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

Keywords

Preventive Resin Sealant; Mixed Dentition; Mandibular Teeth; Innovative Technique.

Introduction

Dental caries is a complicated disease triggered by change in the composition of the bacterial biofilm, which causes an imbalance in the demineralization and remineralization cycles, resulting in cavitation [1]. Dental caries is a common oral disease in children, particularly in the first permanent molars, and the disease's incidence is related to economic and social disadvantages. Pits and fissures are among the most vulnerable locations to caries because of their peculiar morphology and lack of mechanical teeth brushing [2]. In Pedodontics, this is especially important for distinguishing caries prone areas in deciduous teeth and first permanent molars. The pit created by the intersection of developmental grooves on the molar occlusal surface is a fascinating anatomical feature that is more prone for dental caries because of its plaque retentive nature. The mesiobuccal groove is a unique feature of mandibular first molars. It's a kind of sulcus that runs from the occlusal to buccal surfaces and is often unnoticed during dental examinations. This narrow groove, though often shallow, can host a small but active bacterial population that can easily cause cavitation [3]. According to data from the National Health and Nutrition Examination Survey (NHANES) 2011-2012, 21% of children aged 6 to 12 years had tooth decay in their permanent teeth. In children and adolescents, pit and fissure caries contribute for about 90% of dental decay in permanent posterior teeth and 44% of caries in primary teeth [4].

Prevention at the initial phase of dentistry is a wonderful option, particularly in paediatric dentistry. Although the use of prevention measures plays such an important role in early screening treatment, this knowledge must be extended to practice dentistry. To secure pits and fissures, more efficient steps are needed, such as the use of pit and fissure sealants. Sealant application is a protective conservative technique that involves introducing sealants into the pits and fissures of caries-prone teeth; the sealant then micro mechanically binds to the tooth, creating a physical barrier that holds bacteria apart from their nutritional supplement [5]. Regardless of the fact that the effectiveness and caries preventive effect of pit and fissure sealants have been well reported in the literature, they are still perceived to be underused globally. Majority of the public health programme are supplying free pit and fissure sealant for the first permanent molar of school-aged children and this plan was launched in 2011 to reduce the prevalence of dental caries in children. When appropriate patient choice and application techniques are followed, pit and fissure sealants can eliminate occlusal caries [6]. Sealant retention rates should be improved over time, which necessitates effective adaptation and deep sealant penetration.

Studies on whether bur preparation of pits and fissures improves sealant retention by increasing adaptation and penetration are still ambiguous. Preventive resin sealant is used to repair minor exploratory cavities in enamel, while localized carious lesions are eliminated without enlargement into the adjacent normal tooth [7]. Resin-based sealants and glass ionomer cement-based sealants are the two most common varieties of sealant products on the market today. The carious lesions are filled with more fillers containing resins, but for a pit and fissure caries, as well as for an intact tooth, are sealed with a preventive resin sealant. Nowadays, a variety of commercially produced sealant products on the market, including resin-based sealants such as bisphenol A-glycidyl methacrylate monomers or urethane dimethacrylate, which are polymerized using either a chemical or a light activation mechanism [8]. When contrasted to controls without sealants, sealants were efficient in avoiding occlusal and proximal dental caries in children's molars, according to a study [9]. Another research found that sealants were more efficient than fluoride varnishes in reducing occlusal caries in children's molars, although the proof was of poor quality [10]. Our team has extensive knowledge and research experience that has translate into high quality publications [11-23, 24-30].

The main purpose of our study was to assess the prevalence of most commonly treated mandibular teeth with preventive resin sealant in 6 to 12 year old pediatric patients with mixed dentition.

Materials and Methods

With the approval of the Institutional ethical committee, this retrospective study was conducted in a private university setting. About 5,00,000 case sheets were obtained from June 2019 to March 2020. Informed consent was obtained from the parents or guardian regarding usage of the clinical data for research purposes.

Inclusion criteria of this study was the pediatric population within the age group of 6 to 12 years who had treatment with preventive resin sealant in their mandibular arch within the time period extending from June 2019 to February 2021. The patients who had preventive resin sealant treatment in their maxillary arch as well as patients of other age groups having only primary and permanent dentition were excluded in the study. The sampling bias was minimised by a simple random sampling method. A third examiner reviewed the case records of the collected data to confirm the validity of the data with post-operative photographs. If any error in data entry or patient details or clinical data were noticed, that case sheet was excluded from the study.

The collected data was then tabulated for statistical analysis using SPSS. Descriptive statistics and chi square tests were performed with the level of significance at 5% (p<0.05). The independent variables of the study were gender and geographic background. The dependent variables were the age of the patient and mandibular teeth treated with preventive resin sealant.

Results

A total of 6209 case sheets were analysed for this study. Most of the treated children are likely to be in the age of 12 years (19.99%), 18.56% were 11 years old, 15.89% were 10 years old, 14.83% were 9 years old , 14.04% were of 8 years old, 12.09% were 7 years old and only 4.6% were 6 years old (Figure 1). Nearly more than half of the study population who are treated with preventive resin sealant in their mandibular teeth (54.86%) were males and only 45.14% of the population were females (Figure 2). The left and right first Mandibular molars were commonly treated (36.82% and 35.90% respectively) compared to other mandibular teeth (Figure 3). Males were more commonly treated for resin sealant in mixed dentition period when compared to females which was statistically significant (Figure 4). (p-value = 0.001).

