Despite being largely preventable, tooth decay remains the most common chronic disease of children ages six to 11 (21%) and adolescents ages 12 to 19 (58%), based on data from the National Health and Nutrition Examination Survey of 2011-2012.1 Few tools work better than sealants for preventing decay, and the stakes are high. Oral disease contributes to more than 51 million hours of missed school each year and can greatly impact a child's concentration and self-esteem.
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Pit-and-fissure sealants are one of the most underutilized interventions for preventing carious lesions. Numerous randomized controlled clinical trials have shown sealants to be efficacious in preventing caries, especially among children. To update the profession on best practices for sealant use, a panel convened by the American Dental Association (ADA) and the American Academy of Pediatric Dentistry developed an updated clinical practice guideline that was published in the Journal of the American Dental Association and Pediatric Dentistry titled, "Evidence-based Clinical Practice Guideline for the Use of Pit-and-fissure Sealants."2
This guideline is based on the systematic review of scientific literature related to sealants found in the summary article titled, "Sealants for Preventing and Arresting Pit-and-fissure Occlusal Caries in Primary and Permanent Molars."3 We found that children who received sealants are up to 80% less likely to develop carious lesions, and therefore we recommend the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars in children and adolescents.
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Based on the evidence, sealants are more effective in preventing and arresting pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared to the nonuse of sealants or use of fluoride varnishes without sealants. While fluoride varnish performs an important function in terms of preventing carious lesions, data from three studies we reviewed with nearly 2,000 total participants showed that those who received pit-and-fissure sealants on occlusal surfaces saw a 73% reduction in the risk of developing new carious lesions, compared to participants who received only fluoride varnishes.4-6
This evidence clearly shows that sealants are more effective than fluoride varnishes for preventing carious lesions on occlusal surfaces. Based on the evidence of the studies reviewed, we are also comfortable in saying that sealants can minimize the progression of noncavitated occlusal carious lesions (also referred to as initial lesions) of the tooth with the sealant.
One common misconception about sealants is that they could be associated with hazardous exposure to bisphenol A (BPA). To put things into perspective, a new article from the ADA Professional Product Review examined common BPA exposure from sealants compared with everyday items such as food, drinks, receipts, dust, and cosmetics.7 The data shows that the total amount of BPA a child is exposed to when receiving sealants is 100 times less than what a child is exposed to when simply breathing air. BPA exposure should not be considered as a contraindication to sealant use when a dentist and a patient's parent/guardian are considering them as part of a comprehensive oral health-care plan.
Sealants are not only effective in preventing decay, but evidence indicates they can also halt the progression of existing, noncavitated carious lesions in the teeth to which they are applied.3 It is also worth noting that sealants are considered practical, as many dental plans cover them (CDT code 1351). By preventing carious lesions, sealants offer long-term cost savings to patients and their families, helping them achieve a positive oral health trajectory.
This new guideline should give dentists clear direction to use sealants to improve the oral health of patients. The bottom line is sealants are safe, and they work.
REFERENCES
1. National Health and Nutrition Examination Survey (NHANES) report of 2011–2012. http://www.cdc.gov/nchs/products/databriefs/db191.htm. Accessed August 15, 2016.
2. Wright JT, Crall JJ, Fontana M, et al. Evidence-based clinical practice guideline for the use of pit-and-fissure sealants: A report of the American Dental Association and the American Academy of Pediatric Dentistry. J Am Dent Assoc. 2016;147(8):672–682.e12. doi: 10.1016/j.adaj.2016.06.001.
3. Wright JT, Tampi MP, Graham L, et al. Sealants for preventing and arresting pit-and-fissure occlusal caries in primary and permanent molars. Pediatr Dent. 2016;38(4):282–308.
4. Bravo M, Llodra JC, Baca P, Osorio E. Effectiveness of visible light fissure sealant (Delton) versus fluoride varnish (Duraphat): 24-month clinical trial. Community Dent Oral Epidemiol. 1996;24(1):42–6.
5. Liu BY, Lo EC, Chu CH, Lin HC. Randomized trial on fluorides and sealants for fissure caries prevention. J Dent Res. 2012;91(8):753–8. doi: 10.1177/0022034512452278.
6. Houpt M, Shey Z. The effectiveness of a fissure sealant after six years. Pediatr Dent. 1983;5(2):104–6.
J. Timothy Wright, DDS, MS, received his DDS degree from West Virginia University in 1978, and his specialty training in pediatric dentistry and a master's of science degree from the University of Alabama at Birmingham. He is a faculty member at the University of North Carolina, has served as chair of the Pediatric Dentistry Department, and is currently director of strategic initiatives.
