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DENTAL SEALANTS
-r
DENTAL SEALANTS ADA COUNCIL ON ACCESS, PREVENTION AND INTERPROFESSIONAL RELATIONS; ADA COUNCIL ON SCIENTIFIC AFFAIRS SUPPORTED BY ADA COUNCIL ON COMMUNICATIONS; ADA COUNCIL ON DENTAL EDUCATION; ADA COUNCIL ON DENTAL PRACTICE; ADA COUNCIL ON DENTAL BENEFIT PROGRAMS
Dental sealants have proved to be highly effetive in preventing pit and fissure dental canes. This report describes the ADA's stance on sealants and efforts to
educate dentists and patients about the benefits of sealants.
Oor the past several decades, a significant decline in the prevalence of dental caries in children in the United States has been welldocumented.1 Fluoride has played a large role in decreasing the amount of smooth surface decay, but fluoride has its least preventive effect on pit and fissure caries.2 The National Dental Caries Prevalence Survey showed that 84 percent of caries in 5- to 17-yearold children involved surfaces with pits and fissures.3 EFFICACY
Dental sealants have been shown to be highly effective in the prevention of pit and fissure caries, a fact acknowledged by the American Dental Association for many years.4 Key issues are that the sealant is properly placed, remains intact and is maintained over time. With complete retention, sealed surfaces are virtually impervious to decay. Studies using chemically activated sealants report 92 percent to 96 percent retention after one year, with 67 percent to 82 percent retention after five years.5 Studies of long-term retention of chemically activated sealants showed 41 percent to 57 percent completely covered after 10 years.6 After 15 years, one study showed complete sealant retention of 27.6 percent and partial retention of 35.4 percent.7 Clinical results for up to five years for sealants polymerized by visible light are similar to those of chemically activated systems.6 CURRENT PRODUCTS AND TECHNIQUE
The Association has an acceptance program to evaluate the safety and effectiveness of commercially available sealants (Box, "Sealant Materials Accepted by the ADA Council on Scientific Affairs"). Currently, the list of pit and fissure sealants classified as acceptable by the Council on Scientific Affairs includes those that are chemically activated as well as those that are activated by visible light. Good retention of sealants requires careful application. Recent articles have provided helpful technical reviews.89 Inadequate isolation and subsequent contamination are the most common reasons for JADA, Vol. 128, April 1997 485
~ASSOCIATION REPORT sealant failure. Avoiding contamination is critical throughout the sealant application processparticularly from the time of acid removal through curing of the sealant. Previously, an etching time of 60 seconds was recommended, but current information shows that 15 seconds of etching creates satisfactory retentive conditions.10"11 It has been reaffirmed that sufficient eruption of new permanent teeth is necessary to allow for proper isolation.12 For continual effectiveness, sealants should be checked regularly as part of periodic recall visits and replaced as needed. Use of opaque or tinted materials may aid in monitoring sealant retention. CONSIDERATIONS FOR USE
Many individuals and groups stand to benefit from sealant placement. The key element is the professional judgment of the dentist, for a specific patient, at a specific time. Based on the patient's disease risk factors and presence of oral disease, the dentist should determine the frequency and type of preventive treatment needed. Sealants could be indicated for both children and adults who - for a variety of reasons may be at moderate or high risk of dental caries; - have incipient caries (limited to enamel) of pits and fissures; - have existing pits and fissures anatomically susceptible to decay; - have sufficiently erupted permanent teeth with susceptible pits and fissures."3 The teeth with the highest priority for sealant placement are usually the first and second permanent molars.'4 Sealant success 486 JADA, Vol. 128, April 1997
is positively associated with eruption status of teeth because the more fully erupted a tooth is, the greater the ability to maintain a dry field. Sealant application on other surfaces of the permanent dentition (for example, buccal and lingual pits and grooves) may be indicated under circumstances of high caries risk. Because of their shallow occlusal structure, primary molars generally are not as susceptible to caries as permanent molars. When indications of high caries risk are present, the dentist may wish to place sealants on primary molars.
