What is a silent fissure and its effects on children
Dr. Masoume Yousefi
تهران
Numerous evidences show that this method is effective, but its effects depend on the type of sealant, the condition of the tooth (milk or permanent), compliance with humidity and environmental materials, and regular examinations. In the following, key concepts, benefits, limitations, and recommendations are presented along with evidence.
Introduction
Tooth decay, especially in the pits and fissures of the biting surface, is one of the most common oral problems in children. Due to the difficulty of cleaning with a toothbrush, the grooves are places where plaque and bacteria accumulate.
Fissure sealant is a substance that is stretched over these grooves to block the path of bacteria accumulation and acid penetration into tooth enamel and prevent decay.
Evidences about the effectiveness of fissure sealant
**1. Reduction of dental caries in permanent teeth (molars)**
• An umbrella review including several reviews of interventional studies has shown that fissure sealant on permanent teeth of children/teenagers significantly prevents the occurrence of caries.
•For example, in a study that focused only on permanent molars, resin-based sealant caused a relative reduction in the risk of caries by 33-30%.
2.**Comparison with other preventive methods such as fluoride varnish**
• Some studies show that fissure sealant may be more effective than fluoride varnish in some situations, especially for the occlusal surfaces of permanent teeth.
•However, the evidence for the definitive superiority of cyanate over fluoride varnish is still inconclusive; Different studies have shown different results.
**3. Milk teeth**
• There is less evidence for the effect in milk teeth. Some studies have shown that sealants can also be effective in primary teeth, but the quality of the evidence is usually lower and uncertainty is higher.
If the sealant is torn or cracked, the protection is effectively reduced.
•Typically, for resin-based sealants, good durability is seen in the first 12 months and a gradual decrease in the following years.
•Glass ionomer type sealants have a faster effect, especially in situations where humidity control is difficult.
• The evidence is fainter in deciduous teeth; There are fewer and lower quality studies. • Problems related to sealant maintenance and failure (loss of retention) over time; If the sealants are not maintained properly, the protection will be reduced. • There are concerns about the resin's ingredients, particularly the release of chemicals such as bisphenol A (BPA), but so far the evidence suggests they are safe under normal conditions. • Effectiveness may decrease over time, so oral follow-up and restoration or replacement of sealant is essential if necessary.
Conclusion and recommendations
• Fissure sealants are an effective tool to prevent caries of permanent teeth in children and adolescents, especially in molars and when the quality of work is appropriate. • In cases where humidity control is difficult or the child's cooperation is limited, the use of sealants that are more resistant to humidity or the use of glass ionomer materials can be a more suitable option. • Regular inspection and repair is essential to maintain protection. • In public health programs and school health centers, fissure sealants can be of great economic and health value, especially for high-risk children.
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