Evaluation of resin-based fissure sealants placed under field conditions
BACKGROUND: The application of dental sealants is a recommended procedure to prevent and control dental caries. However, despite strong evidence for the safety and effectiveness of dental sealants, their use still remains low, especially among children from lower socioeconomic communities. The World Health Organization (WHO), Centres for Disease Control and Prevention (CDC) and the Association of State and Territorial Dental Directors (ASTDD) strongly endorse the implementation of school based dental sealant programmes as a community-based preventive strategy to increase sealant use and reduce dental caries. However, in the WHO African Region, oral health is seen as a very low priority and this is compounded by limited technical and managerial resources. The availability of human resources and equipment are crucial for the successful placement of dental sealants. A gap in the research literature was identified for determining the effectiveness of fissure sealants placed under field conditions. AIM: To evaluate the caries preventive effect as well as retention status of a resin-based fissure sealant that was placed under field conditions as part of a school based sealant programme. METHODOLOGY: A cross-sectional comparative study was conducted at two primary schools in close proximity of each other in the same low socio-economic area in Beaufort West, South Africa. The study population consisted of grade two children between the ages of 7-9 years who had fully erupted first permanent molar teeth. The case group consisted of 100 learners who received dental sealants on caries-free first permanent molar teeth 12 months earlier. The control group consisted of a random selection of the same number of learners from the adjacent school. Dental caries on the occlusal surfaces of the first permanent molar teeth was detected by making use of the decayed (D) portion of the decayed, missing and filled tooth (DMFT) score, while a separate diagnosis distinguished between cavitated and non-cavitated lesions. Sealant retention was determined by a calibrated examiner who was not involved in the placement of the sealants. RESULTS: The response rate of the study was 80.0% (n=100) and 78.9% (n=356) of the fissure sealants that were originally placed were evaluated. When the sealants were placed in 2013, 52.0% of the children were female and at the 12 month follow-up, 51.3% were female. The average age of the female children at follow-up was 8 years and 4 months (99.9 months) and 8 years and 5 months (101.8 months) for the males. The standard deviation of the gender profiles differed by 1 month only and implies an equal distribution of age between female and male children throughout the study. Just less than ten per cent (7.8%) of the sealants were fully intact at the 12 month follow-up examination and 91% were totally lost, which is a higher sealant loss rate than what is generally reported on in the literature. Of the 7.8% fully retained sealants, a statistically significant proportion (p=0.044) were found on the mandibular molar teeth. The caries incidence rate in the sealed group was 7.1% versus 9.1% in the control group. Relative risk (RR) calculations was slightly lower for the sealed (RR=0.79) than the unsealed (RR=1.02) teeth. CONCLUSION: The study showed a 2% lower caries prevalence rate on the occlusal surfaces of the sealed versus the unsealed teeth. However, this does not represent a statistically significant finding (P=0.39). The study also showed a low retention rate for the resin-based sealants placed under field conditions (12 month retention rate of 7.8%). The results from this study has therefore shown that resin-based fissure sealants placed on grade 1 learners under field conditions appear to be not ideal in preventing the onset of dental caries on the occlusal surfaces of the first permanent molar teeth.