Fissure seal or fluoride varnish?

Area of Science:

• Dentistry
• Preventive Dentistry
• Caries Prevention

Background:

• Dental caries remains a significant public health issue, particularly on occlusal surfaces of permanent teeth.
• Fissure sealants and fluoride varnishes are common preventive strategies.
• Comparative effectiveness data between these interventions is crucial for clinical decision-making.

Purpose of the Study:

• To systematically review randomized controlled trials comparing fissure sealants (alone or with fluoride) versus fluoride varnish alone for preventing occlusal caries in children and adolescents.
• To assess the quality of evidence for different sealant materials and follow-up durations.

Main Methods:

• Searched multiple databases for randomized controlled trials (RCTs) with at least 12 months follow-up.
• Included studies comparing fissure sealants (resin-based, glass ionomer-based) or combined with fluoride varnish against fluoride varnish alone.
• Extracted data, assessed risk of bias, and analyzed results by sealant type and follow-up period using odds ratios and mean differences.
• Assessed evidence quality using GRADE methods.

Main Results:

• Eight RCTs involving 1747 children were included.
• Low-quality evidence suggests resin-based fissure sealants are superior to fluoride varnish in preventing occlusal caries (pooled OR = 0.69).
• One trial showed sustained benefit of sealants over 9 years.
• Evidence for glass ionomer sealants was of very low quality, precluding conclusions.

Conclusions:

• Scarce and diverse data limits definitive conclusions on the comparative effectiveness of sealants and fluoride varnish.
• Low-quality evidence suggests potential superiority of resin-based fissure sealants over fluoride varnish for preventing occlusal caries.
• Further high-quality research is required to clarify differences in effectiveness.