Pit and fissure sealants: a review of the literature.
Over the past two decades, scientific research on pit and fissure sealants has established its efficacy as a primary preventive procedure and its importance in managing dental caries. Therefore, oral health care professionals must become familiar with this research if they are to recommend and utilize sealants.
Development of Sealant Materials
The concept of sealing the fissures of teeth to prevent caries is over 100 years old. In 1895, a report in Dental Digest by Wilson described the use of oxyphosphate cement to seal fissures. While this procedure did not provide long-term protection, it did introduce the concept of preventing dental caries in teeth fissures using a physical barrier.
In the years to follow, attempts by Hyatt, Bodecker, Kline and Knutson and Ast et al. to find a sealing material that provided long lasting barrier protection met with limited success. A notable breakthrough in the development of effective sealant materials occurred in 1955, when Buonocore reported the use of acid to etch the enamel surface prior to applying acrylic resin. The acid-etch technique allowed for sufficient bonding between the resin material and enamel, and provided the basis for further development of effective sealant materials.
In 1976, the Council on Dental Materials of the American Dental Association (ADA) designated sealants as a safe and effective means of preventing pit and fissure caries. Subsequent research and manufacturing efforts produced a variety of sealant materials, including autopolymerized or visible-light polymerized; semi-filled with inert particles or unfilled; with or without fluoride; and clear, tinted, or opaque.
The literature also contains various recommendations for surface preparations and cleaning the occlusal surface prior to sealant placement, including use of hydrogen peroxide, pumice, water, air polishing a sharp instrument tip, or a bristle brush.[8-12] Analyses of these variables indicated no significant difference in retention of sealant, regardless of method used. Acid etching appears to sufficiently remove the minimal pellicle, and cleanse pits and fissures. In some cases of poor oral hygiene, plaque, debris, and stains should be removed to evaluate the condition of the tooth surface.
Two studies indicated no significant difference in retention of sealant related to the use of liquid versus gel etchant.[15,16] Recent research investigating other enamel conditioning methods, such as air abrasion and carbon dioxide laser techniques, has been conducted to determine their effectiveness in sealant applications.[17-21]
Two variables most likely to affect the efficacy and retention of a sealant are the clinician's ability to use proper application/isolation techniques and the eruption status of the tooth.[23-25] Clinicians must follow the recommended etching and curing times while maintaining a dry field of operation. The most common cause of sealant failure is generally agreed to be moisture contamination during application.
To ensure adequate isolation, complete eruption of the tooth is preferable. Dennison et al. found that posterior teeth with the operculum covering the distal marginal ridge of the occlusal surface were twice as likely to need sealant replacements than those with the marginal ridge exposed.
Additional considerations regarding sealant materials include the effects of fluorides and air polishing on existing sealants, and the need for occlusal adjustment. A study was conducted to determine the effect of topical fluorides (both acidulated phosphate fluoride and neutral sodium) on semi-filled and unfilled sealants, and glass ionomer materials. Results indicated that acidulated phosphate fluorides may cause deterioration of semi-filled sealants and glass ionomers, but not unfilled sealants. Studies of the effects of air-polishing on self- and light-curing sealants found no statistically significant loss of sealant materials due to air polishing.
The need for occlusal adjustment following sealant placement was investigated by Tilliss et al., who suggested that natural wear of unfilled sealants is sufficient to establish appropriate occlusion, while use of a semi-filled sealant material requires checking the occlusion and possible adjustment of the occlusal contacts.
A recent study reported that bis-GMA based sealants appeared to contribute to human exposure to xenoestrogens. Researchers applied bisphenol-A-based sealants to the molars of 18 college-aged volunteers. They compared saliva samples taken before and after treatment and found bisphenol A present in the post-treatment samples. Concerns about bisphenol A leaching after sealant placement lead to Hamid and Hume studying the in vitro release of bisphenol A. They reported that the chemical could not be found in eluates from any sealant tested. Further research is necessary to establish whether there are adverse consequences of using bisphenol-a-based sealants.
Retention and Effectiveness
The primary factor associated with the efficacy of sealants is their ability to remain bonded to the occlusal surface. Weintraub's review of sealant effectiveness compared retention, caries incidence, and reapplication rates reported in numerous studies. Based on the results of this comprehensive work, the author concluded that: 1) children and young adults experience a high rate of occlusal caries (80-90%) and a relatively low rate of proximal caries (10-20%); 2) the benefits of large-scale sealant programs decline with increasing age; 3) after one application, the percent of effectiveness and complete retention declines over time -- median effectiveness and retention rates were 83% and 92%, respectively, after one year, which declined to 55 and 66% after seven years; 4) there was no significant difference in benefits of sealants between Studies of fluoridated and fluoride-deficient communities; 5) studies comparing reapplication rates and restorations indicate that reapplication of a sealant is needed to maintain its preventive effect over time. The studies Weintraub reviewed indicate that completely retained sealants prevent decay, but sealants that are lost should be reapplied.
It has been suggested that a tooth without decay four years after eruption is not likely to decay in the future. This theory no longer appears to be valid.[33,34] Several researchers investigated the risk of occlusal caries throughout life and found continuing caries susceptibility.[35,36] These findings suggest that children may benefit from sealants, even when teeth had erupted several years prior, and that reapplying sealants throughout life may be beneficial.
