Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents

 

Abstract

Background

Although pit and fissure sealants are effective in preventing caries, their efficacy may be related to the caries prevalence in the population.

Objectives

The primary objective of this review was to evaluate the caries prevention of pit and fissure sealants in children and adolescents.

Search methods

We searched the Cochrane Oral Health Group Trials Register, CENTRAL (The Cochrane Library 2007, Issue 3) and MEDLINE (to October 2007); EMBASE (to June 2007); SCISEARCH, CAplus, INSPEC, NTIS, PASCAL, DARE, NHS EED and HTA (to February 2008). There were no language or publication restrictions.

Selection criteria

Randomised or quasi-randomised controlled trials of at least 12 months in duration comparing sealants with no sealant or sealants from different classes of materials for preventing occlusal caries in children and adolescents under 20 years. The primary outcome was the increment in the numbers of carious occlusal surfaces of premolars and molars.

Data collection and analysis

Two review authors independently screened search results, extracted data and quality assessed trials. Risk ratios (RR) were calculated for differences between intervention and control groups and in split-mouth studies for differences of paired tooth surfaces being carious or not. The meta-analyses were conducted using a random-effects model.

Main results

Sixteen studies were included in the review; 7 studies provided data for comparison of sealant versus control without sealant and 10 studies for comparison of sealant versus sealant. Five split-mouth studies and one parallel group study with 5 to 10 year old children found a significant difference in favour of second or third generation resin-based sealants on first permanent molars, compared to a control without sealant, with a pooled RR of 0.13 (95% confidence interval (CI) 0.09 to 0.20), 0.22 (95% CI 0.15 to 0.34), 0.30 (95% CI 0.22 to 0.40), and 0.40 (95% CI 0.31 to 0.51) at 12, 24, 36 and 48-54 months follow up, respectively. Further, one of those studies with 9 years of follow up found significantly more caries in the control group compared to resin sealant group; 27% of sealed surfaces were decayed compared to 77% of surfaces without sealant.
The results of the studies comparing different sealant materials were conflicting.

Authors' conclusions

Sealing is a recommended procedure to prevent caries of the occlusal surfaces of permanent molars. The effectiveness of sealants is obvious at high caries risk but information on the benefits of sealing specific to different caries risks is lacking.

 

Plain language summary

Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents

Children who have their molar teeth covered by a sealant are less likely to have dental decay in their molar teeth than children without sealant.
Sealants are coatings applied by the dentist or by another person in dental care on the grooves of mainly molar teeth. These coatings are intended to prevent the growth of bacteria that promote decay in grooves of molar teeth. The review shows that after 4.5 years the sealed permanent molar teeth of children aged 5 to 10 had over 50% reduction in decay on biting surfaces compared to teeth without sealants. One study with longer follow up showed that after 9 years only 27% of sealed tooth surfaces were decayed compared to 77% of tooth surfaces without sealant.

 

摘要

背景

預防孩童和青少年恆牙齲齒之窩洞溝隙封填劑

雖然窩洞及溝隙封填劑對於預防齲齒是有效的，它們的功效可能和族群中齲齒的盛行率有關。

目標

這篇回顧主要的目地是評估在孩童以及青少年進行窩洞和溝隙封填對於預防齲齒的效果。

搜尋策略

我們搜尋的範圍包括the Cochrane Oral Health Group Trials Register, CENTRAL (The Cochrane Library 2007年, 第3期), MEDLINE (至 2007年10月); EMBASE (至2007年6月); SCISEARCH, CAplus, INSPEC, NTIS, PASCAL, DARE, NHS EED 以及 HTA (到2008年2月)。這些範圍中並沒有語言或是出版的限制。

選擇標準

至少持續12個月的隨機或是半隨機對照試驗，針對預防孩童和小於20歲的青少年咬合面的齲齒，比較有無使用或採用不同種類封填劑的隨機或類隨機對照試驗。初步的結果顯示在小臼齒和臼齒咬合面有齲齒數目上的增加。

資料收集與分析

2位文獻回顧的作者分別獨自篩選了搜尋的結果，摘取出數據和評估試驗的品質。用RR(Risk ratios)來計算實驗組和對照組兩者的差異性以及分口實驗中配對牙齒間其表面是否有齲齒。使用隨機效用模式進行統合分析。

主要結論

在回顧中包含了16個實驗；有7個實驗比較有使用封填劑的實驗組以及沒有使用封填劑的對照組，另外還有10個實驗是用來比較不同材料的封填劑。5個分口實驗和1個平行小組實驗對於5到10歲的孩童發現使用第2代或是第3代以樹脂為基底的封填劑於恆牙第一大臼齒上和沒有使用封填劑的對照組來做比較有顯著的差異性，RR為0.13(95% CI 0.09 到 0.20), 0.22 (95% CI 0.15 到 0.34), 0.30 (95% CI 0.22 到 0.40), 和 0.40 (95% CI 0.31 到 0.51) 分別是追蹤12, 24, 36和48到54個月。另外在這些實驗當中有1個實驗經過9年的追蹤發現對照組比有使用樹脂封填組有顯注齲齒的現象；有封填過的牙齒中27%有發現蛀牙，沒有使用封填劑的牙齒中77%表面發現有蛀牙。有關不同材料封填劑的比較實驗結果是不一致的。

作者結論

封填是被建議用於預防恆牙臼齒咬合面齲齒的一個方式。封填劑使用在高齲齒風險的病人有顯著的效果，但缺乏針對不同齲齒的封填效益的資訊。

翻譯人

本摘要由臺灣大學附設醫院韓依文翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

臼齒有被封填的孩童比沒有被封填的孩童蛀牙的機會較低。牙醫師或是其他牙科照護者大部份將封填劑封填於臼齒的溝縫中。封填劑可以用來預防溝縫中細菌的生長。回顧指出5歲到10歲孩童被封填的恆牙臼齒經過4.5年後跟沒有封填的來做比較，咬合面上的蛀牙減少50%。有一個長時間追蹤的實驗指出經過九年後有被封填的牙齒蛀牙機率為27%而沒有封填的牙齒則為77%。