Occlusal Sealant Success Over Ten Years in a Private Practice: Comparing Longevity of Sealants Placed by Dentists, Hygienists, and Assistants

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Chad Abby Date: 3/13/2009
Article title: Occlusal Sealant Success Over Ten Years in a Private Practice: Comparing Longevity of Sealants Placed by Dentists, Hygienists, and Assistants
Author(s): Bernadette Folke, James Walton, Robert Feigal
Journal: Pediatric Dentistry
Volume (number): 26:5
Month, Year: 2004
Major topic: Sealants
Minor topic(s): Comparing longevity of sealants placed by dentists, hygienists and assistants
Type of Article: retrospective cohort study
Main Purpose: To evaluate the success of permanent molar sealants by comparing the effectiveness of sealants placed by dentists, dental hygienists, and dental assistants in a private dental practice, with all operators using identical, standardized, application technique and four-handed dentistry.
Overview of method of research: The selection criteria for this study were fully erupted permanent first molars treated with occlusal pit and fissure sealants, patients between 5-16 years of age, no caries or previous restorations on the sealed teeth and patients who returned for at least one follow-up appointment at least 6 months after initial placement. After review 810 patients met the criteria. Each tooth was treated the same with an enamelplasty performed by a dentist prior to placing the sealant. From the selected group of patients a total of 3,194 permanent first molars were treated. The data was collected and evaluated by survival analyses methods for – time to first failure, fluoride history, caries experience, operator type, behavior at sealant placement, tooth type, age at placement and patient gender.
Findings: Pits and fissures account for 88% of childhood caries in populations with overall low caries risk. With excellent application technique and follow-up care, it has been reported that caries protection approaches 100% in pits and fissures in which sealant has been retained. While many studies have been done on sealant effectiveness based on the material type and controlled variables, few have been done determining the effectiveness of various providers.
Key points/Summary: The estimated survival rate for one year approached 100% while the cumulative survival probability for 10 years was 87%. The mean survival time for sealants placed in this study was 5 years. When considering operator type, dentists and RDAs had a mean survival time of 3.45 years and 3.65 years respectively, whereas RDHs had a mean survival time of 7.71 years. The risk for sealant failure was significantly lower in sealants placed by RDHs compared to those placed by dentists or RDA. Previous caries experience at time of sealant placement and no fluoride exposure at placement were highly correlated to increased sealant failure. Children in nonfluoridated areas showed almost twice the risk of failure as compared to children in optimal fluoridated areas. Behavior showed a slightly higher risk of failure, age and dmft were highly significant with slight increased risk in failure. Supplemental fluoride showed a protective effect but was marginally significant. This study supports delegation of sealant delivery to auxiliaries, since dental assistants and dental hygienists were equal to or better than the dentists in long term sealant effectiveness.
Assessment of article: Good article