ADA updates sealants guidelines
A systematic review and the updated clinical practice guidelines it helped generate published in the August edition of The Journal of the American Dental Association give a clear indication to dental professionals as to the marked benefit of the use of sealants in preventing and managing occlusal caries in children and adolescents, said the article’s lead author, Dr. John Timothy Wright.
“The guidelines show that sealants are more effective in managing pit and fissure caries than fluoride treatments, such as varnish,” said Dr. Wright, a professor and the director of strategic initiative in the department of paediatric dentistry at the University of North Carolina School of Dentistry. “They also show that benefits are obtained by the variety of materials currently marketed in the US for sealant use (e.g., resin-based materials, glass ionomer materials, polyacid-modified resin, and resin-modified glass ionomers).”
The ADA Council on Scientific Affairs and the ADA Centre for Evidence-Based Dentistry, in collaboration with the American Academy of Paediatric Dentistry, convened a working group to update sealant guidelines, which the council first developed in 2008. The working group, which included clinical experts, stakeholders and methodologists, undertook a systematic review that informed development of the evidence-based guidelines.
The group’s literature search identified 23 relevant clinical trials evaluating sealants and their ability to prevent or manage dental caries for two years or longer, and the group included the data from all of the clinical trials in their analysis, Dr. Wright said.
The analysis indicated that children treated with sealants have about a 70 to 80 per cent reduction in the incidence of occlusal caries compared with children that do not receive sealants. There were no reports of any adverse outcomes or health concerns related to the use of pit and fissure sealants, adding further to the merit of using sealants as a routine part of preventive dental services.
Dr. Elliot Abt, chair of the Council on Scientific Affairs, which oversaw the systematic review and the guidelines, said the two publications demonstrate one of the main tenets of the ADA, which is producing and effectively communicating useful scientific information, including guidelines, to its members.
“A guideline basically is a presentation of the evidence,” Dr. Abt said. “It’s not a protocol, it’s not a standard of care. It’s basically saying to the user, ‘Here’s the current best evidence on this topic’. You can combine that evidence with your clinical experience and patient circumstances to make a sound clinical decision.”
The guidelines and the systematic review of randomised controlled trials related to sealants are available online at JADA.ADA.org. Every month, JADA articles are published online in advance of print publication.
To help explain sealant benefits to patients, the ADA Catalogue offers three illustrated handouts: the brochure “Dental Sealants: Protecting Teeth, Preventing Decay”, available in English or Spanish (W291); the mini-brochure “Seal Out Decay” (W191); and the “Sealants Quick Reference”, a two-sided card (W276). All three titles say what a sealant is and how it is applied, with before-and-after photos of sealant application. – Michelle Manchir
