Primary Molar Occlusal Caries Prevention: Glass-Ionomer Sealant versus Fluoride Varnish.

Abstract

Objectives: This study aimed to compare the effectiveness of glass-ionomer sealant (GIS) versus topical application of 5% sodium fluoride varnish (NaFV) in preventing occlusal caries development in primary molars among preschool children. Methods: Children aged 3-4 years with at least one primary second molar (PSM) with no or only non-cavitated occlusal enamel caries were recruited and examined by one calibrated examiner for visible plaque index (VPI), dmfs and ICDAS scores. They were randomly assigned to either Group 1 – application of 5% NaFV at 3-month interval or Group 2 – single placement of GIS on primary molars. Participants’ sociodemographic and oral health-related information were collected with parental questionnaires. Two blinded examiners evaluated occlusal caries development in primary molars and GIS retention after 6 and 12 months. Negative binomial regression using Generalized Estimating Equations was employed to adjust for clustering effect, and evaluate the influence of the included variables on the development of occlusal caries into dentine of the treated PSMs at 12 months. Results: At baseline, 1,159 PSMs in 323 children received treatment. At 12 months, 989 (85.3%) molars in 280 (86.7%) children were evaluated. No significant difference in proportion of molars with caries developed or progressed into dentine was observed between NaFV (7.8%) and GIS (8.0%) groups (p=0.913). The retention rate of GIS at 6 and 12 months were 24.6% and 13.5%, respectively. Regression analyses indicated only baseline dmft score of the child (p=0.005) and ICDAS score of PSMs (p<0.001) had significant associations with occlusal caries progression. Conclusions: Both quarterly NaFV application and a single GIS placement are equally effective in preventing occlusal caries development in primary molars over a 12-month period. Progression of occlusal caries into dentine in primary molars is associated with baseline caries experience of the child and presence of incipient enamel lesion in the molar.