The Effectiveness of Fissure Sealant Therapy Placed by Professional Complementary to Dentistry Compared with Dentists

Abstract

Background: Dental caries is a process that may take place on any tooth surface in the oral cavity where a microbial biofilm (dental plaque) is allowed to develop over a period. From the public health perspective, the prevention of caries is still a major challenge. The development of dental caries within the mouth follows a fixed hierarchy indicating that tooth surfaces vary in caries susceptibility. The most susceptible surfaces are the buccal pits and occlusal-fissured surfaces of the first molar teeth. Since the 1960`s many trials have investigated the effectiveness of using sealants on pit and fissure surfaces. However, the cost effectiveness of sealants is an important issue considered by many studies noted that cost-effectiveness of sealants would be enhanced by using trained auxiliaries to apply them. The changes in dentistry and oral health reveal a need to review the roles of dental auxiliaries in order to deliver quality care cost-effectively. There were number of studies conducted on the effectiveness of dental auxiliaries around the world. According to the purpose of this project, studies evaluated the effectiveness of Professional complementary to dentistry (PCDs) and different type of dental auxiliaries in carrying out complete restorations and in the preventive therapies, fissure sealants, traumatic restorative treatment were evaluated in literature review. The aim of the present study is to review the literature and assess whether PCDs can perform pit and fissure sealants as effectively as dentist through investigation of the caries preventive effect of sealant placed by dentist relative to sealant placed by PCDs. Method: Electronic databases were searched till January 2005. The databases which were used are: Medline via Ovid, Cochrane databases of systematic review , DARE (Database of Abstracts of Reviews of Effectiveness), CCTR (Clinical Controlled Trials Register) Cochrane Library, Dissertation Abstracts International database, NHS EED, CENTRAL, NHS CRD (National Health System Centre for Review and Dissemination). In addition, a hand search of references has been done after searching relating articles in mentioned databases. Results: The conclusion of the Galloway review (2003) shows that the studies available were not only poor, but also old. They searched from the 1960s, with more coming from the 1970s than from other decades and few of these studies come from the UK. It also recommended that there is a need for rigorous British studies to improve the evidence about effectiveness and cost-effectiveness of PCDs. In updated search for effectiveness of work by PCDs in carrying out fissure sealants, only one of the studies compare the caries preventive effect of fissure sealant placed by PCDs but in the USA and in a single private practice. Folke et al concluded that assistants showed increased risk of failure in occlusal sealants compared with the Hygienists, whereas dentists did not differ significantly from the dental hygienists in one private practice. Conclusion: It can be seen from present review that, some new research has been published after Galloway review, which could answer some of the questions regarding quality of work by PCDs. In this regard further researches need to demonstrate the preventive effectiveness of fissure sealant placed by PCDs in the community services in the UK and compare them with the dentists’ work.