AAPD Reference Manual 2022-2023

CLINICAL PRACTICE GUIDELINES: PIT AND FISSURE SEALANTS

of submission for publication or when new evidence dictates that the panel change the course of action suggested in this guideline. Recommendations How to use these recommendations. The recommendations in this clinical practice guideline aim to assist patients, clinicians, and other stakeholders when making health care decisions. Al- though this clinical practice guideline covers the typical patient that the target audience treats on a daily basis, there may be specific situations in which clinicians may want to deviate from the recommendations listed below. Clinical expertise plays a key role in determining which patients fit into the scope of this guideline and how these recommendations align with the values, preferences, and the context of an individual patient. 23 When the panel grades a recommendation as strong, this means that in most situations clinicians may want to follow the course of action suggested by the panel and only in a selected few circumstances may they need to deviate from it. Strong rec- ommendations are usually associated with benefits or harms clearly outweighing one over the other, based on high- to moderate-quality evidence (certainty in the evidence), overall homogeneous values and preferences among patients, and in- expensive or easy-to-implement interventions. 14,15 Conditional recommendations, on the other hand, indicate that clinicians may want to follow the course of action suggested by the panel; however, the panel also recognizes that different choices would be appropriate for individual patients. This type of recommenda- tion is usually associated with a close balance between benefits

and harms, low- to very low-quality evidence, important variability in patients’ values and preferences, and substantial costs or challenges when trying to implement the intervention (Table 1). 4,14,15 When facing a conditional recommendation, clinicians should pay special attention to the reasons that justify such judgment from the guideline panel. This information can be found in the remarks section presented with each recommend- ation. Table 2 shows a summary of the key recommendations included in this guideline. Question 1. Should dental sealants, when compared with non-use of sealants, be used in pits and fissures of occlusal surfaces of primary and permanent molars on teeth deemed to have clinically sound occlusal surfaces or noncavitated carious lesions? Summary of findings. Data from 9 randomized controlled trials 9, 24-31 showed that in children and adolescents with sound occlu- sal surfaces, the use of pit-and-fissure sealants compared with nonuse of sealants, reduces the incidence of occlusal carious lesions in permanent molars by 76% after 2 to 3 years of follow-up (odds ratio [ OR ], 0.24; 95% CI, 0.19-0.30) ( sTable 1 , available in the supplemental data following refer- ences). In absolute terms, for a population with a caries baseline risk (prevalence) of 30%, 207 carious lesions would be prevented out of 1,000 sealant applications (95% CI, 186-225 fewer lesions) after 2 to 3 years of follow-up. Available data assessing the effect of sealants compared with a control without sealants in a mixed population of patients with sound occlusal surfaces and

DEFINITION OF QUALITY OF THE EVIDENCE AND STRENGTH OF RECOMMENDATIONS

Table 1.

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* Reproduced with permission of the publisher from Balshem and colleagues. 13

† Sources: Andrews and colleagues. 14,15

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THE REFERENCE MANUAL OF PEDIATRIC DENTISTRY