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

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Snapshot

Summary of CPSTF Finding

The Community Preventive Services Task Force finds insufficient evidence to determine the effectiveness of community-based initiatives to promote use of dental sealants. Although strong evidence exists for the efficacy of sealants and their delivery through school-based programs for preventing caries (tooth decay), few studies examined uptake of sealants following community-based promotion initiatives and their results were inconsistent.

Intervention

Community-based dental sealant promotion initiatives aim to increase sealant use, especially among specific populations at high risk for tooth decay (e.g. low-income).

These initiatives can take many forms including continuing education courses for dental professionals; educational campaigns for parents, community leaders, or third party payers of dental treatment; policies to promote access to sealants; financial incentives or reimbursement; and promotional activities to increase the number of schools with sealant delivery programs and the number of students participating in these programs.

School-based sealant delivery programs, which are distinct from community-based initiatives to promote use of sealants, have been recommended by The Community Preventive Services Task Force based on strong evidence of effectiveness in preventing tooth decay among children.

A meta-analysis (Ahovuo-Saloranta et al., 2013) has shown that dental (pit and fissure) sealants prevent caries (tooth decay) in children and adolescents by 81% at 2 year follow-up. Sealants are clear or opaque plastic resinous materials applied to the chewing surfaces of the back teeth to prevent tooth decay. Despite their effectiveness, sealant use remains low, especially among children from low-income families and certain racial or ethnic groups.

CPSTF Finding and Rationale Statement

Read the full Task Force Finding and Rationale Statement [PDF - 161 kB] for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

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What the CPSTF Found

About The Systematic Review

The Task Force 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 Task Force 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 [PDF - 215 kB].

Context

There is no information for this section.

Summary of Results

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.

Summary of Economic Evidence

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

Applicability

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

Evidence Gaps

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified 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.

Study Characteristics

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.

Supporting Materials

Analytic Framework

Analytic Framework [PDF - 227 kB]

Summary Evidence Table

Summary Evidence Table [PDF - 256 kB]

Included Studies

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).

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.

Additional Materials

There is no information for this section.

Search Strategies

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

MeSH descriptor Tooth demineralization explode all trees
(caries in All Text or carious in All Text)
(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) )
(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) )
(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) )
(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) )
(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) )
(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) )
MeSH descriptor Dental plaque this term only
( (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)
MeSH descriptor Dental health surveys explode all trees
("DMF Index" in All Text or "Dental Plaque Index" in All Text)
(#1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12)
MeSH descriptor Pit and fissure sealants this term only
(fissure in All Text near/6 seal* in All Text)
(dental in All Text near/3 sealant* in All Text)
(resin* in All Text near/4 sealant* in All Text)
(compomer* in All Text near/4 sealant* in All Text)
(composite* in All Text near/4 sealant* in All Text)
MeSH descriptor Glass ionomer cements explode all trees
MeSH descriptor Resins, synthetic explode all trees
("glass ionomer*" in All Text or glassionomer* in All Text or glass-ionomer* in
- All Text)
(#20 or #21 or #22)
sealant* in All Text
(#23 and #24)
(#14 or #15 or #16 or #17 or #18 or #19 or #25)
(#13 and #26)
MeSH descriptor Schools this term only
( (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) )
(#28 or #29)
(#13 and #30)
(#31 or #27)

MEDLINE via OVID

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

EMBASE via OVID

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

Review References

Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, Mäkelä 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.

Considerations for Implementation

The Task Force 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.

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