CDC’ ’s Expert Panel s Expert Panel CDC on School- -based Sealant based Sealant on School Programs Programs Barbara Gooch DMD, MPH Barbara Gooch DMD, MPH Division of Oral Health Division of Oral Health Centers for Disease Control and Prevention Centers for Disease Control and Prevention bgooch@cdc.gov bgooch@cdc.gov
Presentation Overview Presentation Overview � Explain CDC Explain CDC’ ’s decision to convene an s decision to convene an � expert panel expert panel � Describe objectives and methods Describe objectives and methods � � Present major questions addressed Present major questions addressed �
Presentation Overview Presentation Overview � Review findings of existing systematic Review findings of existing systematic � reviews of sealant effectiveness reviews of sealant effectiveness � Examine studies included in Task Force Examine studies included in Task Force � review of school sealant programs for: review of school sealant programs for: • Caries assessment criteria prior sealant Caries assessment criteria prior sealant • placement placement • Caries risk in study populations Caries risk in study populations •
Reasons for Convening Panel Reasons for Convening Panel � Request from ASTDD Request from ASTDD � � Current guidelines last revised in 1994 Current guidelines last revised in 1994 � � New information available New information available � • Effectiveness of sealants in clinical and Effectiveness of sealants in clinical and • school programs (Systematic reviews) school programs (Systematic reviews) • Caries assessment techniques Caries assessment techniques • • Prevalence of caries and sealants in the U.S. Prevalence of caries and sealants in the U.S. •
http:/ / w w w .cdc.gov/ m m w r/ PDF/ ss/ ss5 4 0 3 .pdf
Reasons for Convening Panel Reasons for Convening Panel � Caries prevalence is still high in children. Caries prevalence is still high in children. � � Percent of children with sealants has Percent of children with sealants has � increased, but disparities remain. increased, but disparities remain. � Susceptibility of molars is much greater Susceptibility of molars is much greater � than for other teeth. than for other teeth. • Macek Macek MD MD et al. et al. J Public Health Dent J Public Health Dent • 2003;63(3):174- -82. 82. 2003;63(3):174
Objectives Objectives � To review guidelines and best practices for To review guidelines and best practices for � school- -based sealant programs based sealant programs school • Guidelines from Albany Workshop, Guidelines from Albany Workshop, J Public Health J Public Health • Dentistry ( (Suppl Suppl), ), 1995 1995 Dentistry � To ensure that guidelines and best practices To ensure that guidelines and best practices � • Reflect current science Reflect current science • • Support practices that are appropriate in school Support practices that are appropriate in school • settings settings
Objectives Objectives � Review focuses on: Review focuses on: � • Methods of assessing tooth surface status Methods of assessing tooth surface status • • Indications for sealant application based on Indications for sealant application based on • findings of the assessment findings of the assessment • Placement techniques Placement techniques • • Evaluation of sealed teeth Evaluation of sealed teeth •
Evaluate Pit & Fissure Surfaces Caries-free Questionable Enamel Caries Dentin Caries Restore Seal Seal SEAL If at risk for caries based on an evaluation of •pit & fissure morphology •eruption status •caries pattern •patient’s perception/desire for sealant Evaluate sealed teeth for sealant integrity and retention, and caries DO NOT SEAL progression. Monitor if the individual and teeth are not at risk
Panel Members Panel Members Panelists (continued) – Chair – Gary Rozier, DDS, MPH Mark Mallatt, DDS, MSD � � University of North Carolina at Chapel Hill Indiana State Department of Health Daniel M. Meyer, DDS � Panelists – American Dental Association Wanda R. Miller, RN, MA, NCSN, FNASN � Diane Brunson, RDH, MPH National Association of School Nurses � Susan M. Sanzi-Schaedel, RDH, MPH Colorado Dept. of Public Health/Environ � David K. Curtis, DMD Multnomah County Health Department � Mark Siegal, DDS, MPH American Academy of Pediatric Dentistry � Margherita Fontana, DDS, PhD Ohio Department. of Health � Richard Simonsen, DDS, MS Indiana University School of Dentistry � Harold Haering, DMD Arizona College of Dentistry and Oral Health � Benedict I. Truman, MD, MPH American Dental Association � Larry Hill, DDS, MPH Centers for Disease Control and Prevention � Domenick T. Zero, DDS, MS Cincinnati Health Department � Jayanth Kumar, DDS, MPH Indiana University School of Dentistry � New York State Department of Health
