September 2007

Objective: To describe the use and outcomes of fissure sealants applied to the first permanent molars (FPMs) of children with high caries risk. Design Retrospective cohort study. Setting General dental practices in North West England. Participants 677 children between the ages of 5 and 14 years who had dmfs≥2, and regularly attended 50 general dental practitioners. Outcomes Analyses were performed at patient level. Logistic regression models, taking into account the clustering of subjects within dental practices, were fitted to identify whether the decision to fissure seal FPMs was significantly associated with gender, socio-economic status, number of carious primary teeth and percentage of carious primary teeth filled. Similar logistic regression models were fitted for caries experience in FPMs. Results Poorer children were significantly (p<0.05, OR=0.84, 95% CI=0.71, 0.99) less likely to receive fissure sealants than affluent children, whilst girls (p<0.01, OR=1.54, 95% CI=1.12, 2.12) were more likely to have sealants than boys. The total number of carious primary teeth was also a significant (p<0.01, OR=1.15, 95% CI=1.06, 1.25) independent predictor of dentists’ decisions to fissure seal FPMs. For each carious primary tooth, the odds of having caries in FPMs increased by 1.16 (95% CI=1.06, 1.26). Analysis showed that pit and fissure caries in FPMs was not affected by the presence or absence of fissure sealants. Conclusions The decision to fissure seal FPMs is affected by caries experience in the primary dentition. Girls and affluent children were more likely to receive fissure sealants. It appears that the placement of fissure sealants by general dental practitioners was not effective in preventing pit and fissure caries in these high-risk children. Key words: carious primary teeth, first permanent molars, fissure sealants, first permanent molars, general dental service