[Influence of Fissure Sealants on Dental Health of Elementary School Children in Weimar - A Longitudinal Observational Study under Real-life Conditions]. / Einfluss der Fissurenversiegelung auf die Zahngesundheit von Weimarer Grundschülern ­ Eine longitudinale Beobachtungsstudie unter Alltagsbedingungen.

The aim of the present observational study was to assess the effect of the number and timing of placing fissure sealants (FS) on caries prevalence in elementary school children under real-life conditions. Methods: Oral health data from 7- to 10-year-old elementary school children (n=505) attending 4 consecutive annual checkups between 2004 and 2009 was extracted from the public health service database. The number of intact FS and the number of teeth affected by caries was scored according to WHO standard (1997). Results: 34.9% pupils had at least one, 10% 4 FS. Children without FS had a higher dental caries rate compared to peers with FS (0.2 DT/0.4 DMFT vs. 0.1 DT/0.2 DMFT). Pupils with 4 FS showed the lowest number of teeth with caries (0 DT/0 DMFT). Children with an early application of FS had a lower D-component than children with a later or missing application (0.1 DT vs. 0.2 DT). Pupils with less than 4 FS had a higher risk of developing caries in their permanent dentition compared to peers with 4 FS (OR 4.36). Conclusion: FS is an effective caries preventive measure under real-life conditions. Early application and sealing of all 4 molars can optimize the prevention of caries in the permanent dentition.

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.

Remineralization Capacity of Three Fissure Sealants with and without Gaseous Ozone on Non-Cavitated Incipient Pit and Fissure Caries.

OBJECTIVE: The purpose of this study was to investigate the remineralization activation of the application of three fissure sealants (FSs), alone or with gaseous ozone (GO), on non-cavitated initial caries and evaluate the clinical success of FS. STUDY DESIGN: Sixty children who had DIAGNOdent scores between 10-30 on bilateral symmetric mandibular first permanent molars were included in study. In a split-mouth design, teeth were assigned to experimental (with GO) and control (without GO) groups. GO was applied to teeth on one side and then the same brand of randomly selected FSs was applied to the teeth on both sides. Children were divided into 3 groups based on type of FS (Group 1: Aegis {Bosworth Co, North Hamlin Avenue Skokie, Illinois, USA}, Group 2: Fuji Triage {GC, Tokyo, Japan}, Group 3: Helioseal {Ivoclar Vivadent, Liechtenstein, Germany}). All FSs were then examined for retention rates at 1, 3, 6, 9, and 12 months; at the end of 12 months, all FSs were removed with an air-abrasion device and DIAGNOdent scores noted to compare with the initial values. RESULTS: The application of GO with either Fuji Triage or Aegis FS was effective on remineralization (p<0.05); however, the application of Helioseal FSs was not effective (p>0.05). The 1(st) and 12(th) months' full retention rates of Fuji Triage FSs was a significant difference (p<0.05) from other FSs (Aegis and Helioseal) (p>0.05). CONCLUSIONS: GO+Aegis FS showed the highest remineralization; and, at the end of 12 months, its clinical success was higher than other FSs.

Resin infiltration of fissure caries with various techniques of pretreatment in vitro.

The resin infiltration technique might be used for occlusal caries lesions in order to arrest their progression. This in vitro study evaluated the influence of various modifications of the infiltration technique on the penetration abilities of the infiltrant into occlusal lesions. Extracted human molars and premolars (n = 140) with non-cavitated white spot lesions were randomly allocated to 7 groups. As control, specimens were etched with 15% hydrochloric acid (HCl) gel for 120 s and resin infiltrated for 180 s (Icon; DMG). As modification HCl gel reduced in surface tension and viscosity with and without abrasives was applied using 3 different types of brushes either to oscillate or rub the HCl gel onto the enamel surface. The median maximum lesion depth was 1,232 µm (interquartile range 882-1,513). Compared with the control procedure [23% (16/50)] a higher percentage penetration was observed if the HCl gel was mixed with a small amount of abrasives were rubbed into the fissures using a modified brush with stiff bristles that were adjusted to the fissure relief for either 120 s [100% (64/100)] or 30 s [98% (61/100); p < 0.05; Mann-Whitney test]. All other experimental treatments resulted in penetration results in-between. It can be concluded that the use of an abrasive HCl gel in conjunction with a modified brush mostly enhances resin infiltration into fissure caries lesions.

The minimally invasive management of early occlusal caries: a practical guide.

