Effectiveness of Preventive Interventions on First Molars in School Children

Objectives: The purpose of the study was to compare the effectiveness of selected clinical preventive interventions on the prevention of occlusal caries in permanent first molars. Methods: All grade 1 and 2 children from socially deprived backgrounds with high caries risk and between 6-8 years of age with 4 clinically healthy first permanent molars (N=85) were exposed to the following preventive interventions: (1) conventional light cured resin fissure sealant (n=30); (2) no intervention / control group (n=30); (3) daily school-based toothbrushing with a fluoridated dentifrice (n=25). The groups were followed up for caries development on the occlusal surfaces of the first permanent molars after 6, 12, 18 and 24 months. The presence or absence of caries was diagnosed according to the WHO (1997) criteria. Results: The caries rate for lower first molars in the control group was higher after 2 years (52 – 60%) compared to the upper first molars (36 - 40%), while for the brushing group the caries rate for the lower first molars varied between 20 – 30% compared to the upper first molars varying between 20 – 25%. In the fissure sealant group the caries rate for lower first molars varied between 11 – 14% and for upper first molars between 7 – 18%. The caries protection rate after 2 years was 88% for the fissure sealant group, 78% for the toothbrushing group and 56% for the control group. The difference between the fissure sealant - and control group was statistically significant ( chi-squared : p = 0.012). Conclusion: The results from this study indicated a definite caries preventive benefit for both fissure sealant and tooth brushing groups compared to the control group. It further underlines the merit of considering such programmes in communities with high caries risk.