Cochrane · intervention · CD012981
Sealants for preventing dental caries in primary teeth
Ramamurthy, P, Rath, A, Sidhu, P, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
28
current version
GRADE rated
12
No studies
12
Included studies
9
as reported
No studies 12 · 42.9%Ungraded 4 · 14.3%Very low 6 · 21.4%Low 6 · 21.4%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 up to 12 years of age at the start of the study | 1120 children aged 18 months to 8 years; 1977 tooth surfaces evaluated; mostly general population, two studies recruited high-caries-risk children (n=1120) |
| Intervention | Sealants placed on the occlusal surfaces of primary molar teeth for the prevention of caries; no restriction on sealant type; direct application only; co-interventions allowed if identical in both arms | Fluoride-releasing resin-based sealant; glass ionomer-based sealant (high- or low-viscosity); resin-based sealant (autopolymerised or light-cured); flowable resin composite; autopolymerised sealant |
| Comparison | No sealant; or a different type of sealant (resin-based group used as comparator when comparing to other types; conventional material used as comparator when comparing to newer material) | No sealant (3 studies, 709 children); a different sealant material (6 studies, 411 children) |
| Outcomes | Primary: incidence of new dental caries on treated occlusal surfaces (caries incidence); progression of non-cavitated enamel caries; mean caries increment (change in dmft/s). Secondary: retention of sealant (dichotomous); adverse events (any type) and safety | Caries incidence (n=7); mean caries increment (n=4); retention of sealant (n=9); adverse events (n=1); progression of non-cavitated enamel caries (n=0) |
| Study designs | Randomised controlled trials (RCTs) of parallel-group and split-mouth design; no restriction on unit of randomisation or follow-up duration | RCT: 1 parallel-group and 8 split-mouth studies (n=9) |
| Timing | No restriction on duration of follow-up | Follow-up 12 to 30 months |
Search date: 2021-02. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid
Questions and results
Current version onlyFluoride-releasing resin-based sealant vs No sealant (no treatment)
Population: Children with caries-free or non-cavitated carious lesion primary molars, aged 3-7 years (paediatric department, dental hospital, France)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Retention of sealant (complete or partial retention) 12-24 months | At 12 months, sealants on 96 (70.1%) surfaces completely retained, 25 (18.3%) partially retained, 16 (11.6%) completely lost; at 24 months, 58 (45.3%) completely retained, 29 (22.7%) partially retained, 41 (32%)… | 1 study | Ungraded |
Development of >=1 new carious lesion (caries incidence) 12 months | BB OR 1.21 [0.37, 3.94] 36 per 1000 vs 44 per 1000 | 1 study · 88 participants | Low Downgraded: risk of bias, imprecision |
Adverse events | No studies reported this outcome. | 0 studies | No studies |
Mean caries increment (mean number of new cavitated occlusal lesions) 24 months | Mean number of new cavitated occlusal lesions 0.23 (SD 0.06) in sealed molars vs 0.29 (SD 0.06) in control molars (Wilcoxon matched-pairs signed-rank test P = 0.42) | 1 study · 85 participants | Ungraded |
Development of >=1 new carious lesion (caries incidence) 24 months | BB OR 0.76 [0.41, 1.42] 205 per 1000 vs 164 per 1000 | 1 study · 85 participants | Low Downgraded: risk of bias, imprecision |
Progression of non-cavitated enamel caries | No studies reported this outcome. | 0 studies | No studies |
Glass ionomer-based sealant vs No sealant
Population: Children with caries-free primary first molars (with or without caries on other teeth), aged 1-5 years (paediatric clinic/dental school, India; community dental setting, UK)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Development of >=1 new carious lesion (caries incidence) 6-12 months | OR 0.033 [0.007, 0.149] | 1 study · 107 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events | No studies reported this outcome. | 0 studies | No studies |
Retention of sealant (complete or partial retention) 6-30 months | Chadwick 2005: one or more sealants fully/partially retained in 69 (31.2%) children at 12-30 months; Joshi 2019: at 12 months 75 (43.6%) teeth completely retained, 58 (33.7%) partially retained, 39 (22.7%) completely… | 2 studies | Ungraded |
Development of >=1 new carious lesion (caries incidence) 12-30 months | OR 0.97 [0.63, 1.49] 235 per 1000 vs 229 per 1000 | 1 study · 449 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Mean caries increment (dmft) 12 months | Joshi 2019: dmft 8.43 (SD 5.84) with sealant vs 10.05 (SD 6.16) with no sealant at 12 months (caries threshold uncertain); Chadwick 2005: no significant difference in caries increment on occlusal surfaces, no summary… | 2 studies | Ungraded |
Progression of non-cavitated enamel caries | No studies reported this outcome. | 0 studies | No studies |
Glass ionomer-based sealant vs Resin-based sealant (fluoride-releasing or non-fluoride-releasing)
