ReemNaaman, Azza A. El-Housseiny, and NajlaaAlamoudi

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Abstract

This paper reviews the literature and discusses the latest updates on the use of pit and fissuresealants. It demonstrates the effectiveness of pit and fissuresealants in preventingcaries and the management of earlycariouslesions. It compares the use of different sealantmaterials and theirindications. It describes the applicationtechnique for sealants. It also reviews the cost-effectiveness of sealantsas a preventivestrategy. From this review and after the discussion of recentlypublishedstudies on pit and fissuresealants, it is evident that sealants are effective in cariesprevention and in preventing the progression of incipientlesions. It is thereforerecommended that pit and fissuresealant be applied to high-caries-riskchildren for optimumcost-effectiveness. It is a highlysensitivetechnique that needsoptimumisolation, cleaning of the toothsurface, etching, and the application of a thinbondinglayer for maximumbenefit. Recall and repair, whenneeded, are important to maximize the effectiveness of suchsealantuse.

Keywords: pit and fissuresealants, cariesprevention, resin-basedsealants

Introduction

Dentalcaries is a multifactorialdiseasecaused by alteration in the composition of the bacterialbiofilm, leading to an imbalancebetween the demineralization and remineralizationprocesses and manifested by the formation of carieslesions in primary and permanentdentitions [1]. The National Health and NutritionExamination Survey (NHANES) 2011–2012 datashowed that 37% of children, aged 2–8 years old, werediagnosed with dentalcaries in primaryteeth, and 21% of children, aged 6–11, and 58% of children, aged 12–19, werediagnosed with dentalcaries in theirpermanentteeth. Whencomparing this data to the earliersurvey of 1999–2004, an overalldecline in the prevalence of caries in primaryteeth and a slightdecrease in the cariespercentage in permanentteethwasnoticed [2,3]. However, this decreasewas not found to be uniformacross different agegroups or consistent with sociodemographicstatus and different toothsurface sites. Instead, it wasfound that the greatestdecrease in carieswasamongsmoothsurfacesratherthanpits and fissures [4,5]. Pit and fissurecaries accounts for about 90% of the caries of permanentposteriorteeth and 44% of caries in the primaryteeth in children and adolescents [6]. The use of cariespreventiveapproaches, suchascommunitywaterfluoridation, topicalfluoridetherapy, plaquecontrol, and dietarysugarcontrol, hasbeengenerallyseen to be the cause of the overalldecline of cariesprevalence, which in turnhashad a greatereffect on smoothsurfacecariouslesionreduction. The plaqueretentivenature of pits and fissures make themdifficult to clean, therebycausingthem to be more susceptible to cariesthansmoothsurfaces and possibly not to be protected by fluorideadministration [7].

More effectivemeasures are necessary to protectpits and fissures; theseinclude the use of pit and fissuresealants. Sealantapplication is a preventiveconservativeapproachinvolving the introduction of sealantsinto the pits and fissures of cariesproneteeth; this sealantthenbonds to the toothmicromechanically, providing a physicalbarrier that keepsbacteriaaway from theirsource of nutrients [8]. Despite the overallincreases in sealantuse, they are stillconsidered to be underused worldwide although the efficacy and caries-preventiveeffect of pit and fissuresealantshasbeen well documented in the literature.

Data from NHANES in 2011–2012, whencompared to that from a previoussurvey in 1999–2004, showed an increase in the use of sealants in permanentteeth. About 31% of children, aged 6–8 years old, 49% of children, aged 9–11, and 43% of adolescents, aged 12–19, had at least one sealedpermanenttooth [2,3,6].

In Europe, sealantprevalence in adolescentswasfound to be about 58.8% in Portugal and 8% in Greece [9,10]. In the Middle East, in Saudi Arabia, it wasfound that only 9% had a minimum of one permanentmolarsealed [11].

The aim of this paperwas to review the literatureregarding the latest updates on the use of pit and fissuresealants on primary and permanentmolars in children and adolescents.