Fissure sealing of permanent first molars in children receiving a high standard of proaphylactic care

The efficiency of sealing the occlusal fissures of permanent first molars was studied in a group of patients 6-9 yr of age receiving a high standard of prophylactic care. Very soon after the eruption one of the teeth in a homomaxillary pair was sealed, and the contralateral was used for control. The control teeth were painted with a fluoride varnish (Duraphat) every 6 months during the trial. 210 sites in 121 children were sealed and followed for a mean observation period of 23 months. At the end of the study, the retention rate was 62.9%, the percentage of effectiveness 24.2%, and the net gain 7.1%. The dmft index (primary molars and canines) was recorded for each patient at the time sealing was performed. A relationship between the caries prevalence in the primary teeth and the susceptibility for fissure caries in the control teeth was found. Effectiveness and net gain was highest in the group of children with 3-6 dmft.     

Results after 3 years of non-operative occlusal caries treatment of erupting permanent first molars

The aim of the study was to describe the 3-yr results of a treatment program designed to control occlusal caries on the basis of intensive patient education and professional toothcleaning. The sample consisted of 56 children 6-8 yr old with their permanent right first molars in different stages of eruption. The results were compared with record data from 58 children of the same age who had received a traditional caries treatment program including fissure sealing (control group). After 1 yr a significant reduction of occlusal surfaces with visible plaque was noted in the study group as well as an increased proportion of arrested lesions. These results were maintained after 2 and 3 yr. Ten (9%) teeth were sealed and one filled during the study period. Examination of record data in the control group over a 3-yr period revealed that 76 (65%) first molars were sealed and 7 (6%) were filled. During the first year 1/3 of the children in the study group needed 5-6 recall visits, whereas in the following period all children were only seen 1-4 times. In contrast, 50% of the children in the control group needed 5-6 recalls in the 3rd yr. Our data indicate that professional care for erupting teeth on an individual basis has a long-term effect on occlusal surfaces as well. The alternative technique required less clinical time than the traditional application of sealants.     

Evaluation of a routine for prevention and treatment of fissure caries in permanent first molars

Fissure sealing as well as fluoride varnish have shown good preventive effect against fissure caries in newly erupted teeth. The purpose of this study was to evaluate a clinical routine in which these two methods were combined. The evaluation was done in a public dental clinic in Norway, and three dentists performed and evaluated the treatment. The population belonged to two different year classes (born 1978 and 1979), 196 in all, and they were followed semiannually from age 6 until 8 and 9 yr, respectively. The routine was as follows: all erupted permanent first molars without fissure caries were cleaned and painted with a fluoride varnish (Duraphat) every 6 months. Fissures showing incipient caries were opened with a rotating instrument and sealed if caries was restricted to the enamel. Amalgam fillings were placed if caries had progressed to the dentin. The operator time required for the fissure treatment was recorded. After 2 yr observation of children born in 1978 and 1979, 72% of the fissures were intact, 13% had been sealed, and 15% filled, and the corresponding figures after 3 yr (1978-children) were 65%, 15%, and 20%. In approximately 45% of the children all four permanent molars were intact, while about 12% had all molars sealed or filled. The average time spent for application of sealants was 4.1 min and for application of amalgam fillings 5.9 min.     

Comparison of blind and non-blind assessments of occlusal sealant retention

A comparison was made of scoring the retention status of BIS-GMA occlusal sealants 5 years after they had been placed, according to a non-blind and blind method of identification of teeth that had been sealed. Subjects were 175 children ages 15--18. One examiner made all the assessments. Retention of sealant was classified as all present, partly missing or all missing. There was 90.5% complete agreement between non-blind and blind examinations in scoring the retention status of 893 occlusal sites. Essentially no difference in agreement was found between sites on maxillary and mandibular teeth nor according to sites in specific teeth. There was only a slight tendency to classify more sites as having sealant present at the non-blind examinations than at the blind examinations, 56.7% and 55.1%, respectively. These findings would seem to indicate that whether examinations are done blindly or non-blindly is of minor importance in making an accurate assessment of sealant retention.     

