Sealants or fluoride varnishes: which treatment is better for preventing decay in the permanent back teeth of children and adolescents?

Tooth decay is when a small hole develops in a tooth. This happens because bacteria that live in the mouth feed on sugar in the food we eat. As they feed, the bacteria produce acid that attacks teeth. If teeth are not cleaned regularly after eating, or if someone consumes a lot of sugary foods and drinks, the repeated acid attacks can create holes in the hard outer surface of the teeth. If untreated, these holes can deepen and damage the layer of tooth underneath the surface (dentine). Many people around the world develop tooth decay at some point in their life. In most adolescents and children over the age of six years, decay damages the biting surfaces of the permanent teeth at the back of the mouth.

To prevent decay, dentists can apply a dental sealant, or fluoride varnish, directly onto the back teeth. A dental sealant is a coating made from an adhesive material such as resin or glass ionomer, which the dentists applies once to teeth. It seals off the grooves in teeth that tend to collect food, and protects them from the acid. By comparison, a fluoride varnish is a sticky paste that contains high levels of fluoride; fluoride is a mineral naturally present in teeth that protects them from damage. Fluoride varnishes need to be applied to teeth by the dentist two to four times a year. Continue reading

Updated Oral Health Group reviews in Issue 3, 2013 of the Cochrane Library

Issue 3, 2013 of the Cochrane Library features three review updates and two new protocols from the Cochrane Oral Health Group.


c. EE Homepage

Review update:
Interventions for replacing missing teeth: different times for loading dental implants
Marco Esposito,  Maria Gabriella Grusovin, Hassan Maghaireh, Helen V Worthington

When people have dental implants in their jaws, they usually wait several months for the bone around the implants to heal before artificial teeth are attached to the implant. During this period they use removable dentures. This review looked at the effects of attaching artificial teeth either the same day that the implant was placed, or early (after only 6 weeks) compared to the usual delay of at least 3 months. 26 clinical trials were included, featuring a total of 1217 participants. Follow the link to read the conclusions…

Review update:
Operative caries management in adults and children
David Ricketts, Thomas Lamont, Nicola PT Innes, Edwina Kidd, Jan E Clarkson

Tooth decay (dental caries) is a common problem around the world. It can cost a lot of money to treat and causes infection, pain and the loss of teeth. Tooth decay can be controlled by what are known as ‘non-operative’ methods which include cleaning plaque from teeth thoroughly, advising a healthy diet and using fluoride to prevent the decay getting worse. If the decay progresses these ‘non-operative’ techniques may need to be combined with ‘operative’ management which involves filling and restoring teeth where the holes caused by decay prevent cleaning. The fillings will improve the appearance of the teeth and allow the patient to clean them.  Traditionally dentists have removed all of the decay with a dental drill or instruments before a filling is placed. However, removal of all the decay has some disadvantages, including damage to the nerve of the tooth, toothache and possibly weakening of the tooth structure. This method is known as one step complete caries removal. Despite the large number of fillings and restorations placed worldwide on a daily basis, dentists remain uncertain as to which is the best ‘operative management’ strategy for tooth decay. This review included 8 clinical trials with 934 participants.

Review update:
Sealants for preventing dental decay in the permanent teeth
Anneli Ahovuo-Saloranta, Helena Forss, Tanya Walsh, Anne Hiiri, Anne Nordblad, Marjukka Mäkelä, Helen V Worthington

This review update  considers whether dental sealants are an effective preventative treatment for tooth decay. Dental sealants are intended to prevent the growth of bacteria that promote tooth decay in grooves of back teeth. Sealants are applied onto these grooves by a dentist or by another member of the dental care team. There are several sealant materials available, the main types in use are resin-based sealants and glass ionomer cements. This review summarised information from 34 separate studies involving 6529 young people to whom a variety of dental sealants were used for preventing caries and found evidence that applying sealants to the biting surfaces of the back teeth reduces caries when compared to not using sealants.

New protocol:
Enamel matrix derivative for periodontal regeneration in teeth with furcation involvement
Brian Stevenson, David Ricketts, Joseph LY Liu

This review aims to examine the effects of enamel matrix derivative in the treatment of teeth with furcation involvement and to compare it’s effectiveness with the various guided tissue regeneration procedures used in the treatment of these teeth.

New protocol:
Proximal sealing for managing dental decay in primary and permanent teeth
Mojtaba Dorri, Stephen M Dunne, Wael Sabbah, Bahar Kiani

The primary objective of this review is to evaluate the effects of proximal sealing in managing dental decay in primary and permanent dentition in children and adults.

Other highlights of the Cochrane Library, Issue 3, 2013 include:

3 editorials:

Highlighted reviews:

New titles registered at the Cochrane Oral Health Group

After the Cochrane Oral Health Group Editorial Meeting, a total of EIGHT new titles were registered. It has been a bumper month!

Approximal sealing for managing dental decay in primary and permanent dentition
by Mojtaba Dorri, Wael Sabbah, Bahar Kiani

This new review is from a team based in London, Portland (USA) and Mashhad (Iran). It will assess  the effectiveness of different methods and materials used for sealing approximal surfaces in order to manage dental decay.

Dental cavity liners for Class I and Class II resin-based composite restorations
by Andrew B. Schenkel, Ivy Peltz and Analia Veitz-Keenan

This team, based at New York University, will look at whether there is any benefit in placing dental cavity liners in resin-based composite restorations, considering any type of liner (to include calcium hydroxide, glass ionomer, flowable composite, zinc phosphate cement and zinc eugenol cement).

Maxillary distraction osteogenesis versus orthognathic surgery in cleft lip and palate patients
by Dmitrios Kloukos, Piotr Fudalej, Patrick Sequeira and Christos Katsaros

There are two widely used types of surgical reconstruction for cleft lip and palate patients: maxillary distraction osteogenesis and orthognathic surgery. This review will compare the two. The team is based at the University of Bern in Switzerland, and in Nijmegen, Netherlands.

Prevention and treatment of oral candidiasis in edentulous patients
by Analia Veitz-Keenan, Silvia Spivakovsky, Leila Jahangiri, Winnie Furnari

Is any one treatment better than another in preventing and treating oral candidiasis in edentulous patients? This review, from a team based at New York University, will look at this question.

We look forward to receiving the protocols of these new systematic reviews.

In addition to these four titles, another four have been registered as part of a grant from the Centers of Disease Control and Prevention. Led by Dr. Anne-Marie Glenny, the project to update five systematic reviews is now underway. Joining Anne-Marie on the review team will be Dr. Tanya Walsh and Professor Helen Worthington. They will be working on:

  • School-based and school-linked fissure sealant delivery programs for the prevention of dental caries
  • Community wide fissure sealant promotion programs
  • Water fluoridation for the prevention of dental caries
  • Population based interventions for the prevention of sports-related craniofacial injuries