Clinical Update

The clinical update online is a free member service providing up to 11 FREE CPD hours per year.

Each month, the clinical update is published online and in the Victorian Dentist. There are 11 clinical updates per year, corresponding with the distribution of the Victorian Dentist from February to December. This service is available to ADAVB and ADATas members only. Members can log in to view and answer the clinical update questions. If you answer at least nine out of 10 questions correctly, you will receive one hour of scientific CPD.

Please note: Each new clinical update will be available from the first business day of each month.

The effectiveness of completely and incompletely sealed first permanent molars on caries prevention

Osterc LL, Suklan J, Pavlic A. Clin Exp Dent Res. 2020;1–10.   
doi.org/10.1002/cre2.280

Introduction

Dental caries is a health problem affecting 60–90 per cent of children (WHO 2017). Eighty-eight per cent of caries lesions develops in first permanent molars (FPMs) and second permanent molars (SPMs) pits and fissures despite the occlusal surface accounting for a small proportion of tooth surfaces. The likelihood of caries lesions developing is mainly during eruption of the tooth due to increased plaque accumulation on the surface during eruption and incomplete post-eruptive mineralisation of the enamel.

Fissure sealants can prevent caries development, slow down and can halt the progression of the initial caries lesion. This is due to the physical barrier preventing nutrients entering the fissures limiting the growth and production of acid. Glass Ionomer Cement (GIC) sealants release fluorides to remineralise initial caries. Resin-based sealants reduced caries lesions by 11–51 per cent over a two-year period compared with non-sealed teeth. Over a seven-year period, children with sealed teeth had a caries incidence of 29 per cent, compared with 74 per cent of non-sealed teeth.

There is not a significant amount of data on incompletely sealed fissures and caries risk. It is generally accepted that all sealed surfaces should be monitored and sealant reapplied if marginal integrity has been lost. The aim of this study was to review the extent, quality of fissure sealant placement and caries morbidity on FPMs in children of between eight and 12 years of age. The protective effect of the fissure sealant in relation to the quality of the sealant was studied over that four-year period.

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