Occlusal sealant success over ten years in a private practice: comparing longevity of sealants placed by dentists, hygienists, and assistants.
OBJECTIVE
The purpose of this 10-year, retrospective, cohort study was 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 an identical, standardized, application technique and 4-handed dentistry.


METHODS
From 810 patient records that met entry criteria, the long-term follow-up records of 3,194 permanent first molars were evaluated. Data were collected and evaluated by survival analyses methods for: (1) time to first failure (caries or restoration of the sealed surface); (2) fluoride history; (3) caries experience; (4) operator type; (5) behavior at sealant placement; (6) tooth type; (7) age at placement; and (8) patient gender.


RESULTS
Cumulative survival probability for 10 years in this practice was 87%, using Kaplan Meier analyses. The factors associated with an increased risk of failure included: (1) age (P<.001); (2) dmft (P<.003); (3) no fluoride (P<.001); (4) dentist (P<.001); and (5) registered dental assistant (P<.001). While all operator groups had success rates equal to or exceeding previous studies, dentists and registered dental assistants showed 3 times and 2 times the risk of failure, respectively, compared to the registered dental hygienists. The no-fluoride group showed almost twice the risk of failure as compared to the optimal fluoride group. Behavior showed a slightly higher risk of failure that approached significance. Age and dmft were highly significant, with slight increased risk of failure. Supplemental fluoride showed a protective effect, but this was marginally significant. Gender and tooth-type were not significant in this model. Major variations in success rates were observed in the dental assistant group, with 2 individuals accounting for most of the failures.


CONCLUSIONS
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.
University of Michigan, Ann Arbor, Mich, USA. bfolke@prodigy.net
Bernadette D
BD
Folke
James L
JL
Walton
Robert J
RJ
Feigal
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D015331:Cohort Studies; D032022:Delegation, Professional; D003726:Dental Assistants; D003750:Dental Fissures / Q000628:therapy*; D003756:Dental Hygienists; D019232:Dental Restoration Failure; D003793:Dental Restoration, Permanent; D003815:Dentists; D005260:Female; D006801:Humans; D008297:Male; D010895:Pit and Fissure Sealants; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis
D010895:Pit and Fissure Sealants