Comparison between Fissure Sealant and Fluoride Varnish on Caries Prevention for First Permanent Molars: a Systematic Review and Meta-analysis

Abstract

The high prevalence and heavy socioeconomic burden for caries of first permanent molars (FPMs) make the prevention of this disease a major public health goal. Current guidelines recommend a preference of fissure sealant (FS) over fluoride varnish (FV) based on two recent systematic reviews. However, evidences of these two studies are weak because of scarce data and some limitations. Besides, an upto-date large scale randomized controlled trial (RCT) reported commensurate effectiveness of these two techniques. Thus, in order to more accurately compare the clinical efficacy between FS and FV on caries prevention for FPMs, we carried out this systematic review and meta-analysis. A total of 8 RCTs involving 3289 participants and 6878 FPMs fulfilled the inclusion criteria. Our meta-analysis for the first time showed that there was no statistical difference on caries incidence or occlusal DMFS increment between sealant group and fluoride varnish group at 2~3 years' follow-up. In that sense, biannual applications of FV or FS may be equally effective on caries prevention for FPMs. These results do not support routine recommendation of FS over FV, thus shedding light on current conceptions. Our findings endow clinicians with a window to reconsider the choice between these two techniques. Caries is one of the most prevalent chronic diseases worldwide 1-5. Approximately 2.4 billion people, accounting for 35% of the world population, are affected by untreated caries 1,2. Though enormous public resources have been poured into caries prevention, the global prevalence of untreated caries remained stagnant during the last decades 1. Untreated caries can be much burdensome socioeconomically 3-5. The economic loss thereof amounts to hundreds of billions of dollars every year 3. As a matter of fact, the high prevalence associated with heavy disease burden make caries prevention a major public health goal. First permanent molars (FPMs) are of great significance to caries prevention 6,7. Decay of FPMs constitutes the biggest component of decayed missing filled tooth index (DMFT) among children and adolescents 8,9. As well as being highly prevalent, caries of FPMs also imposes an overwhelming disease burden. FPMs are the keys to establish permanent occlusion 10. Severe FPMs caries often cause pain and infection, diminished dietary intake and malocclusion 1,8-10. At present, two techniques, namely fluoride varnish (FV) and fissure sealant (FS), are introduced to prevent caries of FPMs, both proved effective 11,12. However, it still cannot be concluded clearly which of these two skills is clinically superior. Current practice guidelines recommend a preference for FS over FV 6,7. This recommendation was supported by two very recent systematic reviews. Meta-analysis of them favored FS rather than FV with statistical significance 6,7. But the evidences of these two studies were assessed as weak (Details of their limitations will be identified and discussed below). Besides, a large-scale, high-qualified RCT updated recently showed that ther...

Minimally Invasive Therapies for the Management of Dental Caries—A Literature Review

“…A recent meta-analysis showed that over a 2-3-year follow-up period, there was no statistical difference in the incidence of occlusal caries on first permanent molars following sealant and FV application [23]. These findings corroborate those of Chestnutt et al who found that the effectiveness of FV in preventing occlusal decay on first permanent molars was higher but not statistically different from sealants (caries incidence 17.5% vs. 19.6%) following a 3-year period.…”

Tratamiento de caries en época de COVID-19: Protocolos clínicos para el control de generación de aerosoles

“…Los barnices de fluoruro aplicados tópicamente se han utilizado ampliamente como una intervención no invasiva para el tratamiento de lesiones de caries. La aplicación de barnices de flúor dos veces al año, en la dentición primaria o permanente, está asociado a una reducción significativa de la aparición de lesiones de caries dental, [9][10][11] teniendo en cuenta la condición de la desmineralización dental. Su efecto relativo está relacionado con el nivel de riesgo de caries y con la exposición a otras fuentes de flúor, 9 la concentración recomendada es del 5%.…”

“…Su uso en molares permanentes en erupción también se indica para prevenir la desmineralización, con dos aplicaciones anuales. 11…”

“…Os vernizes fluoretados aplicados topicamente têm sido amplamente utilizados como uma intervenção não invasiva de tratamento das lesões de cárie. A aplicação de vernizes fluoretados duas vezes ao ano, na dentição decídua ou permanente, está associada a uma redução substancial no incremento da cárie, [9][10][11] atendo-se à condição de desmineralização dentária. O seu efeito relativo está relacionado ao nível de risco de cárie e exposição a outras fontes de flúor, 9 com evidência na concentração de 5%.…”

“…Topical Fluoride varnish has been widely used as a non-invasive intervention to treat carious lesions. Applying fluoride varnish twice a year, in the primary or permanent dentition, is associated with a significant reduction of new dental caries lesions, [9][10][11] considering surface dental demineralization. Its relative effectiveness is related to the caries risk level and other fluoride exposure sources.…”