European Fissure Sealant Guidelines: assessment using AGREE II.

BACKGROUND: Pit and fissure sealants are effective in reducing the incidence of occlusal caries, and multiple clinical practice guidelines (CPGs) have been developed for recommending their proper use. The usefulness of CPGs depends on their quality and on the rigour of the guideline development process. OBJECTIVE: A study was made to assess the quality of current European CPGs based on the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument, which uses 23 key items rated on a 7-point scale to assess practice guideline development and the quality of reporting. METHODS: A search was conducted for fissure sealant guidelines for preventing caries in children and adults at high and low risk published in the last 10 years. Calibration was carried out before scoring to assess agreement between the appraisers using the AGREE II instrument. RESULTS: The searches identified 19 relevant guidelines, and following application of the inclusion/exclusion criteria, three guidelines were retained for evaluation. The proportion of observed agreement was calculated, expressed by the agreement separately for positive and negative ratings (PA = 0.89, NA = 0-91). The results of the guideline assessments revealed the highest score for the Irish guideline, a moderate score for the French guideline and the lowest score for the European guideline. CONCLUSIONS: Based on the AGREE II instrument, the results obtained show significant variation in the quality assessment of the three European Fissure Sealant Guidelines. Future studies should be carried out both to develop quality dental CPGs and to investigate effective ways of adopting them.

Evidence-based Clinical Practice Guideline for the Use of Pit-and-Fissure Sealants.

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 U.S. 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 non-cavitated 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 re-orient their efforts toward increasing the use of sealants on the occlusal surfaces of primary and permanent molars in children and adolescents.

A randomized controlled trial of cluster audit and feedback on the quality of dental sealant for rural schoolchildren.

THE OBJECTIVE: To examine whether audit and feedback could improve the quality of the application of dental sealant in rural Thai school children. RESEARCH DESIGN: A single blind, cluster randomized controlled trial was conducted. CLINICAL SETTING: Hospital-based and school-based school sealant applied by dental nurses in Southern province of Thailand. PARTICIPANTS: Dental nurses and school children who received dental sealant were involved. INTERVENTION: The intervention consisted of confidential feedback of data and tailor-made problem-solving workshops. MAIN OUTCOME MEASURES: Sealant quality was measured by sealant retention and caries on sealed surfaces at six-month after sealing. The teeth examinations were done among different groups of children prior and after the intervention. RESULTS: After the intervention, the sealant retention rate increased dramatically in the intervention group, whereas in the control group the rate was similar to that found at baseline. The rate of caries after the intervention was stable in the intervention group and increased slightly in the control group. At the beginning of the study, the adjusted odds ratio of complete sealant retention between the intervention and control group was 0.47 which increased to 1.99 at the end of the study. However, no effect on caries on sealed surfaces was observed. CONCLUSIONS: The intensive focus on actual problems during the audit and feedback improved the dental nurses' performance and the quality of the dental service, although it had no statistical impact on the incidence of caries.

Evidence-based Clinical Practice Guideline for the Use of Pit-and-Fissure Sealants.

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 U.S. 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 non-cavitated 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 re-orient their efforts toward increasing the use of sealants on the occlusal surfaces of primary and permanent molars in children and adolescents.

Selamento de lesões de cárie em dentina de molares decíduos: estudo clínico controlado e randomizado / Sealing of carious lesions in dentin of deciduous molars: clinical controlled and randomized study

