EFFICIENCY OF FISSURE SEALANTS IN DENTAL CARIES PREVENTION AMONG YOUNG SCHOOL CHILDREN. A COMPARATIVE EVALUATION

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1 Pediatric dentistry EFFICIENCY OF FISSURE SEALANTS IN DENTAL CARIES PREVENTION AMONG YOUNG SCHOOL CHILDREN. A COMPARATIVE EVALUATION Fuad Abdo AL-SABRI 1, Ahmed Mohammed EL-MARAKBY 2, Bilal Diab MOURSHED 3, Kiran Shankaraiah PALAKURTHY 4, Nabil SALAH 5, Nashwan Ahmed QAED 6 1 Assoc. Prof. PhD, BDS, MSc, MD, Thamar University, Thamar, Yemen, Al-Farabi Colleges, Riyadh, Saudi Arabia 2 Assist. Prof. PhD, BDS, MSc, MD, Al-Farabi Colleges, Riyadh, Saudi Arabia, Al-Azhar University, Egypt 3 Lecturer, MD, BDS, MSc, Al-Farabi Colleges, Riyadh, Saudi Arabia 4 Lecturer, MD, BDS, MDS, Al-Farabi Colleges, Riyadh, Saudi Arabia 5 PhD, MD, Thamar University, Thamar, Yemen 6 Lecturer, MD, BDS, MSc, Al-Farabi Colleges, Riyadh, Saudi Arabia Corresponding author: Kiran Shankaraiah Palakurthy; palakurthykiran@gmail.com Abstract Introduction: Dental caries is one of the endemic disease conditions still affecting the humans and their oral tissues. The methods applicable for the prevention of caries at global level are still a long way ahead. Aims: To assess the prevalence of dental caries among prepubescent and adolescent school children of Thamar city, Yemen. Materials and methods: A cross-sectional study was conducted among the school going children of Thamar city. 120 children, with ages between 6 and 15 years, were selected by the simple random sampling technique. The children were evaluated for dental caries activity using fissure sealants retention rate, sealants efficiency being evaluated with scaling criteria. Results and discussion: The retention rate of the 6-11 year-old group of children after 1, 2 months was 100%, 95% after 4 months, 89.8 % after 6 months, 94.11% after 8 months and 88% after 10 months, respectively. The retention rate of the year-old group after 1, 2 months was 100%, 94.4% after 4 months, 90% after 6 months, 87.5% after 8 months and 91.54% after 10 months, respectively. Conclusions: Significantly different values were found between the two age groups (6-11, years) as to the retention rate and efficiency of sealants. Keywords: dental caries, fissure sealants, disintegration. 1.INTRODUCTION Dental caries is a chronic, bacteriologically mediated, multifactorial disease that can affect the dentition of both children and adolescents, being also the most prevalent chronic disease in early childhood in most communities, to be still considered as a major public health problem worldwide [1-3]. The high percentage of caries in children is recorded on the occlusal surface of teeth, the highest risk for caries initiation in children being observed on the first and second permanent molars. Two factors considered important for plaque accumulation and caries initiation on the occlusal surfaces are the stage of eruption s functional status and tooth specific anatomy. The intrinsic property of the dental plaque to release lactic acid, which results in the dissolution of inorganic minerals of the tooth, leads to dental caries propagation [4]. In the year 1981, WHO and Federation Dentaire International (FDI) jointly formulated the first global oral health goals to be achieved by 2000, as follows: children reaching the age of 12 will not possess an average of more than three decayed, missing, and filled permanent teeth (DMFT) [5]. Preventive treatment options for dental decay includes fluoridated toothpaste prophylaxis with conventional brushing technique, as the fluoridated toothpaste represents today the most cost-effective fluoride delivery system to caries-risk communities, considered as a masterpiece for all cariespreventive strategies [6]. They are frequently employed in most of the dental clinics, henceforth, fluoride varnishes and fissure sealants are preventive options for caries propagation [7]. In the year 1967, dental sealants were introduced to prevent caries propagation in pits International Journal of Medical Dentistry 271