Pits and fissures on the occlusal surfaces of posterior teeth are sites affected commonly by demineralisation caused by the caries process. Clinicians face daily challenges in detecting these lesions, accurately diagnosing their activity and choosing from a range of management options. Traditionally, the detection of an active (or potentially active) occlusal lesion invariably resulted in the preparation of a standardised occlusal cavity, often extending beyond the confines of diseased tissue, followed by the insertion of a direct restorative material, most commonly dental amalgam. The overwhelming weight of contemporary evidence now favours minimally invasive (MI) operative management when required (usually after non-operative prevention has failed), and a wide range of equipment, materials and operative techniques is available to help operators to preserve the maximum amount of healthy/repairable tooth tissue and to allow restoration with more biologically respectful, tooth-preserving materials. This paper aims to provide clinicians with practical guidance in the prevention, early detection, predictable diagnosis and minimally invasive management of early occlusal carious lesions.

Glass ionomer ART sealant and fluoride-releasing resin sealant in fissure caries prevention--results from a randomized clinical trial.

BACKGROUND: The relative performance of ART sealant and fluoride-releasing resin sealant in preventing fissure caries in permanent molars was compared in a randomized clinical trial conducted in southern China (ClinicalTrials.gov NCT01829334). METHODS: After obtaining ethical approval, healthy schoolchildren who had permanent first molars with occlusal fissures which were sound but deep or presented with only incipient caries were recruited for the study. Included molars were randomly allocated into one of four parallel study groups in units of left/right teeth per mouth. Two of the four groups adopted the methods of ART or fluoride-releasing resin sealant placement while the other two groups adopted the topical fluoride application methods. Fissure status of the molars in each group was evaluated every 6 months. Development of dentine caries and sealant retention over 24 months in the molars in the two sealant-using groups was compared in this report. Outcome on cost-effectiveness of all four groups over 36 months will be reported elsewhere. RESULTS: At baseline, a total of 280 children (383 molars) with mean age 7.8 years were involved for the two sealant groups. After 24 months, 261 children (357 molars) were followed. Proportions of molars with dentine caries were 7.3% and 3.9% in the ART sealant and fluoride-releasing resin sealant groups, respectively (chi-square test, p = 0.171). Life-table survival analysis showed that sealant retention (full and partial) rate over 24 months for the resin sealant (73%) was significantly higher than that (50%) for the ART sealant (p < 0.001). Molar survival (no development of dentine caries) rates in the ART sealant (93%) and fluoride-releasing resin sealant (96%) groups were not significantly different (p = 0.169). Multilevel logistic regression (GEE modeling) accounting for the effects of data clustering and confounding factors confirmed this finding. CONCLUSIONS: Though the retention of fluoride-releasing resin sealant was better than that of the ART sealant, their effectiveness in preventing fissure caries in permanent molars did not differ significantly over 24 months. ART sealants could be a good alternative when and where resources for resin sealant placement are not readily available.

Clinical comparison of a flowable composite and fissure sealant: a 24-month split-mouth, randomized, and controlled study.

OBJECTIVES: The aim of this clinical study was to evaluate the retention rate and caries-prevention effect of a flowable composite compared to a conventional resin-based sealant in a young population over a 24-month period. METHODS: Thirty-four patients, ranging in age from 16 to 22 years, diagnosed with at least 2 non-cavitated pit-and-fissure caries in the first and second molars were selected for this randomized split-mouth design trial. A total of 220 sealants, were placed in 117 upper molars and 103 lower molars. The teeth were sealed with a flowable resin composite (Tetric Evo Flow) or a sealant material (Helioseal F). Each restoration was independently evaluated in terms of retention and the presence of caries at baseline and at 1, 6, 12, and 24 months. Data were analyzed using non-parametric Mann-Whitney U and Friedman 1-way ANOVA tests at p<0.05. RESULTS: Tetric Evo Flow showed complete retention with 100%, 95.5%, 93.8%, and 88.5% at 1, 6, 12, and 24-month evaluations, respectively, while Helioseal F retention rates were 98.1%, 95.5%, 94.8%, and 85.4%, respectively, for the same evaluation periods. At the 24-month recall, 4 (4.2%) total losses were observed in subjects treated with Tetric Evo Flow and 2 total losses (2.1%) for Helioseal F, respectively. No significant differences were observed between the materials in retention rates or caries incidence for each evaluation period (p>0.05). CONCLUSION: Placement of flowable composite as fissure sealants in the younger population seems to be as effective as conventional fluoride containing fissure sealants for the prevention of fissure caries. CLINICAL RELEVANCE: The use of a flowable composite as a fissure sealant material, in conjunction with a total-etch, single bottle adhesive, yielded better retention than did the conventional fluoride containing resin-based fissure sealant over a 24-month period in young patients.

