The use of fissure sealants in public health programs: a reactor's comments

The papers presented a thorough, up-to-the-minute look at fissure sealants and their possible use in dental public health programs. The papers demonstrated that sealant technology has progressed to the point that where properly used, retention rates and caries-prevention effectiveness are, even over a five-year period, satisfactory. As a reactor to the papers, I attempted to underline three points: First, with respect to the sealant-amalgam comparison, the point must be made forcefully that sealants are not an alternative to amalgams. Rather, they represent a highly effective and technically practical procedure that, if correctly employed in a preventive program, would significantly reduce the cutting of teeth and the placement of amalgams. This is particularly relevant to the use of sealants in private practice. Second, in formal public health programs, the use of sealants should probably be concentrated on the more highly caries-susceptible children in the population who would require a full range of chairside preventive procedures. Third, for the immediate future there is a pressing need for a limited number of well-defined studies to further investigate the cost and price determinants associated with the fissure-sealant procedure. These points were all explicitly or implicitly made in the papers presented and I appreciate having had the opportunity to reemphasize them.