Effectiveness of fissure sealant 3 years after application

abstract – Findings 3 years after the application of a fissure sealant revealed that of the 166 sealed permanent first molars, 7.8 % of the sealants were missing or partly missing, 14.5 % were in fair condition, and 77.8 % had remained in good condition. During the 3-year test period, 7.8 % of the sealed permanent molars had become carious, while 63.3 % of the respective control teeth had decayed. The teeth which had sealants in good condition showed no caries, whereas 92.3 % of the teeth which had sealants missing or partly missing showed carious fissures. The net gain in the study was 104, and the percentage effectiveness of the method was 88.1 %. The treatment effect was found to be very significant when analyzed on the basis of homologous paired test-control teeth (P < 0.001). The sealing of pits and fissures was found to have a positive treatment effect on 60.2 % of the subjects when evaluated on an individual basis (0.1 < P < 0.05).     

Pulpal reactions to surface-sealed silicate cement and composite resin restorations

abstract – The effect of surface sealing and presence of bacteria in connection with pulpal response to silicate cement and composite resin restorations was tested in monkey teeth. Surface-sealing of silicates reduced the pulpal reactions to this material, whereas no such effect was observed when composites were sealed. Bacteria regularly occurred on the cavity walls except underneath zinc oxide/eugenol (ZOE) fillings and when silicates were sealed with ZOE. The frequency of bacteria was higher in teeth with unacceptable pulpal responses (44 of 49) than in teeth with acceptable reactions (48 of 79).     

Results after 1 year of non-operative occlusal caries treatment of erupting permanent first molars

The aim of this study was to evaluate a treatment program designed to control occlusal caries on the basis of intensive patient education and professional toothcleaning. The sample consisted of 56 6-8-yr-old children with their permanent right first molars in different stages of eruption. Data from the program were compared with previous data recorded in a similar sample of children. After 1 yr the majority of children in the study group had their permanent right first molars in full occlusion. A significant decrease of surfaces with easily detectable plaque and an increase of surfaces without plaque was observed. The proportion of arrested lesions increased and active enamel lesions decreased. Fissure sealing was only needed in two teeth in contrast to more than 2/3 of molars in a comparable sample of children. The program proved to be an efficient alternative to fissure sealing in preventing occlusal caries in erupting teeth.     

Study of the dental health of children in remission from acute lymphoblastic leukaemia in Northern Ireland

Abstract – The dental health of 54 children in remission from acute lymphoblastic leukaemia was compared with a similar number of matched healthy control subjects. Frequency of dental attendance was similar in both groups but most children in remission from leukaemia attended a hospital dentist, whereas children in the control group visited a dentist in general practice or in the public health service. Children in remission from leukaemia used fluoride supplements significantly more frequently than their controls. There was no difference in plaque or gingivitis scores between groups. Children in remission from leukaemia had a significantly lower number of decayed primary teeth (d) than their matched controls but there were no significant differences between study and control groups of m, for Dmft values. There was a significantly greater number of extracted teeth (M) and a significantly greater overall decay experience (DMFT) in the permanent dentition of children in remission from leukaemia compared to their controls. There were no significant differences between study and control groups for D or F values. The mean number of sealed teeth per patient was significantly higher in the study than in the control group.     

Sealant retention and effects on occlusal caries after 2 years in a public program

A clinical trial of one application of Nuva-Seal fissure sealant was conducted under School Dental Service conditions in a low-income area of London. The sealant was applied to one of a cariesfree pair of permanent teeth by schools' dentists, the other tooth being left as a control. One examiner, who did not apply the sealant, conducted examinations at baseline, after 6 months, and after 2 years. There were 118 children, initially aged 5-12, who remained in the trial after 2 years. The sealant was fully retained on 27.4 % of the teeth, partially retained on 40.6 %, and missing on 17.9 %. The remaining 14.1 % of teeth had been restored. There was no statistically significant difference between subjects who had less decay in sealed teeth and those who had less decay in control teeth. The sealant was 13.6 % effective (not significant, P less than 0.4) in preventing caries in sealed teeth. These results are less favorable than those in other trials reported. The potential role of fissure sealants in a School Dental Service is discussed.     

