Acculturation and dental sealant use among US children

Trends in the Use of Pit and Fissure Sealants in Adolescents and Their Impact on the Decayed, Missing, and Filled Teeth (DMFT) Index: An Ecological Study in Mexico

BACKGROUND

Untreated dental caries in permanent teeth is the most common health disorder. Pit and fissure sealants (PFS) are one of the effective treatment options that help prevent caries.  Objective: The objective of this study is to evaluate the temporal trends in the use of PFS among adolescents (ages 10-14) in Mexico from 2005 to 2014 and to determine their specific impact on the decayed, missing, and filled teeth (DMFT) index at the national level, using aggregated data from epidemiological surveillance.

METHODOLOGY

An ecological study was carried out. The data were from the Epidemiological Surveillance System of Oral Pathologies (SIVEPAB, 2005-2014). The dependent variable was the DMFT index. The independent variable was PFS prevalence during the time of the study. In the statistical analysis, the non-parametric test for trends and Spearman's correlation in Stata were used.

RESULTS

The average DMFT was 3.43 in children 10 to 14 years old. During the 10-year study period, in no year were more than 2.5% of 12-year-old adolescents attending publicly funded dental health services in Mexico observed to have one or more teeth with PFS. The average PFS prevalence use in 12-year-old adolescents was 1.57%. No trend was observed in the use of PFS (z=-0.66, p=0.509), but there was a decrease in the DMFT index (z=-2.54, p=0.011). There was no statistically significant correlation (p>0.05) between the percentage of adolescents with at least one tooth with PFS and the average DMFT.

CONCLUSION

In the present ecological study, PFS prevalence was low. While there was no discernible trend in PFS use, there was a decrease in the DMFT index, seemingly unrelated to PFS use.

Second molar sealants among US adolescents and their association with select sociodemographic factors and first molar sealants: A cross-sectional study using National Health and Nutrition Examination Survey data

BACKGROUND

Caries is an important public health concern. Dental sealants are effective in preventing caries; however, their uptake is suboptimal and little is known about second molar (2M) sealants. The authors examined the prevalence of 2M sealants among US adolescents and investigated the factors associated with their presence.

METHODS

The authors conducted a cross-sectional analysis of 2011-2016 National Health and Nutrition Examination Survey data on adolescents aged 12 through 19 years with complete sealant data (n = 3,636). Race and ethnicity, income, and first molar (1M) sealant were primary variables of interest. The logistic regression models were used to estimate the factors associated with 2M sealants. All analyses used survey weights and accounted for complex survey design.

RESULTS

Only 34.6% of adolescents (95% CI, 31.2% to 38.0%) had 2M sealants. Approximately 89.0% of adolescents (95% CI, 86.1% to 92.0%) with 2M sealants and 19.6% (95% CI, 17.1% to 22.2%) without 2M sealants had 1M sealants. In the adjusted models, race and ethnicity were strongly associated with 2M sealant presence, but the association did not hold when 1M sealant was included in the model. 1M sealants were the most significant factor explaining the presence of 2M sealants (odds ratio, 0.03; 95% CI, 0.02 to 0.04).

CONCLUSIONS

Two of 3 adolescents lacked 2M sealants, with considerable disparities in their presence. To improve adolescent oral health, clinical and community programs should increase delivery of 2M sealants.

PRACTICAL IMPLICATIONS

Study findings highlight the need to evaluate adolescent sealant delivery programs to improve the uptake of 2M sealants.