Simonsen[37,38] studied sealant retention using a retrospective case-control study of children with permanent molars. Among those who received a single application of a white-colored autocured sealant in 1976, 74% of the pit and fissure surfaces of permanent first molars were non-carious 15 years later. Simonsen noted that, although he only had looked at studies of a single application of sealants, children can potentially maintain caries-free molars through timely reapplication of sealants.
A clinic-based sealant program was conducted for Guamanian children in grades one through eight to reduce caries rates on this fluoride-deficient island. Sealants were applied to the teeth of over 15,000 children from 1984 to 1986. Decayed, missing, and filled surfaces scores (DMFS) were reduced by 45%. In addition, the first annual evaluation indicated a sealant retention rate of 94 percent.
The effectiveness of sealants when applied in dental practices rather than clinical trials or public health programs was examined by Ismail and Gagnon. In 1990, a random sample of children (n=733) aged 6 to 9 was examined over a two-year period in Quebec to evaluate sealants in private dental practices. Sealants on 600 occlusal surfaces of permanent first molars were determined to be fully sealed. After two years, 73.5% were still fully sealed. Compared with unsealed sound molars, the fully sealed teeth had a 75% lower incidence of new restorations.
In another study, of retention rates, Romcke, et al., evaluated 8,340 chemically cured sealants placed between 1978 and 1985. After one year, complete retention was found on 89% of the teeth; 60% after seven to nine years. Six percent needed maintenance sealing after one year, while sealant removal was required for only 1% due to occlusal caries and 2% due to interproximal caries. These studies suggest that sealants can effectively prevent dental caries when applied in private practices.
Incipient Caries and the Use of Sealants
In the mid-1980s, based on research findings demonstrating that intact sealants halted caries progress, a consensus panel convened by the National Institute of Dental Research (NIDR) endorsed the use of sealants on incipient caries. Viewed from the perspective of the medical model of disease, dental caries is a preventable infection primarily caused by Streptococcus mutans. Research on the use of sealants over incipient carious sites has shown consistently that bacteria tend to die out and caries do not progress when early infections are sealed.[43-50] One study indicated that viable bacteria decreased by as much as 98% after being isolated under a sealant for two years. In addition, radiographic and audio-pressure transduction investigations have found that caries ceased in sealed incipient infections.[45,51-53]
Longitudinal evaluation of sealant effect on the caries experience of initially sound and incipient lesions was completed on 96 children in a public health program. After five years, the initially incipient surfaces that were sealed had a 10.8% caries rate while unsealed surfaces reached 51.8%. Initially sound surfaces had a decay rate of 8.1% for sealed surfaces and 12.5% for unsealed. The authors concluded that sound tooth surfaces did not appear to benefit greatly from sealants and recommended sealing of incipient surfaces to reduce decay rates.
Inadvertent sealing of incipient lesions should not be a clinical concern and, in fact, these surfaces should be sealed first. As long as the sealant margin is intact, bacteria decrease and caries should not progress. Improvements in caries diagnosis, case planning, and treatment have important implications for sealant use. Anusavice recommends that the decision-making process for restorative treatment include a consideration of sealants and preventive resins.
Studies of the use of glass ionomer (polyalkenoate) as a fissure sealant indicate significantly lower retention rates than resin-based fissure sealants.[56,57] However, the rate of reduction in caries is similar for each material. van Noort Suggests that, although the glass ionomer appears lost, some material may be retained in the fissure an, continues to prevent caries. Overbo and Raadal compared the extent of microleakage that occurs in glass ionomer cement and a diluted composite material. Extensive leakage was found in the glass ionomer cement throughout the material, and at the margin of the cement and the enamel; no leakage was found in composite specimens.
The use of glass ionomers has been suggested for erupting teeth where isolation from saliva is a problem and caries risk is high: however, further research is needed to determine the long-term benefits of this approach. A clinical study involving intentional salivary contamination indicated that sealant retention is possible on wet enamel if a bonding agent is used between the enamel and sealant.
The effect of sealing over newly placed dental restorations has been investigated in an effort to extend the life of such restorations.[62,63] If microleakage can be reduced by sealing the margins, the need for replacement of restorations would be minimized. Replacing restorations usually involves further removal of tooth structures, which weakens the tooth and can lead to fracture.
Comparing surfaces restored with composite and sealed, amalgam and sealed, and amalgam but not sealed, showed that covering a new restoration with sealant can be beneficial. Amalgam restorations sealed with a pit and fissure sealant exhibited significantly less microleakage and superior marginal integrity. Composite restorations with sealant prevented caries effectively for four years.
Anderson proposed a technique using sealants to repair the fractured non-carious margins of existing amalgams in order to increase their longevity. With proper surface preparations and appropriate selection of a sealing material, the ditched margins of amalgams can be repaired to effectively prevent microleakage and preserve the existing restoration.
Use of sealants with orthodontic care may reduce enamel demineralization at the margins of bands. Liebenberg Suggested that fissure sealants cover the occlusal surface and any open margins between the band and tooth to eliminate the iatrogenic defect created by the band-tooth interface. It was suggested that this technique could reduce the demineralization that results from insufficient bonding of the cements and their solubility in oral fluids.
