Title: Additional caries protection by sealing permanent first molars compared to fluoride varnish applications in children with low caries prevalence: 2-year results
Abstract: Aim The aim of this study was to assess whether there is an additional caries preventive benefit to be gained by sealing first permanent molars in children with low caries prevalence compared with fluoride varnish applications only. In addition, caries risk parameters and treatment should be evaluated. Method In a two-year longitudinal split-mouth study, the occlusal surfaces of 181 permanent molars in 98 children (5-8 years of age) were sealed and coated biannually with fluoride varnish and 181 molars were treated with fluoride varnish only. During the initial session, caries (defs/DMFS, initial lesions), plaque (API), gingivitis (SBI), and treatment time for sealants/fluoride application were recorded. In the final examination, the status of the sealants was recorded in addition to the baseline parameters. Results The sealant retention rate was 81.2%. The difference of caries increment in sealed teeth (5.5%, n = 9) compared with teeth which received fluoride varnish only (17.5%, n = 30) proved to be significant (p <0.01). Effectiveness was 72% and 57%, and the net gain 14.8% and 13.5% in maxilla and mandible, respectively. The relative risk in a lower first permanent molar (0.43) was higher than for an upper (0.28). Caries on primary teeth, initial lesions in permanent molar fissures, and oral hygiene at baseline were not sufficiently discriminatory for a risk-based preventive decision. The treatment time for fluoride applications (9 min) was just one third of that of sealants (28 min). Conclusion Fissure sealants yield a significant caries preventive benefit over fluoride varnish treatment in children with low caries prevalence but they require a considerably higher treatment time.