CompletedPublic Health & HealthcarePregnancy, Children & Inherited Conditions
Seal or Varnish? A randomised trial to determine the relative cost and effectiveness of pit and fissure sealants and fluoride varnish in preventing dental decay
A third of British 12-year-olds in deprived areas will have decay in their permanent molars by the time they finish primary school. The trial directly compares two preventive treatments—plastic sealants painted into the grooves of the teeth versus fluoride varnish brushed onto the surface—to find which works better, costs less, and is more acceptable to children and parents. Sealants require a lengthy dental procedure with drills and suction; varnish takes seconds to apply. Neither treatment has been tested head-to-head in a large UK trial, so dentists lack clear guidance on which to use, especially in the poorest communities where decay rates are three times higher than in affluent areas. If the trial shows one treatment is clearly superior, NHS dental services could shift resources toward the more effective option, reducing the 84% of decay that occurs on the biting surfaces of first molars. The findings will be directly applicable in high-need areas where health inequalities are worst, potentially preventing thousands of children from needing fillings or extractions.
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Dental caries (tooth decay) remains a significant source of morbidity in children, particularly those from deprived backgrounds where levels of decay are three times higher than in better off areas. In the worst affected areas 69% of 12 year olds have decay in their permanent teeth. The majority of this (84%) is located on the biting surface of the first molars which erupt at age six. We know that the application of pit and fissure sealants to the biting surface is effective in preventing tooth decay. This treatment consists of a plastic coating that occludes the rough biting surface which harbour decay-causing bacteria. The application at six-monthly intervals of fluoride varnish, containing high levels of fluoride is also known to prevent decay. This works by strengthening the tooth enamel making it more decay resistant. What is not known is which of these two modes of treatment works best and which is the most cost-effective. It is also not know which of these treatments are most acceptable from the perspective of children and their parents. Fissure sealant application requires an involved dental intervention (use of rotary brush, tooth surface preparation to make the sealant stick, use of a sucker to keep the tooth dry). Varnish application simply involves painting the tooth surface. This trial will examine the relative clinical and cost effectiveness of these treatments and investigate their acceptability to children and their parents. The study will take the form of a randomised trial in which children will receive either fissure sealants on their first permanent molars or fluoride varnish. We will determine the success of the study, by comparing the proportion of children who receive the alternative treatments who are caries-free in their first molar teeth after three years. We will also look at the cost effectiveness and patient acceptability of the treatments. The findings from this study will be applicable across the NHS, particularly in areas of high need with greatest health inequalities.
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