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.

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.

BACKGROUND: This article presents evidence-based clinical recommendations for the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars in children and adolescents. A guideline panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Pediatric Dentistry conducted a systematic review and formulated recommendations to address clinical questions in relation to the efficacy, retention, and potential side effects of sealants to prevent dental caries; their efficacy compared with fluoride varnishes; and a head-to-head comparison of the different types of sealant material used to prevent caries on pits and fissures of occlusal surfaces. TYPES OF STUDIES REVIEWED: This is an update of the ADA 2008 recommendations on the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars. The authors conducted a systematic search in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other sources to identify randomized controlled trials reporting on the effect of sealants (available on the US market) when applied to the occlusal surfaces of primary and permanent molars. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the quality of the evidence and to move from the evidence to the decisions. RESULTS: The guideline panel formulated 3 main recommendations. They concluded that sealants are effective in preventing and arresting pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes. They also concluded that sealants could minimize the progression of noncavitated occlusal carious lesions (also referred to as initial lesions) that receive a sealant. Finally, based on the available limited evidence, the panel was unable to provide specific recommendations on the relative merits of 1 type of sealant material over the others. CONCLUSIONS AND PRACTICAL IMPLICATIONS: These recommendations are designed to inform practitioners during the clinical decision-making process in relation to the prevention of occlusal carious lesions in children and adolescents. Clinicians are encouraged to discuss the information in this guideline with patients or the parents of patients. The authors recommend that clinicians reorient their efforts toward increasing the use of sealants on the occlusal surfaces of primary and permanent molars in children and adolescents.

Ohio dentists' awareness and incorporation of the dental home concept.

BACKGROUND: The authors measured the awareness of the dental home concept among pediatric dentists (PDs) and general practice dentists (GPs) in Ohio and determined whether they included dental home characteristics for children 5 years and younger into their practices. METHODS: The authors sent a pretested 20-question survey to all Ohio PDs and to a random sample of approximately 20 percent of GPs in Ohio. The authors designed the survey to elicit information about dental home awareness and the extent to which dental home characteristics were incorporated into dental practices. RESULTS: More than 90 percent of both GPs and PDs incorporated or intended to incorporate into their dental practices the specific dental home characteristics mentioned in 20 of 41 items related to dental home characteristics. Of the respondents who did not already incorporate dental home characteristics into their practices, however, most did not intend to do so. Less than 50 percent of respondents in both groups responded positively to some items in the culturally effective group, and GPs were less likely than were PDs to provide a range of behavior management services and to provide treatment for patients with complex medical and dental treatment needs. PDs were more likely than were GPs to accept Ohio Medicaid (64 versus 33 percent). PDs were more likely than were GPs (78 versus 18 percent) to be familiar with the term "dental home." More recent dental school graduates were more familiar with the term. CONCLUSIONS: Most Ohio PDs' and GPs' practices included characteristics found in the definition of dental home, despite a general lack of concept awareness on the part of GPs. Research is needed to provide an evidence base for the dental home. Practical Implications. Once an evidence base is developed for the important aspects of the dental home and the definition is revised, efforts should be made to incorporate these aspects more broadly into dental practice.

Body mass index measurement in schools: partnering with oral health.

OBJECTIVES: The purpose of this review was to examine methodological similarities and differences in states that have implemented joint school-based oral health/body mass index (BMI) surveillance. METHODS: Individuals in states with joint oral health/BMI surveillance were interviewed by e-mail and phone on the following: how the collaboration came about, survey methodology, rewards for participation, BMI data collection methods, data forms, BMI results, how BMI data were utilized, lessons learned, and challenges. RESULTS: Nine states were represented in this review (Colorado, Georgia, Illinois, Maine, New Hampshire, North Dakota, Ohio, Wisconsin, and Wyoming). All states collected surveillance data among third-grade children through selecting a random, stratified sample of elementary schools. These states also used state-specific BMI protocols, including use of standardized, calibrated equipment to measure height/weight. Many states also used local support to implement the surveillance program and used external sources for statistical support. Differences among these states included types of rewards used, mode of consent, and parties involved in the collaboration. The most common uses of the BMI data include: assessing the magnitude of the problem, informing programs, allocation of resources, identification of priority areas for prevention research, support for grant applications, and program evaluation. CONCLUSIONS: Although there are some minor differences among states that have implemented joint school-based oral health/BMI surveillance, there are overarching similarities such as survey design and standardization of BMI measures. States considering implementing BMI surveillance efforts can use this review as a starting point to consider attributes such as program effectiveness and methods to improve or enhance surveillance systems already in place.

Do school-based dental sealant programs reach higher risk children?

