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

  • Review
  • Intervention

Authors


Abstract

Background

Most of the detected increment in dental caries among children and adolescents is confined to occlusal surfaces of posterior permanent molars. Dental sealants and fluoride varnishes are much used preventive options for caries. Although the effectiveness of sealants and fluoride varnishes for controlling caries as compared with no intervention has been demonstrated in clinical trials and summarised in systematic reviews, the relative effectiveness of these two interventions remains unclear. This review is an update of one first published in 2006 and last updated in 2010.

Objectives

Primary objective

• To evaluate the relative effectiveness of fissure sealants compared with fluoride varnishes, or fissure sealants together with fluoride varnishes compared with fluoride varnishes alone, for preventing dental caries in the occlusal surfaces of permanent teeth of children and adolescents.

Secondary objectives

• To evaluate whether effectiveness is influenced by sealant material type and length of follow-up.

• To document and report on data concerning adverse events associated with sealants and fluoride varnishes.

Search methods

We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 18 December 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 11), MEDLINE via Ovid (1946 to 18 December 2015) and EMBASE via Ovid (1980 to 18 December 2015). We also searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the World Health Organization (WHO) Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on language or date of publication when searching electronic databases. We screened the reference lists of identified trials and review articles for additional relevant studies.

Selection criteria

We included randomised controlled trials with at least 12 months of follow-up comparing fissure sealants, or fissure sealants together with fluoride varnishes, versus fluoride varnishes for preventing caries in the occlusal surfaces of permanent premolar or molar teeth, in participants younger than 20 years of age at the start of the study.

Data collection and analysis

Two review authors independently screened search results, extracted data and assessed risk of bias of included studies. We attempted to contact study authors to obtain missing or unclear information.

We grouped and analysed studies on the basis of sealant material type (resin-based sealant and glass ionomer-based sealant: glass ionomer and resin-modified glass ionomer) and different follow-up periods. We calculated the odds ratio (OR) for caries or no caries on occlusal surfaces of permanent molar teeth. For trials with a split-mouth design, we used the Becker-Balagtas odds ratio. For continuous outcomes and data, we used means and standard deviations to obtain mean differences. We presented all measures with 95% confidence intervals (CIs).

We assessed the quality of the evidence using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methods.

We conducted meta-analysis using the fixed-effect model, as data from only two studies were combined. We had planned to conduct meta-analyses using a random-effects model when more than three trials were included in the meta-analysis.

Main results

In this review, we included eight trials with 1746 participants (four of the trials were new since the 2010 update). Seven trials (1127 participants) contributed to the analyses, and children involved were five to 10 years of age at the start of the trial.

Sealant versus fluoride varnish
Resin-based fissure sealants compared with fluoride varnishes
Four trials evaluated this comparison (three of them contributing to the analyses). Compared with fluoride varnish, resin-based sealants prevented more caries in first permanent molars at two-year follow-up (two studies in the meta-analysis with pooled odds ratio (OR) 0.69, 95% confidence interval (CI) 0.50 to 0.94; P value = 0.02; I2 = 0%; 358 children evaluated). We assessed the body of evidence as low quality. The caries-preventive benefit for sealants was maintained at longer follow-up in one trial at high risk of bias: 26.6% of sealant teeth and 55.8% of fluoride-varnished teeth had developed caries when 75 children were evaluated at nine years of follow-up.

Glass ionomer-based sealants compared with fluoride varnishes
Three trials evaluated this comparison: one trial with chemically cured glass ionomer and two with resin-modified glass ionomer. Researchers reported similar caries increment between study groups regardless of which glass ionomer material was used in a trial. Study designs were clinically diverse, and meta-analysis could not be conducted. The body of evidence was assessed as of very low quality.

Sealant together with fluoride varnish versus fluoride varnish alone
One split-mouth trial analysing 92 children at two-year follow-up found a significant difference in favour of resin-based fissure sealant together with fluoride varnish compared with fluoride varnish only (OR 0.30, 95% CI 0.17 to 0.55). The body of evidence was assessed as low quality.

Adverse events
Three trials (two with resin-based sealant material and one with resin-modified glass ionomer) reported that no adverse events resulted from use of sealants or fluoride varnishes. The other five studies did not mention adverse events.

Authors' conclusions

Currently, scarce and clinically diverse data are available on the comparison of sealants and fluoride varnish applications; therefore it is not possible to draw clear conclusions about possible differences in effectiveness for preventing or controlling dental caries on occlusal surfaces of permanent molars. The conclusions of this updated review remain the same as those of the last update (in 2010). We found some low-quality evidence suggesting the superiority of resin-based fissure sealants over fluoride varnish applications for preventing occlusal caries in permanent molars, and other low-quality evidence for benefits of resin-based sealant and fluoride varnish over fluoride varnish alone. Regarding glass ionomer sealant versus fluoride varnish comparisons, we assessed the quality of the evidence as very low and could draw no conclusions.

Plain language summary

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

Review question

This review aimed to assess whether dental sealants (or sealants together with fluoride varnishes) or fluoride varnishes are more effective for reducing tooth decay on biting surfaces of permanent back teeth in young people.

Background

Although children and adolescents have healthier teeth today than in the past, tooth decay is still a problem among some individuals and populations, and it affects a large number of people around the world. Most decay in children and adolescents is concentrated on the biting surfaces of permanent back teeth. Preventive treatment options for tooth decay include tooth brushing with a fluoride toothpaste, use of fluoride supplements (e.g. fluoride tablets) and application of dental sealants and topical fluorides at dental clinics.

