A Survey of Attitudes and Training of Pediatric Dentistry Residents and Faculty in the United States Regarding the LGBTQ Patient Population.

Purpose: The purpose of this study was to assess the knowledge, attitude, and training of pediatric dental residents and faculty on the management of patients who belong to the LGBTQ (lesbian, gay, bisexual, transgender, and queer) community. Methods: This cross-sectional survey included a 16-item questionnaire to assess the attitudes and training regarding the LGBTQ population, separately for pediatric dental residents and faculty across the United States. Statistical significance was set at the level of five percent, and data were analyzed using descriptive statistics, Wilcoxon rank-sum, and Fisher's exact tests. Results: In total, 132 residents and 40 faculty members completed the survey (response rates equal 14.4 percent and 16.9 percent, respectively). Residents were significantly more likely to respond that requiring LGBTQ training should be in the curriculum and that they have acquired skills to provide equal service to both LGBTQ and non-LGBTQ patients and families (faculty equals 35 percent, residents equals 57.6 percent; P<0.001). Residents were significantly more likely than faculty to respond that the American Academy of Pediatric Dentistry should publish an exclusive policy statement regarding LGBTQ oral health disparities (faculty equals 40 percent, residents equal 62.1 percent; P=0.01). Conclusions: The resident and faculty of pediatric dentistry programs in the United States have adequate awareness of managing lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients in the dental office and are willing to treat these patients, and most respondents have an interest in further education.

Reporting stAndards for research in PedIatric Dentistry (RAPID): an expert consensus-based statement.

BACKGROUND: Reporting guidelines for different study designs are currently available to report studies with accuracy and transparency. There is a need to develop supplementary guideline items that are specific to areas within Pediatric Dentistry. This study aims to develop Reporting stAndards for research in PedIatric Dentistry (RAPID) guidelines using a pre-defined expert consensus-based Delphi process. METHODS: The development of the RAPID guidelines was based on the Guidance for Developers of Health Research Reporting Guidelines. Following a comprehensive search of the literature, the Executive Group identified ten themes in Pediatric Dentistry and compiled a draft checklist of items under each theme. The themes were categorized as: General, Oral Medicine, Pathology and Radiology, Children with Special Health Care Needs, Sedation and Hospital Dentistry, Behavior Guidance, Dental Caries, Preventive and Restorative Dentistry, Pulp Therapy, Traumatology, and Interceptive Orthodontics. A RAPID Delphi Group (RDG) was formed comprising of 69 members from 15 countries across six continents. Items were scored using a 9-point rating Likert scale. Items achieving a score of seven and above, marked by at least 70% of RDG members were accepted into the RAPID checklist items. Weighted mean scores were calculated for each item. Statistical significance was set at p < 0.05 and one-way ANOVA was used to calculate the difference in the weighted mean scores between the themes. RESULTS: The final RAPID checklist comprised of 128 items that were finalized and approved by the RDG members in the online consensus meeting. The percentage for high scores (scores 7 to 9) ranged from 69.57 to 100% for individual items. The overall weighted mean score of the final items ranged from 7.51 to 8.28 (out of 9) and the difference was statistically significant between the themes (p < 0.05). CONCLUSIONS: The RAPID statement provides guidance to researchers, authors, reviewers and editors, to ensure that all elements relevant to particular studies are adequately reported.

Prospective randomized clinical trial of primary molar crowns: 36-month results.

PURPOSE: To clinically evaluate the clinical success of a primary zirconia molar crown, compared with stainless steel crowns (SSCs). METHODS: This randomized, controlled clinical trial was designed as a split-mouth study. 50 subjects ranging in age from 3-7 years were recruited to provide a total of 50 paired teeth requiring primary molar crowns, each participant receiving a SSC and zirconia crown. Restorations were evaluated at 6-, 12-, 24-, and 36-month recall appointments examining the following criteria: gingival health, estimate of the degree crown was high in occlusion, surface roughness, staining on crown surface, wear of opposing arch tooth, color match, anatomic form, marginal integrity, marginal discoloration, proximal contact area, secondary caries at crown margin and parent/guardian satisfaction with crown appearance. RESULTS: The 36-month follow up included 23 subjects (46%). 35 crowns (35%) were evaluated; of the 18 zirconia crowns and 17 SSCs, there were no failures at the 36-month evaluation. The only significant differences in the parameters evaluated were parent satisfaction, with the zirconia crown preference (P< 0.05) and gingival health, with the zirconia crowns having healthy adjacent gingiva (P< 0.01). The 36-month results indicated that zirconia primary molar crowns performed similarly to an established SSC for restoration of primary molars. CLINICAL SIGNIFICANCE: The findings from this study indicated that at 36 months, NuSmile ZR zirconia crowns clinically performed as well as stainless steel crowns.

