The surface-specific caries pattern of participants in a school-based fluoride mouthrinsing program with implications for the use of sealants

Clinical Evaluation of Retention of Hydrophilic and Hydrophobic Pit and Fissure Sealants in Permanent First Molars: An 18 Months Follow-up: Randomized Controlled Trial

Introduction

Deep pits and fissures are more prone to caries development due to their complex morphological anatomy. Preventive measures, such as pit and fissure sealants, can help in the reduction of dental caries. Conventional sealants being hydrophobic in nature, require isolation. Sealants which are hydrophilic have been introduced as an alternative where isolation is difficult to achieve.

Aim

To compare and evaluate the retention and marginal integrity of hydrophilic pit and fissure sealant (Embrace WetBond) with hydrophobic pit and fissure sealant (Clinpro) in permanent first molars.

Materials and methods

Sealants were applied randomly using the split-mouth design technique on 80 permanent first molars in children aged between 6 and 9 years and evaluation was done at 3, 6, 9, and 18 months.

Results

The difference in retention rates between the groups was not significant using the Chi-squared test, though the WetBond group exhibited better results with 40% complete retention at the end of 18 months while in the Clinpro group, it was 37.50%. The marginal integrity in both the sealant groups was also found to be statistically insignificant. Caries incidence was found to be slightly higher in the Clinpro group.

Conclusion

The clinical performance of Embrace WetBond was better when compared to Clinpro because of its moisture-tolerance capacity. Embrace Wetbond pit and fissure sealant can be the choice of material in cases where moisture control is a challenging issue.

How to cite this article

Gyati O, Jain M, Sogi S, et al. Clinical Evaluation of Retention of Hydrophilic and Hydrophobic Pit and Fissure Sealants in Permanent First Molars: An 18 Months follow-up: Randomized Controlled Trial. Int J Clin Pediatr Dent 2023;16(2):350-356.

Fluoride Varnishes for Preventing Occlusal Dental Caries: A Review

Dental caries are most likely to occur on occlusal surfaces from the early eruptive stages of the tooth. In children, about 80% to 90% of dental caries are occlusal caries. Different preventive modalities are used to prevent occlusal caries. One of the methods used for occlusal caries prevention is fluoride varnish. A vast number of clinical trials have evaluated several types of sealant material and fluoride varnish to assess their ability to prevent occlusal caries in both primary and permanent dentition. The purpose of the current study was to provide an updated overview of the development, composition, mechanism of action, application, and safety of fluoride varnish, as well as its effect on occlusal caries prevention. This review of recently published studies on fluoride varnish and its effect on occlusal caries prevention shows that in children at moderate to high risk of caries, fluoride varnishes prevent occlusal caries. Both resin-based fissure sealants and fluoride varnish are effective for occlusal caries prevention for first-permanent molars. However, it was not possible to identify which one has the best effect. It is recommend that fluoride varnish is applied for children at high risk of caries two to four times per year.

Comparative Evaluation of Retention, Cariostatic Effect and Discoloration of Conventional and Hydrophilic Sealants - A Single Blinded Randomized Split Mouth Clinical Trial

Introduction:

Pit and fissures are approximately eight times vulnerable than the smooth surface caries lesion. Sealants are effective in preventing, arresting, and progression of pit-and-fissure occlusal caries lesions. The failure of sealant resin-based retention is mainly attributed to the moisture contamination. To overcome this drawback, UltraSeal XT^® hydro, a moisture-friendly sealant, has been introduced.

Aim:

This study aimed to compare and evaluate the retention, cariostatic effect, and discoloration of conventional Clinpro™ 3M™ ESPE™ and hydrophilic UltraSeal XT^® sealants among 12 to 15-year-old schoolchildren for 3 months.

Materials and Methods:

A single-blinded, randomized, split-mouth clinical trial was conducted among thirty schoolchildren aged 12–15 years. Sealants used in the present study were Group I – Clinpro™ and Group II – UltraSeal XT^® hydro. Sealants were provided in the school by two operators based on the computer-generated random sequence and the study participants were evaluated after 3 months for sealant coverage, caries incidence, and discoloration using Color, Coverage and Caries sealant evaluation system. Sealant coverage between the two sealants was compared using Mann–Whitney U-test and Z-test for proportions.