Many individuals and groups stand to benefit from sealant placement. The key element is the professional judgment of the dentist, for a specific patient, at a specific time. Historically, concem was expressed regarding the potential placement of sealants over known enamel carious lesions. However, substantial data have been collected indicating that lesions (both diagnosed and undiagnosed) at the base of the fissure are arrested by sealant application."5'6 Caries-causing bacteria trapped beneath intact resin do not regenerate, and enamel lesions do not progress. The decision to use sealants on sites containing known enamel lesions is the responsibility of the dentist. ASSOCIATION ACTIVITIES
The Association has actively promoted wider utilization of dental sealants by the profession and
greater awareness on the part of the public. The Council on Access, Prevention and Interprofessional Relations, or CAPIR, distributes to ADA members a Dental Sealant Resource Kit consisting of scientific review articles and educational information. In April 1994, the ADA, via CAPIR, participated in a national sealant workshop to evaluate and update recommendations for sealant use."2 CAPIR also developed the June 1995 JADA supplement, "Caries Diagnosis and Risk Assessment: A Review of Preventive Strategies and Management," which included a section on dental sealants, detailing current information on indications and considerations. Finally, CAPIR sponsored a scientific session on sealants at the 1995 ADA annual session. The Council on Scientific Affairs sponsors the Seal of Acceptance Program. Accepted products include those for which there is adequate evidence of safety and efficacy. These products may use the Seal of Acceptance, an authorized statement or both. Currently, there are 13 dental sealant materials accepted through this program. The Association continuously monitors the literature regarding dental sealants and supports ongoing research into safety and efficacy of all dental products. One recent in vitro study'7 raised questions regarding the estrogenic potential of a monomer used in some types of currently marketed sealants. Nonetheless, the only documented adverse effects from clinical placement of dental sealants are allergic in nature."8 The Council on Dental Benefit Programs, or CDBP, has endeavored to gain acceptance of
ASSOCIATION REPORT sealants by dental plan purchasers so that sealants are included as preventive measures in dental plans and reimbursed by third-party payers. The benefit code for dental sealants was adopted in 1982, and since 1987 the ADA's policy statement on preventive coverage in dental benefits plans has included sealants as one of the procedures that should be a covered benefit. Current efforts are geared toward educating employees, employers and benefit administrators about sejants so that dental plans inclde sealant coverage. I(In 1994, the Association began thE development of dental practice parameters. The parameters sftte that "dental sealants may be applied to pits and fissures as a preventive measure. "19 The Association has developed numerous sealant informational and patient education materials ttt are available from the ADA calog, including brochures, posters and videotapes. In addition to the best-selling "Seal Out Decay" statement-stuffer, the 1R96-97 ADA catalog offers a fullsize brochure, "Benefits of !alants." Several sealant-related video news releases and public service announcements have been distributed, and two satellite media tours have been conducted. Several National Children's Dental Health Month kits have included tip sheets and press releases on sealants, most recently in 1993 and 1995. Both the Council on Dental Education and the Council on Dental Practice support the provision of dental sealants within the context of preventive oral health care. Association policy, adopted in 1988, maintains that auxiliary personnel who participate in the provision of dental care must have appropriate edu-
SEALANTMAlERIAtS ACCETED BY THEADA COUNCIL ONSCENWIC AFFAIRBS PRODUCT
MANUFACTURER
- Alpha Pluor Seal nI, Type II - Alpha-De3nt Chemical Cure Pit and Fissure Sealant - Alpha-Dent Lilght Cure Pit and Fissure Sealant - Baritone 13, Type II - Concise Light Cure WVhite Sealant - Concise WVhite Sealant
-Cnfi-Dietal Products Co. lphadent P ucts Co.
- Helioiseal F, Type II - Helioseal, Type H - Prisma-Shield, Type II - Prisma-Shield Compules Tips VLC Tinted Pit and Fissure Sealant - Prisma-Shield VLC Pilled Pit and Fissure Sealant - Seal-Rite Low Viscosity, Type II - Seal-Rite, Type II
- Alphadental Products Co. - Confi-Dental Products Co. - 3M Dental Produicts Division - 3M Dental Products Division - Ivoclar NrhAmerica lInc. - Ivoclar North America Inc. - Dentspy, L.D. Caulk Divi.sion - Dentsply, L.D. Caulk Di[vision i Dentsply, 1LJD. Caulk
Division - Pullpdent Corp. - Pulpdent Corp.
