Pit and Fissure Sealant Versus Fluoride Varnish In Prevention of Occlusal Caries

Salem, Katayoun; Shahsavari, Fatemeh; Kazemnejad, Ehsan; Poorhabibi, Zahra

doi:10.18869/acadpub.3dj.3.1.46

Cited by 6 publications

(17 citation statements)

References 12 publications

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“…A total of 950 studies surfaced during the search procedures. After selection according to the inclusion and exclusion criteria, 8 studies were included for quantitative synthesis (meta-analysis), yet five of these 8 studies were not included in previous meta-analysis (Table 1) [13][14][15][16][17][18][19][20] . RCTs included in present study dated from 1984 to 2017, which enrolled in 3289 participants and 6878 FPMs.…”

Section: Resultsmentioning

confidence: 99%

“…CI is the primary outcome to measure caries prevention efficacy. Six of included RCTs reported this outcome [13][14][15][16]18,19 . Three layers of CI were demonstrated, including CI of enrolled children, CI of FPMs, and CI of FPMs' occlusal surfaces.…”

Section: Fs or Fv And Caries Incidence (Ci)mentioning

confidence: 99%

“…PATIENT ARMS www.nature.com/scientificreports www.nature.com/scientificreports/ CI of FPMs. Six included RCTs reported this outcome [13][14][15][16]18,19 . These RCTs included a total of 6878 FPMs.…”

Section: Study Type (Study Design)mentioning

confidence: 99%

“…Among them only Bravo 1996 reported statistical superiority of FS on reducing CI of FPMs (RR: 2.68, 95% CIs: 1.76 to 4.08) 19 . Others showed no significant difference [13][14][15][16]18 . Our overall RR of this outcome lacked statistical significance to show superiority between FV and FS (RR: 1.29; 95% CIs: 0.95 to 1.75; p = 0.10).…”

Section: Replacement Of Sealantmentioning

confidence: 99%

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Comparison between Fissure Sealant and Fluoride Varnish on Caries Prevention for First Permanent Molars: a Systematic Review and Meta-analysis

Jiang

et al. 2020

Sci Rep

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The high prevalence and heavy socioeconomic burden for caries of first permanent molars (FPMs) make the prevention of this disease a major public health goal. Current guidelines recommend a preference of fissure sealant (FS) over fluoride varnish (FV) based on two recent systematic reviews. However, evidences of these two studies are weak because of scarce data and some limitations. Besides, an upto-date large scale randomized controlled trial (RCT) reported commensurate effectiveness of these two techniques. Thus, in order to more accurately compare the clinical efficacy between FS and FV on caries prevention for FPMs, we carried out this systematic review and meta-analysis. A total of 8 RCTs involving 3289 participants and 6878 FPMs fulfilled the inclusion criteria. Our meta-analysis for the first time showed that there was no statistical difference on caries incidence or occlusal DMFS increment between sealant group and fluoride varnish group at 2~3 years' follow-up. In that sense, biannual applications of FV or FS may be equally effective on caries prevention for FPMs. These results do not support routine recommendation of FS over FV, thus shedding light on current conceptions. Our findings endow clinicians with a window to reconsider the choice between these two techniques. Caries is one of the most prevalent chronic diseases worldwide 1-5. Approximately 2.4 billion people, accounting for 35% of the world population, are affected by untreated caries 1,2. Though enormous public resources have been poured into caries prevention, the global prevalence of untreated caries remained stagnant during the last decades 1. Untreated caries can be much burdensome socioeconomically 3-5. The economic loss thereof amounts to hundreds of billions of dollars every year 3. As a matter of fact, the high prevalence associated with heavy disease burden make caries prevention a major public health goal. First permanent molars (FPMs) are of great significance to caries prevention 6,7. Decay of FPMs constitutes the biggest component of decayed missing filled tooth index (DMFT) among children and adolescents 8,9. As well as being highly prevalent, caries of FPMs also imposes an overwhelming disease burden. FPMs are the keys to establish permanent occlusion 10. Severe FPMs caries often cause pain and infection, diminished dietary intake and malocclusion 1,8-10. At present, two techniques, namely fluoride varnish (FV) and fissure sealant (FS), are introduced to prevent caries of FPMs, both proved effective 11,12. However, it still cannot be concluded clearly which of these two skills is clinically superior. Current practice guidelines recommend a preference for FS over FV 6,7. This recommendation was supported by two very recent systematic reviews. Meta-analysis of them favored FS rather than FV with statistical significance 6,7. But the evidences of these two studies were assessed as weak (Details of their limitations will be identified and discussed below). Besides, a large-scale, high-qualified RCT updated recently showed that ther...

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Section: Resultsmentioning

confidence: 99%

Section: Fs or Fv And Caries Incidence (Ci)mentioning

confidence: 99%

Section: Study Type (Study Design)mentioning

confidence: 99%

Section: Replacement Of Sealantmentioning

confidence: 99%

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Comparison between Fissure Sealant and Fluoride Varnish on Caries Prevention for First Permanent Molars: a Systematic Review and Meta-analysis

Jiang

et al. 2020

Sci Rep

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“…61,[66][67][68] In their 2016 review of these studies, Ahovuo-Saloranta et al 16 said that it was not possible to reach conclusions about whether to apply FS or FV to the occlusal surfaces of permanent molars to best effect. The clinical outcomes from the current trial suggest that there is no significant difference in the clinical outcome, irrespective of whether FS or FV is used.…”

Section: What Other Studies Foundmentioning

confidence: 99%

Seal or Varnish? A randomised controlled trial to determine the relative cost and effectiveness of pit and fissure sealant and fluoride varnish in preventing dental decay

