Shah Nilesh H, Fellows Jeffrey L, Polk Deborah E
Dental Public Health, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA.
Center for Health Research, Kaiser Permanente, Portland, Oregon, USA.
Caries Res. 2025;59(1):11-21. doi: 10.1159/000540884. Epub 2024 Aug 16.
Dental sealants applied to occlusal pit-and-fissure surfaces have been shown to prevent caries and arrest occlusal noncavitated carious lesions (NCCLs). The American Dental Association (ADA) recommends that oral healthcare providers apply sealants on occlusal NCCLs. Though the evidence is clear that sealants are effective, few studies have examined the adoption of the ADA guideline by dentists and the duration of protection provided by sealants in a large real-world setting.
This study used observational electronic health record (EHR) data from a network of dental clinics to follow teeth over a 2 year time period from when they were diagnosed as having an occlusal NCCL until either they were treated with a restoration or the time period ended with no restoration. The objectives of the study were to determine: (1) the degree to which dentists adopted the guideline, (2) whether the duration of protection was different for teeth that received a sealant from teeth that did not receive a sealant, and (3) whether dentists' experience placing sealants was associated with the duration of protection.
Overall, there were 7,299 teeth in the sample. Of those, dentists restored 591 teeth and applied sealants on 164. The sealant application rate for eligible teeth was 2.2%. Sealant application was associated with provider, with 1.9% of providers placing more than half of the sealants. By the end of the observation period, the proportion of teeth progressing to restorations was 8.2% for teeth that had not received a sealant and 3.0% for teeth that had received one (RR = 0.37; 95% CI: 0.16-0.88; p = 0.02). Multilevel survival analysis showed that teeth that had not received a sealant were restored sooner than teeth that had received a sealant (aHR = 0.11; 95% CI: 0.03-0.36; p < 0.01). Overall, teeth that received a sealant had an 89% reduced hazard of restoration within 2 years compared with teeth that did not receive sealants.
This study found that by arresting decay, the presence of sealants led to fewer restorations and delayed restorations compared with teeth not receiving a sealant or restoration in the 2 years following diagnosis of occlusal NCCL in clinical settings.
应用于咬合面窝沟的牙科密封剂已被证明可预防龋齿并阻止咬合面非龋性龋损（NCCL）。美国牙科协会（ADA）建议口腔医疗服务提供者对咬合面NCCL应用密封剂。尽管有明确证据表明密封剂是有效的，但很少有研究在大型实际环境中考察牙医对ADA指南的采用情况以及密封剂提供的保护持续时间。
本研究使用来自牙科诊所网络的观察性电子健康记录（EHR）数据，对牙齿从被诊断为咬合面NCCL开始直至接受修复治疗或观察期结束且未进行修复治疗的2年时间进行跟踪。该研究的目的是确定：（1）牙医采用该指南的程度；（2）接受密封剂的牙齿与未接受密封剂的牙齿的保护持续时间是否不同；（3）牙医应用密封剂的经验是否与保护持续时间相关。
总体而言，样本中有7299颗牙齿。其中，牙医对591颗牙齿进行了修复，对164颗牙齿应用了密封剂。符合条件牙齿的密封剂应用率为2.2%。密封剂的应用与医疗服务提供者有关，1.9%的提供者应用了超过一半的密封剂。到观察期结束时，未接受密封剂的牙齿进展为修复治疗的比例为8.2%，接受了密封剂的牙齿为3.0%（风险比=0.37；95%置信区间：0.16 - 0.88；p = 0.02）。多水平生存分析表明，未接受密封剂的牙齿比接受了密封剂的牙齿更快接受修复治疗（校正风险比=0.11；95%置信区间：0.03 - 0.36；p < 0.01）。总体而言，与未接受密封剂的牙齿相比，接受密封剂的牙齿在2年内修复的风险降低了89%。
本研究发现，在临床环境中，自咬合面NCCL诊断后的2年里，与未接受密封剂或未进行修复治疗的牙齿相比，密封剂的存在通过阻止龋齿进展，减少了修复治疗的次数并延迟了修复治疗的时间。