2 Fuad Abdo AL-SABRI, Ahmed Mohammed EL-MARAKBY, Bilal Diab MOURSHED, Kiran Shankaraiah PALAKURTHY, Nabil SALAH and fissures, especially on the occlusal surface of the tooth [8]. It was recognized by ADA that sealants are effective in preventing the growth of bacteria that initiate and propagate caries [9]. Resin-based pit and fissure sealants form a barrier on the occlusal surface of premolars and molars, preventing caries initiation; also noticed was that bacteria can remain in the pit and fissures without being detected, thus increasing the risk of caries [10]. Most resin-based sealant materials are releasing fluoride after polymerization. Clinical application of fissure sealants is recommended soon after tooth eruption, as sealants release fluoride at the base of the sealed groove, which provides a fluoride rich layer available when re-mineralization of an incipient lesion takes place [11]. Recent studies on novel materials indicate that resin or glass ionomer cement-based materials are the most commonly used for sealing occlusal surfaces [12, 13], few studies confirming the effectiveness of other materials, such as compomers [14]. However, the relative effectiveness of different types of sealants has yet to be established [15]. A safe and effective preventive treatment for caries initiation and propagation involves pit and fissure sealants. Regular reassessment, in order to avoid the development of dental caries, on teeth with partial or total loss of fissure sealants is recommended [11]. The key criterion for a successful treatment outcome is a complete isolation of teeth against saliva contamination [16]. Information on fissure sealants efficiency of caries prevention in the children of Yemen is based on the reports available from other regions of the world; therefore, this study was carried out to evaluate the retention and efficiency of sealants in two different age groups of school children from Thamar city. 2. MATERIALS AND METHODS The comparative study was conducted in the school children in Thamar city, Yemen. 120 children with ages between 6 and 15 years were randomly selected for the study and divided into 2 age groups - of 6-11 and years, respectively - with erupted premolar and molar teeth to receive fissure sealants (Seal-it, Spident), during the academic year Inclusion and exclusion criteria were applied, the subjects with no restorations or sealants on their fissures and no detectable caries meeting the inclusion criteria. All subjects had a satisfactory oral hygiene. Details of the procedure applied were explained to the parents and written Informed Consent was obtained from them. Using a split-mouth design, the experimental teeth were sealed with fissure sealant while the teeth from another part of the mouth acted as a control group for all subjects. Procedure Application of fissure sealants on the experimental tooth was carried out according to the techniques described by clinical procedures for pit and fissure sealant placement. The experimental teeth on which the sealants were to be applied were randomly selected; they were isolated using cotton rolls and saliva ejector, then thoroughly air-dried. The teeth were etched with phosphoric acid for 20 seconds, then washed for 10 seconds and air-dried again to observe the white chalky appearance of the etched tooth, after which the fissure sealant was applied following manufacturer s instructions. Sealant s retention was checked immediately with an explorer. Checking sealant s retention The children from both age groups were invited after 1, 2, 4, 6, 8 and 10 months for evaluating sealant s retention by visual aids - a dental explorer and a mouth mirror. Sealant s retention and the presence of carious lesions were checked in the control and experimental teeth. Each sealant is visually and directly evaluated by the examiner with the following scale: 1. No loss of sealant 2. Partial loss of sealant 3. Complete loss of sealant. Also, the sealant was indirectly evaluated with the bitewing X-ray and the following scale: 0= Sound tooth / No radiolucency 272 volume 21 issue 4 October / December 2017 pp

