The Challenges of Undertaking Fissure Sealant Programme Mfuleni South Africa

Objectives: The efficacy and cost-effectiveness of fissure-sealants is well-established. Their delivery in the field has many challenges: operator skill, working environment, moisture control and vision. It has been suggested that self-etch sealant materials may partially address these limitations. We conducted a study with schoolchildren in Mfuleni, South Africa.
Objectives: To establish if a fissure sealant regime can be implemented effectively under sub-optimal conditions in an outreach setting and to compare its application outcomes with conventional sealant

Methods: More than 550 children aged 6-9 years from one school in Mfuleni participated in this programme. Sealants were applied within the school, either in a mobile dental unit (conventional sealant Clin Pro 3M ), or the in a classroom (self-etch sealant Constic DMG-dental), without using air syringe or suction). Consent was obtained for all participants prior to the study. The research was approved by the UWC Biomedical Research Ethics Committee.
Results: Both fissure sealing approaches (self-etch and conventional) could successfully be implemented in the school setting. Over two years, more than 1500 permanent molar teeth were sealed, along with more than 300 deciduous molars. Clinical outcomes assessments imply that fissure sealants placed using the self-etch material were less retentive than the conventional technique. Challenges of using the self-etch sealant included operator constrictions ( lighting, posture), teeth isolation and moisture control. Some logistical challenges were relevant to both methods, including communication, follow-ups on children, relying on multi-national research team, and township related conditions such as safety concerns, taxi wars , power and water shortages .
Conclusions: Fissure sealing is a practical preventive approach that can be applied under sub-optimal conditions for relevant communities. Lessons were learned of how to minimize the numerous difficulties and challenges working in this setting. The relative efficacy and clinical outcomes of both sealant methods will be discussed separately.