AAPD Reference Manual 2022-2023

CLINICAL PRACTICE GUIDELINES: PIT AND FISSURE SEALANTS

caries prevalence in the tables), the guideline panel acknowl- edged that clinicians lack a reliable and valid chairside tool to conduct a caries risk assessment. There is a need for such a tool to enable clinicians to extrapolate the results from this analysis to their patients in a more accurate manner. • The poor quality or complete lack of reporting in relation to resealing prevented the panel from using this information during the decision-making process. The panel highlighted the need for improving the report of reapplication of sealants as 1 more relevant outcome in primary studies assessing the effect of this intervention. Question 4. Are there any adverse events when using pit-and- fissure sealants? Summary of findings. There has been concern that dental seal- ants might exhibit adverse effects. This is primarily associated with bisphenol A ( BPA ). It has been suggested that the BPA present in some sealants may have estrogenlike effects 52 ’ 53 ; however, the evidence does not support the transient effect of a small amount of BPA in placing patients at risk. 54 Studies also have evaluated the correlation of developing carious lesions in teeth with fully or partially lost sealants and found no greater risk than in teeth that had never been sealed. 55 Two randomized controlled trials measuring the occurrence of adverse effects asso- ciated with sealants found no events related to this outcome. 27,56,57 Conclusions The evidence shows that sealants available in the U.S. market at the time of this systematic review are an effective intervention for reducing the incidence of carious lesions in the occlusal surfaces of primary and permanent molars in children and adolescents compared with the nonuse of sealants or fluoride varnishes. This benefit is inclusive to both sound occlusal surfaces and non- cavitated occlusal carious lesions. Clinicians should use these recommendations but consider carefully individual patient factors, especially where the guideline panel offered conditional recommendations. In addition, sealant use should be increased along with other preventive interventions to manage the caries disease process, especially in patients with an elevated risk of developing caries. Further research is needed to provide more risk-oriented recommendations, particularly regarding the devel- opment of a valid and reliable chairside tool for clinicians to assess a patient’s caries risk. References 1. Tellez M, Gray SL, Gray S, Lim S, Ismail AI. Sealants and dental caries: dentists’ perspectives on evidence-based rec- ommendations. J Am Dent Assoc 2011;142(9):1033-40. 2. Riley JL 3rd, Gordan VV, Rindal DB, et al; Dental PBRN Collaborative Group. Preferences for caries prevention agents in adult patients: findings from the dental practice based research network. Community Dent Oral Epidemiol 2010;38(4):360-70. 3. Beauchamp J, Caufield PW, Crall JJ, et al; American Dental Association Council on Scientific Affairs. Evidence-based

clinical recommendations for the use of pit-and-fissure seal- ants: A report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 2008;139(3):257-68. 4. Young DA, Novy BB, Zeller GG, et al; American Dental Association Council on Scientific Affairs. The American Dental Association Caries Classification System for clinical practice: a report of the American Dental Association Coun- cil on Scientific Affairs [published correction appears in J Am Dent Assoc 2015;146(6):364-5]. J Am Dent Assoc 2015;146(2):79-86. 5. Dye BA, Thornton-Evans G, Li X, Iafolla TJ. Dental caries and sealant prevalence in children and adolescents in the United States, 2011-2012. Available at: "http://www.cdc. gov/nchs/products/databriefs/db191.htm". Accessed June 9, 2016. 6. U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General Exec- utive Summary. Rockville, Md.: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000. 7. Macek MD, Beltran-Aguilar ED, Lockwood SA, Malvitz DM. Updated comparison of the caries susceptibility of various morphological types of permanent teeth. J Public Health Dent 2003;63(3):174-82. 8. Wright JT, Tampi MP, Graham L, et al. Sealants for prevent ing and arresting pit-and-fissure occlusal caries in primary and permanent molars: A systematic review of randomized controlled trials–a report of the American Dental Associa- tion and the American Academy of Pediatric Dentistry. J Am Dent Assoc 2016;147(8):631-45. 9. Splieth C, Förster M, Meyer G. Additional caries protection by sealing permanent first molars compared to fluoride varnish applications in children with low caries prevalence: A 2-year results. Eur J Paediatr Dent 2001;2(3):133-7. 10. Brouwers MC, Kerkvliet K, Spithoff K; AGREE Next Steps Consortium. The AGREE Reporting Checklist: A tool to improve reporting of clinical practice guidelines. BMJ 2016; 352:i1152. 11. Anusavice KJ, Shen C, Rawls HR. Phillips’ Science of Dental Materials. St. Louis, Mo.: Elsevier/Saunders; 2013. 12. Guyatt G, Oxman AD, Sultan S, et al. GRADE guidelines: 11. Making an overall rating of confidence in effect esti- mates for a single outcome and for all outcomes. J Clin Epidemiol 2013;66(2):151-7. 13. Balshem H, Helfand M, Schunemänn HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 2011;64(4):401-6. 14. Andrews J, Guyatt G, Oxman AD, et al. GRADE guide- lines: 14. Going from evidence to recommendations–the significance and presentation of recommendations. J Clin Epidemiol 2013;66(7):719-25. 15. Andrews JC, Schunemann HJ, Oxman AD, et al. GRADE guidelines: 15. Going from evidence to recommendation– determinants of a recommendation’s direction and strength. J Clin Epidemiol 2013;66(7):726-35.

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