A Study On The Application Of Different Pit And Fissure Sealants In School-based Sealant Programs

BackgroundAs one of the effective measures to prevent pit and fissure caries in children, pit and fissure sealant,has been widely approved at home and abroad. According to the third national oral health survey carried out by Ministry of Health in2005, our country is the one with high incidence of caries, that5-year-old age group primary tooth caries rate was66.0%;12-year-old children’s permanent teeth suffering caries rate was28.9%, while the pit and fissure was only1.5%. There may be two main reasons:First, insufficient propaganda of the government and society, lead that most of people lack the awareness of children’s anti-caries and the understanding of pit and fissure; On the other hand, China’s current economic condition and limited health care resources made it difficult to extend clinic pit and fissure technology to the community or school. In view of this situation, it is necessary to select a kind of material and method with better anti-caries performance, lower sensitivity of the operation and better generalization. To this day, most of the clinical researches about PFS were in precondition that the equipment and operating conditions can be effectively guaranteed and the composite resin-based fissure sealants was recommended by most scholars. However, there were not enough studies about whether it can be applied to large-scale mass.In recent years, oral medicine has come to a period of transition from cure to prevention. Clinical material is required to not only having a good therapeutic effect, but also maintaining the good oral environment (e.g. fluorine release) so as to achieve the purpose of treatment and prevention. As some studies show, glass ion cement conforms to the concept of modern oral cavity prevention, adhesive chemically, not necessary acid etching, hydrophilic having a good interpretation of the fluorine, performing nest groove closed type effect with no significant differences compared to composite resin. With the development of science and technology, all aspects of properties and performance of glass ion cement have been reformed and improved and in future it might be the most promising material in this field.School-based sealant programs(SBSPs) is the public health project that has been carried out in some developed countries, based on the campus provided financial material resources and policy support by the government., The target population is school-age children from low-income families and the focus is to protect the permanent molar of new eruption. This model not only can increase the rate of PFS and reduce the occurrence of dental caries, but also effectively popularize children’s oral health knowledge. In recent years, Guangzhou government has carried out the project children’s first permenant molar PFS for free within the scope of the city school-age, but the result may be very different in other districts. In order to better give play to the role of its methods to protect teeth, carrying out feasible SBSPs suitable for China’s national conditions and regional characteristics is of great significance.ObjectivesIn this study, the first permanent molar eruption and caries status of children aged 6-10years in Guangzhou Baiyun District was firstly investigated and analysised. On one hand, it could determine the suitable study population for a follow-up experiment, on the other hand, it also was new data for our region’s children caries prevention information and reference. Combining with the characteristics of this region, three groups of school-age children were included in our test and all the checks and procedures were completed in school. Two hydrophilic materials (Embrace WetBond and GC Fuji Ⅶ)and one composite resin-based fissure sealants (Fissurit F)were selected and respectively operated to these three groups. The results of this experiment were evaluated by using International Caries Detection and Assessment System Ⅱ (ICDASⅡ) and analyzing retention rate after three months and six months, and the economic effects were also taken into account. Therefore this study might be significative to explore feasible SBSPs suitable for China’s national conditions and regional characteristics and provide a reference basis for seeking more appropriate materials and technology.Materials and MethodsChapter I:Investigation and analysis of the first permanent molar eruption and dental caries in6to10-year-old children in GuangzhouEight primary schools in Guangzhou Baiyun District were randomly selected by cluster systematic sampling method, and then a total of1048,6to10years old Guangzhou enrollment students were randomly collected, including578boys and470girls. According to the oral health survey basic methods iv(WHO), and the requirements of the third national oral health epidemiological survey program, Children’s dentistry professional physician of Nanfang Hospital, Stomatology Hospital received the uniform training standards compliance test (Kappa values>0.80)before practice. Using a unified configuration of mobile dental examination chairs, lights, and a one-time check of mouth mirror and probe, children’s first permanent molar eruption and caries status were carefully checked and recorded. The records were processed and analyzed by two other staff members using SPSS17.0statistical software. The prevalence of dental caries were compared through chi-square test(the inspection level a=0.05).Chapter II:Caries preventive efficacy of different pit and fissure sealants in school-based sealant programs300school-age children were collected and included according to inclusion and exclusion criteria, and randomly divided into three groups, using three different pit and fissure sealant material for pit and fissure operation respectively including: Embrace WetBond wet adhesive fissure sealants (Pulpdent, USA), Fuji VII glass ionomer dental protection agent (GC, Japan), Fissurit F fissure sealants (Voco, Germany).All the checks and procedures were operated by two pediatric dentists together at the schools. ICDAS II and retention rate of each way were recorded and analyzed after three months and six months.Chapter IE:Economic evaluation of different pit and fissure sealants in school-based sealant programsPreliminary evaluation in economics mainly consist of two aspects on the one hand, the cost effectiveness ratio(CER) was analyzed as the main indicator of cost-effectiveness analysis. The main cost included the costs of each kind of material, payment of medical staff, as well as expense of transportation and other costs." The number of tooth that prevent caries of first permanent molar ICDAS-Ⅱ code≥2" was selected as indicator of the effect, which means comparing the input costs of preventing caries of the first molar using these three different materials; on the other hand, because all the examination and operation were completed by two pediatric dental physicians, the cost time that two physicians respectively sealed one tooth using each kind of these three materials were counted. The specific approach is to count the time that each kind of the material was used to complete the operation threetimes, and then calculated the mean cost time respectively.Result:1. Through the investigation and analysis of the first permanent molar caries and eruption conditions of1048children aged6-10years, Baiyun District, Guangzhou, we counted the first unerupted permanent molars teeth563, that the eruption rate was86.6%; the; total molars caries303on169children, that caries prevalence rate was16.1%. No significant difference in prevalence of dental caries was found in different gender, while statistically significant difference in eruption of the first permanent molars rate were found; and mandibular first permanent molars were the most vulnerable teeth.2. The results of six months showed that there was a significant difference on the sealing effect among these three groups, while there was no significant difference in pairwise comparisons; and no significant difference in caries prevention.3. The CER of three groups were13.05,11.66,10.57respectively. GC Fuji Ⅶ sealed one teeth which significantly lower than the other two groups.Conclusion:1. The first permanent molars caries status of6to10children in local region is very serious—early onseting and widespread, which should be paid more attention by relevant departments. Considering the first permanent molar eruption and dental caries status in the case, it is recommended that7to8-year-old is the best age to receive the operation in our region.2. Both glass ionomer cement and composite resin fissure sealants have good effect of pit and fissure caries prevention in short-term, but the former has such advantages, easy to operate, low costand so on. So it could be applied for and has good promotional value. 3. To carry out School-based sealant programs not only effectively promotes the development and implement of the free pit and fissure sealant project, but also through a relatively low cost caries groups can achieve good results, with important public health significance.