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Figure 1:

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Figure 1. This bar chart represents the age distribution of the children whose mandibular teeth were treated with preventive resin sealant. Most of the treated children are likely to be in the age of 12 years (19.99%). 18.56% were 11 years old, 15.89% were 10 years old, 14.83% were 9 years old , 14.04% were of 8 years old, 12.09% were 7 years old and only 4.6% were 6 years old.

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Figure 2:

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Figure 2. This bar chart represents the gender of the children whose mandibular teeth are treated with preventive resin sealant. Dark green colour in the chart represents female and light green represents male. Nearly more than half of the study population who are treated with preventive resin sealant in their mandibular teeth (54.86%) were males and only 45.14% of the population were females.

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Figure 3:

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Figure 3. This bar chart represents the count of each tooth number of the mandibular arch treated with preventive resin sealant. The left and right first Mandibular permanent molars were commonly treated (36.82% and 35.90% respectively) compared to other mandibular teeth (0.5-5.3%).

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Figure 4:

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Figure 4. This bar chart represents the comparison of gender with the tooth treated with preventive resin sealant. X-axis represents the gender and Y-axis represents the count of teeth treated with sealant with regards to tooth number. The count of tooth number 36 treated with sealant was found to be higher in case of males (20.34%) than the females (16.48%), secondly the males with tooth number 46 treated were found to be 19.91% while the count of female for the same tooth was found to be 15.99%. 2.82% of females had treated tooth number 47, 2.75% in females with tooth number 37 and 2.50% of males with tooth number 47 were treated with preventive resin sealant. From the graph we can interpret that the tooth number 36 of the males are the ones which are mostly treated followed by the tooth number 46 of males. (Pearson Chi square = 30.533a ; p value of 0.001 - statistically significant).

Discussion

Fissure sealants have been shown to be successful in caries prevention and management in both individual and community based approaches for children in the literature. From our study results we found that the preventive resin sealant application in mandibular arch within the age limits was found to be more prevalent in males (54.86%) when compared to females which was 45.14% (figure 2). According to a study, Northern Appalachian females have more protection against dental caries during infancy than males, but not during puberty or adulthood, so male children might need sealants to avoid the caries risk [31]. However, other research shows that females have higher caries risk factors due to differences in salivary composition and flow rate, eating preferences, and genetic variants. Systemic disorders linked to caries have also been correlated to female gender. It has not been proved that prolonged exposure to the oral cavity or a more cariogenic oral microflora indicates higher chance of carious lesions in women [32]. A study reveals the same results that the sealants are placed more in males (53%) against females [33]. In contrast, just 0.8 percent of the male children in Riyadh, Kingdom of Saudi Arabia had a fissure sealant introduced to their permanent first molar, according to a study [34].

From figure 1, it was also found that the prevalence of sealant application in mandibular arch was more frequent in the age of 12 (19.99%). In contrast, another study reveals that the 12 year old patients who went to the dentist because they felt they wanted a restore had a non-statistically relevant (37%) higher risk of getting a sealant than those who went for protection [35]. It was found that the prevalence of sealant treatment was most common in mandibular first molars (36.82% in 36 and 35.90% in 46) when compared to other teeth (figure 3). Most commonly treated teeth in mandibular arch are molars due to deep pit and fissures as they are more prone to food lodgement and have predisposing risk of developing caries [36]. Preventive resin restoration (PRR) can be used on molars against the pit and fissure sealants provided the practitioner is mindful about achieving optimum seal of restoration on tooth structure. Sealants and PRRs are the common prophylaxis used to improve the oral hygiene status of the patients. On comparison between gender and tooth number, it was revealed that most commonly 20.34% males were treated with sealants in tooth number 36 and the second most commonly 19.91% of males were subjected to sealant application in 46, even among females tooth number 36 (16.48%) and 46 (15.99%) are most commonly treated with sealants (figure 4). In our study, premolars were treated rarely in males and females in comparison to mandibular molars. Other studies also reveal that the mandibular molars of the male population are more likely to be treated with preventive resin sealant in comparison with females [37].

The main advantage of conducting the study in the university setting is that it aids as a single centre for multiple people from different localities at the same time. The limitations of the study are minimum external validity as it does not represent the general population and also the validity cannot be extended by encompassing subjects of a wider range. This study was retrospective and doesn’t record success of sealants treatment. This study may enable the necessity for prophylactic management in mandibular molars of mixed dentition particularly in male population.

Conclusion

Within the limitations of the study it can be concluded that permanent first molars were commonly treated by preventive resin sealants particularly, in conjunction with other prevention measures to avoid severe complications to the teeth. Male children were treated predominantly when compared to females.

Acknowledgement

The authors are thankful to Saveetha Dental College for providing data and a platform to express our knowledge.

Source of Funding

The present study was supported by the following agencies

• Dhivyasree beauty parlour, Thiruverkadu,Chennai-77.
• Saveetha Dental College, Saveetha Institute of Medical and Technical Science, Saveetha University.