Sealants recommended to prevent caries
Are pit and fissure sealants effective in preventing decay in children and
adolescents who are at risk of caries?
Ahovuo-Saloranta A, Hiiri A, Nordblad A, Worthington H,
Ma¨kela¨ M. Pit and fissure sealants for preventing dental decay
in the permanent teeth of children and adolescents (Cochrane
Review). In the Cochrane Library. Chichester: John Wiley; 2004,
Issue 3.
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
f
, INSPEC*, JICST-EPLUS
x
, 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.
f
CAplus comprehensive chemistry bibliographic database avail-
able from American Chemical Society (CAS). CAplus covers
international journals, patents, patent families, technical disclo-
sures, technical reports, books, conference proceedings, and
dissertations from all area of chemistry, biochemistry, chemical
engineering,and related sciences from 1907 to the present.
*Inspec database formed in 1967, based on the Science Abstracts
service which has been provided by the Institution of Electrical
Engineers since 1898 providing access to the world’s scientific and
technical literature in physics, electrical engineering, electronics,
communications, control engineering, computers and computing,
and information technology.
x
JICST-EPlus is a comprehensive bibliographic database with
English citations and abstracts covering the literature published in
Japan on all fields of science, technology, and medicine. The file
contains indexed and nonindexed records.
%
NTIS The National Technical Information Service, part of the
US Department of Commerce’s Technology Administration, sup-
ports the nation’s economic growth and job creation by providing
access to information that stimulates innovation and discovery.
$
PASCAL is a unique multidisplinary, multilingual bibliographic
database covering the major international literature in science,
technology, and medicine. Approximately 5000 journal titles are
indexed in PASCAL, which corresponds to a worldwide coverage.
The coverage in PASCAL by language is approximately: English 76%,
French 10%, Russian 6%, German 5%, and other languages 3%.
Commentary
This is the more rigorous of two current systematic reviews
1,2
about
effectiveness of dental sealants in preventing tooth decay. It is the
fourth systematic review on this topic and adds important
information to previous extensive reviews (see the Swedish group’s
2003 study at www.sbu.se or that by the US National Institutes for
Health from 2001 at odp.od.nih.gov/consensus/cons/115/115_in-
tro.htm). As seen in the other reviews, this one shows that in spite
of the quantity of articles published on the issue, very few are of
optimal methodological quality. A common cause of exclusion was
the impossibility of establishing the allocation of patients and the
high dropout rates. The first might be solved by better policies at
learned journals concerning reporting and peer review of trials,
allowing more articles to be analysed.
Address for correspondence: Emma Tavender, Review Group Co-ordinator, Cochrane
Oral Health Group, University Dental Hospital of Manchester, Higher Cambridge Street,
Manchester M15 6FH, UK. E-mail: emma.tavender@man.ac.uk.
www.nature.com/ebd 93
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3A
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2C
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2B
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2A
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1B
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1A
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SUMMARY REVIEW/DENTAL CARIES