Fissure Sealants: Policy versus Reality

Objective: Occlusal surfaces are most vulnerable to decay during eruption and account for nearly 90% of cavities in children. NSW Health policy recommends routine use of fissure sealants (FS) in high risk children. FS are non invasive but their success is largely dependent on retention. The study examined the retention of resin modified glass-ionomer (RMGI) and composite resin (CR) FS placed by dental therapists in public dental clinics and compared the effect of different moisture control methods on retention. Methods: Between September 2007 and March 2008 all child patients, aged 6-11 years, who presented to three community dental clinics in Sydney South West Area Health Service for treatment and met the inclusion criteria were invited to participate. Participants were divided into two groups based on the method of moisture control – rubber dam (RD) or cotton rolls. All participants received RMGI FS on tooth 16 and 46 and CR FS on tooth 26 and 36. The participants were followed up every 6 months for 2 years. Results: There were 312 participants at baseline and 79% completed the study after 2 years. RD group included 159 (51%) children and 154 (49%) participants were girls. CR FS were significantly quicker to place and RD isolation was less comfortable for the participants. The mean dmft dropped from 4.1+2.4 to 2.2+2.5 after 2 years. The retention of RMGI FS in 16 was 85% and 46 was 78% whereas CR retention in 26 was 75% and 36 was 76% after 2 years. However 75% of children partially or fully lost at least one sealant during the 2-year period requiring periodic resealing. Conclusion: The two FS in either group were equally effective but FS required regular monitoring and periodic resealing. Hence, for effective outcome of the policy regular recalls should be part of policy implementation process.