Dental Caries (Cavities): Community-Based Initiatives to Promote the Use of Dental Sealants

The CPSTF finding is based on evidence from a systematic review of three studies (search period 1946-2012). The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to oral health. This finding updates and replaces the 2000 review on Statewide or Community-Wide Sealant Promotion.

Included studies evaluated interventions that used education, mass media, financial incentives, or a combination of these methods.

• One intervention offered financial incentives to dental health professionals and saw a significant 9.8 percentage point increase in the number of children who received sealants.
• Neither education (2 study arms) nor mass media (1 study) showed significant effects on sealant use.

An economic review of this intervention was not conducted because CPSTF did not have enough information to determine if the intervention works.

Applicability of this intervention across different settings and populations was not assessed because CPSTF did not have enough information to determine if the intervention works.

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• More evidence is needed to assess the effectiveness of community-based sealant promotion initiatives for increasing sealant use.
• Additionally, research should be done to better understand dental health professionals’ beliefs and other barriers that prevent change with regard to sealant application.

• Included evidence comes from the United States (2 studies) and the United Kingdom (1 study).
• Studies reported the percentage of children who received sealants, the number of sealants applied per child, and the extent of sealant use among dentists.

Effectiveness Review

Analytic Framework

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

Summary Evidence Table

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained n several publications).

Effectiveness Review

Grembowski D, Spiekerman C, del Aguila MA, Anderson M, Reynolds D, Ellersick A, Foster J, Choate L. Randomised pilot study to disseminate caries-control services in dentist offices. BMC Oral Health 2006;6(7).

Clarkson JE, Turner S, Grimshaw JM, Ramsay CR, Johnston M, Scott A, Bonetti D, Tilley CJ, Maclennan G, Ibbetson R, MacPherson LMD, Pitts NB. Changing clinicians’ behavior: a randomized controlled trial of fees and education. J Dent Res 2008;87(7):640-4.

Siegal MD, Garcia AI, Kandray DP, Giljahn LK. The use of dental sealants by Ohio dentists. J Public Health Dent 1996;56(7):12-21.

Four bibliographic databases were searched: OHG Register, CENTRAL, MEDLINE, and EMBASE. The databases searched covered publications in biomedical and behavioral sciences. Search strategies were adjusted to each database, based on controlled and uncontrolled vocabularies and search software. The types of documents searched in the databases included journal articles, books, book chapters, reports, conference papers, and dissertations. In addition, the bibliographies of all reviewed articles were used to identify any further literature.

OHG Trial Register

“pit and fissure sealant*” OR pit-and-fissure-sealant* OR (fissure* AND seal*) OR “resin seal*” OR “dental seal*” OR “tooth seal*” OR “enamel seal*” OR ((“glass ionomer*” OR glass-ionomer* OR resin*) AND seal*)

AND

(caries or decay or deminerali* or reminerali* or carious or cavit* or (teeth and lesion*) or (tooth and lesion*) or (dental and lesion*)) AND (school* and (program* or campaign* or curricul* or train* or teach*))

CENTRAL

1. MeSH descriptor Tooth demineralization explode all trees
2. (caries in All Text or carious in All Text)
3. (teeth in All Text and (cavit* in All Text or caries in All Text or carious in All
   • Text or decay* in All Text or lesion* in All Text or deminerali* in All Text or reminerali* in All Text) )
4. (tooth in All Text and (cavit* in All Text or caries in All Text or carious in All
   • Text or decay* in All Text or lesion* in All Text or deminerali* in All Text or reminerali* in All Text) )
5. (dental in All Text and (cavit* in All Text or caries in All Text or carious in All
   • Text or decay* in All Text or lesion* in All Text or deminerali* in All Text or
   • reminerali* in All Text) )
6. (enamel in All Text and (cavit* in All Text or caries in All Text or carious in All
   • Text or decay* in All Text or lesion* in All Text or deminerali* in All Text or
   • reminerali* in All Text) )
7. (dentin in All Text and (cavit* in All Text or caries in All Text or carious in All
   • Text or decay* in All Text or lesion* in All Text or deminerali* in All Text or reminerali* in All Text) )
8. (root* in All Text and (cavit* in All Text or caries in All Text or carious in All Text or decay* in All Text or lesion* in All Text or deminerali* in All Text or reminerali* in All Text) )
9. MeSH descriptor Dental plaque this term only
10. ( (teeth in All Text or tooth in All Text or dental in All Text or enamel in All Text
    • or dentin in All Text) and plaque in All Text)
11. MeSH descriptor Dental health surveys explode all trees
12. (“DMF Index” in All Text or “Dental Plaque Index” in All Text)
13. (#1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12)
14. MeSH descriptor Pit and fissure sealants this term only
15. (fissure in All Text near/6 seal* in All Text)
16. (dental in All Text near/3 sealant* in All Text)
17. (resin* in All Text near/4 sealant* in All Text)
18. (compomer* in All Text near/4 sealant* in All Text)
19. (composite* in All Text near/4 sealant* in All Text)
20. MeSH descriptor Glass ionomer cements explode all trees
21. MeSH descriptor Resins, synthetic explode all trees
22. (“glass ionomer*” in All Text or glassionomer* in All Text or glass-ionomer* in
    • All Text)
23. (#20 or #21 or #22)
24. sealant* in All Text
25. (#23 and #24)
26. (#14 or #15 or #16 or #17 or #18 or #19 or #25)
27. (#13 and #26)
28. MeSH descriptor Schools this term only
29. ( (school in All Text near/5 program* in All Text) or (school in All Text near/5
    • campaign* in All Text) or (school in All Text near/5 train* in All Text) or (school* in All Text near/5 teach* in All Text) or (school in All Text near/5 curricul* in All Text) )
30. (#28 or #29)
31. (#13 and #30)
32. (#31 or #27)

