For this literature review of pit and fissure sealant, 1,465 references were selected by a search for "sealants" on PubMed. References were limited to dental journals and papers in the English language. The search comprised papers from 1971 to October 2001. Additional papers of historical significance prior to 1971 were added from memory and from reference lists published in early papers. This paper reviewed the literature on pit and fissure sealants under the following subheadings: (1) laboratory studies, (2) clinical technique and tooth preparation, (3) etching time, (4) auxiliary application of pit and fissure sealant, (5) retention and caries prevention, (6) fluoride used with sealants and fluoride-containing sealant, (7) glass ionomer materials as sealants, (8) options in sealant: filled vs unfilled; colored vs clear; autocure vs light-initiated, (9) sealant placed over caries in a therapeutic manner, (10) cost effectiveness of sealant application, (11) underuse of pit and fissure sealant, (12) the estrogenicity issue, (13) use of an intermediate bonding layer to improve retention, (14) new developments and projections, and (15) summary and conclusions. From a careful and thorough review of peer-reviewed publications on pit and fissure sealant, it is clear that sealants are safe, effective and underused (at least underused in the United States). Pit and fissure sealant is best applied to high-risk populations by trained auxiliaries using sealant that incorporates the benefit of an intermediate bonding layer, applied under the rubber dam or with some alternative short-term, but effective, isolation technique, onto an enamel surface that has been cleaned with an air polishing technique and etched with 35% phosphoric acid for 15 seconds. The dental profession awaits with enthusiasm, and some impatience, the incorporation of dentin-bonding technology into the development of a modern, more durable, resin-based sealant.

Pit and fissure sealant: review of the literature.

The objectives of this study were to evaluate systematically the evidence of the caries-preventive effect of fissure sealing of occlusal tooth surfaces and to examine factors potentially modifying the effect. The search strategies included electronic databases, reference lists of articles, and selected textbooks. Inclusion criteria were randomized or quasi-randomized clinical trials or controlled clinical trials comparing fissure sealing with no treatment or another preventive treatment in children up to 14 years of age at the start; the outcome measure was caries increment; the diagnostic criteria had been described; and the follow-up time was at least 2 years. Inclusion decisions were taken and grading of the studies was done independently by two of the authors. The main measure of effect was relative risk reduction. Thirteen studies using resin-based or glass ionomer sealant materials were included in the final analysis. The results showed that most studies were performed during the 1970s and a single application had been utilized. The relative caries risk reduction pooled estimate of resin-based sealants on permanent 1st molars was 33% (relative risk = 0.67; CI = 0.55-0.83). The effect depended on retention of the sealant. In conclusion, the review suggests limited evidence that fissure sealing of 1st permanent molars with resin-based materials has a caries-preventive effect. The evidence is incomplete for permanent 2nd molars, premolars and primary molars and for glass ionomer cements. Overall, there remains a need for further trials of high quality, particularly in child populations with a low and a high caries risk, respectively.

Caries-preventive effect of fissure sealants: a systematic review.

– Meta-analysis of published studies was applied to analyze the effectiveness of fissure sealants in preventing dental caries. Studies were identified by a MEDLINE search, supplemented by a hand search of the references in the articles recovered. All articles were assessed on the basis of quality, and were combined with the Mantel-Haenszel method. The prevented fraction in the exposed population (PF) was estimated using pooled relative risk. Heterogeneity of the effect and publication bias were also analyzed. Twenty-four studies were included in the meta-analysis. The overall effectiveness of autopolymerized fissure sealants was 71.36% (95% confidence interval 69.69-72.94%). Effectiveness in preventing caries decreased with time, and increased when drinking water was fluoridated (82.69% vs 72.28%). Heterogeneity was significant in most cases, and was further studied with multiple linear regression analysis. It is concluded that autopolymerizing sealants should be used. More research is needed to compare the effectiveness of dental hygienists and dentists in applying sealants.

