Pit and fissure sealants or fluoride varnishes? 2016

L Paglia
Head Department of Pediatric Dentistry, Istituto Stomatologico Italiano, Milan (Italy).

Despite the general advances in dental care, dental caries is still a global health problem affecting many children. Occlusal surfaces of first permanent molars are the most susceptible sites in the developing permanent dentition. Dentists should use sealants or fluoride varnish - as well as other means - to limit the onset of tooth decay. Application of sealants is a recommended procedure to prevent or control caries. Sealing occlusal surfaces of newly erupted permanent molars in children and teenagers delays caries onset up to 48 months compared with unsealed teeth. However longer follow-ups shows a reduction of the preventive effect [Tikhonova et al., 2015]. A review of 2013 pointed out how sealants are effective in high risk children, however information about the benefits of sealing in other conditions is still scant [Ahovuo-Saloranta et al., 2013]. Fluoride varnishes are frequently used to prevent early childhood caries and reduce caries increment in very young children [Weintraub et al., 2006] and in the most vulnerable populations, where the prevalence of caries is higher and specialist visits are occasional [Chu et al., 2010]. Many studies have reported the effectiveness of different types and forms of fluoride agents in preventing dental caries among children and adolescents [Divaris et al., 2013]. A review clarifies that professional application of a 5% sodium fluoride varnish leads to remineralisation of early enamel caries in children. Solutions of 38% silver diamine fluoride are effective in arresting active dentine caries [Gao et al., 2016]. The last systematic review [Ahovuo-Saloranta et al., 2016], comparing pit and fissure sealants with fluoride varnishes explains that the pooled estimate slightly favours resin sealants over fluoride varnishes at two years. At four and nine years, the only comparative study (with high drop-out rates) found more caries on fluoride-varnished occlusal surfaces than on resin-sealed surfaces. There is evidence suggesting the superiority of resin-based fissure sealants over fluoride varnishes for prevention of occlusal caries in permanent molars, however it is not relevant. Eventually, Ahovuo-Saloranta et al. state that current data do not allow to draw definitive conclusions on whether to apply sealants or fluoride varnishes on occlusal surfaces of permanent molars [2016]. We will publish your opinion and experiences related to this topic in the next EJPD issue: join the discussion and write a letter to the editor!

UI MeSH Term Description Entries
D010895 Pit and Fissure Sealants Agents used to occlude dental enamel pits and fissures in the prevention of dental caries. Dental Sealant,Dental Sealants,Fissure Sealant,Fissure Sealants,Pit And Fissure Sealant,Pit Fissure Sealant,Sealants, Tooth,Pit Fissure Sealants,Sealants, Dental,Fissure Sealant, Pit,Fissure Sealants, Pit,Sealant, Dental,Sealant, Fissure,Sealant, Pit Fissure,Sealant, Tooth,Sealants, Fissure,Sealants, Pit Fissure,Tooth Sealant,Tooth Sealants
D002327 Cariostatic Agents Substances that inhibit or arrest DENTAL CARIES formation. (Boucher's Clinical Dental Terminology, 4th ed) Cariostatic Effect,Cariostatic Effects,Agent, Cariostatic,Agents, Cariostatic,Cariostatic Agent,Effect, Cariostatic,Effects, Cariostatic
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D003731 Dental Caries Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. Caries, Dental,Carious Lesions,Dental Cavities,Dental Cavity,Dental Decay,Dental White Spots,Carious Dentin,Decay, Dental,Dental White Spot,White Spot, Dental,White Spots, Dental,Carious Dentins,Carious Lesion,Cavities, Dental,Cavity, Dental,Dentin, Carious,Dentins, Carious,Lesion, Carious,Lesions, Carious,Spot, Dental White,Spots, Dental White
D005460 Fluorides, Topical Fluorides, usually in pastes or gels, used for topical application to reduce the incidence of DENTAL CARIES. Fluoride Varnishes,Topical Fluorides,Varnishes, Fluoride
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D014089 Tooth Remineralization Therapeutic technique for replacement of minerals in partially decalcified teeth. Remineralization, Tooth
D019228 Tooth Crown The upper part of the tooth, which joins the lower part of the tooth (TOOTH ROOT) at the cervix (TOOTH CERVIX) at a line called the cementoenamel junction. The entire surface of the crown is covered with enamel which is thicker at the extremity and becomes progressively thinner toward the cervix. (From Jablonski, Dictionary of Dentistry, 1992, p216) Crown, Tooth,Crowns, Tooth,Tooth Crowns

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