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; e-mail: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 12-15 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, 12-15 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
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 12-15 years, respectively - with erupted premolar and molar teeth to receive fissure sealants (Seal-it, Spident), during the academic year 2013-14. 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. 271-278
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 12-15 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 120 35 (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 80 136 136 100% 0 0 1 month 65 92 92 100% 0 0 2 month 72 115 115 100% 0 0 4 month 76 122 116 95% 8 0 6 month 67 98 88 89.79% 7 3 8 month 69 102 86 94.11% 8 4 10 month 63 86 76 88% 6 4 International Journal of Medical Dentistry 273
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 - 94.8%, after 8 months - 90.2% and after 10 months - 89.5%. Table 3. Effectiveness of sealant (6-11years) Treated/ Experimental group Control group Time Examined Caries Effectiveness Examined Caries Effectiveness Baseline 136 0 100% 136 0 100% 1 month 92 0 100% 92 0 100% 2 month 115 0 100% 115 0 100% 4 month 122 8 95% 112 17 84.90% 6 month 98 5 94.80% 98 20 79.50% 8 month 102 10 90.20% 102 32 68.60% 10 month 86 9 89.50% 86 40 53.50% For the 12-15 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. 271-278
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 40 90 90 100 0 0 1 month 37 82 82 100 0 0 2 month 28 63 63 100 0 0 4 month 34 72 68 94.44% 4 0 6 month 33 70 63 90.00% 6 1 8 month 30 64 56 87.50% 5 3 10 month 34 71 65 91.54% 2 4 Fig. 2. Sealant s efficiency in the two groups Similarly, the effectiveness rate for the 12-15 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 - 87.5% and after 10 months - 84.5% (Table 5). International Journal of Medical Dentistry 275
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 90 0 100% 90 0 100% 1 month 82 0 100% 82 0 100% 2 month 63 0 100% 63 0 100% 4 month 72 4 94% 72 10 86.00% 6 month 70 7 90.00% 70 17 75.71% 8 month 64 8 87.50% 64 20 68.75% 10 month 71 11 84.50% 71 26 63.38% 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 12-15 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 95.4857 4.66741 6-11 years Control 83.7714 18.05517 0.048 Experimental 93.7143 6.53106 12-15 years Control 86.6714 15.93641 0.044 4. 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. 271-278
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]. 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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):672-82. 21. 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):e0121299. 22. 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):271-8. 23. Griffin SO, Gray SK, Malvitz DM, Gooch BF. Caries risk in formerly sealed teeth. J Am Dent Assoc. 2009;140(4):415-23. 278 volume 21 issue 4 October / December 2017 pp. 271-278