Evaluation of a routine for prevention and treatment of fissure caries in permanent first molars

Fissure sealing as well as fluoride varnish have shown good preventive effect against fissure caries in newly erupted teeth. The purpose of this study was to evaluate a clinical routine in which these two methods were combined. The evaluation was done in a public dental clinic in Norway, and three dentists performed and evaluated the treatment. The population belonged to two different year classes (born 1978 and 1979), 196 in all, and they were followed semiannually from age 6 until 8 and 9 yr, respectively. The routine was as follows: all erupted permanent first molars without fissure caries were cleaned and painted with a fluoride varnish (Duraphat) every 6 months. Fissures showing incipient caries were opened with a rotating instrument and sealed if caries was restricted to the enamel. Amalgam fillings were placed if caries had progressed to the dentin. The operator time required for the fissure treatment was recorded. After 2 yr observation of children born in 1978 and 1979, 72% of the fissures were intact, 13% had been sealed, and 15% filled, and the corresponding figures after 3 yr (1978-children) were 65%, 15%, and 20%. In approximately 45% of the children all four permanent molars were intact, while about 12% had all molars sealed or filled. The average time spent for application of sealants was 4.1 min and for application of amalgam fillings 5.9 min.