Dentist use patterns for pit and fissure sealants and topical fluorides

A survey of 2,800 general dentists from six licensing regions was conducted to determine the current rate of pit and fissure sealants and topical fluoride use. The response rate was 56 percent. Seventy percent of general dentists used sealants on newly erupted secondary teeth and 20 percent of general dentists had never used sealants. Sixty-five percent of general dentists used topical fluorides on pedodontic patients at six-months intervals and 25 percent used them at one-year intervals. Dentists with more frequent use of sealants tended to be recent graduates who used new procedures, spent more practice time in pedodontics, came from the central region, had a hygienist in their practice, and belonged to the Academy of General Dentistry. Dentists with more frequent use of topical fluorides tended to perform frequent recall examinations. Those who performed frequent recall examinations were more likely to come from Florida and the Southeast, to believe caries spread rapidly, to be recent graduates, and to have a greater percentage of patients with insurance.     

The role of sealants in caries prevention programs

Pit-and-fissure sealants have been employed as an element in dental prevention programs for more than 30 years. The technique for sealant placement has evolved over time to become somewhat more invasive today. However, a meticulous technique is still required for success. Practitioners recently estimated that their one- and three-year sealant success rates were 89 percent and 78 percent, respectively. Grand medians for sealant success rates after one year in clinical trials have been reported to be as high as 83 percent for effectiveness and 92 percent for complete retention. Seven-year rates were 55 percent and 66 percent, respectively. Several changes in caries epidemiology have had an impact on the use of sealants. These changes include: * Declines in overall caries rates in U.S. schoolchildren during the latter decades of the 20th century; * A relative increase in the percentage of the population DMFS constituted by occlusal caries; and * A general slowing in the rate of lesion progression. Dentists' abilities to diagnose occlusal surface status also affect the decision to seal. Sealant cost-effectiveness can be improved by: * Targeting at-risk populations; * Using sealants on incipient lesions and minimally defective restorations; and * Training more dental auxiliaries to place sealants under a dentists' supervision. Concerns about sealing over decay and the estrogenicity of sealant components are addressed. Sealant guidelines, as promulgated by the Workshop on Guidelines for Sealant Use, are reviewed; and conclusions are presented about the role of sealants in prevention programs.     

Colorado pit and fissure sealant survey: attitudes toward and use of pit and fissure sealants by Colorado general dentists

The purpose of this study was to conduct a survey of Colorado general dentists regarding the use of and attitudes toward pit and fissure sealants. The survey consisted of a questionnaire to determine the utilization levels of sealants by general dentists, reasons for limited placement or non-utilization of sealants, whether sealant placement was delegated to dental auxiliaries or not, and if continuing education courses on sealants had been attended by the dentists and/or their dental auxiliaries. A total of 544 completed questionnaires were available for study. The results indicated that sealants were used by 82.7% of the dentists. Approximately 70% of the practitioners reported that they utilized sealants either routinely or occasionally. Reasons for limited placement or non-utilization of sealants were, in descending order: 1) Not covered by insurance; 2) Inadvertent sealing in of caries; 3) Sealants do not last; 4) Sealants too expensive; 5) Not familiar with sealant technique; 6) Sealants not effective. Placement of sealants was delegated as follows: 1) Dentists, 64.8%; 2) Hygienists, 17.8%; 3) Assistants, 17.4%. Continuing education courses had been attended by 29.1% of the dentists surveyed. Only 6.6% of the dentists indicated that their staff had attended continuing education courses on sealant placement. A relatively high percentage of Colorado dentists are utilizing sealants on a frequent basis. Major reasons for limited usage or non-utilization of sealants relates to lack of insurance coverage and concern regarding sealing in of caries. A need for continuing education courses on sealants appears to exist.     

The effect of education upon dentists' knowledge and attitude toward fissure sealants.