MEDLINE via OVID

1. exp TOOTH DEMINERALIZATION/
2. (caries or carious).mp.
3. (teeth adj5 (cavit$ or caries$ or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
4. (tooth adj5 (cavit$ or caries$ or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
5. (dental adj5 (cavit$ or caries$ or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
6. (enamel adj5 (cavit$ or caries$ or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
7. (dentin$ adj5 (cavit$ or caries$ or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
8. (root$ adj5 (cavit$ or caries$ or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
9. Dental plaque/
10. ((teeth or tooth or dental or enamel or dentin) and plaque).mp.
11. exp DENTAL HEALTH SURVEYS/
12. (“DMF Index” or “Dental Plaque Index”).mp.
13. or/1-12
14. “Pit and Fissure Sealants”/
15. (fissure$ adj6 seal$).mp.
16. (dental adj3 sealant$).mp.
17. (resin$ adj4 sealant$).mp.
18. (compomer$ adj4 sealant$).mp.
19. (composite$ adj4 sealant$).mp.
20. exp Glass Ionomer Cements/
21. exp Resins, synthetic/
22. (“glass ionomer$” or glassionomer$ or glass-ionomer$).mp.
23. 20 or 21 or 22
24. sealant$.mp.
25. 23 and 24
26. 14 or 15 or 16 or 17 or 18 or 19 or 25
27. 13 and 26
28. Schools/
29. (school$ adj5 (program$ or campaign$ or curricul$ or train$ or teach$)).mp
30. 28 or 29
31. 30 and 13
32. 27 or 31
33. case reports.pt.
34. Comment/
35. Letter/
36. Editorial/
37. or/33-36
38. 32 not 37
39. exp animals/ not humans.sh.
40. 38 not 39

EMBASE via OVID

1. exp DENTAL CARIES/
2. (caries or carious).mp.
3. (teeth adj5 (cavit$ or caries$ or carious or decay$ or lesion$ or deminerali$ or
   • reminerali$)).mp.
4. (tooth adj5 (cavit$ or caries$ or carious or decay$ or lesion$ or deminerali$ or
   • reminerali$)).mp.
5. (dental adj5 (cavit$ or caries$ or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
6. (enamel adj5 (cavit$ or caries$ or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
7. (dentin$ adj5 (cavit$ or caries$ or carious or decay$ or lesion$ or deminerali$
   • or reminerali$)).mp.
8. (root$ adj5 (cavit$ or caries$ or carious or decay$ or lesion$ or deminerali$ or
   • reminerali$)).mp.
9. TOOTH PLAQUE/
10. ((teeth or tooth or dental or enamel or dentin) and plaque).mp.
11. (“DMF Index” or “Dental Plaque Index” or “Dental Health Survey$”).mp.
12. or/1-11
13. “Fissure Sealant”/
14. (fissure$ adj6 seal$).mp.
15. (dental adj3 sealant$).mp.
16. (resin$ adj4 sealant$).mp.
17. (compomer$ adj4 sealant$).mp.
18. (composite$ adj4 sealant$).mp.
19. Glass Ionomer/
20. exp Resins/
21. (“glass ionomer$” or glassionomer$ or glass-ionomer$).mp.
22. 19 or 20 or 21
23. sealant$.mp.
24. 22 and 23
25. 13 or 14 or 15 or 16 or 17 or 18 or 24
26. 12 and 25
27. School/
28. (school$ adj5 (program$ or campaign$ or curricul$ or train$ or teach$)).mp.
29. 27 or 28
30. 12 and 29
31. 30 or 26
32. exp animals/
33. exp human/
34. 33 not 32
35. 31 and 34

Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, M kel M, Worthington HV. (2013) Sealants for preventing dental decay in the permanent teeth. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD001830. DOI: 10.1002/14651858.CD001830.pub4.

CPSTF did not have enough evidence to determine whether the intervention is or is not effective. This does not mean that the intervention does not work, but rather that additional research is needed to determine whether or not the intervention is effective.

Other evidence-based interventions such as school-based sealant delivery programs should be considered when making decisions about potential ways to increase sealant use.