* This list includes prodcts acepted as of August 1996. This list may be incomplete, as review by the Council is ongoing
cation and training and meet any additional criteria needed to ensure competence.20 PUBLIC HEALTH SEALANT
PROGRAIMS
The Association's CDBP conducts an annual survey of dental programs in Medicaid. The data collected each year serve as a means of focusing the efforts of states and the dental profession to ensure that dental care is accessible and equitably provided to Medicaid recipients. The 1995 survey had a response rate of 75 percent. Of those responding, 33 states offered some form of coverage for sealants under Medicaid. Coverage ranged from 100 percent reimbursement to coverage for first permanent molars only.2' Over the past several years, the number of public health
sealant programs has expanded in an effort to increase the prevalence of sealants in children with limited access to health care. In 1990, the United States Public Health Service published a national health objective for the year 2000, stating that 50 percent of children should have sealants on one or more permanent molar teeth.22 When that objective was set, the prevalence of sealants in children was very low-11 percent of children aged 8 years and 8 percent of children aged 14 years. Today, the prevalence has increased slightly, but still remains low. The Third National Health and Nutrition Examination Survey (NHANES III), which collected data from 1988 to 1991, reported that nearly 19 percent of U.S. children aged 5 to 17 JADA, Vol. 128, April 1997 487
ASSOCIATION REPORT years had sealants on their permanent or primary teeth, which is more than double the percentage of children with sealants in the previous national survey (7.6 percent in 1986-87). Despite the increase in sealant prevalence, fewer than one in five U.S. children and adolescents aged 5 to 17 years had one or more sealed permanent teeth.23 Public health sealant programs are either school-based, schoollinked or a combination of the two. The American Association of Community Dental Programs, in conjunction with other oral health agencies, has developed a manual, "Seal America: The Prevention Invention," which provides information for public health program administrators.24 This manual recommends that public health sealant program coordinators work closely with organized dentistry at the local level to ensure successful results and full compliance with the state dental practice act. SUMMARY
Dental sealants have been documented over time to be highly effective in the prevention of pit and fissure dental caries. Relative to the potential for appropriate sealant use, however, actual placement is low. The
ADA supports sealants as an appropriate means to prevent pit and fissure caries and has produced numerous sealant resource materials for the membership and the public. Finally, public health departments are actively working to establish school-based or school-linked sealant programs for children with limited access to preventive dental care. m Address reprint requests to the Council on Access, Prevention and Interprofessional Relations, ADA, 211 E. Chicago Ave., Chicago, Ill. 60611. 1. Brunelle JA, Carlos JB. Changes in the prevalence of dental caries in U.S. schoolchildren, 1961-1980. J Dent Res 1982;61:1346-51. 2. Waggoner WF. Managing occlusal surfaces of young permanent molars. JADA 1991;122(11):72-6. 3. U.S. Public Health Service, National Center for Health Statistics. The prevalence of dental caries in United States children, 197980: the national dental caries prevalence survey. Washington, D.C.: Government Printing Office, 1981; NIH publication no. 82-2245. 4. Council on Dental Health and Health Planning and Council on Dental Materials, Instruments, and Equipment. Pit and fissure sealants. JADA 1987;114:671-2. 5. Mertz-Fairhurst EJ. Current status of sealant retention and caries prevention. J Dent Educ 1984;48(Supplement 2):18-25. 6. Ripa LW. Sealants revisited: an update of the effectiveness of pit and fissure sealants. Caries Res 1993;27(Supplement 1):77-82. 7. Simonsen RJ. Retention and effectiveness of dental sealant after 15 years. JADA 1991;122(11):34-42. 8. Waggoner WF, Siegal M. Pit and fissure sealants: updating the technique. JADA 1996;127:351-61. 9. Goldstein RE, Parkins FM. Using airabrasive technology to diagnose and restore pit and fissure caries. JADA 1995;126:761-6. 10. Tandon S, Kumari R, Udupa S. The effect of etch-time on the bond strength of a sealant