Reporting stAndards for research in PedIatric Dentistry (RAPID): A development protocol.

Reporting guidelines can improve the quality of reports of research findings. Some specialities in health care however require guidance on areas that are not captured within the existing guidelines, and this is the case for Paediatric Dentistry where no such standards are available to guide the reporting of different types of study designs. The 'Reporting stAndards for research in PedIatric Dentistry' (RAPID) group aims to address this need by developing guidelines on reporting elements of research of particular relevance to Paediatric Dentistry. The development of RAPID guidelines will involve a five-phase process including a Delphi study, which is an explicit consensus development method designed and implemented in accordance with the Guidance on Conducting and REporting DElphi Studies. The guideline development process will be overseen by an Executive Group. Themes specific to areas in Paediatric Dentistry will be selected, and items to be included under each theme will be identified by members of the Executive Group reviewing at least five reports of experimental and analytical study types using existing reporting guidelines. For the Delphi study, the Executive Group will identify an international multidisciplinary RAPID Delphi Group (RDG) of approximately 60 participants including academics, Paediatric Dentists, parents, and other stakeholders. Each item will be evaluated by RDG on clarity using a dichotomous scale ('well phrased' or 'needs revision') and on suitability for inclusion in the Delphi study using a 9-point Likert scale (1 = 'definitely not include' to 9 = 'definitely include'). The items will then be included in an online Delphi study of up to four rounds, with participants invited from stakeholder groups across Paediatric Dentistry. Items scored 7 or above by at least 80% of respondents will be included in the checklist and further discussed in a face-to-face Delphi consensus meeting. Following this, the Executive Group will finalize the RAPID guidelines. The guidelines will be published in peer-reviewed scientific journals and disseminated at scientific meetings and conferences. All the outputs from this project will be made freely available on the RAPID website: www.rapid-statement.org.

Survival of Zirconia Crowns in Primary Maxillary Incisors at 12-, 24- and 36-Month Follow-Up.

Purpose: The purpose of this study was to assess the survival probability of zirconia crowns (ZCs) on primary maxillary incisors placed in children diagnosed with severe early childhood caries at 12-, 24-, and 36-month follow-up visits in a university pediatric dental clinic. Methods: Ninety-four teeth in 30 healthy 24- to 60-month-olds who received ZCs under general anesthesia participated in this study (N equals 94). Data included children's demographics, dental-related variables, appointment dates, survival of crown, and type of failure (defined as replacement of lost ZCs or extraction of the treated tooth due to evidence of apical periodontitis prior to natural exfoliation). Descriptive statistics were performed to examine demographics, while Kaplan-Meier survival curves were used to estimate survival probabilities of ZCs over time. Unadjusted and adjusted hazard ratios (HR) from Cox proportional hazard regression with robust standard errors were used to compare risk of ZC failure by patient and tooth characteristics. Results: The overall survival probabilities for ZCs at 12, 24, and 36 months were 93 percent, 85 percent, and 76 percent, respectively. Conclusion: With esthetic characteristics and high survival probabilities, zirconia crowns present as a suitable alternative for reconstruction of primary maxillary incisors in young children. (Pediatr Dent 2019;41(5):385-90).

Hidden Caries: A Case Report of a 17 Years Old Male with Two Affected Mandibular Premolars.

Hidden caries is the term used to describe carious lesions that are not visualized clinically on erupted teeth but can be detected radiographically. The exact etiology remains an area of controversy. The purpose of the current case report was to discuss the diagnosis and treatment of two mandibular premolars with hidden caries. After diagnosis was established, both premolars were treated with indirect pulp caps and resin-based composite restorations. A one year follow up appointment revealed both teeth to be free from signs and symptoms of inflammation.

Inhibition of Demineralization at Restoration Margins of Z100 and Tetric EvoCeram Bulk Fill in Dentin and Enamel.