O objetivo do presente estudo foi avaliar a eficácia da técnica de selamento realizada sobre dentina cariada em molares decíduos. Para isto, um ensaio clínico controlado e randomizado foi desenvolvido. Previamente ao ensaio clínico, um estudo para avaliação de método foi realizado. Buscou-se comparar o risco à cárie em crianças (n=28) de 3 a 9 anos de idade, através dos seguintes instrumentos preditores: Cariogram® com análise microbiológica (níveis salivares de Streptococcus mutans - SM) incluída no modelo; Cariogram® sem SM incluído no modelo; e um formulário baseado no Cariogram® também sem a variável SM. Os resultados demonstraram que não houve diferença entre os métodos de avaliação (p>0,05) e que os níveis salivares de SM não foram necessários para avaliação do risco da criança a desenvolver cárie. Diante desses resultados, os sujeitos foram aleatoriamente alocados em dois grupos: principal (STC) e controle (RPTC), levando-se em conta a classificação de risco (baixo, moderado ou alto) à doença. Assim, uma homogeinização dos grupos, quanto à saúde bucal das crianças, foi alcançada. Buscando-se comparar STC com RPTC, os principais desfechos do ensaio foram o sucesso clínico dos selamentos e das restaurações (através do critério USPHS); bem como a presença ou não de progressão de cárie (análise pareada de radiografias interproximais), avaliados por examinadores externos e cegos, ao longo de 1 ano de acompanhamento. A ansiedade das crianças antes e após cada tratamento e o tempo despendido em cada uma das intervenções representaram desfechos secundários. Os níveis salivares de S. mutans, Lactobacillus spp. Candida spp. e Bifidobacterium spp. das crianças, também foram observados e comparados entre os grupos antes e após os tratamentos. Após 1 ano de acompanhamento, 22 crianças foram avaliadas, totalizando 44 dentes com lesões oclusais (1,5mm de diâmetro) até o 1/3 externo de dentina. Clinicamente não houve diferença entre os grupos em relação às restaurações. Apenas um elemento do STC apresentou progressão da lesão após 1 ano, contudo não houve diferença estatística entre os tratamentos (p=0,529). O nível de ansiedade não sofreu alterações significativas antes e após as duas intervenções (p=0,650). A média de tempo de tratamento do STC (9,03 ± 1,91 min) foi estatisticamente menor (p=0,002) que a média do RPTC (17,13 ± 5,26). Em acréscimo, os níveis salivares de todos os microrganismos avaliados não foram diferentes, entre as crianças dos dois grupos, em cada momento de avaliação. Os resultados demonstraram que a técnica de selamento de cárie até 1/3 externo da dentina pode ser indicada em Odontologia, uma vez que não alterou a ansiedade das crianças, reduziu o tempo de cadeira e apresentou uma taxa de sucesso clínico e radiográfico sem diferença estatística em relação à remoção parcial de tecido cariado seguida da restauração (AU)

The aim of this study was to evaluate the efficacy of the sealing technique performed on carious dentin in primary molars. For this, a controlled, randomized clinical trial was developed. Prior to the trial, a study method was executed. Thus, the risk of caries in children (n = 28) aged 3-9 years old was compared by the using of the following predictors instruments: Cariogram® with microbiological analysis (salivary levels of Streptococcus mutans - SM) included in the model; Cariogram® without SM included in the model; and a form based on Cariogram® also without SM variable. The results showed no difference between the assessment methods (p> 0.05) and the salivary levels of SM were not essential to assess the caries risk of children. Taking these results into account, the subjects were randomly divided into two groups: main (SCT) and control (PRCT), considering the risk classification (low, moderate or high) to the disease. Thus a homogenization of the groups was achieved, regarding the caries risk status of children. Seeking to compare SCT with PRCT, the main outcomes of the trial were the clinical success of sealings and restorations (by USPHS criteria); as well as the presence or absence of caries progression (paired analysis of bitewing radiographs), evaluated by blind independent examiners over 1-year follow-up. The anxiety of children before and after each treatment and the time required for each intervention comprised the secondary outcomes. Salivary levels of S. mutans, Lactobacillus spp., Candida spp. and Bifidobacterium spp. were also observed and compared between the groups before and after the treatments. After 1 year of follow up, 22 patients were evaluated, thus 44 teeth with occlusal lesions (1.5 mm diameter) in the outer half of dentin were analysed. Clinically, there was no difference between the groups regarding restorations. Only one molar from SCT showed lesion progression after 1 year, but there was no statistical difference between the treatments (p = 0.529). The anxiety level did not change significantly after the two interventions (p = 0.650). The average treatment time SCT (9.03 ± 1.91 min) was statistically lower (p = 0.002) than the mean of the PRCT (17.13 ± 5.26). In addition, the salivary levels of all target microorganisms were not different between children included in both groups at each assessment point. The results demonstrated that caries sealing technique performed on the outer half of carious dentin may be used in dentistry since it did not alter the children anxiety, reduced chair time and demosntrated clinical success rate and no radiographic statistical difference in relation to the partial caries removal followed by restoration. (AU)

Clinical safety, quality and effect of resin infiltration for proximal caries.