Banks and Richmond performed a clinical test using two enamel sealing systems (viscous and non-viscous) to prevent enamel decalcification following bracket bonding. Results indicated that 75% of the 80 participants were affected by enamel decalcification. Use of the viscous sealant produced a 13% reduction in demineralization, while the non-viscous sealant produced no significant difference. The authors recommended continued research to reduce the risk of orthodontic treatment.
As health care costs continue to rise, there is an increasing need to promote effective preventive measures. There have been limited studies to determine the cost-effectiveness of sealants.[68,69] Kuthy examined dental insurance claims for over 1.3 million children over a three-year period -- to 1986 1988 -- and found that the average one-surface restoration charge more than doubled the average sealant charge. A similar ratio was found in survey data published by the Bureau of Economic and Behavioral Research of the ADA.[71,72] Perhaps more significant than the difference in initial cost is the potential for reducing of long-term dental treatment expenses.[73,74]
Sealant use has increased gradually but remains relatively, low, especially considering its potential to prevent caries. Widespread use has been constrained by a lack of consumer knowledge, a low level of provider awareness and acceptance, and a lack of public access to professional preventive services.[32,75,76]
Surveys in the 70s and early 80s indicated that 40 to 60% of dentists used sealants.[77,78] A 1986 survey indicated that 81% of dentists used sealants, but 66% applied them to only five or fewer patients per week. Similar usage patterns were evident in a national survey of pediatric dental practices, where 55.4% of practitioners used sealants but applied them to less than half of their pediatric patients. More recent surveys indicate up to 90% of practitioners report using sealants, but defining actual usage in the future necessitates determining how frequently each practitioner places sealants.[81,82]
The data that most clearly suggests an underutilization of sealants are in reports of sealant prevalence in schoolchildren. NIDR's 1985 - 86 survey of US schoolchildren indicated that only 7.6% had sealants. Sealant prevalence in children, adolescents, and adults reported in the 1988-1991 Third National Health and Examination Survey (NHANES III- Phase 1) indicated that 18.5% of children and adolescents aged 5 to 17 had one or more sealed permanent teeth, and only 1.4% of adults aged 18 and over had a least one sealed tooth.
In 1990, in an effort to increase sealants in private and public health settings, the US Public Health Service established a dental health objective of 50% of children ages 8 and 14 to have sealants on one or more permanent molar teeth by the year 2000. In conjunction are efforts to increase awareness of sealants and their efficacy. In April 1994, guidelines for sealant use were written by a workshop of 22 clinicians, policy makers, program administrators, and oral health researchers in the Journal of Public Health Dentistry. The guidelines provide important recommendations to establish sealants in individual care and community health programs.
In 1994, sealants were promoted by: 1) the National Public Health Dental Sealant Program Conference in Columbus, Ohio, which was attended by dental health representatives from 35 states and two territories (featuring the first presentation of the recommendations of the Workshop on Guidelines for Sealant Use); 2) a national survey of public health sealant programs conducted by the Ohio Department of Health; 3) development of the "SEAL AMERICA: the Prevention Invention" videotape and manual, which provided instructions for developing and operating school-based sealant programs; 4) funding of the national school-based Oral Health/Dental Sealant Resource Center at the University of Illinois at Chicago School of Public Health to promote sealant programs nationwide and serve as a resource for dental sealant programs.
Numerous researchers have sought to identify the reasons why sealants are underused. Surveys of adoption patterns, use of auxiliaries, perceived barriers, attitudes, and knowledge indicate that practitioners may not be familiar with sealant literature.[77,88-96] This is most notable in surveys of perceived barriers to using sealants. Results indicate continued misconceptions, despite the accumulation of scientific research to the contrary. The most frequently noted misconceptions included the supposition that sealants are easily lost or seal in decay; that patients resist the expense, prefer amalgam restorations, or do not understand sealant value; and that sealant effectiveness is not proven.[77,90]
Data collected from the NHANES III, 1988-91 national survey indicated an increase in sealant prevalence. A study of Ohio dentists found that the percent of sealant users increased from 1989 to 1992 and that lack of insurance coverage was identified as the major barrier to patients receiving sealants.
Dental Hygienists' Knowledge and Use
Most state dental practice acts permit sealant placement by dental hygienists.[98-101] However, delegation of sealant application is low.[77,102,103] Research has shown that dental hygienists and dental assistants can apply sealants effectively and that the procedure should be delegated to them. [103-106] In addition, numerous studies establish the cost-effectiveness of sealants being applied by dental hygienists and dental assistants.[108-111] Future research on this topic may indicate an increase in delegation of sealant application from earlier years.
A study of dental hygienists practicing in Minnesota and Wisconsin investigated their knowledge, opinions, and use of sealants. These baseline data were collected prior to the 1983 NIH Consensus Development Conference on Dental Sealants in the Prevention of Tooth Decay. Results indicated that 64% of Minnesota hygienists and 84% of Wisconsin hygienists were not applying sealants. Among dental hygienists who did place sealants, their frequency of use per week was low; only 5 and 4% of Minnesota and Wisconsin hygienists, respectively, reported placing them more than 3 times per week. Responses to an open-ended question to determine reasons for nonuse indicated that Minnesota hygienists were most likely to mention lack of employer acceptance or a nonpermissive office policy. Wisconsin hygienists mentioned sealants not being applied in the office and a lack of employer acceptance or nonpermissive office policy. Other reasons were a lack of training, resources, and equipment; the employer applied or did not delegate the responsibility for application to the hygienist; and the patient or parents lacked understanding. The reasons for nonuse reported by hygienists differ from those given by dentists, who focused the lack of acceptance on concerns about technical procedures.
