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

Oral Health Dental caries5 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

current version

GRADE rated

No studies

Included studies

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

Current version only

Resin-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

CD003067.PUB5 (current) · 8 questions

Outcome	Effect	Evidence	Status / GRADE
Time taken to apply pit and fissure sealant or fluoride varnish same question in other reviews	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) same question in other reviews	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 same question in other reviews	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 same question in other reviews	MD 5.02 [4.55, 5.94]	1 study · 75 participants	Ungraded
Change in DMFT (decayed, missing and filled permanent teeth) increment 2 years same question in other reviews	MD -0.08 [-0.14, -0.02]	1 study · 542 participants	Ungraded
Change in DMFS (decayed, missing and filled permanent surfaces) increment 2 years same question in other reviews	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 same question in other reviews	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 same question in other reviews	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

CD003067.PUB5 (current) · 5 questions

Outcome	Effect	Evidence	Status / GRADE
Progression of dentinal carious lesions into enamel or dentine same question in other reviews	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 same question in other reviews	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 same question in other reviews	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 same question in other reviews	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 same question in other reviews	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

CD003067.PUB5 (current) · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Progression of dentinal carious lesions into enamel or dentine 1 year same question in other reviews	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 same question in other reviews	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 same question in other reviews	MD 0.23 [0.02, 0.44]	1 study	Ungraded
Dentine caries in permanent molars (yes/no) 1, 2 and 3 years same question in other reviews	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

Resin-based fissure sealant (visible-light-polymerized) vs Fluoride varnish

Population: Children and adolescents from the general population, younger than 20 years of age at the start of the study

CD003067.PUB4 · 5 questions

Outcome	Effect	Evidence	Status / GRADE
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	Ungraded
Dentine caries in permanent molars (yes/no) 2 years	OR 0.69 [0.50, 0.94] 132 per 1000 vs 95 per 1000	2 studies · 358 participants	Low Downgraded: indirectness
Safety of sealants and fluoride varnishes (adverse events)	Three studies (Bravo 2005; Liu 2012; Tagliaferro 2011) considered adverse events; participants detected and reported no adverse events. The other five studies did not mention adverse events.	3 studies	Ungraded
Number of visits to the dentist for repair of sealant or fluoride varnish application	Bravo 2005: average treatment visits per child 2.2 (SD 1.1) for resin sealant group vs 7.3 (SD 1.0) for varnish group.	1 study · 75 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	Ungraded

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

CD003067.PUB4 · 3 questions

Outcome	Effect	Evidence	Status / GRADE
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 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] 223 per 1000 vs 79 per 1000	1 study · 92 participants	Low Downgraded: risk of bias, imprecision, indirectness

Resin-modified glass ionomer fissure sealant plus oral health education vs Fluoride varnish plus oral health education

Population: Children and adolescents from the general population, younger than 20 years of age at the start of the study

CD003067.PUB4 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Change in DMF increment on occlusal surfaces of first permanent molars 24 months · low caries risk	Tagliaferro 2011: for low-caries-risk groups, no statistically significant differences among treatments after 24 months.	1 study	Ungraded
Change in DMF increment on occlusal surfaces of first permanent molars 24 months · high caries risk	Tagliaferro 2011: after 24 months, high-risk sealant group (HRS) mean DMF increment 0.06 (SD 0.25) vs high-risk varnish group (HRV) 0.29 (SD 0.68); similar caries increment reported.	1 study	Ungraded
Dentine caries in permanent molars (yes/no) 1, 2 and 3 years	SoF2: No difference in caries after 1, 2 and 3 years. 3 trials (1 study 21 evaluated children at 1 year [Florio 2001, RMGI, OR 0.18, 95% CI 0.01 to 4.27]; 2 studies 581 evaluated at 2 years [Ji 2007, Tagliaferro 2011];…	3 studies	Very low Downgraded: risk of bias, imprecision, inconsistency
Progression of caries lesion into enamel or dentine 1 year	Florio 2001 (RMGI vs fluoride varnish at 1 year) included only enamel caries lesions and reported arrestment of enamel caries lesions or progression into dentine with both interventions (Analysis 2.1).	1 study · 21 participants	Ungraded