Fissure Seal or Fluoride Varnish? A Randomized Trial of Relative Effectiveness

Abstract

Fissure sealant (FS) and fluoride varnish (FV) are effective in preventing dental caries when compared with a no-treatment control. However, the relative clinical effectiveness of these interventions is uncertain. The objective of the study was to compare the clinical effectiveness of FS and FV in preventing dental caries in first permanent molars (FPMs) in 6- to 7-y-olds. The study design was a randomized clinical trial, with 2 parallel arms. The setting was a targeted-population program that used mobile dental clinics in schools located within areas of high social and economic deprivation in South Wales. A total of 1,016 children were randomized 1:1 to receive either FS or FV. Resin-based FS was applied to caries-free FPMs and maintained at 6-mo intervals. FV was applied at baseline and at 6-mo intervals for 3 y. The main outcome measures were the proportion of children developing caries into dentine (DMFT) on any 1 of up to 4 treated FPMs after 36 mo. At 36 mo, 835 (82%) children remained: 417 in the FS arm and 418 in the FV arm. A smaller proportion of children who received FV ( n = 73, 17.5%) versus FS ( n = 82, 19.6%) developed caries into dentine on at least 1 FPM (odds ratio [OR] = 0.84; 95% CI, 0.59 to 1.21; P = 0.35), a nonstatistically significant difference between FS and FV treatments. The results were similar when the number of newly decayed teeth (OR = 0.86; 95% CI, 0.60 to 1.22) and tooth surfaces (OR = 0.85; 95% CI, 0.59 to 1.21) were examined. In a community oral health program, semiannual application of FV resulted in caries prevention that was not significantly different from that obtained by applying and maintaining FS after 36 mo (EudraCT: 2010-023476-23; ISRCTN: ISRCTN17029222).

Cost-Effectiveness through the Dental-Health FRAMM Guideline for Caries Prevention among 12- to 15-Year-Olds in Sweden

“…In terms of the cost-effectiveness of fluoride varnish programmes, a recently published study of a community oral health programme compared fluoride varnish with fissure sealants in caries-free 6-to 7-year-olds in an area with a high caries risk in Wales. No differences in caries prevention effect were found, but fluoride varnish proved to be less expensive and probably more cost-effective in the longer perspective [Chestnutt et al, 2017].…”

Efficacy of Sealing with Glass Ionomer Cement and Transversal Brushing Technique in Erupting First Molars: 18-Month Clinical Follow-Up

“…Other longitudinal studies observed that partial or total loss of the material occurred, but retention did not influence treatment success [13,21,23], and although they are not noticed, sealant particles are retained and block the deeper parts of pits and fissures releasing fluorine [17,24].…”

“…Although studies have shown resinous materials as the material of choice, there are still gaps in showing the best evidence to put into clinical practice [16][17][18][19][20]. Previous studies have shown that transversal brushing and ionomeric sealing techniques may have similar efficacy [13,21]. After that, the important relevance of the theme by comparing techniques in social actions was verified and thus, to fill the gaps and make feasible the planning and execution of social programs aimed at the oral health of the population.…”

Pit and fissure sealants penetration capacity and their correlation with fissure morphology

“…A study showed that sealing S51 permanent molars in all patients further improves the outcome, adding only a small incremental cost relative to risk-based sealing [5]. Another study concluded that sealing primary molars reduces restorations and extractions and ensures an oral environment with less risk factors for recently erupted permanent teeth [6].…”