Sealants are highly effective in preventing dental caries in the pits and fissures of teeth. It has been shown, however, that sealants are not widely used by dentists. This study aimed to educate dental professionals about sealants and to evaluate the effect of such education on dentists' knowledge, attitude and use of sealants. A total of 312 dentists were surveyed to determine their knowledge and attitude toward sealants. Respondents were randomly allocated to "Education" group, who received education materials; and "No Education" group, who received no material (until after the education phase). After 12 months, 105 dentists responded to the post-intervention survey. Comparison between the two surveys shows that dentists' knowledge increased significantly in the "Education" group. No difference was detected in dentists' knowledge in the "No Education" group. Dentists' attitude and sealant use did not significantly improve in any of the groups. It is therefore, concluded that continuing education were more likely to change dentists' knowledge than attitude and behaviour. Effort to encourage sealant use by dentists should continue, but with the recognition that changes in behaviour occur over a long time and that other external factors in the professional environment may affect the rate of change.     

A Study of the Intentional Use of Pit and Fissure Sealants over Carious Lesions

This article reports data on the intentional use by dentists of pit and fissure sealants over carious lesions. In early 1985 a random sample of 127 dentists in general practice and 20 pedodontists from Washington State were interviewed by phone. Completed interviews were obtained from 81.9 percent (N = 104) of the general practitioners and 60.0 percent (N = 12) of the pedodontists. Eighteen percent of the dentists who offer sealants in their practice use sealants on "incipient" or "superficial" lesions. The major reasons given for not sealing lesions are: concern about failure or leakage, lack of confidence, or amalgams would be better. Dentists who seal lesions have larger practices in terms of the number of operatories and patients seen per week, place sealants on a larger proportion of their child patients, and more frequently delegate sealants to the hygienist. There is no relationship between placing sealants on lesions and placing sealants on primary teeth, the dentist's year of graduation, the number of years the dentist has used sealants, being a pedodontist, or employing a hygienist.     

Factors Associated with Fissure Sealant Delegation: Dentist Characteristics and Office Staffing Patterns

The purpose of this research was to identify dentist characteristics and dental office staffing patterns related to delegation of sealant applications. Results from a 1989 ma/led survey were used to characterize Michigan general dentists (N =300) who did or did not delegate sealant applications to auxiliaries and to identify factors associated with delegation. Nearly 50 percent of respondents were applying all sealants themselves. In offices that delegated the procedure, the mean proportion of sealants being applied by dentists was 39.9 percent. Registered dental hygienists were applying 51 percent, while registered dental assistants were applying 6.5 percent. Delegating dentists were more knowledgeable about sealant procedures, held more favorable attitudes, treated more young patients, placed more sealants, and were better informed about the legality of delegation according to the state practice act. Logistic regression analysis found that employing a registered dental hygienist was the most significant factor associated with sealant delegation, followed by employing a registered dental assistant. Findings suggest that dental auxiliaries, and particularly registered dental assistants, are underutilized for applying sealants. Approaches to increasing delegation of sealants may include changing dentists' traditional hiring patterns, highlighting the skills of auxiliaries such as the registered dental hygienist (RDH) and the registered dental assistant (RDA), and increasing awareness of legally allowable procedures that RDHs and RDAs can perform.     

Parental knowledge and attitudes towards pit and fissure sealants

No survey of public knowledge and attitudes towards pit and fissure sealants has been carried out in Australia. This study assessed the knowledge and attitudes of parents of Melbourne school children attending five dental treatment centres, regarding sealants. Of 554 parents surveyed by questionnaire, 487 (88 per cent) provided codable responses which were analysed by the log-likelihood ratio statistic and three-way hierarchical log-linear regression models. A total of 57.5 per cent respondents had heard of sealants; 46.4 per cent knew sealants prevent dental caries, and 45 per cent rated sealants important in caries prevention. Respondents attending private dentists or the Dental Therapy School were more knowledgeable about sealants than those attending other centres. Sealant awareness was related significantly to gender (p < 0.05), country of origin (p < 0.05), family income (p < 0.05), and frequency of dental visits of children (p < 0.001); the apparent association with country of origin, and annual family income, was explained by interactions between these variables and treatment centres. Dentists were the main source of dental health information including sealant awareness (p < 0.001). The most significant factors in sealant awareness were previous discussion of caries prevention by respondents with dentists; dentists as the main source of dental health information; and frequency of dental visits by the child(ren). These three factors confirm the importance of dentist-patient interactions in disseminating oral health information.     