and on the etch-pattern in primary and permanent enamel: an evaluation. ASDC J Dent Child 1989;56(3):186-90. 11. Nordenvall KJ, Brannstrom M, Malmgren 0. Etching of deciduous teeth and young and old permanent teeth. Am J Orthod 1980;78(1):99-108. 12. Workshop on Guidelines for Sealant Use. J Public Health Dent 1995;55(5):263-73. 13. American Dental Association. Caries diagnosis and risk assessment: a review of preventive strategies and management. JADA 1995;126(Supplement). 14. Li SH, Kingman A, Forthofer R, Swango P. Comparison of tooth surface-specific dental caries attack patterns in U.S. schoolchildren from two national surveys. J Dent Res 1993;72(10):1398-405. 15. Mertz-Fairhurst EJ, Schuster GS, ID Fairhurst CW. Arresting caries by sealants: Fe[SE sults of a clinical study. JADA 1986;112(2):194-7. bn 16. Handelman SL. Therapeutic use of sealants for incipient or early carious lesiok-n children and young adults. Proc Finn 1991;87:463-75. 17. Olea N, Pulgar R, et al. EstrogenicityIof resin-based composites and sealants used 4d dentistry. Environ Health Perspect 1996;104(3):298-305. 18. Stanley HR. Local and systemic respqes to dental composites and glass ionomer. Adv ; 91 Dent Res 1992;6:55-64. 19. American Dental Association. Dental q practice parameters. JADA 1995;126 (Supplement). Adopted October 1994. 20. American Dental Association. Comprehensive policy statement on dental )fVD auxiliaries. Transactions 1988:462. 21. American Dental Association, Council Dental Benefit Programs. 1995 survey res4fii of state dental programs in Medicaid. Chici6 ADA Council on Dental Benefit Programs. O( 22. U.S. Department of Health and Human. Services, Public Health Service. Healthy OfO People 2000: national health promotion disease prevention objectives. Washington, D.C.: U.S. Government Printing Office, DHHS publication no. (PHS) 91-50213. S<. 23. Brown I, Kaste LM, Selwitz RH, Furp UJ. Dental caries and sealant usage in U.S. clw dren, 1988-1991. JADA 1996;127:33543. b, 24. American Association of Community Dental Programs. Seal America: The preveri9i tion invention. Cincinnati: AACDP; 1995.
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488 JADA, Vol. 128, April 1997
DENTAL SEALANTS ADA COUNCIL ON ACCESS, PREVENTION AND INTERPROFESSIONAL RELATIONS; ADA COUNCIL ON SCIENTIFIC AFFAIRS SUPPORTED BY ADA COUNCIL ON COMMUNICATIONS; ADA COUNCIL ON DENTAL EDUCATION; ADA COUNCIL ON DENTAL PRACTICE; ADA COUNCIL ON DENTAL BENEFIT PROGRAMS
Dental sealants have proved to be highly effetive in preventing pit and fissure dental canes. This report describes the ADA's stance on sealants and efforts to
educate dentists and patients about the benefits of sealants.
Oor the past several decades, a significant decline in the prevalence of dental caries in children in the United States has been welldocumented.1 Fluoride has played a large role in decreasing the amount of smooth surface decay, but fluoride has its least preventive effect on pit and fissure caries.2 The National Dental Caries Prevalence Survey showed that 84 percent of caries in 5- to 17-yearold children involved surfaces with pits and fissures.3 EFFICACY
Dental sealants have been shown to be highly effective in the prevention of pit and fissure caries, a fact acknowledged by the American Dental Association for many years.4 Key issues are that the sealant is properly placed, remains intact and is maintained over time. With complete retention, sealed surfaces are virtually impervious to decay. Studies using chemically activated sealants report 92 percent to 96 percent retention after one year, with 67 percent to 82 percent retention after five years.5 Studies of long-term retention of chemically activated sealants showed 41 percent to 57 percent completely covered after 10 years.6 After 15 years, one study showed complete sealant retention of 27.6 percent and partial retention of 35.4 percent.7 Clinical results for up to five years for sealants polymerized by visible light are similar to those of chemically activated systems.6 CURRENT PRODUCTS AND TECHNIQUE
The Association has an acceptance program to evaluate the safety and effectiveness of commercially available sealants (Box, "Sealant Materials Accepted by the ADA Council on Scientific Affairs"). Currently, the list of pit and fissure sealants classified as acceptable by the Council on Scientific Affairs includes those that are chemically activated as well as those that are activated by visible light. Good retention of sealants requires careful application. Recent articles have provided helpful technical reviews.89 Inadequate isolation and subsequent contamination are the most common reasons for JADA, Vol. 128, April 1997 485
