The role of sealants in caries prevention programs.

Pit-and-fissure sealants have been employed as an element in dental prevention programs for more than 30 years. The technique for sealant placement has evolved over time to become somewhat more invasive today. However, a meticulous technique is still required for success. Practitioners recently estimated that their one- and three-year sealant success rates were 89 percent and 78 percent, respectively. Grand medians for sealant success rates after one year in clinical trials have been reported to be as high as 83 percent for effectiveness and 92 percent for complete retention. Seven-year rates were 55 percent and 66 percent, respectively. Several changes in caries epidemiology have had an impact on the use of sealants. These changes include: * Declines in overall caries rates in U.S. schoolchildren during the latter decades of the 20th century; * A relative increase in the percentage of the population DMFS constituted by occlusal caries; and * A general slowing in the rate of lesion progression. Dentists' abilities to diagnose occlusal surface status also affect the decision to seal. Sealant cost-effectiveness can be improved by: * Targeting at-risk populations; * Using sealants on incipient lesions and minimally defective restorations; and * Training more dental auxiliaries to place sealants under a dentists' supervision. Concerns about sealing over decay and the estrogenicity of sealant components are addressed. Sealant guidelines, as promulgated by the Workshop on Guidelines for Sealant Use, are reviewed; and conclusions are presented about the role of sealants in prevention programs.