Recurrent caries is still considered the main reason restorations need to be replaced. There are different materials available now that promise to reduce the possibility of recurrent caries by releasing fluoride and inhibiting restoration marginal caries. The purpose of this in vitro study was to evaluate the demineralization inhibition potential of a non-fluoride-releasing resin (Z100TM 3M, St. Paul, MN, USA) and a glass containing resin-based composite (Tetric EvoCeram Bulk Fill, Ivoclar/Vivadent AG, Schaan, Liechtenstein), which contains fluoride. Class V preparations were placed on 22 premolars; the gingival margin was below the cementoenamel junction and the occlusal margin was placed above the cemento-enamel junction. Ten teeth were randomly selected to be restored with Z100 while the other 10 were restored with Tetric EvoCeram Bulk Fill. Both groups were restored following manufacturer's instructions. All teeth had an acid resistant varnish placed within one millimeter of the preparation margins. Both groups were placed in artificial caries challenge solution (pH 4.4). At the end of the 4 days; 100 µm buccolingual sections were obtained for each tooth; these were photographed under polarized light microscopy and the demineralized areas adjacent to the restorations were measured and quantified. The mean (±S.D.) area (µm2) of demineralization from the occlusal margin (enamel) and dentin margin were: Z100 2781.889 ± 1045.213; 3960.455 ± 705.964 and for Tetric EvoCeram Bulk Fill 1541.545 ± 1167.027; 3027.600 ± 512.078. Student's t-test indicated that there was significantly less enamel and dentin demineralization adjacent to Tetric EvoCeram Bulk Fill compared to Z100; there was significantly less demineralization in enamel compared to dentin in both Tetric EvoCeral Bulk Fill and Z100. Tetric EvoCeram Bulk Fill performed better inhibiting demineralization at restoration margins when compared to Z100 and provided better demineralization inhibition in enamel than cementum/dentin.

Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective.

BACKGROUND: This paper is a summary of the proceedings of the International Association of Paediatric Dentistry Bangkok Conference on early childhood caries (ECC) held in 3-4 November 2018. AIM: The paper aims to convey a global perspective of ECC definitions, aetiology, risk factors, societal costs, management, educational curriculum, and policy. DESIGN: This global perspective on ECC is the compilation of the state of science, current concepts, and literature regarding ECC from worldwide experts on ECC. RESULTS: Early childhood caries is related to frequent sugar consumption in an environment of enamel adherent, acid-producing bacteria in a complex biofilm, as well as developmental defects of enamel. The seriousness, societal costs, and impact on quality of life of dental caries in pre-school children are enormous. Worldwide data show that ECC continues to be highly prevalent, yet infrequently treated. Approaches to reduce the prevalence include interventions that start in the first year of a child's life, evidence-based and risk-based management, and reimbursement systems that foster preventive care. CONCLUSIONS: This global perspective on ECC epidemiology, aetiology, risk assessment, global impact, and management is aimed to foster improved worldwide understanding and management of ECC.

Prospective Randomized Clinical Trial of Primary Molar Crowns: 24-Month Results.

Purpose: The purpose of this study was to evaluate the clinical success of a new primary zirconia molar crown compared with stainless steel crowns (SSCs). Methods: This randomized, controlled clinical trial was designed as a split-mouth study. Fifty three- to seven-year-old children were recruited to provide a total of 50 pairs of teeth requiring primary molar crowns, with each participant receiving a SSC and zirconia crown. Restorations were evaluated at six-month, 12-month, and 24-month recall appointments examining the following criteria: gingival health; estimate of extent the crown was high in occlusion; surface roughness; staining on crown surface; wear of opposing arch tooth; color match; anatomic form; marginal integrity; marginal discoloration; proximal contact area; secondary caries at crown margin; and parent/guardian satisfaction with crown appearance. Results: The 24-month follow-up included 39 patients (78 percent). Seventy crowns (70 percent) were evaluated; of the 36 zirconia crowns and 34 SSCs, there were no failures at the 24-month evaluation. The only significant difference in the parameters evaluated was in parental satisfaction with the zirconia crown preference (P<0.05). Conclusion: Current 24-month results indicate that zirconia primary molar crowns perform similarly to an established stainless steel crown for restoration of primary molar teeth.

Dentin and enamel demineralization inhibition at restoration margins of Vitremer, Z 100 and Cention N.

PURPOSE: To examine the in vitro caries inhibition of a resin-modified glass-ionomer cement, and a fluoride and calcium releasing resin-based composite. METHODS: Standardized Class V preparations were placed in 30 molars, the gingival margin placed below the cemento-enamel junction. Randomly, 10 Vitremer, 10 Z 100 and 10 Cention N restorations were placed according to manufacturer's instructions, in 30 teeth. The Z 100 non fluoride-releasing resin-based composite group acted as the control. All teeth had an acid-resistant varnish placed to within 1 mm of restoration margins and they were placed into artificial saliva for 2 weeks, the saliva being replenished every 48 hours. All teeth were subjected to thermocycling each day and to an artificial caries challenge (pH 4.4) for one hour twice a day. Sections of 100 µm were obtained, photographed under polarized light microscopy and then demineralized areas adjacent to restorations were quantitated. RESULTS: The mean (± S.D.) area (µm 2) demineralization 100 µm from the enamel and dentin margins were: Vitremer 1,554 ± 1,153, 4,125 ± 301; Cention N 3580 ± 1,518, 6,246 ± 630; Z 100 13,257 ± 3,794, 8,842 ± 1,799. A Mann-Whitney Rank Sum Test indicated that Vitremer had significantly less enamel demineralization then Cention N (P< 0.003) and Z 100 (P< 0.001) and Cention N had significantly less enamel demineralization than Z 100 (P< 0.001) and Z 100 (P< 0.001). Vitremer also had significantly less dentin demineralization than Cention N (P< 0.001) and Cention N had significantly less dentin demineralization than Z 100 (P< 0.001). CLINICAL SIGNIFICANCE: Recurrent caries remains a concern and this in vitro research indicates that Cention N, as well as Vitremer may clinically inhibit caries at restoration margins.

Fluoride release and re-release from a bioactive restorative material.

PURPOSE: To compare the amount of fluoride release and re-release of three different restorative materials. METHODS: The three restorative materials included a resin-based composite (Z100TM, 3M-ESPE), a resin-modified glass ionomer cement (VitremerTM, 3M-ESPE) and a bioactive material (Activa Bioactive-RestorativeTM, Pulpdent,). Ten disks were fabricated from each material. The disks were immersed in deionized water and stored. Samples were taken from each vial on Days 1, 7, 14 and 30 for fluoride ion analysis. Each disk was then exposed to 2.0% neutral sodium fluoride gel (0.9% fluoride ion, Dentsply), immersed in deionized water and stored. Samples were taken on Days 1, 7, 14 and 30 for fluoride ion analysis utilizing a fluoride-specific ion-analyzer. RESULTS: Z100 released less fluoride on Days 1 (P< 0.001), 7 (P= 0.001) and 14 (P< 0.022) for Phase I (initial release) than Phase II (re-release). Vitremer and Activa released less fluoride on Days 7, 14 and 30 (P< 0.001) for Phase II than Phase I. For all intervals of Phase I, Vitremer released the most fluoride, Activa released the second most, and Z100 released the least. These results were the same for Days 7, 14 and 30 of Phase II. The level of fluoride release from Activa was less than that of Vitremer, and greater than that of Z100 for all intervals of Phase I. The results were the same for all but one interval of Phase II. CLINICAL SIGNIFICANCE: This in vitro study evaluated the fluoride release and subsequent re-release of fluoride following a topical fluoride treatment to analyze if the materials were truly bioactive. The results indicate the bioactive material does uptake fluoride and re-release it which could offer inhibition to caries at restoration margins.

Fluoride release and re-release from various esthetic restorative materials.

PURPOSE: To measure the amount of fluoride release and re-release after re-charge from two commonly used esthetic restorative materials and compare it to a new experimental material. METHODS: 30 standardized disc-shaped specimens were fabricated using resin-based composite (Z100), resin-modified glass-ionomer cement (Vitremer) and a new experimental material which is a self-curing resin-based composite with light curing option. 10 specimens were made from each material. The specimens of each group were immersed separately in 10 ml distilled water. Fluoride release was measured after 1, 7, 14 and 30 days using a fluoride-specific ion electrode and an ion-analyzer. The specimens were then exposed to 2.0% neutral sodium fluoride foam (0.9% fluoride ion). The amount of fluoride re-released was measured at Days 1, 7, 14 and 30. RESULTS: An ANOVA indicated a statically significant variance among the groups (P< 0.001). The experimental group demonstrated significantly less fluoride release at Day 1 compared to Day 31 (first day after 2% sodium fluoride application). At Days 7, 14 and 30 there was significantly more fluoride release than Day 7, 14 and 30 after the topical fluoride application (P< 0.001). There was significantly more fluoride release from Vitremer than the experimental material at Days 1 and 7. However, similar release was observed at Days 14 and 30 for Vitremer and experimental material, but not for Z100. Both Vitremer and the experimental material showed significantly more release of fluoride compared to Z100 at all time points. CLINICAL SIGNIFICANCE: This study demonstrates that the new experimental material released fluoride, re-charged and re-released fluoride at a level comparable to Vitremer but more than Z100.

