March 2007

Objectives: This study investigated the effectiveness of fissure sealants in a community-based programme and the relationship between fissure sealants effectiveness and exposure to fluoridated water. Design: Prospective cohort study of children attending the School Dental Service (SDS) of two Australian states, Queensland and South Australia, across a period of between 6 months and 3.5 years (mean=2 years). Methods: Oral health data on 4–15-year-olds were obtained as part of regular examinations by the SDS while questionnaire data on residential and water consumption history were provided by children’s parents or guardians. Participants: A sub-group of 789 children (mean age=10.5 years) was selected with one contralateral pair of permanent first molars at baseline where the occlusal surface of one molar had been fissure sealed while the paired surface was diagnosed as sound. Results: The caries incidence of the fissure sealed occlusal surfaces was 5.6% compared to 11.1% for sound surfaces (p<0.001), demonstrating a 50% reduction in caries incidence for sealed vs non-sealed surfaces. The reduction in caries increment attributable to fissure sealing increased across fluoridated water exposure categories - a 36.4% reduction was found for children with 0% exposure (p>0.05), a 55.0% reduction for children with intermediate exposure (p<0.01), and an 82.4% reduction for children with 100% lifetime exposure to fluoridated water (p<0.001). Differences between odds ratios for fissure sealants across exposure categories were not statistically significant. Conclusions: The effectiveness of fissure sealants in community-based programmes may be further improved when coupled with increased lifetime exposure to optimally fluoridated water. Key words: Caries; children, fissure sealants; water fluoridation