Do school‐based dental sealant programs reach higher risk children?

Objectives: This report compares sealant prevalence by caries risk status among third graders at Ohio schools with and without school‐based dental sealant programs (S‐BSPs), and estimates the percent of children receiving sealants in S‐BSPs who are higher risk for dental caries. Methods: We analyzed data from a statewide open‐mouth oral health survey of Ohio third grade schoolchildren for sealant prevalence by S‐BSP availability and caries risk classification. Children were classified as higher or lower risk for dental caries based on school lunch program enrollment and other non‐clinical access‐related indicators. Differences between groups were evaluated by the chi‐square test (P < 0.05). Results: At schools with no S‐BSPs, higher risk children were less likely to have dental sealants than lower risk children (28.7 percent versus 42.7 percent, P < 0.001). At schools with S‐BSPs, sealant prevalence for both risk categories was equivalent for higher and lower risk children (59.4 percent, 63.4 percent, P = 0.428). Higher risk children at schools with S‐BSPs were more than twice as likely to have a sealant as higher risk children at non–S‐BSP schools (59.4 percent versus 28.7 percent, P < 0.001). Of higher risk children with at least one sealant, 61 percent attended a school with an S‐BSP compared with 12.3 percent of lower risk children with at least one sealant. Higher risk children accounted for at least 75 percent of children receiving sealants through S‐BSPs. Conclusions: In Ohio, targeting S‐BSPs by family income‐based school‐level criteria was effective in reaching higher risk children.     

Dental sealant longevity in a cohort of young U.S. naval personnel

BACKGROUND: The U.S. Navy emphasizes caries prevention and encourages the placement of dental sealants on the caries-susceptible teeth of patients at risk of developing caries. The authors analyzed dental records to assess the longevity of dental sealants placed in naval personnel. METHODS: A cluster sample of dental records from 1,123 personnel who entered naval service in 1997 was drawn from eight Navy dental treatment facilities. The authors determined the number of sealants provided, the number of sealants that failed over the observation period (1997-2001), the dates of sealant failure and the longevity of sealants placed during and after recruit training. RESULTS: A total of 319 personnel received sealants during their first two years of service. The authors evaluated 1,467 sealed teeth. They followed the sealants for an average of 35 months. They noted 179 sealant failures in 102 subjects; 69 previously sealed teeth required sealant replacement, and 110 sealed teeth required restoration of the occlusal surface. Among those sealants that failed, the mean length of time from placement to failure was 26 months. Sealant failure rates were significantly higher among subjects at moderate risk or high risk of developing caries than among subjects at low risk. CONCLUSIONS: After an average of 35 months, 87.8 percent of the sealants placed in this population were retained and functional. Subjects who were at moderate or high risk of developing caries demonstrated significantly higher sealant failure rates than those at low risk of developing caries. CLINICAL IMPLICATIONS: Dental sealants can be retained successfully in adults. They should be considered a viable treatment alternative for adult patients who are susceptible to caries; however, patients at elevated risk of developing caries may require more frequent re-evaluation and maintenance to achieve maximum benefit.     