Methods Methods � Expert Panel convened twice Expert Panel convened twice � • Focused review of state of science and Focused review of state of science and • practice practice • Engaged in discussions Engaged in discussions • • Drafted recommendations based on Drafted recommendations based on • science and expert opinion science and expert opinion
Methods Methods � Strength of evidence documented Strength of evidence documented � for each draft recommendation for each draft recommendation • Rely on findings of published systematic Rely on findings of published systematic • reviews reviews • Await findings of ongoing review of Await findings of ongoing review of • sealant effectiveness in managing caries sealant effectiveness in managing caries • Document specific attributes of included Document specific attributes of included • studies in major systematic reviews studies in major systematic reviews
Outcomes Outcomes � To revise guidelines to reflect current state To revise guidelines to reflect current state � of the science of the science � To identify information gaps To identify information gaps � � To determine reporting and dissemination To determine reporting and dissemination � strategies strategies
Major Questions: Major Questions: 1. What is the effectiveness of sealants in 1. What is the effectiveness of sealants in preventing: preventing: • Caries initiation on sound surfaces? Caries initiation on sound surfaces? • • Caries progression on surfaces with early, Caries progression on surfaces with early, • non- -cavitated cavitated or frank, or frank, cavitated cavitated lesions? lesions? non 2. Which surfaces (sound; carious – – early; early; 2. Which surfaces (sound; carious carious – – frank) are indicated for sealant frank) are indicated for sealant carious placement? placement?
Major Questions: Major Questions: 3. What caries assessment methods are 3. What caries assessment methods are necessary to determine which surfaces necessary to determine which surfaces should be sealed? should be sealed? 4. Are additional procedures, such as 4. Are additional procedures, such as enameloplasty, indicated during , indicated during enameloplasty placement? placement? 5. Are current protocols adequate for 5. Are current protocols adequate for monitoring sealant retention? monitoring sealant retention?
Questions: Questions: 1. What is the effectiveness of sealants in 1. What is the effectiveness of sealants in preventing: preventing: • Caries initiation on sound surfaces? Caries initiation on sound surfaces? • • Caries progression on surfaces with early, Caries progression on surfaces with early, • non- -cavitated cavitated or frank, or frank, cavitated cavitated lesions? lesions? non
Questions: Questions: 1. What is the effectiveness of sealants in 1. What is the effectiveness of sealants in preventing: preventing: • Caries initiation on sound surfaces? Caries initiation on sound surfaces? • • Caries progression on surfaces with early, Caries progression on surfaces with early, • non- -cavitated cavitated or frank, or frank, cavitated cavitated lesions? lesions? non
Sealant Effectiveness Sealant Effectiveness Caries Initiation Caries Initiation Llodra JC JC et al et al . Community Dent and . Community Dent and Llodra Oral Epidemiol Epidemiol 1993;21:261 1993;21:261- -8. 8. Oral � Meta Meta- -analysis of 14 studies of analysis of 14 studies of � autopolymerized sealant sealant autopolymerized � Prevented Fraction = 71% (95% CI = 69, 71) Prevented Fraction = 71% (95% CI = 69, 71) � • • 78% at 1yr; 59% at >4 yrs 78% at 1yr; 59% at >4 yrs
Sealant Effectiveness Sealant Effectiveness Caries Initiation Caries Initiation Rozier RG. J Dent RG. J Dent Educ Educ 2001;65:1063 2001;65:1063- -72. 72. Rozier � Updated Updated Llodra Llodra review review � � Added 5 studies: Added 5 studies: � • Heterogenous Heterogenous in design; materials ( in design; materials ( 3 auto; 2 • 3 auto; 2 visible light) visible light) • Magnitude of effect Magnitude of effect – – similar to similar to Llodra Llodra • NIH Consensus Development Conference on Diagnosis and NIH Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life, March 26- -28, 2001 28, 2001 Management of Dental Caries Throughout Life, March 26
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