Effectiveness of Sealing Caries: A Way to Reduce Disparities in Dental Caries

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DESCRIPTION (provided by applicant): There is strong evidence for the effectiveness of sealants in preventing caries, and their use through school-based programs is an important way of providing access to care for underserved, high caries risk populations in this country. However, one of the major barriers in sealant utilization is the concern of sealing over caries. Our long-term goal will be: 1) to examine the effectiveness of dental sealants in managing different stages of the caries process in the pits and fissures of permanent teeth, and 2) to help determine the most appropriate threshold for treatment decisions on when to seal a caries lesion. The specific aims of this exploratory proposal are to: 1) assess the feasibility of new and innovative ways to monitor caries over time under a sealant, as well as different ways to measure sealant retention and wear; 2) assess the prevalence, incidence, and distribution of different stages of the caries disease process in the permanent molars of 7-10 year old children (2nd, 3rd and 4th grade) in the Amish population in northern Indiana; and 3) further develop a successful partnership with this community. The Amish, although a very uniform ethnic and racial group, are extremely underserved with major dental needs. We do not anticipate that their inclusion will negatively impact the generalizability of our long-term outcomes, but to the contrary will greatly facilitate the evaluation of long-term effectiveness of dental sealants, because the Amish have extremely low mobility and can be easily followed over time. An Advisory Board, including investigators and Amish community members, will be formed at the start of the project. The Board will be instrumental in guiding the selection of schools that best fit the study's inclusion criteria, and in designing the most effective recruitment strategy for use in this community. The Board will also help train the research team to work with this community's cultural believes and needs, and will continuously review all components and stages of this project for identification of barriers and solutions. After screening and consenting, sixty children will be enrolled in the one year exploratory clinical study. A strength of this proposal is that it will use the International Caries Detection and Assessment System (ICDAS) as the outcome variable for determining caries prevalence, incidence, and the stage of caries severity at the time of sealant placement. ICDAS is a new histological-validated system for clinical identification of caries lesions. Fully erupted permanent molars that fit the inclusion criteria will be sealed and monitored over a one year period. Two of the most innovative, objective and sensitive methods for caries detection, the Quantitative Light induced Fluorescence system (QLF) and DIAGNOdent system will be used in this study for their feasibility to detect and monitor sound or carious lesions sealed during the study. These methods will be compared to the use of traditional radiography. Feasibility of examining sealant retention and wear will be done by comparing the use of a clinical index for sealant retention, with analysis of clinical photographs and impressions of the sealed teeth.