3 EFFICIENCY OF FISSURE SEALANTS IN DENTAL CARIES PREVENTION AMONG YOUNG SCHOOL CHILDREN. A COMPARATIVE EVALUATION (RUNNING TITLE: EFFICIENCY OF FISSURE SEALANTS AMONG SCHOOL CHILDREN) 1= Enamel radiolucency 2= Enamel radiolucency up to the dentino-enamel junction 3= Enamel radiolucency involving the outer half of dentin 4= Enamel radiolucency involving the inner half of dentin. Checking sealing s effectiveness The effectiveness of the sealant on the subjects is verified based on the presence or absence of sealants in the control (untreated) and experimental (treated) teeth at 1, 2, 4, 6, 8 and 10 months appointments. 3. RESULTS 120 patients belonging to two different age groups, i.e. 80 children with ages of 6-11 years and 40 adolescents with ages of years were subjected to examination. The distribution of treated teeth is presented in Table 1, 226 teeth - of which 106 premolars and 120 molars - being selected randomly. Table 1. Distribution of teeth Sample teeth No of teeth Age group 226 Premolars 106 Molars (6-11years) 71 (12-15 years) 76 (6-11 years) 54 (12-15 years) For the 6-11 year age group, 65, 72, 76, 67, 69 and 63 children were re-examined 1, 2, 4, 6, 8 and 10 months after the application of fissure sealants, as presented in Table 2. After 1, 2 months, no loss of sealant and no caries initiation were noticed, while, after 4 months, 8 sealants were partially lost; after 6 months, 7 sealants were partially lost and 3 sealants completely lost; after 8 months, 8 sealants were partially lost and 4 sealants were completely lost; after 10 months, 6 sealants were partially lost and 4 sealants were completely lost. The retention rate after 1, 2 months was 100%, 95% after 4 months, 89.8 % after 6 months, 94.11% after 8 months and 88% after 10 months, respectively (Table 2). Fig. 1 shows the comparison of retention rates between the two age groups. Months No. of Children Table 2. Retention rate of sealant (6-11years) No. of teeth Sealant retained Retained sealant % Partially lost complete loss Baseline % month % month % month % month % month % month % 6 4 International Journal of Medical Dentistry 273

4 Fuad Abdo AL-SABRI, Ahmed Mohammed EL-MARAKBY, Bilal Diab MOURSHED, Kiran Shankaraiah PALAKURTHY, Nabil SALAH Fig.1. Comparison of retention rates between two age groups The effectiveness of sealants in preventing caries initiation, as compared to the control group for the age group of 6-11 years, is depicted in Table 3. After 1, 2 months, the effectiveness of sealant activity in preventing caries initiation is 100%, after 4 months the effectiveness rate is 95%, after 6 months %, after 8 months % and after 10 months %. Table 3. Effectiveness of sealant (6-11years) Treated/ Experimental group Control group Time Examined Caries Effectiveness Examined Caries Effectiveness Baseline % % 1 month % % 2 month % % 4 month % % 6 month % % 8 month % % 10 month % % For the year age group, 1, 2, 4, 6, 8 and 10 months after the application of fissure sealant, 37, 28, 34, 33, 30 and 34 children were re-examined (Table 4). After 1, 2 months, no loss of sealant and no caries initiation were noticed while, after 4 months, 4 sealants were partially lost; after 6 months, 6 sealants were partially lost and 1 sealant completely lost; after 8 months, 5 sealants 274 volume 21 issue 4 October / December 2017 pp

5 EFFICIENCY OF FISSURE SEALANTS IN DENTAL CARIES PREVENTION AMONG YOUNG SCHOOL CHILDREN. A COMPARATIVE EVALUATION (RUNNING TITLE: EFFICIENCY OF FISSURE SEALANTS AMONG SCHOOL CHILDREN) were partially lost and 3 sealants were completely lost; after 10 months, 2 sealants were partially lost and 4 sealants were completely lost. The retention rate after 1, 2 months was 100%, 94.4% - after 4 months, 90% - after 6 months, 87.5% - after 8 months and 91.54% - after 10 months, respectively (Table 4). Fig. 2 shows the effectiveness of sealant in the two groups. Table 4. Retention rate of sealant (12-15 years) Months No. of Children No. of teeth Sealant retained Sealant retained % Partially lost Complete loss Baseline month month month % month % month % month % 2 4 Fig. 2. Sealant s efficiency in the two groups Similarly, the effectiveness rate for the year age group is shown in Table 5, as follows: in the experimental teeth after 1, 2 months - 100%, after 4 months - 94%, after 6 months - 90%, after 8 months % and after 10 months % (Table 5). International Journal of Medical Dentistry 275

6 Fuad Abdo AL-SABRI, Ahmed Mohammed EL-MARAKBY, Bilal Diab MOURSHED, Kiran Shankaraiah PALAKURTHY, Nabil SALAH Time Table 5. Effectiveness of sealant (12-15 years) Treated/ Experimental group Teeth Examined Control group Caries Effectiveness Examined Caries Effectiveness Baseline % % 1 month % % 2 month % % 4 month % % 6 month % % 8 month % % 10 month % % Data analysis The data obtained after the complete follow up of the samples, the retention rate and effectiveness of fissure sealants were statistically analyzed using independent sample t paired test and interpreted, as no statistically significant difference (P < 0.05) was noticed in the two age (6-11 year and year) groups between the experimental and the control samples (Table 6). Table 6. T- paired Independent sample test Age Group Mean Standard Deviation Significance Experimental years Control Experimental years Control DISCUSSION In the present study, a comparative analysis is made between two age groups of children and adolescents who require sealants, their effectiveness and retention rate being analyzed. As known, the success rate of the sealant is wholly dependent on the motivation of the parents who bring their children at the scheduled appointment [17]. According to the study of Feigal and Donly (2002), sealants can be beneficial to children at any age group, the conclusion being that the post eruptive age alone should not be used as a major criterion for making a decision of using or not sealants [18]. Application of sealants on fissures was highly effective in preventing caries in a population aged 18 to 20 years, as concluded by Yildiz et al. in 2004 [19]. The recently published systematic review of ADA and of the American Academy of Pediatric Dentistry (2016) concluded that sealants are safe and effective in preventing or arresting the progression of tooth decay, compared to the fluoride varnish treatment [20]. Veiga N.J. et al. (2015) conducted a study for establishing whether the actual usage of sealants and the socio-demographic factors are correlated to caries prevalence, and concluded that application of sealants should be complemented with oral health education for children, 276 volume 21 issue 4 October / December 2017 pp

7 EFFICIENCY OF FISSURE SEALANTS IN DENTAL CARIES PREVENTION AMONG YOUNG SCHOOL CHILDREN. A COMPARATIVE EVALUATION (RUNNING TITLE: EFFICIENCY OF FISSURE SEALANTS AMONG SCHOOL CHILDREN) adolescents and their families to assimilate the oral hygiene habits and for a primary prevention and early diagnosis of oral diseases [21]. Ahovuo-Saloranta, A. et al. (2015) stated the effectiveness of sealants, which prevent bacterial growth, which causes caries. In addition, sealing of the occlusal surfaces of permanent molars in children and adolescents reduces caries up to 48 months [9]. Clinical trials indicate that pit and fissure sealants as safe and effective in preventing caries in children and adolescents, recent reviews having shown that, when fissure sealants are retained on incipient non-cavitated lesions, which prevents the access to the fermentable substrate, bacteria s cariogenic potential is blocked, an obvious reduction of caries progression being thus recorded; therefore, the effectiveness of fissure sealants in the management of early non-cavitated lesions has been proven by in many studies [22,23]. 