Results:

A total of 47 teeth (78.3%) with UltraSeal XT^® Hydro had the sealant covering in all the fissures compared to Clinpro™ 3M™ ESPE™ which was 46.7% (28 teeth) and the difference was observed to be statistically significant.

Conclusion:

Hydrophilic UltraSeal XT^® Hydro yielded better sealant coverage (retention) compared to the conventional Clinpro™ 3M™ ESPE™. No difference was observed with regard to cariostatic effect and discoloration.

Surface-specific efficacy of fluoride varnish in caries prevention in the primary dentition: results of a community randomized clinical trial

OBJECTIVES

Fluoride varnish (FV) is efficacious in caries prevention although its effects among different tooth surfaces are poorly understood. This study sought to determine the extent to which caries-preventive effects of a community intervention that included FV application among preschool-aged children varied according to primary tooth anatomy and baseline tooth pathology.

METHODS

Secondary analysis was undertaken of data from a community-randomized controlled trial among 543 3- to 5-year-old Aboriginal children in 30 Northern Territory Australian communities. Children in intervention communities received community health promotion and FV application once every 6 months. Net caries (d(3)mfs) risk and 95% confidence limits (CL) were estimated for the control and intervention arms, and stratified according to tooth anatomy/location and baseline pathology (sound, enamel opacity, hypoplastic defect or precavitated carious lesion). The intervention's efficacy was quantified using generalized estimating equation modeling accounting for study design and clustering. The assumption of efficacy homogeneity was tested using a Wald χ(2) test with a p < 0.2 criterion and post hoc pairwise comparisons.

RESULTS

The intervention resulted in a 25% reduction (relative risk, RR = 0.75; 95% CL = 0.71, 0.80) in the 2-year surface-level caries risk. There was substantial heterogeneity in FV efficacy by baseline surface pathology: RRs were 0.73 for sound, 0.77 for opaque, 0.90 for precavitated, and 0.92 for hypoplastic surfaces. Among sound surfaces, maxillary anterior facials received significantly more benefit (RR = 0.62) compared to pits and fissures (RR = 0.78).

CONCLUSION

The intervention had greatest efficacy on surfaces that were sound at baseline. Among those sound surfaces, maxillary anterior facials received most caries-preventive benefit.

A half-century of community water fluoridation in the United States: review and commentary

The nearly 50-year history of community water fluoridation is reviewed with the major emphasis on the benefits and safety of fluoridation. Other aspects of water fluoridation also described include the apparent reduction in measurable fluoridation benefits because of the abundance of other fluoride sources, the diffusion of fluoridation effects into fluoride-deficient communities, preeruptive and posteruptive effects, technical and cost aspects, sociopolitical and legal issues that affect the successful fluoridation of communities, and alternatives to community water fluoridation. The majority of studies have evaluated the effectiveness of water fluoridation on the permanent teeth of children, while there are fewer studies on deciduous teeth and in adults; the relationship between fluoride ingestion and bone health needs further clarification; the sociopolitical issues of fluoridation need to be better understood.

Contemporary treatment of incipient caries and the rationale for conservative operative techniques

This article provides evidence to support the use of more conservative cavity preparation techniques with adhesive restorative resins. The authors discuss the issue of conservative operative techniques related to hidden or occult caries. The support for contemporary technology also concerns methods of caries detection and the role of magnification, caries risk assessment of the patient, conservative caries management, instrumentation, materials, and techniques.

Effect of caries experience in primary molars on cavity formation in the adjacent permanent first molar

This study sought to address the influence of a sound versus affected first and/or second deciduous molar on the incidence of visible caries experience in the adjacent permanent first molar. Clinical and questionnaire data were obtained from a 6-year prospective oral health screening project in Flanders, Belgium (Signal-Tandmobiel project), where 4,468 children (born in 1989) were examined annually during their primary school time. A multiple survival model allowing for dependent data with possible censoring was applied. The impact of timing of tooth emergence (determining the period at risk), gender, presence of sealants and reported oral hygiene habits was also considered. Cavity formation in permanent first molars was clearly influenced by the status of the adjacent primary molars;the effect of the second deciduous molar was most pronounced. Moreover, if both deciduous molars experienced caries and the child presented with poor oral hygiene, a peak in cavity formation of the permanent first molar 1-2 years after emergence was noticed. On the other hand, if a child presented with good oral hygiene, no peak was observed; caries risk increased slightly over time. No significant benefit from restoring primary molars could be demonstrated, possibly because of methodological limitations.