~ASSOCIATION REPORT sealant failure. Avoiding contamination is critical throughout the sealant application processparticularly from the time of acid removal through curing of the sealant. Previously, an etching time of 60 seconds was recommended, but current information shows that 15 seconds of etching creates satisfactory retentive conditions.10"11 It has been reaffirmed that sufficient eruption of new permanent teeth is necessary to allow for proper isolation.12 For continual effectiveness, sealants should be checked regularly as part of periodic recall visits and replaced as needed. Use of opaque or tinted materials may aid in monitoring sealant retention. CONSIDERATIONS FOR USE
Many individuals and groups stand to benefit from sealant placement. The key element is the professional judgment of the dentist, for a specific patient, at a specific time. Based on the patient's disease risk factors and presence of oral disease, the dentist should determine the frequency and type of preventive treatment needed. Sealants could be indicated for both children and adults who - for a variety of reasons may be at moderate or high risk of dental caries; - have incipient caries (limited to enamel) of pits and fissures; - have existing pits and fissures anatomically susceptible to decay; - have sufficiently erupted permanent teeth with susceptible pits and fissures."3 The teeth with the highest priority for sealant placement are usually the first and second permanent molars.'4 Sealant success 486 JADA, Vol. 128, April 1997
is positively associated with eruption status of teeth because the more fully erupted a tooth is, the greater the ability to maintain a dry field. Sealant application on other surfaces of the permanent dentition (for example, buccal and lingual pits and grooves) may be indicated under circumstances of high caries risk. Because of their shallow occlusal structure, primary molars generally are not as susceptible to caries as permanent molars. When indications of high caries risk are present, the dentist may wish to place sealants on primary molars.
Many individuals and groups stand to benefit from sealant placement. The key element is the professional judgment of the dentist, for a specific patient, at a specific time. Historically, concem was expressed regarding the potential placement of sealants over known enamel carious lesions. However, substantial data have been collected indicating that lesions (both diagnosed and undiagnosed) at the base of the fissure are arrested by sealant application."5'6 Caries-causing bacteria trapped beneath intact resin do not regenerate, and enamel lesions do not progress. The decision to use sealants on sites containing known enamel lesions is the responsibility of the dentist. ASSOCIATION ACTIVITIES
The Association has actively promoted wider utilization of dental sealants by the profession and
greater awareness on the part of the public. The Council on Access, Prevention and Interprofessional Relations, or CAPIR, distributes to ADA members a Dental Sealant Resource Kit consisting of scientific review articles and educational information. In April 1994, the ADA, via CAPIR, participated in a national sealant workshop to evaluate and update recommendations for sealant use."2 CAPIR also developed the June 1995 JADA supplement, "Caries Diagnosis and Risk Assessment: A Review of Preventive Strategies and Management," which included a section on dental sealants, detailing current information on indications and considerations. Finally, CAPIR sponsored a scientific session on sealants at the 1995 ADA annual session. The Council on Scientific Affairs sponsors the Seal of Acceptance Program. Accepted products include those for which there is adequate evidence of safety and efficacy. These products may use the Seal of Acceptance, an authorized statement or both. Currently, there are 13 dental sealant materials accepted through this program. The Association continuously monitors the literature regarding dental sealants and supports ongoing research into safety and efficacy of all dental products. One recent in vitro study'7 raised questions regarding the estrogenic potential of a monomer used in some types of currently marketed sealants. Nonetheless, the only documented adverse effects from clinical placement of dental sealants are allergic in nature."8 The Council on Dental Benefit Programs, or CDBP, has endeavored to gain acceptance of