Population: 'Healthy' children with caries-free second primary molars, aged 3-5 years (schools and kindergartens, India and China)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Development of >=1 new carious lesion (caries incidence) 6-24 months | N/A - insufficient quantitative information available; 200 (2 studies). Comments: Due to the methods of data collection, analysis and reporting we were unable to provide any quantitative estimates. Fei 2011 narrative:… | 2 studies · 200 participants | Very low Downgraded: risk of bias, imprecision |
Progression of non-cavitated enamel caries | No studies reported this outcome. | 0 studies | No studies |
Retention of sealant (complete or partial retention) 24 months | BB OR 0.20 [0.11, 0.36] 70 per 1000 vs 320 per 1000 | 1 study · 100 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events | 1 study reported adverse events as some discomfort such as nausea; 1 child experienced a strong gag reflex following the glass ionomer-based sealant while 8 children reported feeling uncomfortable after the fluoride… | 1 study · 100 participants | Very low Downgraded: risk of bias, imprecision |
Fluoride-releasing resin-based sealant vs Resin-based sealant
Population: Children with caries-free second primary molars, aged 4-8 years (dental clinic, Turkey and Spain)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events | No studies reported this outcome. | 0 studies | No studies |
Retention of sealant (complete or partial retention) 6-24 months | Effect estimate not calculable; 69 (2 studies). Retention equivocal: Unal 2015 100% (fluoride resin) vs 96.0% (resin) at 12 months; Baca 2007 84.1% (fluoride resin) vs 97.7% (resin) at 12 months; at 24 months 87.8% vs… | 2 studies · 69 participants | Very low Downgraded: imprecision, inconsistency |
Progression of non-cavitated enamel caries | No studies reported this outcome. | 0 studies | No studies |
Development of >=1 new carious lesion (caries incidence) 6-24 months | N/A - insufficient quantitative information available; 69 (2 studies). Comments: Due to the different sealant materials, data reporting (split-mouth studies reported as parallel-group) and the very low number of tooth… | 2 studies · 69 participants | Low Downgraded: imprecision |
Flowable resin composite vs Fluoride-releasing resin-based sealant
Population: Children who were regular dental attenders with caries-free first or second primary molars (public health service clinic, Brazil)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events | No studies reported this outcome. | 0 studies | No studies |
Progression of non-cavitated enamel caries | No studies reported this outcome. | 0 studies | No studies |
Development of >=1 new carious lesion (caries incidence) | No studies reported this outcome. | 0 studies | No studies |
Retention of sealant (complete or partial retention) 12 months | Effect estimate not calculable. All sealants were completely or partially retained; 40 (1 RCT). Flowable composite: 39/40 completely retained (1 partially lost) at 6 months; resin-based: 33 completely and 7 partially… | 1 study · 40 participants | Low Downgraded: risk of bias, imprecision |
Autopolymerised sealant vs Light polymerised sealant
Population: Children with sound primary molars, aged 2-4 years (municipal dental clinics or hospital paediatric clinics, Denmark)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Retention of sealant (complete or partial retention) 24-36 months | OR 0.68 [0.33, 1.44] 904 per 1000 vs 865 per 1000 | 1 study · 52 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Adverse events | No studies reported this outcome. | 0 studies | No studies |
Development of >=1 new carious lesion (caries incidence) 24-36 months | OR 0.58 [0.15, 2.19] 98 per 1000 vs 59 per 1000 | 1 study · 52 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Progression of non-cavitated enamel caries | No studies reported on this outcome. | 0 studies | No studies |
Sealant (any type) vs No sealant
Population: Children with sound primary molars or with non-cavitated enamel caries on primary molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events (any type) and safety of sealant | no estimate extracted | NR | No studies |
Incidence of new dental caries on treated occlusal surface(s) of sound primary molars (caries incidence) | no estimate extracted | NR | No studies |
Retention of sealant | no estimate extracted | NR | No studies |
Mean caries increment (change in dmft/s) at the occlusal surface | no estimate extracted | NR | No studies |
Progression of non-cavitated enamel caries | no estimate extracted | NR | No studies |
One type of sealant vs A different type of sealant
Population: Children with sound primary molars or with non-cavitated enamel caries on primary molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Progression of non-cavitated enamel caries | no estimate extracted | NR | No studies |
Adverse events (any type) and safety of sealant | no estimate extracted | NR | No studies |
Incidence of new dental caries on treated occlusal surface(s) of sound primary molars (caries incidence) | no estimate extracted | NR | No studies |
Mean caries increment (change in dmft/s) at the occlusal surface | no estimate extracted | NR | No studies |
Retention of sealant | no estimate extracted | NR | No studies |