Chestnutt

Hutchings

Playle

et al. 2017

Health Technol Assess

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Background Fissure sealant (FS) and fluoride varnish (FV) have been shown to be effective in preventing dental caries when tested against a no-treatment control. However, the relative clinical effectiveness and cost-effectiveness of these interventions is unknown. Objective To compare the clinical effectiveness and cost-effectiveness of FS and FV in preventing dental caries in first permanent molars (FPMs) in 6- and 7-year-olds and to determine their acceptability. Design A randomised controlled allocation-blinded clinical trial with two parallel arms. Setting A targeted population programme using mobile dental clinics (MDCs) in schools located in areas of high social and economic deprivation in South Wales. Participants In total, 1016 children were randomised, but one parent subsequently withdrew permission and so the analysis was based on 1015 children. The randomisation of participants was stratified by school and balanced for sex and primary dentition baseline caries levels using minimisation in a 1 : 1 ratio for treatments. A random component was added to the minimisation algorithm, such that it was not completely deterministic. Of the participants, 514 were randomised to receive FS and 502 were randomised to receive FV. Interventions Resin-based FS was applied to caries-free FPMs and maintained at 6-monthly intervals. FV was applied at baseline and at 6-month intervals over the course of 3 years. Main outcome measures The proportion of children developing caries into dentine (decayed, missing, filled teeth in permanent dentition, i.e. D4–6MFT) on any one of up to four treated FPMs after 36 months. The assessors were blinded to treatment allocation; however, the presence or absence of FS at assessment would obviously indicate the probable treatment received. Economic measures established the costs and budget impact of FS and FV and the relative cost-effectiveness of these technologies. Qualitative interviews determined the acceptability of the interventions. Results At 36 months, 835 (82%) children remained in the trial: 417 in the FS arm and 418 in the FV arm. The proportion of children who developed caries into dentine on a least one FPM was lower in the FV arm (73; 17.5%) than in the FS arm (82, 19.6%) [odds ratio (OR) 0.84, 95% confidence interval (CI) 0.59 to 1.21; p = 0.35] but the difference was not statistically significant. The results were similar when the numbers 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. Trial fidelity was high: 95% of participants received five or six of the six scheduled treatments. Between 74% and 93% of sealants (upper and lower teeth) were intact at 36 months. The costs of the two technologies showed a small but statistically significant difference; the mean cost to the NHS (including intervention costs) per child was £500 for FS, compared with £432 for FV, a difference of £68.13 (95% CI £5.63 to £130.63; p = 0.033) in favour of FV. The budget impact analysis suggests that there is a cost saving of £68.13 (95% CI £5.63 to £130.63; p = 0.033) per child treated if using FV compared with the application of FS over this time period. An acceptability score completed by the children immediately after treatment and subsequent interviews demonstrated that both interventions were acceptable to the children. No adverse effects were reported. Limitations There are no important limitations to this study. Conclusions In a community oral health programme utilising MDCs and targeted at children with high caries risk, the twice-yearly application of FV resulted in caries prevention that is not significantly different from that obtained by applying and maintaining FSs after 36 months. FV proved less expensive. Future work The clinical effectiveness and cost-effectiveness of FS and FV following the cessation of active intervention merits investigation. Trial registration EudraCT number 2010-023476-23, Current Controlled Trials ISRCTN17029222 and UKCRN reference 9273. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 21. See the NIHR Journals Library website for further project information.

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Clinical effectiveness of pit and fissure sealants in primary and permanent teeth of children and adolescents: an umbrella review

Amend,

Boutsiouki,

Winter

et al. 2024

Eur Arch Paediatr Dent

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Purpose This umbrella review aimed to critically appraise the evidence published in systematic reviews (SRs) on the clinical effectiveness of sealants compared with each other/the non-use in primary/permanent teeth of children and adolescents with at least 12-month follow-up. Methods A systematic literature search on 4 electronic databases was conducted up to January 18th, 2023. Following handsearching, two review authors independently screened retrieved articles, extracted data, and assessed the risk of bias (RoB) using the risk of bias in systematic reviews (ROBIS) tool. Based on a citation matrix, the overlap was interpreted by the corrected covered area (CCA). Results Of 239 retrieved records, 7 SRs met the eligibility criteria with a moderate overlap among them (CCA = 7.4%). For primary molars, in 1120 1.5- to 8-year-old children, data on the clinical effectiveness of sealants were inconclusive. For permanent molars, 3 SRs found a significant caries risk reduction for sealants versus non-use (≤ 36-month follow-up). There was insufficient evidence to proof superiority of sealants over fluoride varnish for caries prevention (3 SRs), and to rank sealant materials according to the best clinical effectiveness in permanent molars. One study was rated at low and 6 at high RoB, which did not allow for a valid quantitative synthesis. Conclusion Considering the limitations of this umbrella review, sealants are more effective for caries prevention in children’s permanent molars compared to no treatment. Future well-implemented RCTs are needed to draw reliable conclusions on the clinical effectiveness of sealants in primary and permanent teeth of children and adolescents.

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Pit and Fissure Sealant Versus Fluoride Varnish In Prevention of Occlusal Caries

Cited by 6 publications

References 12 publications

Comparison between Fissure Sealant and Fluoride Varnish on Caries Prevention for First Permanent Molars: a Systematic Review and Meta-analysis

Comparison between Fissure Sealant and Fluoride Varnish on Caries Prevention for First Permanent Molars: a Systematic Review and Meta-analysis

Seal or Varnish? A randomised controlled trial to determine the relative cost and effectiveness of pit and fissure sealant and fluoride varnish in preventing dental decay

Clinical effectiveness of pit and fissure sealants in primary and permanent teeth of children and adolescents: an umbrella review

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