Pits and fissures are generally recognised as highly susceptible to caries and least likely to benefit from systemic or topical fluoride, and sealants to prevent caries and are therefore considered cost effective (Mertz-Fairhurst, 1984; Simonsen, 1989). In one study 78% of first permanent molars that had had a single application of sealant placed in pits and fissures were caries free compared with 31.8% for the unsealed matched pairs (Mertz-Fairhurst, 1982). However, it is also recognised that the cost-effectiveness is dependent upon a number of factors that are related to its use, e.g. the caries prevalence in the population; the different tooth types (premolars, molars) sealed; whether all teeth and fissure sites are routinely sealed or based on specific indications; the retention of the sealants; and to what extent other caries preventive methods are used (e.g. fluoride varnish) (Raadal et al 2001). The caries rate in premolars are generally lower than in molars, and in populations with an average caries rate it has been calculated that 25-40 sealants must be placed in premolars to save one surface from becoming carious, while the corresponding rate is 5-10 for molars (Feigal 1998). If the retention rate is low, which is frequently the case if many 'difficult-to-seal-teeth' are treated, the need for re-sealing and restorative treatment of carious fissures increases, which reduces the cost-effectiveness.
It has therefore been suggested that fissure sealants should not be routinely used in all children and all teeth, but based on an individual risk-evaluation (Workshop on Guidelines for Sealant use: recommendations, 1995). In the future Professions Complementary to Dentistry (PCD's) will play a significant role in improving even further the cost effectiveness of sealants.
Login
Forgotten password