ADA Issues Evidence-Based Clinical Recommendations on Pit-and-Fissure Sealants
The ADA Council on Scientific Affairs has released its first evidence-based clinical recommendations for the use of pit-and-fissure sealants1. The clinical recommendations were developed through a comprehensive evidence-based process, including critical evaluation of the available evidence on pit-and-fissure sealants and preparation of graded clinical recommendations that dentists can apply in patient care. The clinical recommendations are featured in the March 2008 Journal of the American Dental Association (JADA), and are available at ADA.org in full-report format and as an executive summary for chairside use.
In a 2004 survey, the ADA asked member dentists to identify clinical questions they would like answered through an evidence-based process, and the effectiveness of dental sealants for managing or arresting carious lesions in permanent teeth ranked high on the list of clinical issues.
In November 2006, the ADA convened a panel of experts to assess the scientific evidence and develop practice-oriented recommendations on four focused clinical questions:
- Under what circumstances should sealants be placed to prevent caries?
- Does placing sealants over early (non-cavitated) lesions prevent progression of the lesion?
- Are there conditions that favor the placement of resin-based vs. glass ionomer cement sealants in retention or caries prevention?
- Are there any techniques that could improve retention and caries prevention of sealants?
The panel evaluated systematic reviews and other primary studies, using a standard system to grade the quality of the evidence and the strength of each recommendation. After a comprehensive review process, the Council approved the evidence-based recommendations on pit-and-fissure sealants as a tool for dentists to use in their clinical decision-making process.
The expert panel identified high-quality evidence to support two conclusions that dentists have known for years:
- dental sealants are effective at preventing dental decay; and
- both children and adults can benefit from sealant application.
Other conclusions may be less well known to practitioners, such as:
- sealants can stop the progression of non-cavitated (incipient) lesions; and
- in most cases, removing tooth structure before placing a sealant is not recommended.
Overall, pit-and-fissure sealants are effective as long as they are applied properly, monitored and replaced when needed. Sealant retention is also significantly enhanced when a four-handed technique is used, and resin-based sealants are the first choice of materials for dental sealants.
The full JADA report includes information on:
- suggestions for the detection of incipient carious lesions;
- the process the ADA followed to develop the evidence-based clinical recommendations;
- the system for classifying the strength of the recommendations based on the supporting evidence; and
- clinical recommendation summary charts (as quick references).
The March 2008 JADA also includes a “For the Dental Patient” page, which is designed to help dentists speak with patients in plain language about pit-and-fissure sealants for caries prevention.
The sealant clinical recommendations are a valuable resource for finding and applying the best current evidence into day-to-day patient care, in tandem with the dentist’s clinical expertise and the patient's treatment preferences. This comprehensive review and analysis of the available evidence will help dentists present the benefits and risks of the treatment and prevention options available today. For more information, visit ADA.org for a set of Questions & Answers on the new sealant clinical recommendations.
Footnotes1. Beauchamp J, Caufield PW, Crall JJ, Donly K, Feigal R, Gooch B, Ismail A, Kohn W, Siegal M, Simonsen R.. Evidence-based clinical recommendations for the use of pit-and-fissure sealants. A report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2008 Mar;139(3):257-68.
Document Posted March 2008