Dental caries experience and prevalence of children afraid of dental treatment

The aim of this study was to examine the clinical outcome with regard to dental caries of high self reported dental anxiety in a group of Scottish secondary schoolchildren. 1103 children participated in the study, mean age 14 yr (sd 0.35 yr), and the prevalence of high dental anxiety was 7.1% (95% CI = 5.6%, 8.6%). When these children were compared with their contemporaries their DMFT and all its components were higher but only the mean MT reached statistical significance after adjusting for gender and social class. Children with a high dental anxiety were 62% more likely to have at least 1 missing tooth due to caries. In addition this group when compared to the rest of the study population, had a significantly lower mean number of teeth fissure sealed and a lower proportion of children with sealants. No similar trend was obvious for children who had a high general fear. The dentally anxious more accurately perceived their treatment need and were more likely to defer, cancel or not turn up for dental appointments.     

Retention of a fissure sealant with caries reduction in Finnish children after six months

abstract — The purpose of this study was to test the retention as well as the caries reduction potential of a fissure sealant under Finnish dietary conditions. The 150 children who served as subjects were selected on the basis of having at least one pair of sound permanent molars. Two hundred first molars, 43 premolars and 119 primary molars were sealed, while the respective tooth from the other side of the jaw was left untreated and used as the control. The findings after 6 months revealed that all 362 sealants persisted. Among the sealants of the first permanent molars, 99% were in excellent condition. All sealants of the permanent premolars and of the primary molars were excellent. Among the permanent control molars 43 (22%) showed carious fissures while among the sealed permanent molars, only 3 (1.5%) had carious fissures. This gives a 93% reduction of the fissure caries. Both the control and the sealed premolars were all sound. None of the sealed primary molars were decayed compared to 7.6% decayed on the control side.     

A comparison of retention and the effect on caries of fissure sealing with a glass-ionomer and a resin-based sealant

OBJECTIVE: To compare the retention and the caries preventive effect of a glass-ionomer developed for fissure sealing (Fuji III) and a chemically polymerized resin-based fissure sealant (Delton). DESIGN: A split mouth randomized design using contralateral teeth. SETTING: WHO Regional Demonstration, Training and Research Center for Oral Health, Damascus, Syrian Arab Republic. SAMPLE AND METHODS: 179 children, 7 years old at the start of the study, were recruited from schools close to the Center. Only children with at least one pair of permanent first molars that were caries free or only had incipient lesions were included in the study. Follow-up examinations for sealant retention were done after 6 months, 1 year, 2 years and 3 years. The number of children available for reexamination was 129 (after 6 months); 121 (after 1 year); 115 (after 2 years) and 116 (after 3 years). Four dental hygienists were trained in the sealant procedures and did approximately one fourth of the sealants each. RESULTS: After 3 years the glass-ionomer sealant was completely lost in almost 90% of the teeth compared to less than 10% of the resin sealed teeth. After 3 years the relative risk of a tooth sealed with glass-ionomer over that of a tooth sealed with resin was 3.38 (95% CL: 1.98; 5.79). This finding was consistent over type of tooth. CONCLUSIONS: The glass-ionomer sealant tested in the present study had poorer retention and less caries protective effect than the resin-based sealant used.     

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.     

Follow-up study of sealing and filling with composite resins in the prevention of occlusal caries

A diluted composite resin (Concise diluted with Concise Enamel Bond) was used for fissure sealing and filling in 896 permanent first molars of 281 children, initially 5--7 years of age. Ordinary fissure sealing was used for fissures with no apparent caries, while a filling method was used after an explorative drilling with a small round bur (Ash No. 1/2) in fissures with incipient caries. On the basis of clinical evaluation every 6 months, the frequency of total retention of the composite material after different observation periods was calculated using the life table method. The rate of success in the fissure sealing group was 94.8% after 6 months, falling to 75.2% after 30 months. The corresponding data for the filled teeth were 92.6 % and 83.5%. It would seem that diluted composite resin is well suited for the prevention of caries in pits and fissures.     