In 1983, a nationwide study of dental hygienists who had graduated one year earlier indicated that the majority of respondents never applied sealants. Seventy-four percent did not apply sealants for adult patients and 60% did not apply sealants for children. The authors associate this with low levels of self-perceived competency in providing sealants and employers' negative attitudes and reluctance to delegate. They recommended that dental hygiene education programs provide more extensive experience in applying sealants to facilitate the competence and willingness to negotiate with employers to delegate this preventive service. However, since sealant prevalence increased after this recommendation was made,[83,84] educational programs may have implemented the recommendation.
In a 1985 study of sealant use by dental hygienists in Virginia, 53.1% reported receiving experience (theory, laboratory, or clinical) in sealant application during their professional education. This compared to 50% of pediatric dentists and 28% of general dentists reporting. The study also found that 68.6% of dental hygienists who worked in general practice said they applied sealants. The most frequent reason given for not applying them was that the dentist did not believe in their use. The authors concluded that a lack of professional knowledge about sealants existed and recommended additional basic and continuing education for students and practitioners respectively.
Public Knowledge and Acceptance
The general public's knowledge of oral diseases and their prevention were investigated by Gift et al., using data from the National Health Interview Survey (NHIS). Results indicated that racial and ethnic minorities and groups with low levels of formal education demonstrate the least knowledge of prevention of oral diseases. Only one-third of adults had heard of sealants and 25% of those adults could not correctly identify the purpose of sealants.
NHIS data suggested that both the pattern of dental visits and use of sealants are strongly associated with socioeconomic status. In that survey, children in low income and education categories experienced fewer dental visits and had fewer sealants, due to a lack of funds, knowledge, insurance, and access to preventive dental services.[76,116]
Because public/community sealant programs can provide effective preventive strategies to target specific populations such as low-income children, the importance and use of these programs are expanding. Cohen and Horowitz reported an increase from 21 to 29 in the number of states with community sealant programs between 1985 and 1991. By 1994, all 50 state Medicaid programs reported providing reimbursement for sealants.
Many school-based sealant programs that target children were established in response to the Healthy People 2000: National Health Promotion and Disease Prevention Objective, which set a goal of 50% of children ages 8 and 14 years having at least one permanent molar sealed by the year 2000. Implementing school-based sealant programs can provide access to care for children who are at high risk or whose parents have limited financial resources for preventive dental care.
Public awareness of sealants significantly affects whether a child has them applied. Parents must know about sealants before they can make an informed choice. Surveys of parents' knowledge of sealants indicated that dentists and dental hygienists are the most frequent source of information about sealants.[118-120] Selwitz found that parents were more likely to obtain sealants for their children if the dentist or a staff recommended them. A study conducted shortly after the NIH conference reported that mass media also served as an important source of public information about sealants. Horowitz and Frazier recommended public education programs from as many sources as possible to increase the demand for sealants.
A survey of physicians and teachers in Utah indicated that 68% of physicians were unfamiliar with sealants; and while most dental health teachers taught brushing, flossing, and low-sugar diets, less than 20% included information about sealants. This study also investigated the influence of insurance coverage for sealants on parents' decisions to have sealants for their children. Of the 627 respondents, 44% of urban and 39% of rural parents indicated they would have sealants placed whether or not insurance covered any of the Cost.
In reviewing the societal and professional factors associated with use of sealants, Frazier stated:
"although national health policy today
recognizes the rights of patients and
consumers to be accurately and fully informed
about procedures available to protect their
health and to give informed consent for
treatment procedures performed,
information about sealants has been all but hidden
from public view."
To increase awareness and use of sealants, Frazier recommended improved communication among dental researchers, dental educators, practitioners, and dental licensing boards, all of whom are obliged through employment, position, or public licensure to act on behalf of the public interest.
Conclusion and Recommendations
The scientific research conducted over the past 25 years clearly has established the effectiveness of pit and fissure sealants in preventing occlusal caries. Their demonstrated effectiveness notwithstanding, sealants continue to be underutilized as a method of disease prevention, particularly for school-age children. Because the literature reviewed in this article suggests that the potential to markedly reduce the incidence of dental caries through use of pit and fissure sealants has not been realized, the following recommendations are made:
1) Advocate caries management curricula in dental and dental hygiene education, which encompass the clinical, behavioral, preventive, ethical, and philosophical aspects of preventing infectious disease. 2) Encourage practicing clinicians to participate in caries management courses to close the "gap" between what we know as health care professionals and what we actually do as clinicians. 3) Develop public education programs to ensure that parents and caregivers are aware of the availability and efficacy of pit and fissure sealants. Activities could include a) use of media, such as television, radio, newspapers, parents' magazines, child health care books, and children's storybooks; b) provision of educational programs for parental groups, school health educators, school and public health nurses, family practitioners, pediatricians, and pediatric nurses; and c) use of educational displays at local libraries, child health care centers, women's health centers, child daycare centers, community and school health fairs, hospital pediatric units, and pharmacies. 4) Provide accurate information and education to insurance providers and business administrators about the benefits of sealants. This can be facilitated by providing sealant education materials for employee bulletin boards, paycheck stuffers, and company wellness programs. 5) Continue research studies that a) develop even more efficacious sealants, b) determine factors associated with clinical sealant use by oral health care providers, c) evaluate the lifetime benefits for individuals who have sealants, and d) develop standardized assessments of the actual frequency and number of sealants being placed. 6) Organize dental health professionals to assess the dental needs in their local communities. Developing or collaborating with existing public health programs can be useful in establishing access to care for targeted populations with limited financial resources and/or high risk of dental disease. Involving dental health professionals is important to the implementation and success of community and school-based dental care programs. 7) Utilize existing sealant education resources and materials to provide consumers and health professionals with accurate information.
