08 March 2021

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Caries of the fissures: seal or varnish? Current preventive guidelines

Authors: Maria Teresa De Grazia, Eleonora Angelino, Luciano Zaffarano, Tersilla Bosia, Gianluca Trebbi, Maria Grazia Cagetti

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dental caries, an irreversible progressive demineralization of hard dental tissues, is still the most common chronic disease in childhood. The aim of this paper is to describe and compare the two most studied and utilised preventive methods to control pits and fissure lesions on the occlusal surface of permanent molars: dental sealants and fluoride varnishes. The mechanical protection of sealants, both in resin and in glass ionomer cement, has been widely described in dentistry literature, as well as the demineralizing efficacy of fluoride varnishes has; however, even today, it is not clear which of the strategies is the most effective or recommended in the diverse clinical situations. 

Materials and methods
 a bibliographic research has been conducted by making use of the Medline and Scopus databases. One hundred and thirty papers have been evaluated and even 7 in vivo studies have been considered relevant for the purpose of the present review work. 

Conclusions
both sealants and fluoride varnishes are two effective preventive methods when resorted to be employed within an adequate preventive program. The sealants, from the available extensive and analysed studies, have shown a greater efficacy in preventing tooth decay compared to fluoride varnishes, in particular in the case of high-risk patients, when they are positioned within 2 years from eruption. In fact, sealants may definitely include a good capacity of providing a mechanical protection, with a chemical efficacy when F-ion release materials or even when the bioactive ones are put to use. Fluoride presence usually increases the remineralisation of hard tissues; bioactive materials have antibacterial capabilities through the release of alkaline ions. However, the caries preventive efficacy would increase by the combination of the two methods. When clinicians have to choose the preventive strategy for a patient, they do need to take into  account the individual caries risk, which is assessed by means of a handful of basic parameters which fundamentally include oral hygiene, diet, salivary flow, concentration of cariogenic bacteria within the biofilm, as well as the patient’s socio-economic level, and after the evaluation of the opportunity to control the humidity of the operating field, in addition to the collaborating grade offered by the child. 

Clinical significance
In the light of the present findings, it can be stated that there is still no scientific evidence that decisively decrees which of the preventive methods closely examined is the most effective in caries prevention. The preventive efficacy of both sealants and fluoride varnishes in caries prevention, and in treating no-cavitated initial lesions are widely recognized in dentistry. New high quality clinical studies are needed to demonstrate which preventive method is to be chosen in different clinical situations.