An Evaluation of the Saskatchewan Pit and Fissure Sealant Program: a Longitudinal Followup

The Saskatchewan Health Dental Plan (SHDP) is a publicly funded dental insurance program for children between the ages of five and 16 years residing in the province. In 1981, fissure sealants were added as a covered expense. Until September 1, 1987, sealants and other dental treatments covered under the SHDP were provided to schoolchildren by dental therapists in dental clinics established in elementary schools throughout the province. After September 1, 1987, the provision of dental services was transferred to private practitioners in the province. The objectives of this study were to (1) estimate the retention rates of sealants after one, two, and three years of placement; and (2) conduct a longitudinal followup of sealed and unsealed sound teeth to measure the effectiveness of sealants in reducing dental caries incidence. Relative to the first objective, a cohort of children was identified and comparisons were carried out for the periods of 1982-83, 1982-84, and 1982-85. For the last objective, a longitudinal evaluation of effectiveness was carried out only for children five to seven years of age in 1981. Saskatchewan children, who experienced higher caries prevalence than children in the United States, had the highest caries increments on occlusal surfaces of posterior teeth. About 79 percent of the sealants applied by dental therapists were retained three years after application. Sealed teeth experienced 46 percent less caries than unsealed teeth four years after the application of sealants.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of the caries-preventive effect of a glass ionomer sealant and fluoride varnish on newly erupted first permanent molars of children with and without dental caries experience

Abstract

Purpose: This longitudinal clinic study evaluated the effect of a glass ionomer sealant (GIS) and a fluoride varnish (FV) in the prevention of dental decay on newly erupted permanent molars of children with and without caries experience. Materials and methods: Eighty children, aged 6–8 years, with all four newly erupted first permanent molars, were divided into two groups. Group 1 consisted of 53 children without caries experience and group 2 consisted of 27 children with dental caries experience. Permanent molars of the right side were sealed with GIS and the fluoride varnish was applied on the other two permanent first molars. Evaluation of GIS retention and the effectiveness of both materials in the prevention of dental caries were performed after 6, 12 and 18 months. Results: After 18 months, of the 299 teeth, 271 (91%) showed no caries lesions and 28 presented caries lesions (9%). Teeth sealed with GIS had more carious lesions (15) than teeth with fluoride varnish (13). Most of the teeth (70%) that presented carious lesions were in group 2. Of the 138 sealed teeth, only one showed GIS to be totally present, 95 were partially present and 42 teeth were absent. Conclusion: The caries-preventive effect was very similar between both treatments. The presence of dental caries prevailed in the children with caries experience.     

Incidence of dental trauma in the Western Australian School Dental Service

A prospective study was undertaken to determine the annual incidence of trauma to the anterior permanent teeth of children enrolled in the Western Australian School Dental Service. The population comprised 66,500 6-12-yr-old children. 1.66 children and 2.05 teeth per 100 children received trauma. Of the children incurring trauma the incidence per 100 erupted teeth was 11.7. 80.5% of children traumatised one tooth only per incident, but 35% of all teeth that were traumatised involved trauma to two or more teeth. 88% of all traumatised teeth were central incisors. Girls received proportionately more trauma to the maxillary dental arch than did boys. Fracture involving both the enamel and the dentine was the most commonly recorded class of trauma (42.7% of cases). There was no obvious pattern to the overall distribution of trauma through the week or the year. Approximately one-third of all traumata occurred at school, one-third at home, and the remainder elsewhere. Trauma to the maxillary dental arch occurred most frequently at home, while trauma to more than one tooth (multiple trauma) occurred most commonly at school. Trauma incidence resulting from falling or being pushed was almost twice as high among girls as among boys. Bicycle accidents caused a higher than average rate of multiple trauma and of pulpal exposure.     