5. CONCLUSIONS Sealant materials have the ability to be retained in the occlusal surfaces of teeth of children and adolescents, showing a potential effectiveness for caries prevention, their application having deep effects on the dental caries of all tooth surfaces. References 1. Abanto J, Celiberti P, Braga MM, Vidigal EA, Cordeschi T, Haddad AE, Bönecker M. Effectiveness of a preventive program based on caries risk assessment and recall intervals on the incidence and regression of initial caries lesions in children. Int J Paediatr Dent. 2015;25(4): Huew R, Waterhouse P, Moynihan P, Kometa S, Maguire A. Dental caries and its association with diet and dental erosion in Libyan schoolchildren. Int J Paediatr Dent. 2012;22(1): Singh S, Pandey RK. An evaluation of nanocomposites as pit and fissure sealants in child patients. J Indian Soc Pedod Prev Dent. 2011;29(4): Abou Neel EA, Aljabo A, Strange A, Ibrahim S, Coathup M, Young AM, Bozec L, Mudera V. Demineralization-remineralization dynamics in teeth and bone. Int J Nanomedicine. 2016;11: Aggeryd T. Goals for oral health in the year 2000: cooperation between WHO, FDI and the national dental associations. Int Dent J. 1983;33(1): Miller FY, Campus G, Giuliana G, Piscopo MR, Pizzo G. Topical fluoride for preventing dental caries in children and adolescents. Curr Pharm Des. 2012;18(34): Ahovuo-Saloranta A, Forss H, Hiiri A, Nordblad A, Makela M. Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database Syst Rev. 2016;(1):CD Menon Preetha V, Shashikiran ND, Reddy VV. Comparison of antibacterial properties of two fluoride-releasing and a nonfluoride-releasing pit and fissure sealants. J Indian Soc Pedod Prev Dent. 2007;25(3): Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, Mäkelä M, Worthington HV. Sealants for preventing dental decay in the permanent teeth. Cochrane Database Syst Rev. 2013;(3):CD Yu F, Yu H, Lin P, Dong Y, Zhang L, Sun X, Liu Z, Guo H, Huang L, Chen J. Effect of an antibacterial monomer on the antibacterial activity of a pit-andfissure sealant. PLoS One. 2016;11(9):e Azarpazhooh A, Main PA. Pit and fissure sealants in the prevention of dental caries in children and adolescents: a systematic review. J Can Dent Assoc. 2008;74(2): Hesse D, Bonifácio CC, Guglielmi Cde A, Franca Cd, Mendes FM, Raggio DP. Low-cost glass ionomer cement as ART sealant in permanent molars: a randomized clinical trial. Braz Oral Res. 2015; Mickenautsch S, Yengopal V. Validity of sealant retention as surrogate for caries prevention--a systematic review. PLoS One. 2013;8(10):e Kuhnisch J, Mansmann U, Heinrich-Weltzien R, Hickel R. Longevity of materials for pit and fissure sealing--results from a meta-analysis. Dent Mater. 2012;28(3): Botton G, Morgental CS, Scherer MM, Lenzi TL, Montagner AF, Rocha RO. Are self-etch adhesive systems effective in the retention of occlusal sealants? A systematic review and meta-analysis. Int J Paediatr Dent. 2016;26(6): Locker D, Jokovic A, Kay EJ. Prevention. Part 8: The use of pit and fissure sealants in preventing caries in the permanent dentition of children. Br Dent J. 2003;195(7): Autio-Gold JT. Clinical evaluation of a mediumfilled flowable restorative material as a pit and fissure sealant. Oper Dent. 2002;27(4): Feigal RJ, Donly KJ. The use of pit and fissure sealants. Pediatr Dent. 2006;28(2):143-50; 19. Yildiz E, Dorter C, Efes B, Koray F. A comparative study of two fissure sealants: a 2-year clinical follow-up. J Oral Rehabil. 2004;31(10): Wright JT, Crall JJ, Fontana M, Gillette EJ, Nový BB, Dhar V, Donly K, Hewlett ER, Quinonez RB, International Journal of Medical Dentistry 277

8 Fuad Abdo AL-SABRI, Ahmed Mohammed EL-MARAKBY, Bilal Diab MOURSHED, Kiran Shankaraiah PALAKURTHY, Nabil SALAH Chaffin J, Crespin M, Iafolla T, Siegal MD, Tampi MP, Graham L, Estrich C, Carrasco-Labra A. Evidence-based clinical practice guideline for the use of pit-and-fissure sealants: A report of the American Dental Association and the American Academy of Pediatric Dentistry. J Am Dent Assoc. 2016;147(8): Veiga NJ, Pereira CM, Ferreira PC, Correia IJ. Prevalence of dental caries and fissure sealants in a Portuguese sample of adolescents. PLoS One. 2015;10(3):e Oong EM, Griffin SO, Kohn WG, Gooch BF, Caufield PW. The effect of dental sealants on bacteria levels in caries lesions: a review of the evidence. J Am Dent Assoc. 2008;139(3): Griffin SO, Gray SK, Malvitz DM, Gooch BF. Caries risk in formerly sealed teeth. J Am Dent Assoc. 2009;140(4): volume 21 issue 4 October / December 2017 pp