Effectiveness of sealant treatment over five years in an insured population

BACKGROUND: The authors analyzed an insurance claim database to evaluate the use and effectiveness of placing sealants on first and second permanent molars of children in private dental practices. METHODS: A retrospective study was conducted using an insured population with sealant coverage at 70 percent of the usual fee in a preferred provider organization than that limited reapplication to once every three years. Children were selected who were eligible for sealant benefits from July 1, 1990, to June 30, 1991. Two groups were selected for analysis, based on age, as determined by permanent molar eruption dates. Children who received sealants were compared with those who did not to determine post-sealant restorative outcomes after five years. RESULTS: During the full year of coverage, sealants were used in only 16.3 percent of first permanent molars and 11.6 percent of second permanent molars. The five-year incidence of an occlusal restoration having been placed was 13.7 percent and 20.8 percent, respectively, on nonsealed first and second molars and 6.5 percent and 10.4 percent, respectively, on sealed first and second molars. From years three to five, sealant placement provided only nominal additional preventive effect. CONCLUSIONS: In the population selected, both the incidence of occlusal caries and the use of sealants were lower than expected for both age groups. However, within these groups, molar occlusal surfaces were only half as likely to have been restored in sealed teeth than in nonsealed teeth after five years. CLINICAL IMPLICATIONS: Based on the five-year data from a population with a low incidence of caries, the authors found that 15 sealed first permanent molars or 10 sealed second permanent molars prevented placement of one occlusal restoration. Therefore, sealants are more effective when placed in patients with risk factors for occlusal caries.     

Sealants: a review of the materials and utilization

Dental pit and fissure sealants have been shown to be effective in the prevention of dental caries. Currently, sealants are recommended to be placed on teeth that are considered to be "at risk" to develop caries, including teeth that present with incipient enamel lesions. This paper discusses the types of sealant materials available and the placement of the sealant, including appropriate tooth preparation, acid-etching, polymerization, and use of adhesives prior to sealant placement.     

The prescription and outcomes of fissure sealants applied to a group of high caries risk children by general dental practitioners working in the North West of England

OBJECTIVE: To describe the use and outcomes of fissure sealants applied to the first permanent molars (FPMs) of children with high caries risk. DESIGN: Retrospective cohort study. SETTING: General dental practices in North West England. PARTICIPANTS: 677 children between the ages of 5 and 14 years who had dmfs > or =2, and regularly attended 50 general dental practitioners. OUTCOMES: Analyses were performed at patient level. Logistic regression models, taking into account the clustering of subjects within dental practices, were fitted to identify whether the decision to fissure seal FPMs was significantly associated with gender, socio-economic status, number of carious primary teeth and percentage of carious primary teeth filled. Similar logistic regression models were fitted for caries experience in FPMs. RESULTS: Poorer children were significantly (p < 0.05, OR = 0.84, 95% CI = 0.71, 0.99) less likely to receive fissure sealants than affluent children, whilst girls (p < 0.01, OR = 1.54, 95% CI = 1.12, 2.12) were more likely to have sealants than boys. The total number of carious primary teeth was also a significant (p < 0.01, OR = 1.15, 95% CI = 1.06, 1.25) independent predictor of dentists' decisions to fissure seal FPMs. For each carious primary tooth, the odds of having caries in FPMs increased by 1.16 (95% CI = 1.06, 1.26). Analysis showed that pit and fissure caries in FPMs was not affected by the presence or absence of fissure sealants. CONCLUSIONS: The decision to fissure seal FPMs is affected by caries experience in the primary dentition. Girls and affluent children were more likely to receive fissure sealants. It appears that the placement of fissure sealants by general dental practitioners was not effective in preventing pit and fissure caries in these high-risk children.     

Sealants: changing patterns

Although the use of and the attitude toward sealants as a caries-preventive method have improved in the 8-year period between 1974 and 1982, the acceptance still is low, considering the potential value of sealants to patients who are at risk for occlusal caries. More efforts should be directed toward both increasing dentists' and patients' understanding and appreciation of the procedure in preventing caries. It is possible that such a "good sell" has been done with fluorides and oral hygiene that patients do not understand the added value of sealants for the prevention of occlusal caries. Dentists appear to underrate the value of sealants and overrate the value of oral hygiene procedures in the control of caries. Given that some dentists have less-than-positive attitudes toward sealants, it may not be enough to wait for the transmission of knowledge regarding sealants to proceed through the practicing dentist to the patient. Both patient and dentist groups need further appreciation of the value of this procedure if the control of occlusal caries is to be maximized.     

