Caries-preventive Effect of Supervised Toothbrushing and Sealants

Area of Science:

• Dental Public Health
• Pediatric Dentistry
• Caries Prevention

Background:

• Dental caries remains a significant public health issue, particularly in low socioeconomic areas.
• First permanent molars are highly susceptible to caries due to their occlusal morphology.
• Effective caries prevention strategies are crucial for long-term oral health in children.

Purpose of the Study:

• To compare the effectiveness of daily supervised toothbrushing (STB), composite resin (CR) sealants, and atraumatic restorative treatment-high-viscosity glass-ionomer cement (ART-GIC) for caries prevention.
• To evaluate these interventions on both high- and low-caries risk occlusal surfaces of first permanent molars.
• To assess the long-term (3-year) outcomes of these preventive measures in a school-based setting.

Main Methods:

• A 3-year cluster-randomized controlled clinical trial involving 242 schoolchildren (6-7 years old) from low socioeconomic areas.
• Caries risk assessment using ICDAS II and fissure depth codes at the tooth surface level.
• Interventions included daily STB, CR sealants, ART-GIC, or no intervention based on caries risk.

Main Results:

• No statistically significant difference in preventing cavitated dentine carious lesions was found among STB, CR, and ART-GIC for high-caries risk surfaces over 3 years.
• Similarly, no significant difference was observed between STB and no intervention for low-caries risk surfaces over the same period.
• Cumulative survival rates for high-risk surfaces were 95.6% (STB), 91.4% (CR), and 90.2% (ART-GIC); for low-risk surfaces, they were 94.8% (STB) and 92.1% (no intervention).

Conclusions:

• Daily supervised toothbrushing, composite resin sealants, and ART-GIC demonstrate comparable effectiveness in preventing cavitated dentine carious lesions on high-caries risk first permanent molars.
• Supervised toothbrushing and no intervention show similar outcomes for low-caries risk first permanent molars.
• These findings suggest that simpler, less resource-intensive interventions like supervised toothbrushing may be sufficient for caries prevention in certain risk groups.