Efficacy of a moisture-tolerant material for fissure sealing: a prospective randomised clinical trial.

OBJECTIVES: Fissure sealings offer nearly complete protection against fissure caries, provided that they are adequately applied, for composite-based sealants with sufficient moisture control. This is not always attainable, particularly in children with low compliance. To counter this problem, a moisture-tolerant sealant has been developed. The present randomised clinical trial compared such a moisture-tolerant material (Embrace) with a conventional sealant (Helioseal). MATERIAL AND METHODS: In 55 participants (mean age, 10 ± 3 years), corresponding molar pairs were sealed with either Embrace or Helioseal. Retention, quality of sealing, and caries were clinically examined, both tactilely and visually, immediately and after 1 year. RESULTS: After 1 year, 93% of Helioseal sealings were complete, whereas 60% of Embrace sealings showed partial and 13% complete loss. The surface quality of Embrace was significantly worse than that of Helioseal. After the use of Embrace, the sealant margin was noticeable as a slight (distinct) step in 36% (15%). The visual (tactile) examination showed a rough surface in 78% (33%) in the case of Embrace. The Helioseal surfaces were shiny (smooth) in all cases (all differences between Helioseal and Embrace, p ≤ 0.001). Caries was found only after the use of Embrace (4%, n.s. compared to Helioseal). CONCLUSION: The moisture-tolerant material Embrace was distinctly inferior to Helioseal because Embrace showed weaknesses in retention and surface quality. CLINICAL RELEVANCE: Even if a moisture-tolerant sealant would be desirable in particular for children with low compliance, the tested material does not represent an alternative to the standard preparation.

Surface-specific efficacy of fluoride varnish in caries prevention in the primary dentition: results of a community randomized clinical trial.

OBJECTIVES: Fluoride varnish (FV) is efficacious in caries prevention although its effects among different tooth surfaces are poorly understood. This study sought to determine the extent to which caries-preventive effects of a community intervention that included FV application among preschool-aged children varied according to primary tooth anatomy and baseline tooth pathology. METHODS: Secondary analysis was undertaken of data from a community-randomized controlled trial among 543 3- to 5-year-old Aboriginal children in 30 Northern Territory Australian communities. Children in intervention communities received community health promotion and FV application once every 6 months. Net caries (d(3)mfs) risk and 95% confidence limits (CL) were estimated for the control and intervention arms, and stratified according to tooth anatomy/location and baseline pathology (sound, enamel opacity, hypoplastic defect or precavitated carious lesion). The intervention's efficacy was quantified using generalized estimating equation modeling accounting for study design and clustering. The assumption of efficacy homogeneity was tested using a Wald χ(2) test with a p < 0.2 criterion and post hoc pairwise comparisons. RESULTS: The intervention resulted in a 25% reduction (relative risk, RR = 0.75; 95% CL = 0.71, 0.80) in the 2-year surface-level caries risk. There was substantial heterogeneity in FV efficacy by baseline surface pathology: RRs were 0.73 for sound, 0.77 for opaque, 0.90 for precavitated, and 0.92 for hypoplastic surfaces. Among sound surfaces, maxillary anterior facials received significantly more benefit (RR = 0.62) compared to pits and fissures (RR = 0.78). CONCLUSION: The intervention had greatest efficacy on surfaces that were sound at baseline. Among those sound surfaces, maxillary anterior facials received most caries-preventive benefit.

Randomized trial on fluorides and sealants for fissure caries prevention.

To investigate the effectiveness of topical fluorides in preventing fissure caries, we conducted a randomized controlled trial with parallel groups. In total, 501 children (1,539 molars, 3,078 sites), mean age 9.1 years, who had at least one sound permanent first molar with deep fissures or fissures with signs of early caries were recruited. They were randomly allocated among four groups: (1) resin sealant, single placement; (2) 5% NaF varnish, semi-annual application; (3) 38% silver diamine fluoride (SDF) solution, annual application; and (4) placebo control. Follow-up examinations were conducted every 6 months by a masked examiner. After 24 months, 485 children (97%) were examined. Proportions of pit/fissure sites with dentin caries in the sealant, NaF, SDF, and control groups were 1.6%, 2.4%, 2.2%, and 4.6%, respectively. A multi-level logistic regression analysis accounting for the effects of data clustering and confounding factors showed that fissures in any of the three treatment groups had significantly lower risks of carious cavity development into dentin than did controls (p < 0.05). We concluded that placement of resin sealant, semi-annual application of NaF varnish, and annual application of SDF solution are all effective in preventing pit and fissure caries in permanent molars (ClinicalTrials.gov number CT01446107).