[1.] Wilson IP: Preventive dentistry. Dent Dig 1895;1:70-72.
[2.] Hyatt TP: Prophylactic odontotomy: The cutting into the tooth for the prevention of disease. Dent Cosmos 1923;65:234-241.
[3.] Bodecker CF: Eradication of enamel fissures. Dent Items 1929;51:859-866.
[4.] Kline H, Knutson JW: Studies on dental caries XIII. Effect of ammoniacal silver nitrate on caries in the first permanent molar. J Am Dent Assoc 1942;29:1420-1426.
[5.] Ast DB, Bushel A, Chase HC: A clinical study of caries prophylaxis with zinc chloride and potassium pharocyanide. J Am Dent Assoc 1950;41:437-442.
[6.] Buonocore MG: A simple method of increasing the adhesion of acrylic filling materials to enamel surfaces. J Dent Res 1955;34:849-853.
[7.] ADA Council on Dental Materials and Devices and the Council on Dental Therapeutics: Pit and fissure sealants. J Am Dent Assoc 1976;93:134.
[8.] Burrow MF, Makinson OF: Pits and fissures: Remnant organic debris after acid-etching. J Dent Child 1990;57:348-351.
[9.] Donnon MF, Ball IA: A double-blind clinical trial to determine the importance of pumice prophylaxis on fissure sealant retention. Br Dent J 1988;165:283-286.
[10.] Bogert TR, Garcia-Godoy F: Effect of prophylaxis agents on the shear bond strength of a fissure sealant. Ped Dent 1992;14:50-51.
[11.] Garcia-Godoy F, Medlock JW: A SEM study of the effects of air-polishing on fissure sealants. Quintessence Intl 1988;19:465-467.
[12.] Garcia-Godoy F, Gwinnett AJ: A SEM study of fissure surfaces conditioned with a scraping technique. Clin Prev Dent 1987;9:9-13.
[13.] Main C, Thompson JL, Cummings A, et al.: Surface treatment studies aimed at streamlining fissure sealant application. J Oral Rehab 1983;10:307-317.
[14.] Pope BD, Garcia-Godoy F, Summitt JB, Chan D: Effectiveness of occlusal fissure cleansing methods and sealant micromorphology. J Dent Child 1996;May-June:175-179.
[15.] Garcia-Godoy F, Gwinnett AJ: Penetration of acid solution and gel in occlusal fissures. J Am Dent Assoc 1987;114:809-810.
[16.] Brown ME, Foreman FJ, Burgess JO, et al: Penetration of gel and solution etchants in occlusal fissures. J Dent Child 1988;55:265-268.
[17.] Kanellis MJ, Warren JJ, Levy SM: School-based sealant placement: Six-month comparison of two techniques [abstract]. J Dent Res 1996;75:18.
[18.] Haws SM, Oliveira ML, Vargas MA, Kanellis MJ: Airabrasion and microleakage of pit and fissure sealants [abstract]. J Dent Res 1996;75:180.
[19.] Jensen OE, Billings RJ, Featerstone JD: Clinical evaluation of fluorshield pit and fissure sealant. Clin Prev Dent 1990;12:24-27.
[20.] Walsh LJ: Split-mouth study of sealant retention with carbon dioxide laser versus acid-etch conditioning. Aust Dent J 1996;41:124-127.
[21.] Hicks MJ, Flaitz CM, Westerman GH, et al.: Carieslike lesion initiation and progression around laser-cured sealants. Am J Dent 1993;6:176-180.
[22.] Brown JR, Barkmeier WW: A comparison of six enamel treatment procedures for sealant bonding. Ped Dent 1996;18:29-31.
[23.] National Institutes of Health: Consensus development conference statement on dental sealants and the prevention of tooth decay. J Am Dent Assoc 1984;48(suppl):126-131.
[24.] Simonsen RJ: Pit and fissure sealant. J Prac Hyg 1996;1:37-38.
[25.] Dennison JB, Straffon LH, More FG: Evaluating tooth eruption on sealant efficacy. J Am Dent Assoc 1990;121:610-614.
[26.] Hitt JC, Feigal RJ: Use of a bonding agent to reduce sealant sensitivity to moisture contamination: an in vivo study. Ped Dent 1992;14:41-46.
[27.] Kula K, Thompson V, Kula T, et al.: In vitro effect of topical fluorides on sealant materials. J Esthet Dent 1992;4:121-127.
[28.] Huennekens SC, Daniel SJ: Effects of air-polishing on the abrasion of occlusal sealants. Quintessence Int 1991;2581-585.
