Evaluation Of Commonly Treated Mandibular Teeth With Preventive Resin Sealant Among Children With Permanent Dentition

Keywords

Preventive Resin Sealants; Mandibular Molar; Permanent Dentition; Minimally Invasive Procedure; Dental Caries; Innovative Technique.

Introduction

Dental caries is a multifactorial disease caused by a change in the composition of the bacterial biofilm, resulting in an imbalance between the demineralization and remineralization phases, and represented by caries lesions in the primary and permanent dentitions. According to the National Health and Nutrition Examination Survey (NHANES) data from 2011–2012, 58 % of children aged 12–19 had dental caries in their permanent teeth [1]. In children and teenagers, pit and fissure caries account for around 90% of caries in permanent posterior teeth and 44% of caries in primary teeth. Dental caries can easily start on the biting surfaces of posterior teeth, as well as in pits, fissures, and enamel defects. Pits and fissures also have thin enamel at their base [2]. Furthermore, standard oral hygiene steps such as tooth brushing are ineffective in removing plaque that has accumulated in these regions. Because of their morphological complexity, pits and fissures on the occlusal surfaces of posterior teeth are more vulnerable to caries growth than smooth surfaces, making dental hygiene more difficult and contributing to increased plaque accumulation. As compared to the enamel on smooth surfaces, the enamel in pits and fissures cannot obtain the same level of fluoride protection.

Preventive dentistry may be thought of as a compilation of all efforts to prevent dental diseases or the consequences of a person's dental diseases and disorders. These efforts include primary prevention, which refers to any measure taken before the onset of a preventable disease in the pre-pathogenic era [3]. Pit and fissure sealants provide a physical barrier that prevents microorganisms and food particles from accumulating, halting caries development and preventing caries initiation. Caries are most prevalent in permanent first molars, followed by second molars. Since caries develop quickly after a permanent molar erupts into the oral cavity, managing occlusal caries on permanent molars is a major challenge. Pit and fissure sealants' efficacy is dependent on their ability to stay in place for an extended period of time. Dental sealants may be an effective protective tool for pit and fissure caries in at-risk communities whether used as part of a holistic solution to caries prevention on an individual basis or as a public health measure for at-risk populations [4]. Since penetrating the pits and fissures, the dental sealant layer hardens, creating a physical shield that prevents bacteria and nutrients from entering.

The first clinical trial took place in the late 1960s, and today there are a variety of widely available sealant formulations that have been tried, including resin-based sealants that are polymerized using a chemical or light activation system; glass ionomer-based sealants that release fluoride; polyacid-modified resin sealants [5]. Based on the material and process of polymerization, resin-based sealants can be divided into four generations . The first generation of sealants were cyanoacrylates that were activated with a 365 nm ultraviolet light source. These sealants are no longer used due to reported deterioration of the oral cavity over time. Secondgeneration resin sealants contain autopolymerizing or chemically treated BISGMA or urethane dimethacrylate-based materials. To cause polymerisation, third generation sealants contain a diketone initiator and a reducing agent, and they are visible light enabled. Fourth-generation sealants are made of fluoride-releasing resins. Glass ionomer sealants are made of glass ionomer cements which have the ability to chemically bind to the tooth structure. Because of their fluoride-releasing properties, these sealants are commonly used. They have the benefit of being less moisture dependent, allowing them a viable alternative to resin-based sealants in situations where moisture retention is a concern. Compomers and giomers, for example, are hybrid sealants that combine resin and GICs. Compomers are polyacid-modified composite resins, whereas giomers are fluoride-releasing products composed of urethane resins with surface-reacted glass ionomer filler particles. There are new compounds with insufficient evidence on their caries-preventive properties [6]. Due to a lack of clarity within contemporary evaluation standards, grading the seriousness of carious lesions is difficult.

The International Caries Detection and Assessment System (ICDAS), which was recently launched, combines many new standards into a single uniform system, making caries assessment easier. These prevention approaches are simple to implement in dental practise, and a large body of scientific data supports their efficacy [7]. Fluoride gel, fluoride varnish, chlorhexidine, pit-andfissure sealants, and oral hygiene education, for example, have all been the subject of systematic reviews. Since sealants have been shown to be an important prevention process, it is no longer ethical to compare the decay history of sealed and unsealed teeth. As a result, modern sealant formulations cannot be evaluated in this manner. Since sealants have been shown to be an important prevention process, it is no longer ethical to compare the decay history of sealed and unsealed teeth. Only few studies are done on sealants and its use. Our team has extensive knowledge and research experience that has translate into high quality publications [8-20, 21-27].

This study includes its prevalence in the gender and various teeth treated with preventive resin sealants. As a result, modern sealant formulations cannot be evaluated in this manner [28]. The most common outcome in this form of research is sealant to see the prevalence of mandibular permanent teeth treated with preventive resin sealants.

Materials and Methods

This study was conducted in a private university setting. This study was retrospective in nature. A total of 5784 subjects were considered for this study. The main advantage of conducting the study in a university setting is that it aids as a single centre for multiple people from different localities at the same time. On the other hand, the disadvantage is that the subjects in this study do not represent the general population. The inclusion criteria for this study consisted that the subjects had to be children within the age group of 13-17 years. The exclusion criteria consisted of subjects younger than 13 years and those older than 17 years old. The subjects were chosen at random, inclusive of all gender to reduce and minimise sampling bias. The case sheets were verified manually using MS excel. DIAS provided case sheets of patients treated with preventive resin sealant for examination. A third examiner checked through the collected data's case history to double-check the accuracy of the information using post-operative photographs. SPSS was used to tabulate the collected data for statistical analysis. Frequency distribution and Chi-square tests were performed for statistical analysis. The Chi-square test and descriptive statistics were used, with a degree of significance of 5% (p<0.05) .The independent variables of this study were gender and geographic background. the dependent variables were the age of the patient and mandibular teeth treated.

Results

A total of 68 case sheets met the inclusion criteria. Based on the dentition, children with primary dentition had the highest opportunity to get treated with silver diamine fluoride (72.41%) [graph 1]. The DMFT scores above 2 was found to be in 79.31% and below 2 in 20.69% [graph 2].Among the females treated with silver diamine fluoride, 58.52% had DMFT score above 2, while 1.72% had DMFT score less than 2. Among the males treated with silver diamine fluoride, 20.69% had DMFT score above 2, while 18.97% had DMFT score less than 2. Females with a higher caries prevalence were treated with silver diamine fluoride when compared to males. This difference was found to be statistically significant (p=0.000) [graph 3].

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Figure 1:

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Figure 1. This bar chart represents the gender of the children whose mandibular teeth are treated with preventive resin sealen. Pink colour in the chart represents female and orange colour represents male. Nearly half of the study population who are treated with preventive resin in their mandibular teeth were males (50.50%) and only 49.50% were females.

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Figure 2:

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Figure 2. This bar graph represents the age of the children whose teeth are treated with preventive resin sealant. Most of the treated children are likely to be in the age of 13 years (26.59%)(black), 23.08% were 17 years old, 17.86% were 16 years old, 17.19% were 14 years old and 15.28% were 15 years old.

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Figure 3:

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Figure 3. This bar chart represents the count in percentage of each tooth number of the mandibular arch treated with preventive resin sealant. The count of tooth number 36 treated with sealant (brown) was found to be higher (19.88%) than the other affected tooth, 19.26% was in tooth number 46 (blue), 18.64% was in tooth number 47(grey),18.59% was in tooth number 37(purple), 7.60% was in tooth number 45(red), 7.59% was in tooth number 35 (green), 4.288% was in tooth number 34 (dark blue) and 4.14% was in tooth number 44 (yellow). From this graph we can interpret that the mandibular molars both permanent molars and premolars, were commonly treated with the sealants.

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Figure 4:

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Figure 4. This bar chart represents the comparison of gender with teeth treated with preventive resin sealants. X-axis represents the gender and Y-axis represents the count of teeth treated with sealants with regards to tooth number. The count of tooth number 36 (brown) treated with sealants was found to be higher for both the gender. In case of males (10.15%) which was higher than the females (9.73%), secondly the male witty tooth number 46(blue) treated were found to be 9.80% while the count of females for the same tooth was found to be 9.46%. 9.66% of males had treated tooth number 37, 8.92% of females for the same. 9.56% of males had treated tooth number 47, 9.08% of females for the same. For the tooth number 34, 2.11% of males and 2.18% of females were treated. For tooth number 35, 3.54% of males and 4.05% of females were treated. For tooth number 44, 2.06% of males and 2.09% of females were treated. For tooth number 45, 3.61% of males and 3.99% of females were treated. From this graph we can interpret that the tooth number 36 of the males are mostly treated with sealants followed by tooth number 46 of males. Chi-square test shows Pearson chi square value of 5.823a and p value of 0.032 (p<0.05), hence statistically significant association was seen.

Discussion

In this study, based on the inclusion and exclusion criteria, dental treatment records of 5784 children of age 13 to17 years were sorted and examined. Among the total population analysed, 50.50% were males and 49.50% were females (figure 1). Figure 1 shows the frequency of gender treated by preventive resin sealants in permanent mandibular arch. Previous studies stated that females had less occlusal Pit and Fissure caries than males, and there was no statistically meaningful relationship between gender and occlusal pit and fissure caries (P<0.05). Finally, males have a greater incidence of occlusal Pit and Fissure caries than females, with the largest distribution in the 18 to 25 year old age range [29]. In contrast to our study a recent study states that the sealants were more likely to be seen in girls of all age ranges (26 % for 12-yearolds and 19 % for 15-year-olds), as well as patients who went to the dentist for protection rather than those who went because they felt they needed a restoration or were in pain. In all age ranges, girls had a better chance of receiving sealants (26 % for the 12 and 12 % for the 15-year-old )but not with statistically significant difference . This could be due to salivary composition, flow rate and genetic modification [30]. Figure 2 shows the age distribution of patients who have been treated with preventive resin sealants. Most of the treated children are likely to be in the age of 13 years (26.59%). A recent study shows that sealant positioning was linked to caries reduction in both age ranges, including the low use of sealants. The decline in the 12-year-old population was not statistically significant (11%) but rose to a statistically significant 24 % in the 15-year-old group.For children who are at low to high risk for caries formation, the first permanent molars should be sealed soon after eruption at 6 to 7 years of age, and the second permanent molars at 12 to 13 years of age [31]. If the patient is at high risk for caries and has a history of occlusal caries, premolar sealants should be considered. Another study states that just 7.6% of US schoolchildren aged 5 to 17 had one or more dental sealants on permanent teeth, according to data from a nationwide study conducted in 1986 and 1987 [32] . Figure 3 shows the count in percentage of each tooth number of the mandibular arch treated with preventive resin sealant. The count of tooth number 36 treated with sealant was found to be higher(19.88%) than the other affected tooth, 19.26% was in tooth number 46. In all age ranges, first molars were sealed more often than second molars. A previous study shows that sealants were present in 8.3% and 1.4 % of age 12 and 7.4% and 2.2 % of 15-year-olds' first and second molars, respectively .Caries in pits and fissures (occlusal surface, maxillary lingual, and mandibular buccal molars). Another study shows that in comparison to the maxillary, the mandibular first permanent molars had a higher caries prevalence (33%) and more fissure sealants added (1.1%), which were statistically important (P 0.01) [33]. Figure 4 shows that the comparison of gender with teeth treated with preventive resin sealants. The count of tooth number 36 treated with sealants was found to be higher for both the gender. In the case of males (10.15%) which was higher than the females (9.73%). Previous studies show that 4% of the maxillary and 5% of the mandibular 1st permanent molars of the 13-year-old group had sealants. Other studies also show that male population was mostly affected in tooth number 36 [34]. In molars, sealants have been shown to reduce the chance of decay by approximately 80%. When it comes to your child's dental health, this is particularly critical. When assessing the effective action for non cavitated caries lesions, the clinician would consider the use of sealants to stop or slow the development of caries lesions [35]. The limitations of this study is that the population selected was only a particular age group and collected from one region. Future scope of this research should be based on the various ages and from various regions since the usage of sealants can be explored in a wide variety of populations.

Conclusion

This study reveals that pit and fissure sealants were commonly placed in the left permanent first mandibular molar tooth which was higher in males. Creating awareness among parents regarding preventive measures can help in controlling the effect of dental caries in children.

Acknowledgement

The authors are thankful to the Department of Pediatric Dentistry, Saveetha Dental College, Saveetha Institute of Medical and Technical science, Saveetha University for providing a platform in expressing their knowledge.

Source of Funding

The present project was funded by

• Saveetha Dental College

• Saveetha Institute of Medical and Technical Sciences

• Saveetha University

• Varun Beverage Ltd, Tirunelveli.