title: Sealants for Preventing and Arresting Pit-and-fissure Occlusal Caries in Primary and Permanent Molars.
abstract: BACKGROUND
  National Health and Nutrition Examination Survey 2011-2012 data indicated that, in the United States, nearly onefourth of children and over one-half of adolescents experienced dental caries in their permanent teeth. The purpose of this review was to summarize the available clinical evidence regarding the effect of dental sealants for the prevention and management of pit-and-fissure occlusal carious lesions in primary and permanent molars, compared with a control without sealants, with fluoride varnishes, or with other head-to head comparisons.
  
  
  METHODS
  The authors included parallel and split-mouth randomized controlled trials that included at least 2 years of follow-up, which they identified using MEDLINE (via PubMed), Embase, LILACS, the Cochrane Central Register of Controlled Trials, and registers of ongoing trials. Pairs of reviewers independently conducted the selection of studies, data extraction, risk of bias assessments, and quality of the evidence assessments by using the Grading of Recommendations Assessment, Development and Evaluation approach.
  
  
  RESULTS
  Of 2,869 records screened, the authors determined that 24 articles (representing 23 studies) proved eligible. Moderate-quality evidence suggested that participants who received sealants had a reduced risk of developing carious lesions in occlusal surfaces of permanent molars compared with those who did not receive sealants (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.08-0.27) after 7 or more years of follow-up. When the authors compared studies whose investigators had compared sealants with fluoride varnishes, they found that sealants reduced the incidence of carious lesions after 7 or more years of follow-up (OR, 0.19; 95% CI, 0.07-0.51); however, this finding was supported by low-quality evidence. On the basis of the evidence, the authors could not provide a hierarchy of effectiveness among the studies whose investigators had conducted head-to-head comparisons. The investigators of 2 trials provided information about adverse events, but they did not report any adverse events.
  
  
  CONCLUSIONS
  Available evidence suggests that sealants are effective and safe to prevent or arrest the progression of noncavitated carious lesions compared with a control without sealants or fluoride varnishes. Further research is needed to provide information about the relative merits of the different types of sealant materials.
authors.affiliation: Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Wright
authors.affiliation: Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, Ill., USA. tampim@ada.org.
authors.forename: Malavika P
authors.initials: MP
authors.lastname: Tampi
authors.affiliation: American Academy of Pediatric Dentistry, Chicago, Ill., USA.
authors.forename: Laurel
authors.initials: L
authors.lastname: Graham
authors.affiliation: Scientific Information, Science Institute, American Dental Association, Chicago, Ill., USA.
authors.forename: Cameron
authors.initials: C
authors.lastname: Estrich
authors.affiliation: Division of Public Health and Community Dentistry, School of Dentistry, University of California, Los Angeles, Los Angeles, Calif, USA.
authors.forename: James J
authors.initials: JJ
authors.lastname: Crall
authors.affiliation: Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Mich, USA.
authors.forename: Margherita
authors.initials: M
authors.lastname: Fontana
authors.affiliation: School of Dentistry, University of Washington, Seattle, Wash., and a private practitioner, Bozeman, Mont, USA.
authors.forename: E Jane
authors.initials: EJ
authors.lastname: Gillette
authors.affiliation: DentaQuest Institute, Westborough, Mass, USA.
authors.forename: Brian B
authors.initials: BB
authors.lastname: Nový
authors.affiliation: Division of Pediatric Dentistry, School of Dentistry, University of Maryland, Baltimore, Md, USA.
authors.forename: Vineet
authors.initials: V
authors.lastname: Dhar
authors.affiliation: Department of Developmental Dentistry, School of Dentistry, University of Texas Health Science Center, San Antonio, Texas, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Donly
authors.affiliation: Section of Restorative Dentistry, School of Dentistry, University of California, Los Angeles, Los Angeles, Calif, USA.
authors.forename: Edmond R
authors.initials: ER
authors.lastname: Hewlett
authors.affiliation: Department of Pediatric Dentistry and Pediatrics, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA.
authors.forename: Rocio B
authors.initials: RB
authors.lastname: Quinonez
authors.affiliation: Delta Dental of Iowa, Johnston, Iowa, USA; College of Graduate Health Studies, A.T. Still University, Mesa, Ariz., USA; Association of State and Territorial Dental Directors, Reno, Nev., USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Chaffin
authors.affiliation: Children's Health Alliance of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, Wis.
authors.forename: Matt
authors.initials: M
authors.lastname: Crespin
authors.affiliation: Program Analysis and Reports Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Md., USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Iafolla
authors.affiliation: College of Dentistry, The Ohio State University, Columbus, Ohio, USA; American Association of Public Health Dentistry, Springfield, Ill., USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Siegal
authors.affiliation: Center for Evidence-Based Dentistry, American Dental Association, Chicago, Ill., USA; Evidence-Based Dentistry Unit and Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Chile, Santiago, Chile; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Alonso
authors.initials: A
authors.lastname: Carrasco-Labra
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002710:Chlorhexidine / Q000008:administration & dosage; D003750:Dental Fissures / Q000517:prevention & control*; D019229:Dentition, Permanent; D004338:Drug Combinations; D006801:Humans; D008963:Molar; D010895:Pit and Fissure Sealants; D013943:Thymol / Q000008:administration & dosage; D014094:Tooth, Deciduous
chemical_list: D004338:Drug Combinations; D010895:Pit and Fissure Sealants; C079161:chlorhexidine, thymol drug combination; D013943:Thymol; D002710:Chlorhexidine