Sir, I was interested to read the practice paper by Dr Bonetti on Evidence not practised: The underutilisation of preventive fissure sealants.1 In the recently published clinical guideline by the Scottish Intercollegiate Guidelines Network (SIGN),2 it has been suggested that resin-based PFSs should be applied to the permanent molars of all children as early after eruption as possible. In other words, applications should usually take place between the ages of 6-7 years for first permanent molars and 11-12 years for second permanent molars.

In 2012/13, approximately 30% of primary 7 children (mean age 11.5 years) in Scotland received PFSs.3 In Scotland, the current cost of application of PFS to unfilled permanent molar teeth within two years of their eruption is £8.15 per tooth.4 To increase the uptake of PFSs in first permanent molars from 30% to 60% in Scottish children aged 6-7 years, SIGN estimated that the incremental cost would be over £1 million. Similarly, over £1 million would be required to double the uptake of PFSs in second permanent molars in Scottish children aged 11-12 years.2

It was not possible to segregate visits incorporating treatment with visits representing routine examinations in the above estimated costs; therefore, the total cost of service provision in Scotland may have been underestimated. However, potential savings from restorations avoided are also excluded.2

Implementation of the SIGN guideline is the responsibility of each NHS board in Scotland. In NHS Lanarkshire, the NHS board where I have been working, mechanisms have already been in place to review the care provided against the guideline recommendations. This includes the appointment of an executive director, a clinical lead and a managerial lead.