Factors influencing the effectiveness of sealants – a meta-analysis

The aim of the present study was to perform a systematic review on the retention of resin-based sealants (RBSs) according to the material used and the clinical procedure. An electronic search in MEDLINE, EMBASE, Cochrane library and SCOPUS was completed by a hand search in conference proceedings. One hundred and twenty-four studies were identified, 31 of which were included. The retention rate of auto-polymerized and light-cured RBSs did not differ significantly. Light-cured RBSs had a significantly higher retention rate than fluoride-containing light-cured RBSs at 48 months (RR = 0.80, 95% CI: 0.72-0.89) and more. Concerning the clinical procedure, the scarcity of well-conducted studies made judgement difficult, except for the isolation stage. If using a rubber dam did not affect retention of auto-polymerized RBSs, it did for fluoride-containing light-cured RBSs (RR = 2.03, 95% CI: 1.51-2.73).

Retention of resin-based pit and fissure sealants: A systematic review.

Clinical Utilization of Alkaline Phosphatase Measurements

The purpose of this preliminary investigation was to check some safety aspects in the increased intake of fluorides which may become current in association with the use of fluoride additions to sugar products for prevention of dental caries. A total of 300 men from 4 Finnish rural districts supplied blood samples and samples of their households' drinking water (deriving mainly from wells) and answered questionnaires including questions on circulatory diseases diagnosed by a physician. There was a 50-fold difference between the mean water fluoride concentrations in the extreme districts (from 0.05 to 2.57 ppm). The water magnesium varied parallelly with the fluoride, but there was only a two-fold difference between the means of the extreme districts. A high mean of serum potassium was found in the district showing the lowest means of water fluoride and magnesium. A highly significant negative correlation was found between serum potassium and water fluoride (152 samples of blood and water from 3 districts)....

Relationships between the Fluoride and Magnesium Concentrations in Drinking Water and Some Components in Serum Related to Cardiovascular Diseases in Men from Four Rural Districts in Finland

This paper is a continuation of three previously published papers giving a long-term clinical evaluation of an ultraviolet light polymerizable fissure sealant method. The present findings revealed that of the 156 permanent teeth available for study 5 years after initiation, 59.6% retained the sealants in good condition, while 25.6% of the sealants were missing or partly missing. During the test period, 37 (32.2%) of the 115 sealed permanent first molars had become carious, while 92 (80.0%) of the respective paired controls had decayed. An analysis of the efficacy of the treatment on the test-control tooth pairs showed a net gain of 55 and a percentage effectiveness of 59.8%. The sealed teeth were found to be highly significantly less decayed than the respective contols (P less than 0.001). Of the individual subjects, 73.4% were found to have benefited from the treatment.

Caries reduction over 5 years from a single application of a fissure sealant.

— Pretreatment of the enamel with chlorhexidine did not modify enamel solubility, nor did it interfere with the enamel protective action provided by the fluoride. Oral rinses twice a day with the chlorhexidine-fluoride solution, pH 5.8, reduced the spread of plaque (Pl I) by 44% and the total plaque mass (total plaque N) by 38% compared with the effect of rinses with distilled water. Rinses with the NaF solution reduced the plaque mass by 41% while the plaque spread remained unaffected.

Reduction of enamel solubility and plaque development with chlorhexidine-fluoride solutions.

Modification of dental caries and calculus in rats by fluoride and bicarbonate-phosphate-fluoride additions to dietary sugar.

Findings 3 years after the application of a fissure sealant revealed that of the 166 sealed permanent first molars, 7.8% of the sealants were missing or partly missing, 14.5% were in fair condition, and 77.8% had remained in good condition. During the 3-year test period, 7.8% of the sealed permanent molars had become carious, while 63.3% of the respective control teeth had decayed. The teeth which had sealants in good condition showed no caries, whereas 92.3% of the teeth which had sealants missing or partly missing showed carious fissures. The net gain in the study was 104, and the percentage effectiveness of the method was 88.1%. The treatment effect was found to be very significant when analyzed on the basis of homologous paired test-control teeth (P less than 0.001). The sealing of pits and fissures was found to have a positive treatment effect on 60.2% of the subjects when evaluated on an individual basis (0.1 less than P less than 0.05).

S. K. J. Helminen

Papers

Relationships between the Fluoride and Magnesium Concentrations in Drinking Water and Some Components in Serum Related to Cardiovascular Diseases in Men from Four Rural Districts in Finland

Caries reduction over 5 years from a single application of a fissure sealant.

Reduction of enamel solubility and plaque development with chlorhexidine-fluoride solutions.

Modification of dental caries and calculus in rats by fluoride and bicarbonate-phosphate-fluoride additions to dietary sugar.

Effectiveness of fissure sealant 3 years after application.