The Effect of Dental Sealants on Bacteria Levels in Caries Lesions: A Review of the Evidence
Section snippets
Inclusion criteria
This analysis was part of a broader systematic review of sealant effectiveness in known carious lesions in the pits and fissures of permanent teeth. Initially, we included all in vivo studies published in English that compared outcomes, such as caries progression or bacteria levels, in permanent teeth treated with sealants with outcomes in permanent teeth not treated with sealants. Comparisons could involve concurrent randomized controlled trials (RCTs), controlled trials or cohort studies
Description of studies
Of the six studies14, 15, 16, 17, 18, 19 used to calculate outcome measures in this analysis (representing 303 bacteria samples), two studies were RCTs,17, 18 one was a subgroup analysis of an RCT of split-mouth design,14 two were controlled trials that did not mention randomization15, 16 and one was of a before-and-after design (in which the same tooth was sampled before and after sealant placement)19 (Table 1).
About 94 percent of sampled lesions were cavitated at baseline (that is, allowed
DISCUSSION
Sealants were effective in reducing total bacteria counts in caries lesions. The reduction increased with time since sealant placement. At the last follow-up, there was a 100-fold decrease in mean bacteria counts in two studies14, 19 and a 1,000-fold decrease in the remaining two studies.15, 16 Sealants also reduced bacterial cultivability. On average, 47 percent of sealed lesions had viable bacteria (median = 50 percent) compared with 89 percent of unsealed lesions (median = 100 percent). When
CONCLUSION
We found that sealants significantly reduced bacteria levels in cavitated lesions, but that in some studies, low levels of bacteria persisted. These findings support those of a recent meta-analysis that sealants prevented caries progression.12 In combination, these two sets of findings suggest that when sealants are retained, and thus access to fermentable substrates is blocked, bacteria do not appear capable of exerting their cariogenic potential.
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Cited by (0)
Disclosure: None of the authors reported any disclosures.
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the U.S. Centers for Disease Control and Prevention, Atlanta.
The authors gratefully acknowledge the generous contribution of time and expertise by the U.S. Centers for Disease Control and Prevention's Dental Sealant Systematic Review Work Group: James D. Bader, DDS, MPH; Jan Clarkson, BSc, BDS, PhD, FDSRCS(Paed); Margherita Fontana, DDS, PhD; Daniel M. Meyer, DDS; R. Gary Rozier, DDS, MPH; Jane A. Weintraub, DDS, MPH; and Domenick T. Zero, DDS, MS.
- 1
Dr. Oong is a dental public health resident, Centers for Disease Control and Prevention/Division of Oral Health/Surveillance, Investigations, and Research Branch, Chamblee, Ga.
- 2
Dr. Griffin is a health economist, Centers for Disease Control and Prevention/Division of Oral Health/Surveillance, Investigations, and Research Branch, 4770 Buford Highway, MSF10, Chamblee, Ga. 30341
- 3
Dr. Kohn is the associate director of science, Centers for Disease Control and Prevention/Division of Oral Health/Surveillance, Investigations, and Research Branch, Chamblee, Ga.
- 4
Dr. Gooch is a dental officer, Centers for Disease Control and Prevention/Division of Oral Health/ Surveillance, Investigations, and Research Branch, Atlanta.
- 5
Dr. Caufield is a professor, Cariology and Comprehensive Care, New York University College of Dentistry, New York City.