[29.] Tilliss TS, Stach DJ, Hatch RA, et al.: Occlusal discrepancies after sealant therapy. J Pros Dent 1992;68:223-228.
[30.] Olea N, Pulgar R, Perez P, et al.: Estrogenicity of resin-based composites and sealants used in dentistry. Environ Health Persp 1996;104:298-305.
[31.] Hamid A, Hume WR: Release of estrogenic component Bisphenol-A not detected from fissure sealants in vitro (abstract). J Dent Res 1997;76:321.
[32.] Weintraub JA: The effectiveness of pit and fissure sealants. J Pub Health Dent 1989;49 (spec iss) 5,317-330.
[33.] Carlos JP, Gittelsohn AM: Longitudinal studies of the natural history of caries -- II. A life-table study of caries incidence of permanent teeth. Arch Oral Biol 1965;10:739-751.
[34.] Parfitt GJ: The speed of development of the carious cavity. Brit Dent J 1956;100:204-207.
[35.] Ripa LW, Leske GS, Varma AO: Longitudinal studies of the caries susceptibility of occlusal and proximal surfaces of first permanent molars. J Pub Health Dent 1988;48:8-13.
[36.] Leverett DH, Handelman SL, Brenner CM, Iker HP: Use of sealants in the prevention and early treatment of carious lesions: Cost analysis. J Am Dent Assoc 1983;106:39-42.
[37.] Simonsen RJ: Retention and effectiveness of a single application of a white sealant after 10 years. J Am Dent Assoc 1987; 115:31-36.
[38.] Simonsen RJ: Retention and effectiveness of dental sealants after 15 years. J Am Dent Assoc 1991;122:34-42.
[39.] Sterritt GR, Frew RA: Evaluation of a clinic-based sealant program. J Pub Health Dent 1988;48:220-224.
[40.] Ismail AI, Gagnon P: A longitudinal evaluation of fissure sealants applied in dental practices. J Dent Res 1995;74:1583-1590.
[41.] Romcke RG, Lewis DW, Maze BD, et al: Retention and maintenance over 10 years. J Can Res Dent Assoc 1990;56:235-237.
[42.] National Institutes of Health: Consensus development conference statement on dental sealants and the prevention of tooth decay. J Am Dent Assoc 1984;108:233-236.
[43.] Kramer PF, Zelante F, Simionato MR: The immediate and long-term effects of invasive and non-invasive pit and fissure sealing techniques on the microflora in occlusal fissures of human teeth. Ped Dent 1993;15:108-112.
[44.] Jensen OE, Handelman SL: Effect of an autopolymerizing sealant on viability of microflora in occlusal dental caries. Scand J Dent Res 1980;88:382-388.
[45.] Mertz-Fairhurst EJ, Schuster GS, Williams JE, Fairhurst JE: Clinical progress of sealed and unsealed caries. Part I. Depth changes and bacterial counts. J Prosthet Dent 1979;42;521-526.
[46.] Going RE, Loesche WJ, Grainger DA, Syed SA: The viability of micro-organisms in carious lesions five years after covering with a fissure sealant. J Am Dent Assoc 1978;97:455-462.
[47.] Jeronimus DJ, Till MJ, Sveen OB: Reduced viability of microorganisms under dental sealants. J Dent Child 1975;42:275-280.
[48.] Handelman SL: Microbiologic aspects of sealing carious lesions. J Prev Dent 1976;3:29-32.
[49.] Handelman SL, Buonocore MG, Schoute PC: Progress report on the effect of fissure sealant on bacteria in dental caries. J Am Dent Assoc 1973;87:1189-1191.
[50.] Ripa LW: Studies of pit and fissures. In The Use of Adhesives in Dentistry. Buonocore MG, (ed). Springfield, IL: Thomas. 1975:p.120.
[51.] Handelman SL, Leverett DH, Solomon ES, Brenner CM: Use of adhesive sealants over occlusal carious lesions: Radiographic evaluation. Comm Dent Oral Epidemiol 1981;9:256-259.
[52.] Handelman SL, Leverett DH, Iker HP: Longitudinal radiographic evaluation of the progress of caries under sealants. J Pedodon 1985;9:119-125.
[53.] Handelman SL, Leverett DH, Espeland MA, Curzon JA: Clinical radiographic evaluation of sealed carious and sound tooth surfaces. J Am Dent Assoc 1986;113:751-754.
[54.] Heller KE, Reed SG, Bruner FW, et al.: Longitudinal evaluation of sealing molars with and without incipient dental caries in a public health program. J Pub Health Dent 1995;55:148-153.
[55.] Anusavice KJ: Decision analysis in restorative dentistry. J Dent Educ 1992;56:812-822.
[56.] Mejare I, Mjor IA: Glass ionomer and resin-based fissure sealants: A clinical study. Scand J Dent Res 1990;98:345-350.
[57.] Torppa-Saarinen E, Seppa L: Short-term retention of glass-ionomer fissure sealants. Proc Finn Dent Soc 1990;86:83-88.
[58.] van Noort R: Dental materials: 1990 literature review. J Dent 1991;19:327-351.
[59.] Overbo RC, Raadal M: Microleakage in fissures sealed with resin or glass ionomer cement. Scand J Dent Res 1990;98:66-69.