Therapeutic use of sealants for incipient or early carious lesions in children and young adults.

Although the overall caries rate has declined significantly in the past decade, recent studies have shown that caries in occlusal pits and fissures continues to be a significant problem in adolescents and young adults. Radiographic and bacteriologic studies of sealed carious teeth were originally designed to allay the profession's concerns about continued progression of the carious process. These studies have demonstrated that caries is inhibited and may in fact regress under intact sealants. The changes in patterns of caries incidence and the positive results of the sealant studies suggest that alternative approaches to the treatment of incipient or early occlusal caries should be considered. In addition to the radiographic and bacteriological studies of sealed carious teeth, studies on retention over carious pits and fissures, wear, cost effectiveness and changing attitudes of dentists indicate that sealing incipient or early carious lesions is a viable alternative to restoration with amalgam.     

Longitudinal Evaluation of Sealing Molars with and without Incipient Dental Caries in a Public Health Program

Objectives: This study undertook a retrospective evaluation of the effect of sealants on the caries experience of initially sound and incipient permanent first molar pit and fissure surfaces. Methods : Records of children with complete five-year records were obtained from a school-based dental sealant program in a fluoridated community. Sealants were placed on 677 tooth surfaces in 96 children; 120 tooth surfaces in 17 children who received baseline examinations were not sealed because of lack of caregiver consent. Tooth surfaces were initially diagnosed as being sound or having incipient lesions, and evaluated for caries status after five years. Results : For initially incipient surfaces the five-year decay rate was 10.8 percent (41 of 380 surfaces) for sealed surfaces and 51.8 percent (29 of 56 surfaces) for nonsealed surfaces with an odds ratio of 8.88 (95% Cl=4.56, 17.35). Initially sound surfaces had a decay rate of 8.1 percent (24 of 297 surfaces) for sealed surfaces and 12.5 percent (8 of 64 surfaces) for nonsealed surfaces with an odds ratio of 1.63 (95% Cl=0.63, 4.08). The two odds ratios were significantly different. Conclusions : Initially sound tooth surfaces were unlikely to become decayed in five years, and did not benefit greatly from the application of sealants. Within the limitations of this study, there were clear efficiencies in sealing incipient, but not sound, surfaces. The targeting of teeth with incipient caries for sealants is therefore recommended.     

Treatment practices in caries prevention for 6-year-olds in Finland

OBJECTIVES: To evaluate caries-preventive treatment practices in relation to caries state and eruption of first permanent molars (FPMs) among 6-year-olds (n = 3489) examined and treated in public dental clinics in Helsinki during 1992. METHODS: The study subjects were selected on the basis of their caries state using a two-point study design: the high-caries group (n = 99) had the greatest number of DT + dt, the cavity-free group (n = 32) had neither past nor present caries. Evaluation of dentists' caries-preventive treatment decisions was based on data from detailed personal oral health records. RESULTS: In total, 22% of the high-caries patients (mean DT + dt 8.7; range 4-18) had been judged by their dentists as high-risk patients. Eruption of FPMs had no influence on dentists' judgement on caries risk. A subject's number of DT + dt had no influence on the intensity of preventive treatment given, but those with a high-risk judgement from a dentist received more preventive measures per visit than did other high-caries patients. For high-caries patients with erupting FPMs, three visits in 10 included preventive intervention other than sealants, compared to nine in the cavity-free group. Intensity of oral hygiene instruction correlated with presence of erupting FPMs, yet 86% of the patients with erupting FPMs had received no oral hygiene instruction. CONCLUSIONS: Dentists should be encouraged to use standardized criteria, including data on caries state and eruption stage, in judging each patient's risk of caries to provide intensified caries-preventive treatment to those most in need.     

