the ORCA Saturday Afternoon Symposium 2007

“…In contrast, low DMF-S values can be achieved with strict indications for sealants under the conditions that children follow a thorough preventive regime Christiansen, 2005, 2008]. The latter statement is supported in a risk-specific analysis from Germany performed by Heyduck et al [2006], who could show that sealants often failed if caries activity was not controlled with non-operative measures.…”

Clinical comparison of Fuji VII and a resin sealant in children at high and low risk of caries

“…The results of studies assessing the effectiveness of fissure sealant according to patients' caries risk status have been contradictory 17,18) . Some studies have shown that fissure sealants are more effective if used in HR rather than low risk (LR) children 18,19) ; others have found that the higher the dft, the higher the risk of fissure sealant failure 20) , though such sealants are effective in individuals with low or moderate carious activity 21) . There has been no study discussing the preventive effect of Fuji VII in children of different caries risk status.…”

Caries prevalence, severity, and 3‐year increment, and their impact upon New Zealand adolescents' oral‐health‐related quality of life

“…In a study of over 3,000 Swedish adolescents, a social gradient was observed, with a higher caries increment reported among those residing in urban areas or who were children of immigrants or manual workers (6). Other studies have shown that the risk of developing new caries was most influenced by having had earlier experience of caries (5‐7). There has been only one report of New Zealand adolescents' dental caries experience over time; that was from the Dunedin Multidisciplinary Health and Development Study (DMHDS), where a caries increment of 2.2 surfaces from age 15 to 18 was observed two decades ago.…”