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Evidence Supports Using Pit & Fissure Sealant with Fluoride

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Are you using pit-and-fissure sealant? If you’re not, you’re in good company… but based on recent evidence-based clinical recommendations, you may want to reconsider and add this product to your armamentarium.

Sealants have been around since the 1960s, and the general consensus among the dental community is that they prevent and control carious lesions on primary and permanent teeth. However, they’re underutilized, according to a reference article by the American Academy of Pediatric Dentistry (AAPD) and American Dental Association (ADA). It seems curious that a product with a long history and proven effectiveness wouldn’t be at “go-to” for clinicians but, as noted in the study, it may just be a case of having too many options. According to the authors, new sealant materials and techniques continue to emerge for managing pit-and-fissure caries, further complicating the clinician’s decision making. That’s why in 2016, the ADA Council on Scientific Affairs and ADA Center for Evidence-Based Dentistry, in collaboration with the AAPD, convened an expert panel to develop the previous evidence-based clinical recommendations for the use of sealants, originally published in 2008.

Bosworth Pit & Fissure Sealant w/ Fluoride from Keystone Industries is an example of a “new” sealant material formulated and packaged for ease of use, making it a go-to in the operatory. Click the image to the right to learn more.

The sealant guideline panel’s key recommendation was the use of sealants, compared with non-use in permanent molars, with both sound occlusal surfaces and non cavitated occlusal carious lesions in children and adolescents. The strength of the recommendation was “strong” based on “moderate”-quality evidence, based on data from 9 randomized controlled trials that showed that in children and adolescents with sound occlusal surfaces, the use of pit-and-fissure sealants compared with non-use of sealants reduces the incidence of occlusal carious lesions in permanent molars by 76% after 2 to 3 years of follow up.

Remarking on that finding, the panel noted that no studies were identified regarding the effect of sealants on preventing and arresting occlusal carious lesions in adult patients. The panel also stopped short of recommending one type of sealant over another, because of the very low quality of evidence for comparative studies.

So while the evidence supporting the use of a pit-and-fissure sealant for younger patients is clear, material choice remains unclear. However, a closer look at material properties may help to narrow down the choice.

According to the guidelines, the decision of whether to use glass ionomer (GI)-based cement vs. a resin-based cement should take into account the likelihood of experiencing lack of retention when choosing the type of sealant material most appropriate for a specific patient and clinical scenario. In cases where dry isolation is difficult, a material that is more hydrophilic would be preferable to hydrophobic resin-based cement. However, if the tooth can be isolated to ensure a dry site and long-term retention is desired, then a resin-based sealant may be preferable.

Fluoride-releasing properties may also factor into the decision. GI sealants were developed and are used for their fluoride-release properties. However, there are also polyacid-modified resin sealants, also referred to as compomers, that combine resin-based material found in traditional resin-based sealants with the fluoride-releasing and adhesive properties of GI sealants. For some dentists, this material could be the best of both worlds.

One material that combines these desirable properties is Bosworth Pit & Fissure Sealant w/ Fluoride from Keystone Industries. This light-cured resin allows for controllable flowability, keeping the sealant on the tooth while completely filling the pits and fissures and curing to an opaque film on enamel. This material can be applied in four simple steps:

1. First apply an acid etch, typical for resin-based sealant, to enamel for 15 to 20 seconds.

2. Rinse acid etch off with water, and dry with suction or clean, oil-free air.

3. Apply Pit & Fissure Sealant directly to tooth with the disposable application tip or use a disposable brush.

4. Cure the Pit & Fissure Sealant with light for 20 seconds. The final set time is 30 to 40 seconds.  

The evidence is clear: young patients, especially, can benefit from pit-and-fissure sealant. If you’re not a current user, consider taking a closer look at this material.  Learn more about Bosworth Pit & Fissure Sealant and other preventive products at www.dental.keystoneindustries.com.

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