A comparison of two histological validating techniques for occlusal caries

Validation of a diagnostic technique is important to establish whether it actually measures what it is purported to measure. However, the accuracy of the validation technique per se can influence the apparent accuracy of the diagnostic technique.

OBJECTIVES

The aim of this study was to describe two alternative histological validating techniques for occlusal caries and to compare quantitative depth measurements of carious lesions taken using each method.

METHODS

Thirty sections (mean thickness 0.67 mm) were cut to include two to four discrete sites in 10 freshly extracted teeth. The first histological validating technique used a microfocal X-ray unit to produce magnified high definition radiographic images of the sections or 'macroradiographs'. An image analysis system was used to make quantitative measurements of the lesions (if present) with respect to the enamel-dentine junction (EDJ). The second validating technique used a confocal microscope to image beneath the cut surface of the section. Quantitative measurements were taken from the fluorescence images of both sides of each section and a mean depth measurement calculated.

RESULTS

Complete agreement was found between the two validating techniques for the subjective interpretation of the presence and extent of caries. A strong positive relationship was found between the two histological validating techniques for depth measurements made of dentine caries from the EDJ (r = 0.93, P < 0.001). Depth measurements made from the macroradiographs were greater than from the confocal fluorescence images (mean difference = 0.41 mm).

CONCLUSIONS

Both validating techniques enable the identification of sound sites, those with enamel caries and dentine caries. However, quantitative assessments made with each technique could result in disagreement.

Hidden caries: what is it? Does it exist? Does it matter?

Hidden caries is a term used to describe occlusal dentine caries that is missed on a visual examination, but is large enough and demineralised enough to be detected radiographically. The detection rate of such lesions will depend upon the prevalence of caries in the population and the frequency with which bitewing radiographic examinations are performed. Whether 'hidden caries' is a distinct clinical entity, reflecting a particular anatomical fissure topography or a different bacterial aetiology, is unknown. It is possible that an improved visual examination, with careful cleaning and drying of teeth, may improve occlusal caries detection to the point where 'hidden caries' no longer exists. However, this possibility has yet to be tested clinically and until it is, practising dentists would be wise to examine bitewing radiographs carefully for occlusal demineralisation. The authors would treat such hidden lesions by removing soft caries and placing sealant restorations.

Timing of first fillings on different permanent tooth surfaces in Finnish schoolchildren

The timing of the placement of first fillings because of caries on different permanent tooth surfaces was determined at three health centers in Finland. The 927 subjects analyzed were born either in 1970-71 o4 in 1980-81. Basically, two different types of filling placement site were identified: 1) fissures and pits and 2) proximal and smooth surfaces. In some fissures and pits a 'post-eruptive'--that is, fillings placed in the year of emergence--was observed. This step had decreased markedly in the cohort born in 1980-81. The curves plateaued (retardation phase) at 50-60% for the occlusal surfaces in first molars for the children born in 1970-71 and at 20-30% for the younger cohort. The time without any filling varied from 1 to 7 years on smooth surfaces, and some surfaces remained totally filling-free. The filling placement curves followed the pattern of caries attack and can thus be used as an indicator of dental health.

Evaluation of Guamanian dental caries preventive programs after 13 years

OBJECTIVE

To address the high prevalence of dental caries in Guamanian children, a school-based fluoride mouthrinse program, a clinic-based pit and fissure sealant program, and community water fluoridation were phased in over a 13-year period. The purpose of this paper is to evaluate the impact of these programs on the prevalence of dental caries.

METHODS

Cross-sectional samples representative of schoolchildren in grades 1 through 8 were selected in 1976, 1979, 1984, 1986, and 1989. These years include the starting years for each of the three interventions and varying follow-up periods for each. About 1,000 children in each of the survey years were examined to derive DMF surface scores.

RESULTS

After eight years of fluoride mouthrinsing, DMFS scores were reduced by 25.4 percent in 6-14-year-olds. With two additional years of fluoride mouthrinsing and with pit and fissure sealants, overall DMFS scores declined an additional 44.4 percent. In 1989, three years after community water fluoridation was initiated on the island and continuation of the other two programs, there was a further decline in overall DMFS scores of 34.5 percent. Over the entire study period--during which there were 13 years of fluoride mouthrinsing in the schools, five years of sealant application, and three years of community water fluoridation--DMFS scores declined 72.8 percent overall (5.14 surfaces per child) and 71.9, 71.0, and 78.8 percent for occlusal, buccal-lingual, and proximal surfaces, respectively.