Clinical radiographic evaluation of sealed carious and sound tooth surfaces

The results of a 2-year radiographic assessment of 113 carious posterior teeth that were sealed with one of two sealants are presented. Little or no difference was found in radiographic ratings of caries by type of sealant. Sealant loss between annual recall visits had little or no detectable effect on radiographic ratings of caries during the study. Radiographs suggested that caries may regress in sealed teeth with early caries. The results support the safety of sealing incipient caries in pits and fissures to increase the potential uses of sealants.     

Comparison of glass-ionomer and resin-based fissure sealants: a 2-year clinical trial

Abstract – In recent years, the interest in the use of glass-ionomer materials as fissure sealants has increased. The aim of this study was to compare the retention and caries-preventive effect of glass-ionomer (Fuji III) and resin-based light-cured (Delton) fissure sealants. Three health center dentists applied the sealants to 166 children; glass-ionomer sealants on one side and resin-based sealants on the contralateral side of the mouth. After 2 yr, one pair of molar teeth in the mouths of 151 children was compared. Twenty-six percent of glass-ionomer and 82% of resin-based sealants were totally present ( P < 0.001). During the 2 yr, in both groups 4.6% of the sealed surfaces became carious. The results show that the retention of glass-ionomer sealants is markedly inferior to the resin-based sealants. In this study, however, no difference in caries increment on the sealed surfaces was observed. This may be due to the different mechanism of caries prevention for the sealant materials, or to the overall low caries activity of the participants.     

Targeting dental sealants in school-based programs: evaluation of an approach

Several guidelines have been published in the United States to promote the appropriate use of sealants in both individual care and public health programs. Targeting sealants to children and teeth at high risk for dental caries has been accepted as a desirable strategy in school-based programs. However, there is little evidence to show that programs are complying with these guidelines. This report examined the extent to which sealants were targeted to high-risk children at 11 different school-based programs in New York State. Data on 3357 children ages seven to nine were analyzed. The percent of children receiving sealants ranged from 41% to 88%. While in two sites (St. Lawrence & Onondaga) fewer than 52% of the children received sealants; more than 73% received sealants in the remaining nine sites (P < 0.05). The results suggest that there was a wide variation in the implementation of the guidelines for sealant use. Some reasons for not adhering to the guidelines were: difficulty in assuring parents and local dentists that some children were not at risk for caries; lack of confidence in the risk-assessment method; uncertainty regarding what constitutes deep pits and fissures; fear of misclassifying children and requests by school administrators, parents and local dentists that all children should benefit from preventive measures.     

Sealant use and placement techniques among pediatric dentists.

BACKGROUND: Pit and fissure sealant use varies widely among dentists. The authors conducted a survey to determine the current variations and patterns of sealant placement among pediatric dentists. METHODS: The authors mailed a 20-question survey to American Academy of Pediatric Dentistry members from six states, who represented one-third (1,210) of the membership, as well as to all 52 pediatric dentistry departments in U.S. dental schools. The authors examined selection criteria, placement techniques, evaluation methodologies, and the one- and three-year estimated success and reapplication rates of sealant placement. RESULTS: The response rates were 70 percent for practitioners and 90 percent for dental schools. Approximately 80 percent of respondents said they sealed caries-free and questionable carious surfaces. Only 20 percent of the respondents said they sealed incipient carious surfaces; none said they would seal overt caries. Surface preparation was used always or sometimes by 87 percent of the respondents. The estimated one- and three-year sealant retention rates were 89 percent and 78 percent, respectively, for practitioners and 83 percent and 71 percent, respectively, for dental schools. CONCLUSIONS: The survey demonstrated wide variations in selection criteria, placement techniques and evaluation methodologies, yet showed remarkable similarities between practitioners and dental schools. The reported retention rates were consistent with those reported in the literature. PRACTICE IMPLICATIONS: The survey results suggested that pediatric dentists were searching for evidence-based selection criteria and a technique protocol for sealant placement that improved clinical success. The wide technique variations reported were likely a result of training diversity, diagnostic uncertainty, technique and material sensitivity, and an attempt to improve the success rate.