SEAL Cambodia-Evaluation of a modified protocol for placement of Fuji VII® Fissure Sealants at one and two years

Abstract

Objectives: In order to address the severe caries burden among Cambodian children and limited access to dental care this study had two objectives: (1) To evaluate the caries preventive effect of hand-mixed GIC Fissure Sealants (FS) placed on first permanent molars of 6-8 year-old Cambodian children using two protocols in the SEAL Cambodia Project and (2) validate the SEAL Cambodia population-based intervention.

Methods: The study had four groups, two cohorts, and investigated two clinical protocols (original and modified) for FS placement to compare caries preventive fraction. Three groups were followed up at 1y and two were followed up at 2y. The modified protocol involved control of the temperature of the material, the timing of mixing and placement, and adjustment of the occlusion. Data analysis examined differences in caries incidence by group.

Results: At 1 and 2 y, 62.8%, and 68.0% follow-up rates were achieved, respectively. The baseline mean dmft for the first and second cohorts was 8.0 (SD 3.9) and 9.9 (SD 4.3) respectively. The original protocol did not render a statistically significant preventive benefit. A preventive fraction of 89.1% at 1 y and 32.3% at 2 y was achieved using the modified protocol in the second cohort (P < 0.05). Children with baseline dmft> 8 realised half the preventive fraction at 2 y compared to those with dmft <8 (22.3% and 45.8% respectively).

Conclusions: The modified FS protocol increased the caries preventive effect, although it was lower than that reported in other studies.

Clinical significance: This study builds evidence for the use of glass ionomer cement Fissure Sealants (FS) for the prevention of caries at a population level. It showed that improving the field-based clinical protocol for application of FS had a large impact on clinical success.

Keywords: Cambodia; Caries; Caries Prevention; Fissure Sealant; GIC.