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61번 최석우 예방논문1 발표


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61번 최석우 예방논문1 발표

  1. 1. The use of dental sealants inadults: a long-neglectedpreventive measureDavid R. GoreInternational Journal of DentalHygiene 8, 2010
  2. 2. Introduction• Sodium fluoride and its use of tablets,toothpastes, and mouth rinses areintroduced in1945• Sealant placement vs. application offluorides onto the surfaces of teeth– Cost-effective vs. 4 times a year• Sealant can be extended to the adultpopulation
  3. 3. Introduction• Susceptible areas to caries attack– Occlusal surfaces of molars and premolars– Lingual grooves and pits of Maxillary molarsand incisors– Buccal pits of mandibular molars• Prevalence of dental sealants can inhibitthe advancement of caries
  4. 4. Background• ADA accepted sealant as a safe andeffective method of preventing dentalcaries in 1976• Fluoride has been effective in reducingcarious lesions on the smooth surfaces ofenamel, while sealant has been effectiveon the occlusal pits and fissures, too – pitsand fissures are 8 times more vulnerable
  5. 5. Background• NHANES III(Third National Health andNutrition Examination Survey)-sealants– 5% of 18~24 yrs old adults– 2% of 25~39 yrs old adults• Effectiveness of sealants– 82% reduction of caries after 1 year– 52% reduction of caries after 15 year
  6. 6. Rationale for sealant use in adults• Sealant forms a physical barrier betweenthe tooth and any invading bacterialspecies• The idea of applying sealants is especiallyimportant during tooth eruption, andapplication of sealants in suspectedfissure is advisable in older patients with ahigh caries risk
  7. 7. Rationale for sealant use in adults• Secondary recurrent caries is the primaryreason for the failure and replacement ofrestorations in the adult population• Sealing of amalgam restoration marginsright after placement can improve thelongevity of the final restoration (by Mertz-Fairhurst)
  8. 8. Caries risk and caries reduction• Focus in reducing caries should be onprevention• Aggressive use of sealants against pit andfissure carries has a potential foreradicating caries in children, adolescents,and adults• The use of dental sealants tripled over 4-year period resulting in a decrease inamalgam restorations in military
  9. 9. Caries risk and caries reduction• Caries actually does not progress as longas the pit and fissure remains sealed andintact• Sealed, radiographically evident caries didnot progress over a 10-year period
  10. 10. Improving dental sealant retentionin adults• The complete retention rates of dentalsealants after 1 year are 85% or better,and after 5 years the number is at least50%• Sealant should be routinely repaired eachyear• Adult prophylaxis appointment should beexpanded to include evaluation and repairof sealants
  11. 11. Evidence-based research forsealant use in adults• ADA defined EBD as an approach to oralhealth care requiring clinical decision-makingbased on the integrationof systematicassessments related to the patient’s oral andmedical condition and history, the dentist’sclinical knowledge, and the patient’streatment needs and preferences• Concern for future caries in a fissure orgroove on a tooth can easily be resolved byusing a sealant
  12. 12. Future direction• The use of dental sealants in adultdentition has proven to be an effective oralhealth preventive measure• The patient benefits from improved oralhealth care