The success rates of a glass ionomer cement and a resin-based fissure sealant placed by fifth-year undergraduate dental students.

AIM: To evaluate retention and caries prevention of a glass-ionomer cement (GIC) and a resin-based fissure sealant placed by fifth-year undergraduate dental students. METHODS: The study was conducted according to a split-mouth, randomised clinical trial. Children with at least one pair of caries-free permanent first molars with deep pits and fissures were included in the study. The children were selected from a population that had a high risk for dental caries. Sealant materials were applied by fifth-year undergraduate dental students on 346 fissures of the first permanent molars in 173 children. The ages of the children ranged from 7-15 years (mean 9.4). Two researchers at the clinics supervised all of the procedures. Intra-examiner reproducibility and inter-examiner reproducibility were 0.90 and 0.86, respectively, for the clinical assessment of sealant retention and caries evaluation. RESULTS: GIC sealants were completely lost in 31.9% and resin-based sealants in 16.6% (p<0.05). The total retention rates of GIC sealants and resin-based sealants were 13.8% and 20.8%, respectively. After 24 months, the caries increment was 3.4% for GIC sealants and 4.8% for resin-based sealants (p>0.05). CONCLUSIONS: The retention of GIC sealants was markedly inferior to the retention of resin-based sealants; however, GIC when used as a pit and fissure sealant was slightly more effective in preventing occlusal caries.

Caries-preventive effect of sealants produced with altered glass-ionomer materials, after 2 years.

OBJECTIVES: The aim of the present study was to investigate the caries-preventive effect of sealants produced with a high-viscosity glass-ionomer with an elevated powder-liquid ratio (ART), of having energy added to this glass-ionomer, and that of glass-carbomer, in comparison to that of resin composite sealants. METHODS: The randomized controlled trial covered 407 children, with a mean age of 8 years. At a school compound three dentists placed sealants in pits and fissures of high caries-risk children. Evaluation by two independent evaluators was conducted after 0.5, 1 and 2 years. The Kaplan-Meier survival method, ANOVA and t-test were used in analyzing the data. RESULTS: 1352 first permanent molars were sealed. 6.6% of children and 6.8% of sealants dropped out within 2 years. 27 re-exposed pits and fissures, 20 in occlusal and 7 in smooth surfaces, in 25 children, developed a dentin carious lesion. The cumulative survival of dentin carious lesion-free pits and fissures in the glass-carbomer sealant group was statistically significantly lower (97.4%) than those in the high-viscosity glass-ionomer with energy supplied (99%) and the resin-composite (98.9%) sealant groups. There was no statistically significant difference in the cumulative survival of dentin carious lesion-free pits and fissures, between the high-viscosity glass-ionomer with (99%) and without (98.3%) energy supplied sealant groups, after 2 years. SIGNIFICANCE: The survival of dentin carious lesion-free pits and fissures was high in all sealant types. More dentin carious lesions were observed in the glass-carbomer sealant group.

Effect of fluoride gels on occlusal fissures in primary molars: an in vitro study.

AIM: To assess the effect of the application of fluoride gels on the acid resistance of occlusal enamel in primary molars. STUDY DESIGN: Forty-five primary second molars were randomly assigned to three groups: a) control (pH-cycling); b) 2% NaF gel/pH-cycling; and c) 1.23% APF gel/pH-cycling. METHODS: Specimens were longitudinally sectioned in the buccal-lingual direction and used for cross-sectional microhardness testing. Knoop hardness values were converted into vol.% mineral and mineral loss (ΔZ) was then calculated. STATISTICS: The response variables were vol.% mineral and ΔZ. Data were tested using parametric tests at a significance level of 5%. RESULTS: No statistically significant differences were found between groups regarding vol.% mineral or ΔZ. CONCLUSIONS: A single application of a high concentration fluoride compound does not promote greater resistance to demineralisation in enamel pits and fissures, regardless of the product used.

Sealants and dental caries: dentists' perspectives on evidence-based recommendations.

