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An investigation into sealant restoration usage in general dental practice in England by D. C. Hassall and A. C. Mellor Br Dent J 2001; 191: 388–390

Comment

Dental caries is a disease that has undergone dramatic changes in its prevalence,1 and in addition it is becoming primarily a disease affecting the pits and fissures, especially in the permanent dentition. Thus there are proportionally fewer smooth surface lesions. For example, in a sample of American school children 88% of the caries was found in pit and fissure surfaces.2 Ripa et al.3 in their 1988 study reported that the percentage of first molars with occlusal caries or restorations increased by an annual rate of around 10% over a 3-year period. We therefore have a clinical picture of a need for occlusal restorations amongst young people. Practising dentists must address the problem of how these teeth should be restored. Posing such a question before 1970 would have raised many a wry smile – amalgam was all dentists had to use. However, Simonsen's work in the 1970s offered an alternative, the sealant restoration, which had a number of advantages over amalgam, namely:

  • Adhesive retention, reducing the amount of tooth tissue that had to be removed

  • Effectively buried the practice of extension for prevention, whereby healthy occlusal enamel is destroyed. Only carious enamel is removed and the rest of the fissure is sealed

  • Aesthetically more pleasing than enamel

  • Less invasive for the patient.

So here we have a technical advance which brings benefits to the patient and the clinician ... wonderful news.

Well it appears from the work of Hassall and Mellor that a new era in the dental care of occlusal lesions of permanent molars has struggled to gain acceptance, despite the advantages. The reasons for this reluctance are hard to delineate given that the sealant restoration is not a particularly difficult clinical task and offers an incentive in terms of minimal loss of tooth tissue. Indeed one could speculate that most postgraduate deans would be reluctant to fund a course about how to place a sealant restoration given its simplicity.

This paper does not provide all the answers to the conundrum of lack of use of the sealant restoration but it does highlight a common feature of human behaviour. That is our tendency to believe in something but not to translate that belief into action. Smoking, drinking, exercise and safe sex are all aspects of human behaviour where change is difficult to implement and sustain. Just why offering sealant restorations should fall into this cadre of difficult behaviours to change is hard to explain. Hassall and Mellor have challenged the dental profession to accept a simple change to our clinical practice, surely it's a task that is well within our capabilities. Let us hope that amalgam restorations in the occlusal surfaces of permanent molars will be consigned to the history books.