Cost and effectiveness of four methods in preventing fissure caries

Abstract

OBJECTIVES: To investigate the cost and effectiveness of four methods in preventing fissure caries in permanent teeth, namely: 1) a single application of resin fissure sealant (FS), 2) a single application of atraumatic restorative treatment (ART) sealant, 3) application of sodium fluoride (NaF) varnish every six months, and 4) annual application of silver diamine fluoride (SDF) solution. METHODS: Children studying in grades 1-3 in two primary schools in Shenzhen, China, were clinically examined. Permanent first molars with deep occlusal fissures or fissures with signs of early caries were selected and randomly allocated into one of the above four groups. All included teeth in the same side of the mouth of a child received the same treatment. Follow-up examinations at 6-month intervals were conducted by a single trained examiner using caries probes, disposable mouth-mirrors, and an intra-oral LED light source. Status of the molars and the sealants was recorded, especially the presence of caries into dentine, i.e. at the cavitation level. RESULTS: A total of 423 molars in 161 children (mean age 7.9 years) were treated at baseline, and 396 (93.6%) of the teeth were examined after 18 months. No significant difference in effectiveness among the four caries preventive methods was found. The effectiveness were 97.3% for FS, 97.2% for ART, 98.7% for SDF, and 96.4% for NaF (Chi-square test, p>0.05). The material cost per tooth for the four treatments in the 18 months were FS US$0.3, ART US$1.0, SDF US$0.7, and NaF US$0.3. The treatment time for the resin and the ART sealants were similar, about 3-4 minutes per tooth, while that of topical fluoride application was much shorter, less than 30 seconds. CONCLUSIONS: The 18-month effectiveness of the four methods in preventing fissure caries was similar but their material and time cost was different.