CONCLUSIONS

An intensified preventive dentistry program introduced on an island with high caries prevalence twice that of the US mainland was successful, and contributed to a reduction in the prevalence of caries to a level equivalent to that of the United States at the end of the study period.

Comparison of tooth surface-specific dental caries attack patterns in US schoolchildren from two national surveys

The 1979-1980 and the 1986-1987 National Institute of Dental Research (NIDR) surveys of school-aged children revealed that virtually all tooth surfaces experienced a decrease in caries prevalence during the inter-survey period. Overall, there was a 28% decrease in the proportion of tooth surfaces attacked by caries for the primary dentition between the two surveys. The decrease for primary incisors was numerically small (5 surfaces per thousand surfaces at risk) and not statistically significant, whereas decreases in the canines and primary molars were considerably larger (23 surfaces per thousand) and statistically significant. For the permanent dentition, the overall decrease in the proportion of surfaces attacked was 35% during the 1979-87 period. Differences between the two surveys in the proportions of surfaces with caries were largest for pit and fissure surfaces (56 surfaces per thousand), followed by those for posterior approximal surfaces (14 surfaces per thousand) and all other smooth surfaces (5 surfaces per thousand). Almost all of these differences were statistically significant, except for some surfaces which experienced very few caries.

Evaluation of a school-based fluoride mouthrinsing and clinic-based sealant program on a non-fluoridated island

For many years the children of Guam have experienced a high prevalence of dental caries. Surveys conducted on the fluoride-deficient island found that caries levels were double those of US mainland children. In 1976 a school-based fluoride mouthrinse program was initiated involving over 22,000 children in grades kindergarten through eight in weekly rinses with 0.2% neutral NaF. A clinic-based dental pit and fissure sealant program was added in 1984 to the fluoride mouthrinse program. Over 15,000 children participated annually in the sealant program where more than 75,000 teeth were sealed the first year. After 8 yr of fluoride mouthrinsing (1976-1984) mean DMFS scores were 1.79 surfaces per child lower compared to baseline, a decrease of 0.22 DMFS per child per year. During this period proximal DMFS scores decreased 61%, buccal-lingual surfaces 31%, and occlusal surfaces 7%. After 2 yr of fluoride mouthrinsing and sealant application combined overall DMFS scores decreased an additional 2.34 surfaces per child, a reduction of 1.17 DMFS per child per year. Most of this decline took place on pit and fissure surfaces. For the 10-yr period a reduction of 4.13 DMFS per child was seen--a decline from 7.06 DMF at baseline to 2.93 DMF surfaces per child in 1986. This long-term evaluation indicates that dental sealants when used in combination with fluoride mouthrinse were particularly effective in lowering the prevalence of dental caries. Schoolchildren in participating grades on Guam now have dental caries rates close to those of US schoolchildren.

Evaluation of a clinic-based sealant program

In 1984 a comprehensive sealant program was initiated for Guamanian children in grades one through eight. The goal of the program was to reduce caries rates in children on the fluoride-deficient island to a level at or below US mainland scores. At the initiation of the program, decayed, missing, and filled surfaces (DMFS) scores on Guam were approximately double those for US mainland children under 17 years of age. For the clinic-based preventive program, children in grades one through eight were bussed to one of two public health clinics for preventive services. These services included oral health education, toothbrushing instructions, and sealant application. Baseline and follow-up dental examinations (DMFS) were conducted in 1984 and 1986 on 1,061 and 987 children respectively, in grades one through eight to evaluate program impact. From 1984 to 1986, after the advent of a pit and fissure sealant program where over 15,000 children annually had sealants applied to their teeth, DMFS scores decreased 45 percent. The entire reduction in DMFS scores occurred on pitted and grooved surfaces and the effect reduced the DMFS by 2.4 surfaces/child in two years. The overall participation rate for both the elementary and middle schools was 80 percent and the first annual follow-up showed an overall sealant retention rate of 94 percent.

