The Impact of Recent Changes in the Epidemiology of Dental Caries on Guidelines for the Use of Dental Sealants

Abstract

This paper reviews recent changes in the epidemiology of dental caries and assesses their potential impact on the diagnosis and management of the disease and the planning and operation of sealant programs. These changes, such as the decline in caries and slowing of the rate of progression of the disease, have important implications for diagnosing and treating incipient lesions, predicting caries risk, and conducting effective disease preventive programs. Traditional paradigms for restoring carious lesions are being replaced by newer strategies that emphasize disease prevention and conservation of tooth structure. The search continues for the identification of practical models for predicting caries risk at the individual level. This paper describes a method useful for targeting resources in sealant placement programs by enabling one to determine the relative effectiveness of sealing alternative tooth surfaces in the oral cavity. One guide serves as a widely adopted manual for those who use or intend to use dental sealants in caries prevention programs. This paper provides a brief review of that document, "Preventing Pit and Fissure Caries: A Guide to Sealant Use," as well as guidelines for sealant utilization provided by the American Dental Association, and information regarding dental sealant programs under Medicaid. The final portion of the paper provides a synthesis of the epidemiology reviewed and summarizes the implications of findings for sealant programs.

Clinical comparison of Fuji VII and a resin sealant in children at high and low risk of caries

“…Pit caries accounts for about 90% of the total incidence of caries in children and adolescents 1) and there are signs that the severity of caries in the first molar is increasing in young children, especially in those at high risk (HR) of caries 2) . Use of pit and fissure sealants plays an important role in preventing the development of occlusal caries by isolating the covered tooth surfaces from microorganisms and food particles 3,4) .…”

Molecular Studies of the Structural Ecology of Natural Occlusal Caries

“…Much effort has been made to study and analyze the bacterial composition and structure of biofilms in caries lesions, especially in relation with occlusal caries. Occlusal surfaces continue to carry a major burden of caries in contemporary populations [Schwarz et al, 1994;Brown and Selwitz, 1995]. Therefore, studies exploring the ecology of occlusal caries are highly warranted.…”

In vitro assessment of laser efficiency for caries prevention in pits and fissures

“…In permanent teeth, caries decline has been greater on interproximal and smooth surfaces as compared to fissured and occlusal surfaces (Brown and Selwitz, 1995;Selwitz et al, 2007). This fact illustrates the need for caries management by individual risk assessment, so that more definitive measures geared toward high-risk individuals (Featherstone, 2000) and fissured and occlusal surfaces can be taken.…”