OBJECTIVES: This report compares sealant prevalence by caries risk status among third graders at Ohio schools with and without school-based dental sealant programs (S-BSPs), and estimates the percent of children receiving sealants in S-BSPs who are higher risk for dental caries. METHODS: We analyzed data from a statewide open-mouth oral health survey of Ohio third grade schoolchildren for sealant prevalence by S-BSP availability and caries risk classification. Children were classified as higher or lower risk for dental caries based on school lunch program enrollment and other non-clinical access-related indicators. Differences between groups were evaluated by the chi-square test (P < 0.05). RESULTS: At schools with no S-BSPs, higher risk children were less likely to have dental sealants than lower risk children (28.7 percent versus 42.7 percent, P < 0.001). At schools with S-BSPs, sealant prevalence for both risk categories was equivalent for higher and lower risk children (59.4 percent, 63.4 percent, P = 0.428). Higher risk children at schools with S-BSPs were more than twice as likely to have a sealant as higher risk children at non-S-BSP schools (59.4 percent versus 28.7 percent, P < 0.001). Of higher risk children with at least one sealant, 61 percent attended a school with an S-BSP compared with 12.3 percent of lower risk children with at least one sealant. Higher risk children accounted for at least 75 percent of children receiving sealants through S-BSPs. CONCLUSIONS: In Ohio, targeting S-BSPs by family income-based school-level criteria was effective in reaching higher risk children.

Targeting school-based dental sealant programs: who is at "higher risk"?

OBJECTIVES: To assess the effect of various school-level Free and Reduced Price Meal Program (FRPMP) enrollment-based risk thresholds on the ability of school-based sealant programs (S-BSPs) to reach higher risk children. METHODS: We used data from a statewide third grade oral health survey to compare: a) prevalence of dental caries for higher-risk children, using three different sets of child risk criteria based on social determinants; and b) dental caries and other access-related indicators for children at higher-risk schools based on four FRPMP-based thresholds (> or = 60 percent of children FRPMP-enrolled, > or = 50 percent, > or = 40 percent, > or = 30 percent). In addition, we used school enrollment and FRPMP enrollment data to compare the percentages of eligible schools and of higher-risk children resulting from the various thresholds. RESULTS: The prevalence of caries experiences and untreated caries were not significantly different for higher risk children categorized by the respective child caries risk criteria. Regardless of school-level risk threshold, children at higher risk schools were more likely to have caries experience, untreated caries, and no recent dental visit and less likely to have private dental insurance than children at lower risk schools. For these measures, children at higher risk schools were similar to each other regardless of risk threshold and were similar to higher risk children at all schools. The number of additional higher risk children per additional higher risk school showed a large decline between the 40-49 percent and 30-39 percent FRPMP enrollment tiers. CONCLUSIONS: Targeting higher risk schools to reach higher risk children is a practical and effective approach for increasing sealant prevalence through S-BSPs.

Validation of a method for collecting annual, population-based oral health data for the MCH Title V Block Grant.

OBJECTIVES: This study sought to determine whether estimates of oral health-related indicators generated using a relatively small purposive sample of schools were reasonable. METHODS: We collected and analyzed data from two open-mouth school oral health surveys conducted in Ohio in 2004-2005. In each survey, data were gathered for nine indicators using direct observation and a questionnaire. The first survey used unweighted data from 23 sentinel schools purposively selected to represent the state based on the findings of a large 1998-1999 oral health survey (337 schools). The second survey used weighted data aggregated from 374 schools randomly selected to represent each of Ohio's 88 counties. The point estimates from the first data set were compared with 95% confidence intervals (CIs) from the second and Chi-square measures were estimated to determine statistically significant differences. RESULTS: For six of nine indicators, point estimates for the sentinel schools fell within the relatively narrow 95% CIs generated for the 374 schools sampled at the county level. Only one indicator (history of tooth decay) was found to be significantly different according to Chi-square analysis. CONCLUSIONS: Ohio's sentinel schools approach provided reasonable estimates suitable for annual reporting as required for the Title V Maternal and Child Health Block Grant. Data collected in this manner are likely to be reasonable population estimates and less costly than larger surveys.

Ohio dental care providers' treatment of young children, 2002.

