The association of sealed primary molars with caries and restorative treatments

The authors investigated the association of resin-based sealants with the onset of pit and fissure caries (PFC) and smooth surface caries (SSC) on primary molars.

Primary molars with sealant placement or nonplacement in a hospital clinic and operating room (OR) were tracked in this 5-year retrospective study of children younger than 6 years with a high risk of developing caries (n = 383 children, n = 1,845 teeth). Onset of PFC and SSC and subsequent restorative and surgical retreatment were recorded. A Cox proportional hazards model and a flexible parametric model were used to estimate the association of sealant placement with caries incidence and time to caries onset, respectively.

The adjusted hazard ratio of developing PFC on sealed molars was 0.19 (95% CI, 0.11 to 0.32; P < .001) in all settings, 0.35 (95% CI, 0.18 to 0.66; P < .001) in a clinic, and 0.05 (95% CI, 0.02 to 0.14; P < .001) in the OR. The reduction of adjusted hazard ratio for SSC in sealed molars was not significant in all settings, clinic, and OR. Time to PFC onset in sealed molars was 4.76 years (all settings), 4.65 years (clinic), and 4.75 years (OR) vs 4.02 years (all settings), 4.15 years (clinic) and 3.55 years (OR) in unsealed molars. Unsealed primary molars required significantly greater restorative or surgical retreatment.

Sealed primary molars are associated with a reduction of, and delay in, onset time of PFC but not SSC. Sealant placement is associated with less invasive restorative and surgical retreatment in primary molars that developed caries and decreased retreatment in the OR.

Dental sealants on primary molars should be considered for children at high risk of developing caries.