Bonded resin sealant on smooth surface dental enamel--an in vitro study

The aim of this study was to in vitro evaluate the micro leakage of a fissure sealant on sound and demineralized enamel using thermo cycling. The effect of the sealing procedure on sound and demineralized enamel were assessed on human premolars that were divided into one Control group and two Test groups. The Control group served as a baseline reference for the subsequent test procedures. The crowns of five teeth were covered with wax leaving three separate windows on the buccal surfaces. The enamel in one window was acid-etched, in the second window demineralized, and in the third window demineralized and subsequently acid-etched. In Test group 1, containing ten teeth, a defined enamel area on the buccal surfaces was acid-etched and sealed. The sealed area and a border of sound enamel around it were subjected to the demineralizing procedure. In Test group 2, a defined enamel window of 13 teeth was demineralized and subsequently etched and sealed. The sealed area and a border of surrounding enamel were subjected to a new cycle of demineralization. The longitudinal, bucco-lingual sections were examined in polarized light. When placed on acid-etched surfaces, the resin adhered firmly to the enamel with no evidence of demineralization or enlargement of previously demineralized areas underneath the sealants.     

Development of clinical and radiographic signs associated with dark discolored primary incisors following traumatic injuries: a prospective controlled study

Abstract – The purpose was to evaluate late complications of asymptomatic traumatized primary incisors with dark coronal discoloration. The clinical and radiographic signs of 97 teeth of the study group were recorded along a follow‐up period that ranged between 12 and 75 months (mean >36 months). Children's age at time of injury ranged between 18 and 72 months (mean 40). The control group consisted of 102 non‐discolored maxillary primary central incisors in 51 children older than 54 months with no history of dental trauma. In 50 teeth (52%) the color faded or became yellowish and in 47 (48%) it remained dark. Clinical signs of infection, that were diagnosed 5–58 months after the injury, were associated significantly more with dark than yellowish hues (83 and 17%, respectively). Teeth that had changed their color to become yellow presented more PCO than teeth with black/gray/brown coronal discoloration (78 and 6%, respectively). Arrest of dentine apposition was found in 15 teeth, one had yellow coronal discoloration and the remaining 14 had a dark shade. Eleven teeth showed inflammatory root resorption all with dark discoloration. Two atypical types of root resorption were observed: a surface resorption restricted to the lateral aspects of the apical half of the root while the root length remained unchanged and in the other expansion of the follicle of the permanent successor was observed. Expansion of the dental follicle was observed in 72% of all teeth with no significant difference between the various types of coronal discoloration but only half of the cases were associated with resorption of the root of the primary incisor. The various pathologic findings observed in the study group were either absent or rarely seen in the control group. It can be concluded that more than 50% of the primary incisors that retain their dark coronal discoloration acquired after dental injuries remain clinically asymptomatic till the eruption of the permanent successor even if they present accelerated root resorption. Asymptomatic traumatized primary incisors that retain their dark coronal discoloration may develop a sinus tract and inflammatory root resorption years after the injury. There is still a dilemma: which treatment is better for dark discolored primary incisors: early endodontic treatment or follow‐up with the risk of development of infection and root resorption that may require extraction?     

Relationship between DIAGNOdent values and sealant penetration depth on occlusal fissures

The aim of this in vitro study was to evaluate the relationship between laser fluorescence values and sealant penetration depth on occlusal fissures. One hundred and sixty-six permanent molars were selected and divided into four groups, which were each treated using a different sealant (two clear and two opaque). The teeth were independently measured twice by two experienced dentists using two laser fluorescence devices—DIAGNOdent (LF and LFpen)—before and after sealing, and then thermoclycled. After measuring, the teeth were histologically prepared and assessed for caries extension. Digital photographs of the cut sealed sites were assessed, and the sealant penetration depth was measured. All 166 sites were measured by one of the examiners taking as limits the outer and inner surface of the sealant into the fissure. For each device (LF and LFpen) and each group, the difference between the values at baseline and after sealing was plotted against the sealant penetration depth and scatter plots were provided. It could be observed that most of the points were concentrated around the zero line, for both LF and LFpen in the four groups. In conclusion, there is no relation between changes in DIAGNOdent values and increasing of depth sealant penetration within the occlusal fissures.