[60.] Raadal M, Utkilen AB, Nilsen OL: Fissure sealing with light-cured glass ionomer cement compared with resin (abstract). 14th Congress of International Association of Pediatric Dentistry, Chicago. 1993;5-5.
[61.] Feigal RJ, Hitt J, Splieth C: Retaining sealant on contaminated enamel. J Am Dent Assoc 1993:124:88-97.
[62.] Hadavi F, Hey JJ, Ambrose ER: Assessing microleakage at the junction between amalgam and composite resin. Oper Dent 1991;16:6-12.
[63.] Cardash HS, Bichacho N, Imfer S, et al.: A combined amalgam and composite resin restoration. J Prosthet Dent 1990;63:502-505.
[64.] Mertz-Fairhurst EJ, Williams JE, Pierce KL, et al.: Sealed restorations: 4-year results. Am J Dent 1991;4:43-49.
[65.] Anderson MH: Repairing the ditched amalgam. Indiana Dent Assoc J 1993;Sep/Oct: 19-21.
[66.] Liebenberg WH: Extended fissure sealants: An adjunctive aid in the prevention of demineralization around orthodontic bands. Quintessence Intl 1994;25:303-312.
[67.] Banks PA, Richmond S: Enamel sealants: A clinical evaluation of their value during fixed appliance therapy. Eur J Orthod 1994;16:19-25.
[68.] Simonsen RJ: Cost effectiveness of pit and fissure sealant at 10 years. Quintessence Intl 1989;20:75-82.
[69.] Weintraub JA, Stearns SC, Burt BA, et al.: A retrospective analysis of the cost-effectiveness of dental sealants in a children's health center. Soc Sci Med 1993;36:1483-1493.
[70.] Kuthy RA: Charges for sealants and one-surface, posterior permanent restorations: Three years of insurance claims data. Ped Dent 1992;14:405-406.
[71.] Bureau of Economics and Behavorial Research, American Dental Association: Dental fees charged by general practitioners and selected specialists in the United States. Chicago: American Dental Association. 1982.
[72.] Bureau of Economics and Behavorial Research, American Dental Association: Dental fees charged by general practitioners and selected specialists in the United States, 1985. J Am Dent Assoc 1986;113:811-819.
[73.] Robinson AD: The life of a filling. Br Dent J 1971;130:206-208.
[74.] Allan DN: A longitudinal study of dental restorations. Br Dent J 1977;143:87-89.
[75.] Gift HC, Frew R: Sealants: Changing patterns. J Am Dent Assoc 1986;112:391-392
[76.] Gift HC, Newman JF: Oral health of US children: Results of a national health interview survey. J Am Dent Assoc 1992;123:96-106.
[77.] Gift HC, Frew R, Hefferren J: Attitudes toward and use of pit and fissure sealants. J Dent Child 1975;42;460-466.
[78.] Hunt RJ, Kohout FJ, Beck JD: The use of pit and fissure sealants in private dental practice. J Dent Child 1984;51:29-34.
[79.] Faine RC, Dennen T: Survey of private dental practitioners' utilization of dental sealants in Washington state. J Dent Child 1986;53:337-342.
[80.] Romberg E, Cohen LA, LaBelle A: The use of pit and fissure sealant in private practice: A national survey. J Dent Child 1988;55:257-264.
[81.] Bowman PA, Fitzgerald CM: Utah dentists' sealant usage survey. ASDC J Dent Child 1990;57:134-138.
[82.] Gonzalez CD, Frazier PJ, Messer LB: Sealant use by general practitioners: A Minnesota survey. ASDC J Dent Child 1991;58:38-45.
[83.] Brunelle JA: Oral health of US children. The national survey of dental caries in US schoolchildren: 1986-87. National and Fegionalfindings. NIH pub no 89-2247. Washington DC: Department of Health and Human Services. 1989.
[84.] Selwitz RH, Winn DM, Kingman A, Zion GR: The prevalence of dental sealants in the US population: Findings from NHANES III, 1988-91. J Dent Res 1996;(special issue)75:652-660.
[85.] US Public Health Service: Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington DC: Department of Health and Human Services. 1991;pub no (PHS) 91-50213.
[86.] Proceedings of the Workshop on Guidelines for Sealant Use. J of Pub Health Dent 1995;(special issue)55:5.
[87.] 1994: A Year for Sealant Promotion. J Pub Health Dent 1995;(special issue)55:312.
[88.] Chapko MK: Time of adoption of an innovation by dentists in private practice: Sealant utilization. J Pub Health Dent 1991;51:144-151.
[89.] Silversin JB, Coombs JA, Drolette ME: Adoption of dental preventive measures in United States Schools. J Dent Res 1980;59(spec iss D, part 2):2233-2242.
[90.] Hunt RJ, Kohout FJ, Beck JD: The use of pit and fissures sealants in private practice settings. J Dent Child 1984;Jan-Feb:29-33.
[91.] Jerrell RG, Bennett CG: Utilization of sealants by practicing pedodontists. J Ped 1984;8:378-387.
[92.] Call RL, Hicks MI: Sealant utilization patterns and attitudes among Colorado dentists [abstract]. J Dent Res 1986;65(spec iss):339.
[93.] Milton BB, Walsh V, Gift HC: Prevention in the dental office: Results of a preventive dentistry survey. J Am Dent Assoc 1984;108:809-817.
