Definition of At-Risk Occlusal Surfaces of Permanent Molars— A Descriptive Study

The objective of this descriptive study was to define the at-risk occlusal surface to guide the practitioner in the decision of whether to seal or not. Method: All dentists affiliated with the French Society of Pediatric Odontology (SFOP) and general practitioners (GP) registered in postgraduate courses in three French dental schools answered the same questionnaire illustrating four occlusal surfaces of permanent molars. It was focused on obtaining an optimal definition of an at-risk occlusal surface. The corresponding four molars were later sectioned to check the answers. Univariate logistic regression analyses and multivariate logistic regression models were tested to identify the factors associated with the at-risk occlusal surface. Results:Eighty-six SFOP dentists and 136 GP filled in the form. Multivariate logistic regression models stratified by type of practice demonstrated that stained fissures (p=0.001) were only associated with at-risk occlusal surface among GP and the morphology of primary fissure (p=0.001) when considering SFOP dentists alone. The multivariate analyses demonstrated that stained fissures, and primary and secondary fissures were linked to the perception of an at-risk occlusal surface. Conclusion: An at-risk occlusal surface has narrow and deep primary fissures. Numerous secondary fissures could increase the risk. The coloration of fissures should not be used in the definition because it depends on tooth integrity.

pit fissure, sealant, risk, occlusal caries

1. Mejare I, Lingstrom P, Petersson LG, Holm AK, Twetman S, Kallestal C, Nordenram G, Lagerlof F, Soder B, Norlund A, Axelsson S, Dahlgren H. Caries-preventive effect of fissure sealants: a systematic review. Acta Odontol Scand, 61: 321–30, 2003.

2. Ahovuo-Saloranta A, Hiiri A, Nordblad A, Worthington H, Mäkelä M. Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents (Cochrane Review). In: Cochrane Database Syst Rev, 8: CD001830, 2008.

3. Griffin SO, Oong E, Kohn W, Vidakovic B, Gooch BF; CDC Dental Sealant Systematic Review Work Group, Bader J, Clarkson J, Fontana MR, Meyer DM, Rozier RG, Weintraub JA, Zero DT. The effectiveness of sealants in managing caries lesions. J Dent Res, 87: 169–74, 2008.

4. Beauchamp J, Caufield PW, Crall JJ, Donly K, Feigal R, Gooch B, Ismail A, Kohn W, Siegal M, Simonsen R. American Dental Associa-tion Council on Scientific Affairs. Evidence-based clinical recommen-dations for the use of pit-and-fissure sealants: a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc, 139: 380, 2008.

5. Muller-Bolla M, Lupi-Pegurier L, Tardieu C, Velly A, Antomarchi C. Retention of resin-based pit and fissure sealants: A systematic review. Community Dent Oral Epidemiol, 34: 321–36, 2006.

6. American Association of Paediatric Dentistry (AAPD). http://www.aapd.org/media/Policies_Guidelines/G_Restorative.pdf, 2008.

7. Welbury R, Raadal M, Lygidakis NA. EAPD guidelines for the use of pit and fissure sealants. Eur J Paediatr Dent, 5: 179–84, 2004.

8. British Society of Paediatric Dentistry (BSPD). http://www.bspd.co.uk/publication-19.pdf

9. Haute Autorité de Santé. HAS. Haute Autorité de Santé. Appréciation du risque carieux et indications du scellement prophylactique des sillons des premières et deuxièmes molaires permanentes chez les sujets de moins de 18 ans. www.has-sante.fr. 2005.

10. Brown LJ, Selwitz RH. The impact of recent changes in the epidemi-ology of dental caries on guidelines for the use of dental sealants. J Publ Health Dent, 55: 274–91, 1995.

11. Siegal MD. Workshop on Guidelines for sealant use. J Publ Health Dent, 55: 259–311, 1995.

12. Nunn JH, Murray MJ, Smallridge J. British Society of Paediatric Den-tistry (BSPD). British Society of Paediatric Dentistry: a policy docu-ment on fissure sealants in paediatric dentistry. Int J Paediatr Dent, 10: 174–77, 2000.

13. Droz D, Courson F, Muller-Bolla M, Nancy J, Terrie B. Recommandations de la Société Française d’Odontologie Pédiatrique sur la pratique de scellement des puits et fissures. JOSP, 11: 223–27, 2004.

14. Feigal RJ, Donly KJ. The use of pit and fissure sealants. Pediatr Dent, 28: 143–50, 2006.

15. Le Bell Y, Forsten L Sealing of preventively enlarged fissures. Acta Odontol Scand 38:101-4, 1980.

16. Sutalo J, Pupic V, Ciglar I, Skaljac G, Tuda M. Rasterelektronenmikroskopische studie über die penetrationsfähigkeit von versiegelungsmitteln. Oralprophylaxe, 11: 83–8, 1989.

17. Celiberti P, Lussi A. Use of a self-etching adhesive on previously etched intact enamel and its effect on sealant micoleakage and tag for-mation. J Dent, 33: 163–71, 2005.

18. Symons AL, Chu CY, Meyers IA. The effect of fissure morphology and pre-treatment of the enamel surface on penetration and adhesion of fis-sure sealants. J Oral Rehabilitation, 23: 791–8, 1996.

19. Ekstrand KR, Ricketts DNJ, Kidd EAM. Reproducibility and accuracy of three methods for assessment of demineralization depth on the occlusal surface: an in vitro examination. Caries Res, 31: 224–31, 1997.20. van Dorp CS, Exterkate RA, ten Cate JM. The effect of dental probing on subsequent enamel demineralization. ASDC J Dent Child, 55: 343–7, 1988.

21. Yassin OM. In vitro studies of the effect of a dental explorer on the for-mation of an artificial carious lesion. ASDC J Dent Child, 62: 111–7, 1995.

22. Caisse Nationale d’Assurance Maladie Travailleurs Salariés. La dent de 6 ans: prévenir ou soigner. Analyse médicale et économique des premières molaires permanentes dans les dépenses dentaires du régime général de l’assurance maladie. Ed CNAMTS, Paris; 1999.

23. Hescot P, Rolland E. La santé dentaire en France. Enfants de 6 et 12 ans. Ed. UFSBD, Paris; 2006.

24. Cherry-Peppers G, Gift HC, Brunelle JA, Snowden CB. Sealant use and dental utilization in U.S. children. ASDC J Dent Child, 62: 250–5, 1995.

25. Selwitz RH, Winn DM, Kingman A, Zion GR. The prevalence of den-tal sealants in the US population: findings from NHANES III, 1988-1991. J Dent Res, 75: 652–60, 1996.

26. Main PA, Lewis DW, Hawkins RJ. A survey of general dentists in Ontario, Part I: Sealant use and knowledge. J Can Dent Assoc, 63(7): 542–53, 1997.

27. Albert DA. Sealant use in public and private insurance programs. N Y State Dent J, 65: 30–3, 1999.

28. Pitts N. “ICDAS”- an international system for caries detection and assessment being developed to facilitate caries epidemiology, research and appropriate clinical management. Community Dent Health, 21(3): 193–8, 2004.