Exploring Recent Decreases in First Molar Sealants among US Children

Analyses of National Health and Nutrition Examination Survey (NHANES) data suggested a significant decrease in sealant prevalence among children between 2011 to 2014 and 2015 to 2018. We explore whether this decrease could be associated with possible changes in 1) clinical sealant delivery, 2) dental materials (i.e., increased use of glass ionomer [GI] sealants resulting in an inability to detect sealant fragments that still provide preventive benefits or increased use of composite restorations leading to misclassifying sealants as restorations), and 3) examination sensitivity and specificity. We used NHANES data to estimate the prevalences of sealants, untreated caries, and restorations in ≥1 first permanent molar among children aged 7 to 10 y and used Medical Expenditure Panel Survey data to estimate the annual clinical delivery of sealants and fluoride treatments. We examined changes in outcomes between 2 periods (P < 0.05) controlling for selected sociodemographic characteristics. NHANES sealant examination quality was based on the reference examiner's replicate examinations. The adjusted prevalence of sealants decreased relatively by 27.5% (46.6% vs. 33.8%). Overall, untreated caries decreased. Untreated caries and restoration decreased among children without sealants. Annual clinical sealant delivery did not change, whereas fluoride treatment delivery increased. The decrease in sealant prevalence held when assessed for various age ranges and NHANES cycle combinations. While sealant examination specificity remained similar between the periods, sensitivity (weighted by the proportion of exams by each examiner) decreased relatively by 17.4% (0.92 vs. 0.76). These findings suggest that decreased sealant prevalence was not supported by decreased clinical sealant delivery nor increased use of composite restorations. Decreased examination sensitivity, which could be due to an increased use of GI sealants, could contribute to the decrease in sealant prevalence. The decrease in caries among children without sealants could suggest the increased use of GI sealants. However, we could not rule out that the decrease in caries could be attributable to increased fluoride treatment delivery.

Real-world effectiveness of national pit and fissure sealants program in Taiwan

OBJECTIVES

This study investigated the effectiveness of a national population-based pit and fissure sealants (PFS) program in Taiwan.

METHODS

Part 1 (effectiveness of national PFS program) involved children who had participated in the PFS program from 2015 to 2019. After propensity score matching, 670,840 children were selected for analysis until the end of 2019. During follow-up, the permanent first molars of the participants were assessed for caries-related treatments by employing multilevel Cox proportional hazards models. In Part 2 (effectiveness of retained sealants), which involved 1,561 children, sealant retention was evaluated 3 years after placement. A structured questionnaire was employed to collect information on family and individual factors. The endpoints were the same as in Part 1.

RESULTS

In Part 1, the adjusted hazard ratios (HRs) for caries-related treatments among participants in the PFS program were 0.90 (95% confidence interval [CI] = 0.89, 0.91) for dental restoration, 0.42 (95% CI = 0.38, 0.46) for initiation of endodontic treatment, 0.46 (95% CI = 0.41, 0.52) for completion of endodontic treatment, and 0.25 (95% CI = 0.18, 0.34, all Ps < 0.0001) for extraction. In Part 2, the adjusted HR for dental restoration of teeth with retained sealants was 0.70 (95% CI = 0.58, 0.85), significantly lower than that for teeth without retained sealants (P = 0.0002).

CONCLUSIONS

Participation in the national PFS program was associated with a significant reduction of at least 10% in the risk of caries-related treatments, and an additional 30% risk reduction may have been attributed to sealant retention.

CLINICAL SIGNIFICANCE

In a real-world setting, schoolchildren in the national PFS program were associated with a significant reduction of at least 10% in the likelihood of caries-related treatments. The program provided moderate protection against caries for the study population and could be improved by increasing the sealant retention rate.

Release of Bisphenol A from Pit and Fissure Sealants According to Different pH Conditions

Changes in intraoral pH can cause changes in the chemical decomposition and surface properties of treated resin-based pits and fissure sealants (sealant). The purpose of this study is to evaluate the release of bisphenol A (BPA) from sealants under three different pH conditions over time. The test specimen was applied with 6 sealants 5 mg each on a glass plate (10 × 10 mm) and photopolymerized. The samples were immersed for 10 min, 1 h, and 24 h in solutions of pH 3.0, 6.5, and 10.0 at 37 °C. BPA release was measured using a gas chromatography-mass spectrometer. A statistical analysis was performed by two-way ANOVA and one-way ANOVA to verify the effect of pH conditions and time on BPA release. The BPA concentration in the pH 3.0 group was higher at all points than with pH 6.5 and pH 10.0 (p < 0.05), and gradually increased over time (p < 0.05). As a result, it was confirmed that low pH negatively influences BPA release. Therefore, frequent exposure to low pH due to the consumption of various beverages after sealant treatment can negatively affect the sealant’s chemical stability in the oral cavity.