ASSOCIATION REPORT sealants by dental plan purchasers so that sealants are included as preventive measures in dental plans and reimbursed by third-party payers. The benefit code for dental sealants was adopted in 1982, and since 1987 the ADA's policy statement on preventive coverage in dental benefits plans has included sealants as one of the procedures that should be a covered benefit. Current efforts are geared toward educating employees, employers and benefit administrators about sejants so that dental plans inclde sealant coverage. I(In 1994, the Association began thE development of dental practice parameters. The parameters sftte that "dental sealants may be applied to pits and fissures as a preventive measure. "19 The Association has developed numerous sealant informational and patient education materials ttt are available from the ADA calog, including brochures, posters and videotapes. In addition to the best-selling "Seal Out Decay" statement-stuffer, the 1R96-97 ADA catalog offers a fullsize brochure, "Benefits of !alants." Several sealant-related video news releases and public service announcements have been distributed, and two satellite media tours have been conducted. Several National Children's Dental Health Month kits have included tip sheets and press releases on sealants, most recently in 1993 and 1995. Both the Council on Dental Education and the Council on Dental Practice support the provision of dental sealants within the context of preventive oral health care. Association policy, adopted in 1988, maintains that auxiliary personnel who participate in the provision of dental care must have appropriate edu-
SEALANTMAlERIAtS ACCETED BY THEADA COUNCIL ONSCENWIC AFFAIRBS PRODUCT
MANUFACTURER
- Alpha Pluor Seal nI, Type II - Alpha-De3nt Chemical Cure Pit and Fissure Sealant - Alpha-Dent Lilght Cure Pit and Fissure Sealant - Baritone 13, Type II - Concise Light Cure WVhite Sealant - Concise WVhite Sealant
-Cnfi-Dietal Products Co. lphadent P ucts Co.
- Helioiseal F, Type II - Helioseal, Type H - Prisma-Shield, Type II - Prisma-Shield Compules Tips VLC Tinted Pit and Fissure Sealant - Prisma-Shield VLC Pilled Pit and Fissure Sealant - Seal-Rite Low Viscosity, Type II - Seal-Rite, Type II
- Alphadental Products Co. - Confi-Dental Products Co. - 3M Dental Produicts Division - 3M Dental Products Division - Ivoclar NrhAmerica lInc. - Ivoclar North America Inc. - Dentspy, L.D. Caulk Divi.sion - Dentsply, L.D. Caulk Di[vision i Dentsply, 1LJD. Caulk
Division - Pullpdent Corp. - Pulpdent Corp.
* This list includes prodcts acepted as of August 1996. This list may be incomplete, as review by the Council is ongoing
cation and training and meet any additional criteria needed to ensure competence.20 PUBLIC HEALTH SEALANT
PROGRAIMS
The Association's CDBP conducts an annual survey of dental programs in Medicaid. The data collected each year serve as a means of focusing the efforts of states and the dental profession to ensure that dental care is accessible and equitably provided to Medicaid recipients. The 1995 survey had a response rate of 75 percent. Of those responding, 33 states offered some form of coverage for sealants under Medicaid. Coverage ranged from 100 percent reimbursement to coverage for first permanent molars only.2' Over the past several years, the number of public health
sealant programs has expanded in an effort to increase the prevalence of sealants in children with limited access to health care. In 1990, the United States Public Health Service published a national health objective for the year 2000, stating that 50 percent of children should have sealants on one or more permanent molar teeth.22 When that objective was set, the prevalence of sealants in children was very low-11 percent of children aged 8 years and 8 percent of children aged 14 years. Today, the prevalence has increased slightly, but still remains low. The Third National Health and Nutrition Examination Survey (NHANES III), which collected data from 1988 to 1991, reported that nearly 19 percent of U.S. children aged 5 to 17 JADA, Vol. 128, April 1997 487
ASSOCIATION REPORT years had sealants on their permanent or primary teeth, which is more than double the percentage of children with sealants in the previous national survey (7.6 percent in 1986-87). Despite the increase in sealant prevalence, fewer than one in five U.S. children and adolescents aged 5 to 17 years had one or more sealed permanent teeth.23 Public health sealant programs are either school-based, schoollinked or a combination of the two. The American Association of Community Dental Programs, in conjunction with other oral health agencies, has developed a manual, "Seal America: The Prevention Invention," which provides information for public health program administrators.24 This manual recommends that public health sealant program coordinators work closely with organized dentistry at the local level to ensure successful results and full compliance with the state dental practice act. SUMMARY