BACKGROUND: The authors conducted a study to survey the perspectives of dentists regarding the 2010 American Dental Association (ADA) recommendation to seal non-cavitated carious lesions (NCCLs) in children and young adults. METHODS: The authors mailed a questionnaire to a randomly selected sample of 2,400 general dentists (GDs) and pediatric dentists (PDs) in the United States. The sample was chosen by the ADA's Survey Center. The questionnaire included two photographs of NCCLs (permanent first molar and premolar) in a 12-year-old child. Respondents were provided with radiographic findings and asked to choose from several management options. RESULTS: In the absence of radiographic evidence of caries, 37.4 percent and 42.3 percent of GDs and PDs, respectively, indicated that they would seal the NCCL in the molar. For the premolar, a significantly lower percentage of GDs than of PDs indicated that they would seal the NCCL. With radiographic evidence of caries in dentin, less than 4 percent of all dentists surveyed indicated that they would seal the NCCLs, and more than 90 percent indicated that they would remove the caries and place restorations. Less than 40 percent of dentists indicated that they sealed NCCLs in their practice. CONCLUSIONS: The U.S. dentists surveyed have not adopted evidence-based clinical recommendations regarding the sealing of NCCLs. Practice Implications. New educational and dissemination programs should be developed regarding these evidence-based caries management approaches.

Microleakage and SEM analysis of flowable resin used as a sealant following three fissure preparation techniques--an in vitro study.

OBJECTIVE: Preventive procedures using pit and fissure sealants are one of the important aspects of pediatric dental practice. The objectives of this in vitro study were to comparatively evaluate microleakage and resin tag penetration of a flowable resin used as a sealant on molars after preparation with Conventional, Enameloplasty and Fissurotomy techniques. METHOD: A total of 48 teeth were divided into 3 groups (n-16). Group A (CST), Group B (EST), and Group C (FT). Following the fissure preparation sealant was applied as per manufacturer's instructions. 8 samples in each group were used for Microleakage and Resin tag analysis. Microleakage analysis was done under Stereomicroscope after Methylene blue dye immersion by using scoring system. The resin tag analysis was done by measuring the length of resin tags on scanning electron microscope (SEM) images consisting of 10 microm scale taken under optical zoom of 2000 X. RESULTS: Significantly lesser microleakage score (P < 0.01) and longer resin tag penetration (P < 0.001) observed in EST (mean score 0.5 +/- 0.53) & (12.19 +/- 1.93 microm) when compared to CST (mean score 1.75 +/- 0.89) & (5.96 +/- 1.84 microm) and FT (mean score 1.5 +/- 0.53) & (6.76 +/- 1.82 microm) which showed more microleakage and short resin tags. No statistical significance between CST and FT was found. CONCLUSION: EST has proven to be an excellent method for preparation of pits and fissures when Flowable composite is used as a sealant because of its lesser microleakage and longer resin tag penetration.

A review of the clinical application and performance of pit and fissure sealants.

Thorough reviews of pit and fissure sealant are available in the literature. It is the intent of this paper to focus on the clinical aspects of pit and fissure sealant application and the most recent publications that support an evidence-based clinical application technique. Pit and fissure sealants were introduced in 1971 based on the pioneering studies of Buonocore. Additional work initiated by Handelman in 1972 looked specifically at what happens to the bacteria trapped underneath a sealant. Concerns that such entrapment could lead to propagation, or continued development, of caries under a well-sealed area, were mitigated by this and many other succeeding studies. It remains clear that the application of pit and fissure sealant to newly-erupted posterior (and occasionally, anterior) teeth is the best method we have in dentistry to prevent pit and fissure caries, and/or to prevent the continued development of incipient caries into frank caries when the incipient lesion is sealed over with resin.

Comparative evaluation of the effects of an alum-containing mouthrinse and a saturated saline rinse on the salivary levels of Streptococcus mutans.

BACKGROUND: The literature is replete with studies establishing Streptococcus mutans as a major player in the formation of pit and fissure caries in all dentitions. Salivary bacterial levels in turn are related to the number of colonized surfaces. Therefore, decreasing the salivary levels of S. mutans would have a great benefit in decreasing the incidence of dental diseases. AIMS: Keeping in mind the potential antimicrobial effects of saturated saline and alum solutions, the present study was attempted to compare and evaluate the effects of saturated saline rinse and 0.02 M alum mouthrinse on salivary S. mutans levels in children. MATERIALS AND METHODS: The investigation was a double-blind, stratified comparison of three parallel groups of children who used either saturated saline rinse, 0.02 M alum mouthrinse or distilled water (placebo) rinse twice daily under professional supervision for a 21-day period. A total of three saliva samples were taken from each individual - at baseline, on the 10 th day and on the 21 st day, and colony counts of S. mutans were determined. All data were subjected to statistical analysis using Wilcoxon's Signed Ranks Sum and Mann-Whitney "U" test. RESULTS AND CONCLUSIONS: Children using saturated saline rinse and alum rinse showed statistically significant reductions in salivary S. mutans counts after 10 days and also after 21 days. After 21 days, the saturated saline rinse and alum rinse groups showed statistically significant differences over the placebo rinse group. Again, the alum rinse group showed a statistically significant difference over the saturated saline rinse group.