AIM: Resin infiltration of proximal lesions is a new approach to stop caries progression. The aim of this clinical trial was to assess its safety and quality, as well as the therapeutic effect. MATERIALS AND METHODS: In 47 children, adolescents and young adults, ten dentists applied the infiltration material ICON (DMG, Germany) on initial proximal lesions according to the manufacturer's instruction. One lesion with radiographic extension into enamel or the outer third of dentin per participant was allocated for the treatment. The clinical safety and quality of resin infiltration were assessed 1 week, 6 months and 12 months after the treatment and the evaluation of the therapeutic effect was analysed by pair-wise radiographs. RESULTS: The clinical safety and quality of the infiltration were assessed in 45 individuals after 12 months. The test surfaces showed no relevant changes in clinical status, plaque accumulation or gingival status (p > 0.05). A high quality of infiltration was found for the marginal adaptation. In contrast to the improvement of colour at the one-week recall (p = 0.005), the infiltrated surfaces showed a statistically significant increase in the discoloration within the following year (p = 0.014). Out of the 43 lesions which could be assessed radiographically, only two lesions showed progression to a different score (4.7%). CONCLUSION: Resin infiltration can be considered a safe and effective treatment to reduce progression of initial proximal caries.

Microinfiltração sob diferentes tipos de selantes oclusais / Microleakge under different types of pit and fissure sealants

Foram selecionados quarenta pré-molares, divididos em quatro grupos de acordo com o selante aplicado: G1 - Delton; G2 - Conseal F; G3 - Fluroshield; G4 - Vitro Seal Alpha. Todos os espécimes foram termociclados, parcialmente impermeabilizados e armazenados em corante. Cada amostra foi seccionada longitudinalmente para análise da microinfiltração. Os resultados demonstraram que o selante Delton apresentou valores de microinfiltração significantemente maiores do que aqueles encontrados nos selantes Conseal F, Fluroshield e Vitro Seal Alpha (teste de Kruskal-Wallis, p>0.065). Concluiu-se que os selantes Conseal F, Fluoshield e Vitro Seal Alpha foram superiores ao selante Delton quanto à microinfiltração

Variables contributing to the quality of fissure sealants used by general dental practitioners.

This study investigated the factors that could influence microleakage, penetration ability and the formation of resin tags of different sealants used in routine oral health care. One hundred and two caries-free extracted molars were divided into 34 groups of three teeth each. A questionnaire and three teeth were submitted to 34 dentists participating in the study. They completed the questionnaire anonymously based on their own clinical procedures. The teeth were then treated, corresponding to the questionnaires. The types of sealants were categorized into three groups: classical sealant, flowable composite and flowable compomer. The molars were thermocycled in water (5,000 cycles between 5 degrees C and 55 degrees C), then stained with 5% methylene blue for 24 hours. Each tooth was then sectioned longitudinally at three sites. Fissure type, microleakage and penetration ability of the sealants was evaluated with a computer-linked light microscope (25x magnification). Formation of resin tags at the enamel-sealant interfaces was examined using SEM. Variables thought to influence performance of the sealants were analyzed by multiple regression analyses. Classical sealants showed significantly lower microleakage than flowable composites and flowable compomers. Conventional etching with phosphoric acid was critical for sealant success. Agitating the etchant could improve the quality of sealing by decreasing microleakage significantly. In addition, the fissure types had a significant effect on the penetration ability of sealants.

Use of fissure sealant retention as an outcome measure in a dental school setting.

The purpose of this study was to describe and assess the use of fissure sealant retention as a quality measure of the delivery system for pediatric dentistry. The Pediatric Dentistry Section at the Ohio State University College of Dentistry adopted Sealant retention as a measure of quality. Sealant retention in first and second molars was evaluated at each six-month recall appointment. Sealants were categorized as satisfactory or unsatisfactory. Two hundred five sealants were evaluated between March 1998 and March 1999. The mean age of the patients at the time of sealant evaluation was 14.0 +/- 2.9. Mean sealant retention period was 29.8 +/- 23.2 months, with a range of 0.9 to 148 months. Median sealant retention period was 23.2 months. Overall, 75.6 percent of the sealed teeth were classified as satisfactory. Use of this data in making improvements is discussed. Our results indicate that the use of sealant retention is a suitable measure for quality of care in pediatric dentistry.

A proposed method for assessing the quality of sealants--the CCC Sealant Evaluation System.