HPV Vaccination and the Role of the Pediatric Dentist: Survey of Graduate Program Directors.

PURPOSE: This study's purpose was to evaluate what is currently being taught in graduate pediatric dental programs regarding the human papillomavirus (HPV), the HPV vaccine, and risk factors associated with oropharyngeal cancer (OPC). METHODS: A 42-question survey was administered via paper-and-pen survey instrument to attendees at the 2016 American Academy of Pediatric Dentistry (AAPD) annual meeting for graduate and associate program directors. The survey included questions evaluating attitudes/beliefs toward the HPV vaccine and current training in graduate pediatric dentistry programs and aimed to define whether the directors believe that the discussion of HPV vaccination and associated risk factors was within the scope of practice for pediatric dentists. RESULTS: Sixty-four of 71 attendees completed the survey; 77 percent of respondents believe they should be discussing the HPV vaccine with patients/parents. Increased age of respondent was correlated with the idea of discussion of sexual health and its link to OPC being within the scope of practice of pediatric dentistry (r equals 0.35, P=.005). CONCLUSIONS: A majority (77 percent) of graduate and associate program directors believe they should be discussing the human papillomavirus vaccine with patients and parents; however, only 25 percent of respondents currently include information about HPV and the vaccine in their curricula.

Dentin sialoprotein facilitates dental mesenchymal cell differentiation and dentin formation.

Dentin sialoprotein (DSP) is a dentin extracellular matrix protein. It is involved in dental mesenchymal cell lineages and dentin formation through regulation of its target gene expression. DSP mutations cause dentin genetic diseases. However, mechanisms of DSP in controlling dental mesenchymal cell differentiation are unknown. Using DSP as bait, we screened a protein library from mouse odontoblastic cells and found that DSP is a ligand and binds to cell surface receptor, occludin. Further study identified that the C-terminal DSP domainaa 363-458 interacts with the occludin extracellular loop 2aa 194-241. The C-terminal DSP domain induced phosphorylation of occludin Ser490 and focal adhesion kinase (FAK) Ser722 and Tyr576. Coexpression of DSP, occludin and FAK was detected in dental mesenchymal cells during tooth development. Occludin physically interacts with FAK, and occludin and FAK phosphorylation can be blocked by DSP and occludin antibodies. This DSP domain facilitates dental mesenchymal cell differentiation and mineralization. Furthermore, transplantation and pulp-capping procedures revealed that this DSP domain induces endogenous dental pulp mesenchymal cell proliferation, differentiation and migration, while stimulating blood vessel proliferation. This study elucidates the mechanism of DSP in dental mesenchymal lineages and implies that DSP may serve as a therapeutic agent for dentin-pulp complex regeneration in dental caries.

Dentin Sialoprotein is a Novel Substrate of Matrix Metalloproteinase 9 in vitro and in vivo.

Dentin sialoprotein (DSP) is essential for dentinogenesis and processed into fragments in the odontoblast-like cells and the tooth compartments. Matrix metalloproteinase 9 (MMP9) is expressed in teeth from early embryonic to adult stage. Although MMP9 has been reported to be involved in some physiological and pathological conditions through processing substrates, its role in tooth development and whether DSP is a substrate of MMP9 remain unknown. In this study, the function of MMP9 in the tooth development was examined by observation of Mmp9 knockout (Mmp9-/-) mouse phenotype, and whether DSP is a substrate of MMP9 was explored by in vitro and in vivo experiments. The results showed that Mmp9-/- teeth displayed a phenotype similar to dentinogenesis imperfecta, including decreased dentin mineral density, abnormal dentin architecture, widened predentin and irregular predentin-dentin boundary. The distribution of MMP9 and DSP overlapped in the odontoblasts, the predentin, and the mineralized dentin, and MMP9 was able to specifically bind to DSP. MMP9 highly efficiently cleaved DSP into distinct fragments in vitro, and the deletion of Mmp9 caused improper processing of DSP in natural teeth. Therefore, our findings demonstrate that MMP9 is important for tooth development and DSP is a novel target of MMP9 during dentinogenesis.