BACKGROUND: Adequate access to dental care for young children--particularly those from low-income families--is a public concern. The authors conducted a survey of Ohio dental care providers to examine factors influencing their willingness to care for these children. METHODS: Random samples of Ohio general practitioner (GPs) dentists and pediatric dentists (PDs) and all Ohio safety-net dental clinics completed a mail survey regarding treatment of children aged 0 through 5 years. The authors categorized responses by provider type and further analyzed GPs' responses by years since graduation and geographic character. RESULTS: Few Ohio GPs (8 percent) recommended a first dental visit by 1 year of age. While 91 percent of GPs treated children aged 3 through 5 years, only 34 percent treated children aged 0 through 2 years, most often for emergency visits or examinations. Only 7 percent of all GPs and 29 percent of PDs accepted patients enrolled in Medicaid without limitations. CONCLUSIONS: Children's being young (0-2 years of age) and having Medicaid as a payment source made GPs substantially less likely to treat them. Children's being enrolled in Head Start made GPs somewhat more likely to treat them. PRACTICE IMPLICATIONS: New strategies for ensuring dental care access for young children from low-income families are necessary. Such strategies may take the form of interpeer advocacy, education, practice incentives or creation of coordinated GP and PD teams.

Parent or caregiver, staff, and dentist perspectives on access to dental care issues for head start children in Ohio.

OBJECTIVES: We conducted 5 surveys on consumer and provider perspectives on access to dental care for Ohio Head Start children to assess the need and appropriate strategies for action. METHODS: We collected information from Head Start children (open-mouth screenings), their parents or caregivers (questionnaire and telephone interviews), Head Start staff (interviews), and dentists (questionnaire). Geocoded addresses were also analyzed. RESULTS: Twenty-eight percent of Head Start children had at least 1 decayed tooth. For the 11% of parents whose children could not get desired dental care, cost of care or lack of insurance (34%) and dental office factors (20%) were primary factors. Only 7% of general dentists and 29% of pediatric dentists reported accepting children aged 0 through 5 years of age as Medicaid recipients without limitation. Head Start staff and dentists felt that poor appointment attendance negatively affected children's receiving care, but parents/caregivers said finding accessible dentists was the major problem. CONCLUSIONS: Many Ohio Head Start children do not receive dental care. Medicaid and patient age were primary dental office limitations that are partly offset by the role Head Start plays in ensuring dental care. Dentists, Head Start staff, and parents/caregivers have different perspectives on the problem of access to dental care.

Oral health status and access to dental care for ohio head start children.

PURPOSE: The purpose of this survey were to assess the dental caries prevalence rate among children enrolled in Ohio's Head Start programs and assess factors relating to their dental care access. METHODS: Oral screenings were conducted on 2,555 children, ages 3 through 5 years, at 50 Ohio Head Start centers using probability-proportional-to-size sampling. In addition, parental responses to 6 access-oriented questions on the consent form were analyzed. RESULTS: Overall, 38% of 3- to 5-year-old Head Start children screened had experienced dental caries, and 28% had at least 1 untreated decayed tooth. Of the children with caries experience, 73% had decayed teeth, while the remaining 27% had restorations only. Among children, there were no statistically significant differences associated with race or payment method. With regard to dental care access, 11% of Head Start parents reported they could not get wanted dental care for their children during the previous 12 months, most often due to cost of care/lack of insurance. Nine percent of children had a toothache in the previous 6 months. Although 85% of Head Start children had visited a dentist in the previous 12 months, another 10% had never visited a dentist. CONCLUSIONS: The significant prevalence rate of dental caries among Ohio Head Start children is consistent with other states' reports. Although almost 9 of 10 children visited a dentist during the year, three fourths of children with dental caries did not have their care completed by the time they were screened during the second half of the school year. Oral health disparities according to race and payment source were not found among Ohio Head Start children.

Statistical model for assessing the impact of targeted, school-based dental sealant programs on sealant prevalence among third graders in Ohio.

OBJECTIVES: Since Ohio school-based dental sealant programs target economically disadvantaged groups, simple comparison of sealant prevalence between schools with sealant programs and those without is problematic due to underlying disparities between the two in sealant prevalence. The goal of our analysis was to estimate the impact of sealant programs on sealant prevalence among third graders in Ohio by applying a statistical model to data from a 1998-99 Ohio oral health screening survey of schoolchildren to control for differences in background characteristics. METHODS: Included in the analysis were 9,747 third graders at randomly selected schools in Ohio. Chi-square statistics and survey logistic regression were used to analyze the association of sealant presence with school sealant program participation, dental care payment method, sex, race, and school lunch program eligibility. RESULTS: The unadjusted odds ratio for dental sealant presence was 3.4 (95% confidence interval [CI]=2.6, 4.4; P<.01). Adjusting for race and income, the odds of having dental sealants among children in schools with dental sealant programs increased to 4.8 (95% CI=3.5, 6.5; P<.01). CONCLUSIONS: Not controlling for confounders can result in underestimation of the impact of targeted school sealant programs.