Sealant and fluoride varnish in caries: a randomized trial. Fissure sealing of permanent first molars in children receiving a high standard of prophylactic care. Evaluation of non-invasive treatment applied to occlusal surfaces.
Little is known about the effect of discontinuation of sealant or fluoride varnish. The purpose of this study was to compare sealant with fluoride varnish in the prevention of occlusal caries in permanent first molars of children over a nine-year period: 4 yrs for program evaluation plus 5 yrs of discontinuation. A clinical trial was conducted on three groups of six- to eight-year-old schoolchildren: a control group (n = 45); a group (n = 37) in which sealant was applied and reapplied up to 36 mos; and a group (n = 38) in which fluoride varnish was applied and re-applied up to 42 mos. Percent caries reduction was studied in these initially healthy molars with complete occlusal eruption: 129 (control), 113 (sealant), and 129 (varnish) molars met inclusion criteria. Of these, 76.7%, 26.6%, and 55.8% had developed occlusal caries at 9 yrs, which implies caries reductions of 65.4% (SE = 8.5%) for sealants vs. control and 27.3% (SE = 10.2%) for varnish vs. control. Furthermore, the varnish program was not effective during the discontinuation period. The efficiency of sealing the occlusal fissures of permanent first molars was studied in a group of patients 6-9 yr of age receiving a high standard of prophylactic care. Very soon after the eruption one of the teeth in a homomaxillary pair was sealed, and the contralateral was used for control. The control teeth were painted with a fluoride varnish (Duraphat) every 6 months during the trial. 210 sites in 121 children were sealed and followed for a mean observation period of 23 months. At the end of the study, the retention rate was 62.9%, the percentage of effectiveness 24.2%, and the net gain 7.1%. The dmft index (primary molars and canines) was recorded for each patient at the time sealing was performed. A relationship between the caries prevalence in the primary teeth and the susceptibility for fissure caries in the control teeth was found. Effectiveness and net gain was highest in the group of children with 3-6 dmft. The purpose of this study was to evaluate the efficacy of non-invasive methods of treatment for active incipent occlusal caries. Anamnesis, professional prophylaxis, and visual inspection were used to classify 250 Brazilian pre-school-children. First permanent decayed molars (n=98) from thirty-one subjects (6 years+ 6 months) were selected and divided into three groups. Group 1: fissure sealants with resin-modified glass ionomer - Vitremer (n=29); Group 2: fluoride varnish -Duraphat (n=36) and control group: tooth brushing and 0.2 percent NaF weekly mouthwashes (n=33). Four clinical evaluations were carried out over three, six, nine, and twelve months. Caries activity and progression were observed through clinical and radiographic evaluation. The results were analyzed by Fisher=s Exact test. After twelve months, the results showed 100 percent of arrestment of caries activity for Group 1, 83.3 percent for group 2, and 72.7 percent for control group. At the same time, the results showed 0 percent of caries progression for group 1, 5.5 percent for Group 2, and 6.1 percent for control group. Group 1 showed a better inactivation property than the other groups (p<0.05). There were no statistically significant differences in caries progression among these groups (p>0.05). It was concluded that this non-invasive methods were able to arrest the progression of occlusal caries, but fissure sealant showed better results in controlling caries activity.
There was some evidence on the superiority of pit and fissure sealants over fluoride varnish application in the prevention of occlusal decays. However, current scarce data limit recommendations on whether to apply pit and fissure sealants or fluoride varnishes on occlusal surfaces.