Cochrane · intervention · CD003067
Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents
Kashbour, W, Gupta, P, Worthington, HV, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
17
current version
GRADE rated
5
No studies
3
Included studies
11
as reported
No studies 3 · 17.6%Ungraded 9 · 52.9%Very low 5 · 29.4%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children and adolescents from the general population, younger than 20 years of age at the start of the study | Children aged 5 to 10 years at start; 3374 randomised, 2553 evaluated; 11 studies (9 contributing to analyses) |
| Intervention | Pit and fissure sealants of all materials (except first-generation resin-based sealants); Pit and fissure sealants plus fluoride varnish | Resin-based fissure sealant (n=7: Bravo, Chestnutt, Kalnina, Liu, Raadal, Salem, Tang); Glass ionomer fissure sealant (n=1: Ji); Resin-modified glass ionomer fissure sealant (n=2: Florio, Tagliaferro); Resin-based fissure sealant plus fluoride varnish (n=1: Splieth) |
| Comparison | Fluoride varnish | Fluoride varnish (n=11) |
| Outcomes | Occurrence of new dentinal carious lesions on treated occlusal surfaces within 12 months (yes/no); Changes from baseline in DMF figures at surface, tooth and whole-mouth levels; Progression of dentinal carious lesions into dentine; Time taken to apply; Number of visits for repair; Safety (presence or absence of adverse events) | Occurrence of new dentinal carious lesions (n=7); DMFS/DMFT increment (Tang, n=1); Progression of caries into dentine (Florio, n=1); DMF increment high/low caries risk (Tagliaferro, n=1); Changes in DMF at whole-mouth level (Splieth, n=1); Number of visits (Bravo, n=1); Adverse events reported (n=5); Brief economic commentary (4 economic evaluations) |
| Study designs | RCT with at least 12 months of follow-up (parallel-group and split-mouth) | Parallel-group RCT (n=6); Split-mouth RCT (n=2); Cluster-randomised RCT (n=3: Bravo, Salem, Tang) |
| Timing | At least 12 months | Follow-up: 12 months (n=1); 2 years (n=6); 3 years (n=2); 4 years (n=1); 9 years (n=1) |
Search date: 19 March 2020. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov; World Health Organization International Clinical Trials Registry Platform
Questions and results
Show all 5 versionsResin-based fissure sealant vs Fluoride varnish
Population: Children and adolescents from the general population, younger than 20 years of age at the start of the study
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Time taken to apply pit and fissure sealant or fluoride varnish | None of the studies measured time taken to apply pit and fissure sealant or fluoride varnish (resin sealant versus fluoride varnish comparison). | 0 studies | No studies |
Safety of sealants and fluoride varnishes (adverse events) | Five studies (Bravo 2005; Chestnutt 2017; Kalnina 2016; Liu 2012; Tagliaferro 2011) considered adverse events; participants detected and reported no adverse events. | 5 studies | Ungraded |
Incidence of dentinal carious lesion on treated occlusal surfaces of molars or premolars (yes/no) 9 years | RR 0.48 [0.29, 0.79] | 1 study · 75 participants | Very low Downgraded: risk of bias, imprecision |
Number of visits to the dentist for repair of sealant or fluoride varnish application | MD 5.02 [4.55, 5.94] | 1 study · 75 participants | Ungraded |
Change in DMFT (decayed, missing and filled permanent teeth) increment 2 years | MD -0.08 [-0.14, -0.02] | 1 study · 542 participants | Ungraded |
Change in DMFS (decayed, missing and filled permanent surfaces) increment 2 years | MD -0.09 [-0.15, -0.03] | 1 study · 542 participants | Ungraded |
Incidence of dentinal carious lesion on treated occlusal surfaces of molars or premolars (yes/no) 4 years | RR 0.42 [0.21, 0.84] | 1 study · 75 participants | Very low Downgraded: risk of bias, imprecision |
Dentine caries in permanent molars (yes/no) 2-3 years | OR 0.67 [0.37, 1.19] -63 [-129, 32] per 1000 | 4 studies · 1683 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Resin-based fissure sealant plus fluoride varnish vs Fluoride varnish alone
Population: Children and adolescents from the general population, younger than 20 years of age at the start of the study
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Progression of dentinal carious lesions into enamel or dentine | The study (Splieth 2001) did not report progression of dentinal carious lesions into enamel or dentine. | 0 studies | No studies |
Number of visits to the dentist for repair of sealant or fluoride varnish application | The study (Splieth 2001) did not measure the number of visits to the dentist for repair of sealant or fluoride varnish application. | 0 studies | No studies |
Time taken to apply pit and fissure sealant or fluoride varnish | Splieth 2001: total time for sealing and resealing two teeth averaged 29 minutes over 2 years (about 17 minutes initial sealants); each fluoride varnish application under 3 minutes (total 9 minutes). | 1 study | Ungraded |
Changes from baseline in decayed, missing and filled (DMF) figures at whole-mouth level 2 years | Splieth 2001: whole-mouth mean DMFS increased from 0.2 to 0.6 after 1 year and to 1.1 after 2 years; most caries on occlusal surfaces of first permanent molars (50.9%). | 1 study · 92 participants | Ungraded |
Dentine caries in permanent molars (yes/no) 2 years | OR 0.30 [0.17, 0.55] -144 [-176, -87] per 1000 | 1 study · 92 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Resin-modified glass ionomer fissure sealant vs Fluoride varnish
Population: Children and adolescents from the general population, younger than 20 years of age at the start of the study
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Progression of dentinal carious lesions into enamel or dentine 1 year | OR 0.18 [0.01, 4.27] | 1 study · 21 participants | Ungraded |
Change in DMF increment on occlusal surfaces of first permanent molars 24 months · low caries risk | MD 0.07 [-0.03, 0.17] | 1 study | Ungraded |
Change in DMF increment on occlusal surfaces of first permanent molars 24 months · high caries risk | MD 0.23 [0.02, 0.44] | 1 study | Ungraded |
Dentine caries in permanent molars (yes/no) 1, 2 and 3 years | SoF2: No evidence of a difference between interventions in caries after 1, 2 and 3 years; 995 (3 studies); Very low. Studies were clinically different so not combined in meta-analyses; 1 study (Tagliaferro 2011)… | 3 studies · 995 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |