I happened across a great article in the New York Times (readers of this blog may have come to the realization that I’m an avid reader of this publication) that sang the praises of the dental sealant. It still comes as a shock to me to hear of members of my own profession who still don’t place sealants on a routine basis. At our practice, most of our patients have sealants placed; the rare instances when we elect not to place them are for patients with extremely shallow grooves, easily cleaned teeth and a history of no cavities. Otherwise, we are HUGE believers in the value of sealants.
Consider this – most members of the Silent Generation, and even Boomers have a mouthful of fillings, crowns, implants, partial dentures and even full dentures. One of the unheralded medical discoveries of the past century, was that of fluoride, and it’s role in the prevention of dental cavities. In fact the Centers for Disease Control and Prevention (CDC) named the fluoridation of drinking water as one of the Ten Great Public Health Achievements in the 20th Century. And its impact has been seen in the substantial decline in dental disease in both the USA and around the world. However, there are still pockets of resistance in certain population groups (ie. low income communities, individuals with poor access to dental care) where dental caries is still prevalent. Surveys by the CDC show that 21% of children between 6 and 11, and 58% of adolescents have had cavities. So there is still work to be done in decreasing caries especially among the younger members of our population.
That’s where sealants come in. Sealants are a plastic-like tooth colored coating which is easily applied, fills in all the grooves and pits of a tooth where food tends to stick, is cost effective, and has been shown in countless studies to prevent cavities. Where fluoride works well in preventing what’s known as smooth surface (parts of the teeth that are smooth such as in between teeth) caries, it is less effective for preventing caries in the pits and fissures of teeth. It is these areas that are found to disproportionately develop cavities in the teeth of adolescents. And that’s exactly where sealants do their anti-cavity work.
I won’t bore you with the numbers, but the takeaway from the Cochrane study (which looked at 34 well designed sealant studies involving 6000 plus children/adolescents) is that in a population of cavity-free children with a 40% chance of getting a cavity in the next two years without sealants, application of sealants would reduce the rate to just 6%. (For those interested in more scholarly evidence, click here.) Admittedly not zero, which is every dentist’s goal but pretty darn close.
If Evidence-based dentistry is the use of current scientific evidence to guide decision making in dentistry, one should clearly be a believer in the important role sealants play in reducing cavities.