Sealants for Preventing and Arresting Pit-and-fissure Occlusal Caries in Primary and Permanent Molars.

BACKGROUND: National Health and Nutrition Examination Survey 2011-2012 data indicated that, in the United States, nearly onefourth of children and over one-half of adolescents experienced dental caries in their permanent teeth. The purpose of this review was to summarize the available clinical evidence regarding the effect of dental sealants for the prevention and management of pit-and-fissure occlusal carious lesions in primary and permanent molars, compared with a control without sealants, with fluoride varnishes, or with other head-to head comparisons. TYPE OF STUDIES REVIEWED: The authors included parallel and split-mouth randomized controlled trials that included at least 2 years of follow-up, which they identified using MEDLINE (via PubMed), Embase, LILACS, the Cochrane Central Register of Controlled Trials, and registers of ongoing trials. Pairs of reviewers independently conducted the selection of studies, data extraction, risk of bias assessments, and quality of the evidence assessments by using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Of 2,869 records screened, the authors determined that 24 articles (representing 23 studies) proved eligible. Moderate-quality evidence suggested that participants who received sealants had a reduced risk of developing carious lesions in occlusal surfaces of permanent molars compared with those who did not receive sealants (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.08-0.27) after 7 or more years of follow-up. When the authors compared studies whose investigators had compared sealants with fluoride varnishes, they found that sealants reduced the incidence of carious lesions after 7 or more years of follow-up (OR, 0.19; 95% CI, 0.07-0.51); however, this finding was supported by low-quality evidence. On the basis of the evidence, the authors could not provide a hierarchy of effectiveness among the studies whose investigators had conducted head-to-head comparisons. The investigators of 2 trials provided information about adverse events, but they did not report any adverse events. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Available evidence suggests that sealants are effective and safe to prevent or arrest the progression of noncavitated carious lesions compared with a control without sealants or fluoride varnishes. Further research is needed to provide information about the relative merits of the different types of sealant materials.

Sealants for preventing and arresting pit-and-fissure occlusal caries in primary and permanent molars: A systematic review of randomized controlled trials-a report of the American Dental Association and the American Academy of Pediatric Dentistry.

BACKGROUND: National Health and Nutrition Examination Survey 2011-2012 data indicated that, in the United States, nearly one-fourth of children and over one-half of adolescents experienced dental caries in their permanent teeth. The purpose of this review was to summarize the available clinical evidence regarding the effect of dental sealants for the prevention and management of pit-and-fissure occlusal carious lesions in primary and permanent molars, compared with a control without sealants, with fluoride varnishes, or with other head-to head comparisons. TYPE OF STUDIES REVIEWED: The authors included parallel and split-mouth randomized controlled trials that included at least 2 years of follow-up, which they identified using MEDLINE (via PubMed), Embase, LILACS, the Cochrane Central Register of Controlled Trials, and registers of ongoing trials. Pairs of reviewers independently conducted the selection of studies, data extraction, risk of bias assessments, and quality of the evidence assessments by using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Of 2,869 records screened, the authors determined that 24 articles (representing 23 studies) proved eligible. Moderate-quality evidence suggested that participants who received sealants had a reduced risk of developing carious lesions in occlusal surfaces of permanent molars compared with those who did not receive sealants (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.08-0.27) after 7 or more years of follow-up. When the authors compared studies whose investigators had compared sealants with fluoride varnishes, they found that sealants reduced the incidence of carious lesions after 7 or more years of follow-up (OR, 0.19; 95% CI, 0.07-0.51); however, this finding was supported by low-quality evidence. On the basis of the evidence, the authors could not provide a hierarchy of effectiveness among the studies whose investigators had conducted head-to-head comparisons. The investigators of 2 trials provided information about adverse events, but they did not report any adverse events. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Available evidence suggests that sealants are effective and safe to prevent or arrest the progression of noncavitated carious lesions compared with a control without sealants or fluoride varnishes. Further research is needed to provide information about the relative merits of the different types of sealant materials.