Dental sealants have been documented over time to be highly effective in the prevention of pit and fissure dental caries. Relative to the potential for appropriate sealant use, however, actual placement is low. The
ADA supports sealants as an appropriate means to prevent pit and fissure caries and has produced numerous sealant resource materials for the membership and the public. Finally, public health departments are actively working to establish school-based or school-linked sealant programs for children with limited access to preventive dental care. m Address reprint requests to the Council on Access, Prevention and Interprofessional Relations, ADA, 211 E. Chicago Ave., Chicago, Ill. 60611. 1. Brunelle JA, Carlos JB. Changes in the prevalence of dental caries in U.S. schoolchildren, 1961-1980. J Dent Res 1982;61:1346-51. 2. Waggoner WF. Managing occlusal surfaces of young permanent molars. JADA 1991;122(11):72-6. 3. U.S. Public Health Service, National Center for Health Statistics. The prevalence of dental caries in United States children, 197980: the national dental caries prevalence survey. Washington, D.C.: Government Printing Office, 1981; NIH publication no. 82-2245. 4. Council on Dental Health and Health Planning and Council on Dental Materials, Instruments, and Equipment. Pit and fissure sealants. JADA 1987;114:671-2. 5. Mertz-Fairhurst EJ. Current status of sealant retention and caries prevention. J Dent Educ 1984;48(Supplement 2):18-25. 6. Ripa LW. Sealants revisited: an update of the effectiveness of pit and fissure sealants. Caries Res 1993;27(Supplement 1):77-82. 7. Simonsen RJ. Retention and effectiveness of dental sealant after 15 years. JADA 1991;122(11):34-42. 8. Waggoner WF, Siegal M. Pit and fissure sealants: updating the technique. JADA 1996;127:351-61. 9. Goldstein RE, Parkins FM. Using airabrasive technology to diagnose and restore pit and fissure caries. JADA 1995;126:761-6. 10. Tandon S, Kumari R, Udupa S. The effect of etch-time on the bond strength of a sealant
and on the etch-pattern in primary and permanent enamel: an evaluation. ASDC J Dent Child 1989;56(3):186-90. 11. Nordenvall KJ, Brannstrom M, Malmgren 0. Etching of deciduous teeth and young and old permanent teeth. Am J Orthod 1980;78(1):99-108. 12. Workshop on Guidelines for Sealant Use. J Public Health Dent 1995;55(5):263-73. 13. American Dental Association. Caries diagnosis and risk assessment: a review of preventive strategies and management. JADA 1995;126(Supplement). 14. Li SH, Kingman A, Forthofer R, Swango P. Comparison of tooth surface-specific dental caries attack patterns in U.S. schoolchildren from two national surveys. J Dent Res 1993;72(10):1398-405. 15. Mertz-Fairhurst EJ, Schuster GS, ID Fairhurst CW. Arresting caries by sealants: Fe[SE sults of a clinical study. JADA 1986;112(2):194-7. bn 16. Handelman SL. Therapeutic use of sealants for incipient or early carious lesiok-n children and young adults. Proc Finn 1991;87:463-75. 17. Olea N, Pulgar R, et al. EstrogenicityIof resin-based composites and sealants used 4d dentistry. Environ Health Perspect 1996;104(3):298-305. 18. Stanley HR. Local and systemic respqes to dental composites and glass ionomer. Adv ; 91 Dent Res 1992;6:55-64. 19. American Dental Association. Dental q practice parameters. JADA 1995;126 (Supplement). Adopted October 1994. 20. American Dental Association. Comprehensive policy statement on dental )fVD auxiliaries. Transactions 1988:462. 21. American Dental Association, Council Dental Benefit Programs. 1995 survey res4fii of state dental programs in Medicaid. Chici6 ADA Council on Dental Benefit Programs. O( 22. U.S. Department of Health and Human. Services, Public Health Service. Healthy OfO People 2000: national health promotion disease prevention objectives. Washington, D.C.: U.S. Government Printing Office, DHHS publication no. (PHS) 91-50213. S<. 23. Brown I, Kaste LM, Selwitz RH, Furp UJ. Dental caries and sealant usage in U.S. clw dren, 1988-1991. JADA 1996;127:33543. b, 24. American Association of Community Dental Programs. Seal America: The preveri9i tion invention. Cincinnati: AACDP; 1995.
Den1Smc
and9( 199$J
4i ut tb
a.c riq
iv
311
2.a Xi
488 JADA, Vol. 128, April 1997