Sealant use examined in JADA
March issue presents evidence-based clinical recommendations from experts
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Posted Feb. 28, 2008 |
By Jennifer Garvin Pit-and-fissure sealants are an effective way at preventing caries in children and adults—even in early noncavitated (incipient) lesions, according to a new set of ADA evidence-based clinical recommendations.
"Evidence-Based Clinical Recommendations for the Use of Pit-and-Fissure Sealants: A Report of the American Dental Association Council on Scientific Affairs," will be published in the March issue of The Journal of the American Dental Association.
The Council hopes practitioners will use the recommendations as a resource in their clinical decision-making process. In support of that goal, the ADA has developed a set of Questions and Answers to aid dentists in interpreting the new guidelines discussing them with patients.
"This is the second in an ongoing series of evidence-based recommendations that will help our members apply the results of scientific studies to the unique clinical conditions presented by their patients," said ADA President Mark J. Feldman. "We feel certain that dentists and their patients will benefit from these reports."
The recommendations, developed by a CSA expert panel, reinforce the evidence that dental sealants are effective at preventing dental decay (primary prevention) and that both children and adults can benefit from the use of sealants. They also observe that sealants can stop noncavitated (incipient) lesions from progressing (secondary prevention) and, in most cases, removing tooth structure before placing a sealant is not recommended.
The recommendations stress that in order to be effective, sealants must be applied properly, monitored and replaced when needed and the evidence shows that retention of sealants is significantly enhanced when a four-handed placement technique is used.
There is a pull-out executive summary of the recommendations in JADA that explains the systems used for grading the evidence used and how the evidence is classified as to the strength of the recommendations. The ADA also has provided a patient education page, "Dental sealants: Protecting Teeth, Preventing and Halting Decay," which dentists can remove and use to talk with their patients.
Additionally, the March JADA includes two studies by the Centers for Disease Control and Prevention, "The Effect of Dental Sealants on Bacteria Levels in Caries Lesions," and "Four-Handed Delivery of Sealants: Exploring Four-handed Delivery and Retention of Resin-Based Sealants."
The panel began with the following clinical questions:
- Under what circumstances should sealants be placed to prevent caries?
- Does placing sealants over noncavitated lesions prevent progression of the lesion?
- Are there conditions that favor the placement of resin-based vs. glass ionomer cement sealants in retention or caries prevention?
- Are there any techniques that could improve sealants' retention and effectiveness in caries prevention?
The panel worked with ADA Center for Evidence-based Dentistry staff and reviewed systematic reviews and clinical studies to develop recommendations for each of those clinical questions concluding, "sealants are effective in caries prevention and that sealants can prevent the progression of early noncavitated carious lesions."
In the summary of clinical implications, the authors note that they present the recommendations as a resource to be considered in the clinical decision-making process.
"As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences. The evidence indicates that the sealants can be used effectively to prevent the initiation and progression of dental caries."
The Association also has EBD recommendations on professionally applied topical fluoride applications. Both sets of EBD recommendations represent a new approach to developing recommendations for the ADA. The EBD process involves analyzing and weighing the scientific data to support each specific recommendation and is designed to assist dentists in making informed decisions about patient treatments.
Members of the ADA expert panel for sealants were:
- Dr. Jean Beauchamp, former member, ADA Council on Access, Prevention and Interprofessional Relations;
- Dr. Page W. Caufield, professor, cariology and comprehensive care, New York University College of Dentistry;
- Dr. James J. Crall, professor and chair, pediatric dentistry, University of California, Los Angeles School of Dentistry;
- Dr. Kevin Donly, professor and chair, pediatric dentistry, University of Texas Health Sciences Center San Antonio Dental School;
- Dr. Robert Feigal, professor, pediatric dentistry, University of Minnesota School of Dentistry;
- Dr. Barbara Gooch, dental officer, Division of Oral Health, National Center for Health Promotion and Disease Prevention, Centers for Disease Control and Prevention;
- Dr. Amid Ismail, professor, University of Michigan School of Dentistry;
- 'Dr. William Kohn, associate director for science, Division of Oral Health, Centers for Disease Control and Prevention;
- Dr. Mark Siegal, chief, Bureau of Oral Health Services, Ohio Department of Health;
- Dr. Richard Simonsen. dean, Midwestern University College of Dental Medicine.
For more information, contact the ADA by phone at 1-312-440-2878 or by e-mail at science@ada.org.
For information on what to tell your patients, please see the ADA's Q and A segment .
For additional resources on sealants, visit www.ada.org/goto/sealants.
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