Dental sealants are applied to form a physical barrier that prevents growth of bacteria and accumulation of food particles in the grooves of back teeth. Several sealant materials are available: The main types in use are resin-based sealants and glass ionomer cements. Fluoride varnishes are sticky pastes that are professionally applied to the teeth two to four times a year.

Study selection

Authors from the Cochrane Oral Health Group carried out this review of existing studies, and the evidence is current to 18 December 2015. This review is an update of one first published in 2006 and last updated in 2010.

Study characteristics

This review includes eight studies published from 1984 to 2014, in which 1746 participants were randomly assigned (1127 were included in the analyses) to receive dental sealant (or sealant together with fluoride varnish) or fluoride varnish applications, and the extent of tooth decay was compared. Participants were five to 10 years of age at the start of the trial and represented the general population.

Key results

Some evidence suggests that applying resin-based sealants to the biting surfaces of permanent back teeth in children may reduce tooth decay in the permanent teeth of children by 3.7% over a two-year period, and by 29% over a nine-year period, when compared with fluoride varnish applications. Applying resin-based sealant together with fluoride varnish to the biting surfaces of the permanent back teeth may reduce tooth decay by 14.4% over a two-year period compared with fluoride varnish alone. Effects of applying glass ionomer sealants may be similar to those seen when fluoride varnish is applied, but evidence showing the similarity between interventions is of very low quality. Three studies reported that there were no associated adverse events from sealants or fluoride varnish applications; the other studies did not mention adverse events.

Quality of the evidence

Available evidence is of low to very low quality because of the small number of included studies, and because of problems with the way in which studies were conducted. Further, most studies reported a relatively short follow-up time.

Laički sažetak

Pečatni ispuni u odnosu na fluoridne lakove za sprječavanje zubnog karijesa trajnih zubi djece i adolescenata

Istraživačko pitanje

Ovaj Cochrane sustavni pregled ima cilj utvrditi jesu li materijali za pečaćenje (ili materijali za pečaćenje zajedno s fluoridnim lakovima) ili fluoridni lakovi djelotvorniji u smanjenju pojave zubnog karijesa na griznim plohama trajnih stražnjih zuba u mladih osoba.

Dosadašnje spoznaje

Iako danas djeca i adolescenti imaju zdravije zube nego u prošlosti, karijes je i dalje problem kod nekih osoba i populacija, i pogađa veliki broj ljudi u svijetu. Većina karijesa kod djece i odraslih koncentrirana je na griznim površinama trajnih stražnjih zubi. Preventivni tretmani za zubni karijes uključuju četkanje flouridnim pastama, i korištenje dodataka fluorida (npr. tableta fluora) i primjenu pečatnih ispuna i lokalnu fluoridaciju u stomatološkim ambulantama.

Pečatni ispuni koriste se kao fizička barijera koja sprječava rast bakterija i nakupljanje hrane u žljebovima stražnjih zubi. Postoji nekoliko materijala za pečaćenje; glavni materijali u upotrebi su pečati na bazi smole i stakleno-ionomerni cementi. Fluoridni lakovi su ljepljive paste koja se profesionalno primjenjuju na zubima dva do četiri puta godišnje.

Izbor studija

Autori iz Cochrane uredničke skupine za oralno zdravlje (engl. Cochrane Oral Health Group) napravili su ovaj sustavni pregled postojećih studija koje su objavljene do 18. prosinca 2015. Ovaj sustavni pregled literature je nova verzija pregleda koji je prvi put objavljen 2006. godine, a zadnji put je ažuriran 2010.

Značajke istraživanja

U ovom Cochrane sustavnom pregledu uključeno je 8 istraživanja koja su objavljena od 1984. do 2014. i u kojima je 1746 nasumično odabranih sudionika (1127 su bili uključeni u analize) dobilo pečatne ispune (ili pečatne ispune zajedno s fluoridnim lakom) ili nanošenje fluoridnog laka te se uspoređivao razvoj karijesa. Sudionici su imali između 5 i 10 godina na početku istraživanja i prestavljali su opću populaciju.

Ključni rezultati

Neki dokazi pokazuju da korištenje materijala za pečaćenje na griznim plohama trajnih stražnjih zubi kod djece može smanjiti karijes trajnih zuba kod djece za 3,7% kroz razdoblje od dvije godine, te za 29% kroz razdoblje od 9 godina, u odnosu na primjenu fluoridnih lakova. Korištenje pečatnih ispuna na bazi smole zajedno sa flouridnim lakom na griznim plohama trajnih stražnjih zubi može smanjiti karijes za 14,4% kroz razdoblje od dvije godine u odnosu na primjenu samo fluoridnog laka. Učinci primjene pečatnih materijala na bazi staklenog ionomera mogli bi biti slični onima kao kod primjene fluoridnih lakova, no dokazi za to su vrlo niske kvalitete. Tri istraživanja su prikazala informacije da nema neželjenih učinaka pečatnih ispuna i fluoridnih lakova; ostale studije nisu spominjale neželjene učinke.

Kvaliteta dokaza

Predstavljeni dokazi su niske ili vrlo niske kvalitete zbog malog broja uključenih istraživanja te zbog problema s načinom na koji su istraživanja provedena. Nadalje, većina istraživanja je pratila sudionike istraživanja kroz relativno kratko vrijeme.

Bilješke prijevoda

Hrvatski Cochrane
Preveo: Alem Fazlić
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr