Abstract
Objective To determine the effectiveness of fissure sealants and factors influencing their effectiveness.
Data sources Medline search 1975–1990 (pit and fissure sealants), hand search of Medline references identified and 11 relevant dental journals; no unpublished studies were sought.
Study selection Studies were included if they contained original data, were applied to original data, no other preventive measure was used, the effectiveness of sealants could be assessed. Studies in English, French of Spanish were included. All articles were evaluated by two authors to minimise selection and data bias. Where several articles reported the same study only data from the most recent was used.
Data extraction and synthesis The prevented fraction was calculated for each study. Heterogeneity between the studies was investigated using multivariate analysis. Data was analysed for both auto-polymerising and light-cured (UV) sealants.
Results 24 studies meeting the criteria were identified in 34 articles. Only UV light cured and auto-polymerising sealant studies met the criteria so no non UV light-cured were included. The percentage of caries prevented (prevented fraction) is shown in the table. The auto-polymerising sealants were clearly more effective. Effectiveness was shown to decrease with time for both types. Effectiveness may be improved in fluoridated communities (83% c.f. 71%) and operator type may also influence effectiveness. There was a marked heterogeneity between the studies which was partly explained by fluoridation status and incidence of caries in the control group. The authors also note that publication bias (the tendency for reporting positive studies over negative or non-significant findings) could have been a factor.
Conclusions Fissure sealants are effective in preventing dental caries, their effectiveness decreases with time, and periodic reapplication is advisable. Auto-polymerising sealants are more effective than UV light sealants. Fluoridation appears to increase effectiveness, so future studies should note fluoride consumed by study population. Further studies should look at the influence of the operator on effectiveness.
Lodra J C, Bravo M, Delgado-Rodriguez M, Baco P, Galvez R. Factors influencing the effectiveness of sealants — a meta-analysis. Community Dent Oral Epidemiol 1993; 21: 261–268
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Address: J C Lodra, Department of Preventive Dentistry, School of Dentistry, University of Granada, Spain
Funding: University of Granada Grant no. PG/89-24199739
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Ferguson, M. Sealants effective in reducing caries. Evid Based Dent 1, 20 (1998). https://doi.org/10.1038/sj.ebd.6490014
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DOI: https://doi.org/10.1038/sj.ebd.6490014