[94.] Cohen L, La Belle A, Romberg E: The use of pit and fissure sealants in private practice a national survey. J Pub Health Dent 1988;48:26-35.
[95.] Badner VM, Rosenberg D: Dentist use patterns for pit and fissure sealants and topical fluorides. J Dent Educ 1986;50:656-660.
[96.] Callanen VA, Taggart MP, French DP, et al.: A survey of use of pit and fissure sealant by Massachusetts dentists. Presented at the American Public Health Association Meetings, Nov 17-21,1985, Washington DC.
[97.] Siegal MD, Garcia AI, Kandray DP, Giljahn LK: The use of dental sealants by Ohio dentists. J Pub Health Dent 1996;56:12-21.
[98.] American Dental Hygienists' Association, Division of Governmental Affairs. Access 1997;11,51-53.
[99.] Horowitz AM, Frazier PJ: Issues in the widespread adoption of pit and fissure sealants. J Pub Health Dent 1982:42;312-323.
[100.] Cohen L, Rhomberg E, LaBelle A: Pit and fissure sealant use in private practice: Influence of state practice acts. Am J PubHealth 1988:78,316-317.
[101.] Cohen LA, Horowitz AM: Community-based sealant programs in the United States: Results of a survey. J Pub Health Dent 1993;53:241-245.
[102.] Frazier PJ Horowitz AM: Factors influencing adoption of caries preventive methods. Paper presented at Joint Program in Caries Prevention in Dental Education, American Association of Dental Schools, March 13, 1984.
[103.] Tysowsky P, Frazier J: Pit and fissure sealants: Manufacturers' marketing strategies. Paper presented at the 112th Annual Meeting of the American Public Health Association, 1984.
[104.] Leske GS, Pollard S, Cons N: The effectiveness of dental hygienists teams in applying pit and fissure sealant. J Prev Dent 1976;3:33-336.
[105.] Foreman FJ, Matis BA: Sealant retention rates of dental hygienists and dental technicians using differing training protocols. Ped Dent 1992;14:189-190.
[106.] Foreman FJ, Matis BA: Retention of sealants placed by dental technicians without assistance. Ped Dent 1991;13:59-61.
[107.] Ripa LW: Sealants revisited: An update of the effectiveness of pit and fissure sealants. Caries Res 1993;27(suppl 1):77-82.
[108.] Horowitz, H: Pit and fissure sealants in private practices and public health programmes: Analysis of cost-effectiveness. Int Dent J 1980:30;117-126.
[109.] Houpt MI, Shey Z: Cost-effectiveness of fissure sealant placement. J Prev Dent 1980:6;7-10.
[110.] Leverett DH, Handelman SL, Brenner CM, Iker, HP: Use of sealants in the prevention and early treatment of carious lesions: Cost analysis. J Am Dent Assoc 1983:106;39-42.
[111.] Christensen GJ: Increasing patient service by effective use of dental hygienists. J Am Dent Assoc 1995:126;1291-1294.
[112.] Duffy MB, Bernet JK, Chovanec GK, et al.: Dental hygienists' knowledge, opinions, and use of pit and fissures sealants: A comparison of two states. J Pub Health Dent 1987:47:121-133.
[113.] Nielsen-Thompson NJ, Boyer EM: Sealant application frequency. Clin Prev Dent 1988;10:17-22.
[114.] Rubenstein LK, Dinius A: Dental sealant usage in Virginia. J Pub Health Dent 1986; 46:147-51.
[115.] Gift HC, Corbin SB, Nowjack-Raymer RE: Public knowledge of prevention of dental disease. Pub Health Reports 1994;109:397-404.
[116.] Cherry-Peppers G, Gift HC, Brunelle JA, Snowden CB: Sealant use and dental utilization in US children. J Dent Child:1995;62:250-255.
[117.] Seigal MD: Promotion and use of pit and fissure sealants: An introduction to the special issue. J Pub Health Dent 1995;55(spec issue)259-260.
[118.] Bowman PA, Zinner KL: Utah's parent, teacher, and physician sealant awareness surveys. J Dent Hyg 1994;68:279-285.
[119.] Selwitz RH, Colley BJ, Rozier RG: Factors associated with parental acceptance of dental sealants. J Pub Health Dent 1992;52:137-145.
[120.] Lang WP, Weintraub JA, Choi C, Bagramian RA: Fissure sealant knowledge and characteristics of parents as a function of their child's sealant status. J Pub Health Dent 1988;48:133-137.
[121.] National Institutes of Health Consensus Development Conference: Dental sealants in the prevention of tooth decay (Dec 5-7, 1983). J Dent Educ 1984;suppl.48:1-134.
[122.] Frazier PJ, Glasrud PH: Public awareness and source of information about sealants (abstract). J Dent Res 1986;65(spec issue):340.
Joan L. Gilpin, RDH, MA, is a private-practice dental hygienist in Waverly, Iowa, and adjunct dental hygiene instructor at Hawkeye Community College, Waterloo, Iowa.
|Printer friendly Cite/link Email Feedback|
|Author:||Gilpin, Joan L.|
|Publication:||Journal of Dental Hygiene|
|Date:||Jun 22, 1997|
|Previous Article:||Oral Biology.|
|Next Article:||Erythromycin: drug interactions.|