Longitudinal study of the caries susceptibility of occlusal and proximal surfaces of first permanent molars

Ten- to 13-year-old children were examined annually for three years to determine the caries activity in the proximal and occlusal surfaces of first permanent molars. Almost every tooth with an unsound (carious or filled) proximal surface also had an unsound occlusal surface. Caries scores in proximal surfaces remained relatively constant and low. The percentage of teeth with occlusal caries or fillings increased throughout the study, even though the teeth had been erupted for seven to ten years by the end of the study. Within the age range studied, the time that teeth were in the mouth had little effect on the vulnerability of occlusal surfaces to caries attack.

The effects for recall patients of a comprehensive sealant program in a clinical dental public health setting

The preventive outcomes of a comprehensive sealant program in a dental public health treatment center for low SES children are reported. The Linn County (Iowa) Dental Health Center implemented a comprehensive sealant philosophy in 1978. Since then, virtually all pits and fissures in primary and permanent teeth for all new and recall patients have been sealed. The comprehensive sealant philosophy was formulated following a previously reported Dental Health Center study documenting the negative outcomes of unmet treatment need as a result of the lack of continuity of care for this specific low SES target population. Sealants were evaluated for all recall patients seen over a two-month period. The sealants had been placed six months to six years before the two-month examination period. Ninety-five percent of the sealants were intact for the recall patients. Only 3.3 percent of the sealants were in need of repair or resealing--a procedure easily incorporated into the preventive recall appointment. Only 1.5 percent of the teeth were carious, and to a minor extent. To maintain the total sealant treatment philosophy on repaired and newly erupted teeth for recall patients in the dental public health setting requires on the average approximately five additional minutes per recall appointment. Low SES children are at highest risk to dental caries, but are still not guaranteed access to ongoing preventive services. Sealants are of much greater importance than the usual prophylaxis-fluoride regimen for low SES children displaying more episodic than preventive dental behavior. Comprehensive sealant programs should be considered for all dental public health clinical treatment programs for children.

Report of Committee on Scientific Investigation of the American Academy of Restorative Dentistry

A few personal points seem appropriate in summary. It is axiomatic that while research solves problems, it also creates them. As an example, it is an accepted fact that dentistry more than any other profession has made serious inroads into putting itself out of business through research. Each year this report takes note of the reduction in dental caries in children, which has thus triggered a change in the nature of general practice. Be this as it may, it is well to acknowledge that major dental diseases are not disappearing, but their patterns in the population are changing, accompanied by an expansion of other services. Despite the optimistic picture painted earlier in this report, it is grossly premature to acclaim the elimination of caries, and thereby a significant segment of restorative dentistry. Of course the younger age groups have been the major beneficiaries of caries reduction. As the child ages from 9 to 16 years, the percentage of mouths free of caries drops by one half. In addition, the disease pattern in the adult population is being altered because of a longer life span and loss of fewer teeth. Unquestionably what we will, and are already seeing, is not an elimination of restorative dentistry but a different target and changes in procedures because of new materials, therapy, and expanded scope of services. There is yet another subtle change in the trend of dental research and it deals with the reduction in the number of dental schools worldwide and smaller class sizes in those schools. Dental research thereby suffers because of the traditional link between education and research. Thus the potential pool of researchers becomes smaller and research monies for training programs for dental investigators, particularly in clinical research, decreases. This year a surprising number of articles are concerned with manpower as it relates to research priorities. So, it is indeed a time that both the profession and the scientific community find filled with controversy and frustration. Yet never has there been a time that offers more in challenges and rewards.

Time of development of occlusal and proximal lesions: implications for fissure sealants

Analysis of surface and tooth-specific data from NHANES I and HHANES shows that the pattern of dental caries differs greatly from tooth to tooth and surface to surface. Occlusal caries precedes all other types, and increases most rapidly and to the highest levels in the molars. Caries on the proximal surfaces comes later. For sealants to be of value, they must reduce the need for restorations. Therefore, the value of sealants will be determined by the balance between high enough levels of potential caries on occlusal surfaces to give them something to prevent, and low levels of, or sufficiently delayed, proximal lesions to prevent the loss of the otherwise saved occlusal surface. The data presented demonstrate that as of the time of NHANES I, the number of permanent molars that could have had surfaces saved from restoration, at least for a number of years, appears to be sufficient to warrant widespread use of sealants on those teeth. More recent data (HHANES) suggest that the current decline in caries prevalence is likely to reduce the value of sealants in the short run because there are fewer occlusal lesions in young children, but may increase the value of sealants in the long run because proximal caries in older children and adults is also declining.