The clinical recommendations in this table are a resource for dentists to use in clinical decision making. These clinical recommendations must be balanced with the practitioner's professional judgment and the individual patient's needs and preferences.
Dentists are encouraged to employ caries risk assessment strategies to determine whether placement of pit-and-fissure sealants is indicated as a primary preventive measure. The risk of experiencing dental caries exists on a continuum and changes across time as risk factors change. Therefore, caries risk status should be re-evaluated periodically. Manufacturers' instructions for sealant placement should be consulted, and a dry field should be maintained during placement.
|
| TOPIC |
RECOMMENDATION |
GRADE OF
EVIDENCE |
STRENGTH OF
RECOMMENDATION |
| Caries Prevention |
Sealants should be placed in pits and fissures of children's primary teeth when it is determined that the tooth, or the patient, is at risk of developing caries*† |
III |
D |
| Sealants should be placed on pits and fissures of children's and adolescents' permanent teeth when it is determined that the tooth, or the patient, is at risk of developing caries*† |
Ia |
B |
| Sealants should be placed on pits and fissures of adults' permanent teeth when it is determined that the tooth, or the patient, is at risk of developing caries*† |
Ia |
D |
| Noncavitated Carious Lesions‡ |
Pit-and-fissure sealants should be placed on early (noncavitated) carious lesions, as defined in this document, in children, adolescents and young adults to reduce the percentage of lesions that progress† |
Ia |
B |
| Pit-and-fissure sealants should be placed on early (noncavitated) carious lesions, as defined in this document, in adults to reduce the percentage of lesions that progress† |
Ia |
D |
| Resin-Based Versus Glass Ionomer Cement |
Resin-based sealants are the first choice of material for dental sealants |
Ia |
A |
| Glass ionomer cement may be used as an interim preventive agent when there are indications for placement of a resin-based sealant but concerns about moisture control may compromise such placement§ |
IV |
D |
| Placement Techniques |
A compatible one-bottle bonding agent, which contains both an adhesive and a primer, may be used between the previously acid-etched enamel surface and the sealant material when, in the opinion of the dental professional, the bonding agent would enhance sealant retention in the clinical situation§ |
Ib |
B |
| Use of available self-etching bonding agents, which do not involve a separate etching step, may provide less retention than the standard acid-etching technique and is not recommended |
Ib |
B |
| Routine mechanical preparation of enamel before acid etching is not recommended |
IIb |
B |
| When possible, a four-handed technique should be used for placement of resin-based sealants |
III |
C |
| When possible, a four-handed technique should be used for placement of glass ionomer cement sealants |
IV |
D |
| The oral health care professional should monitor and reapply sealants as needed to maximize effectiveness |
IV |
D |
|
* Change in caries susceptibility can occur. It is important to consider that the risk of developing dental caries exists on a continuum and changes across time as risk factors change. Therefore, clinicians should re-evaluate each patient's caries risk status periodically.
† Clinicians should use recent radiographs, if available, in the decision-making process, but should not obtain radiographs for the sole purpose of placing sealants. Clinicians should consult the American Dental Association/U.S. Food and Drug Administration guidelines regarding selection criteria for dental radiographs.
‡ "Noncavitated carious lesion" refers to pits and fissures in fully erupted teeth that may display discoloration not due to extrinsic staining, developmental opacities or fluorosis. The discoloration may be confined to the size of a pit or fissure or may extend to the cusp inclines surrounding a pit or fissure. The tooth surface should have no evidence of a shadow indicating dentinal caries, and, if radiographs are available, they should be evaluated to determine that neither the occlusal nor the proximal surfaces have signs of dentinal caries.
§ These clinical recommendations offer two options for situations in which moisture control, such as with a newly erupted tooth at risk of developing caries, patient compliance or both are a concern. These options include use of a glass ionomer cement material or use of a compatible one-bottle bonding agent, which contains both an adhesive and a primer. Clinicians should use their expertise to determine which technique is most appropriate for an individual patient.
¶ Clinicians should consult with the manufacturer of the adhesive and/or sealant to determine material compatibility.
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