OBJECTIVES: The aim of this paper is to introduce the C (colour) C (coverage) C (caries) Sealant Evaluation System and to present results of its use on a sample of adolescent patients in Scotland. METHODS: Baseline data are presented from a 3-year prospective study in general dental practices across Scotland. Subjects were examined under standardised conditions by one trained and calibrated examiner. RESULTS: 78.6% of the subjects had one or more sealed teeth, over half of these sealants being judged inadequate. There was a low prevalence of dentine caries associated with the sealed teeth (2.8%). The CCC sealant Evaluation System proved practical as demonstrated by its use during the project and had substantial intra-examiner reproducibility. CONCLUSIONS: There was a high level of sealant provision; however, this provision may not be optimal in terms of both targeting of provision and sealant maintenance. The CCC sealant Evaluation System appeared to be a useful assessment tool for assessing sealed surfaces.

Selladores: fundamentos y aplicación / Sealants: fundamentals and application

Los selladores presentan un argumento contundente para la prevención e caries de fosas y fisuras. Las evidencias científicas de su efectividad en prevención de caries, la incorporación de sales de fluoruros y los diferentes tipos de grabado aportan el sustento de su promoción. Su uso debe estar acompañado de un correcto diagnóstico y combinado con educación para la salud, control de la infección. refuerzo con fluoruros y visitas periódicas. Existen dos posibilidades básicas para incorporar el uso de selladores a la práctica odontológica, el plan de tratamiento individual y los programas comunitarios. Para el uso de selladores es necesaria la evaluación de riesgo del paciente, experiencia de caries, utilización de los servicios odontológicos, implementación de medidas preventivas e historia médica familiar y evaluación del riesgo del del diente: morfología de las fosas y fisuras, nivel de actividad de caries e incidencia de caries. Durante los últimos años han sido introducidos en el mercado selladores conteniendo fluoruros. La selección del material de sellado segura la manipulación adecuada por parte del operador. En general las investigaciones actuales apuntan a la utilización de selladores con liberación de fluoruros, ionómeros vítreos y selladores como uso terapéutico (caries de esmalte) (AU)

Selladores: fundamentos y aplicación / Sealants: fundamentals and application

Los selladores presentan un argumento contundente para la prevención e caries de fosas y fisuras. Las evidencias científicas de su efectividad en prevención de caries, la incorporación de sales de fluoruros y los diferentes tipos de grabado aportan el sustento de su promoción. Su uso debe estar acompañado de un correcto diagnóstico y combinado con educación para la salud, control de la infección. refuerzo con fluoruros y visitas periódicas. Existen dos posibilidades básicas para incorporar el uso de selladores a la práctica odontológica, el plan de tratamiento individual y los programas comunitarios. Para el uso de selladores es necesaria la evaluación de riesgo del paciente, experiencia de caries, utilización de los servicios odontológicos, implementación de medidas preventivas e historia médica familiar y evaluación del riesgo del del diente: morfología de las fosas y fisuras, nivel de actividad de caries e incidencia de caries. Durante los últimos años han sido introducidos en el mercado selladores conteniendo fluoruros. La selección del material de sellado segura la manipulación adecuada por parte del operador. En general las investigaciones actuales apuntan a la utilización de selladores con liberación de fluoruros, ionómeros vítreos y selladores como uso terapéutico (caries de esmalte)

The reliability of three methods for evaluating dental sealants.

Three evaluation instruments (global, check-list, and criterion referenced) were used by experienced and inexperienced examiners to evaluate dental sealant end products on 40 extracted teeth. Intra- and interexaminer reliabilities were measured. Experienced examiners achieved higher intrarater reliabilities with all three evaluation instruments than did inexperienced examiners. The highest intraexaminer agreement for all examiners occurred with use of the global evaluation. The highest interexaminer reliability was achieved with the second use of the criterion-referenced evaluation by the experienced examiner. Interexaminer reliability was improved for both types of examiners with the criterion-referenced evaluation.

A survey of private dental practitioners' utilization of dental sealants in Washington state.

The effectiveness of sealants in protecting the occlusal surfaces of teeth has been demonstrated in many clinical investigations, yet many dentists in private practice have been slow to offer sealants to their patients. The majority of dentists (80.7 percent) who responded to the survey in Washington state are currently using sealants. There appears to be a relationship between the use of sealants and the organizational structure of the practice.