Page 14 - GP Fall 2025

Dental Preventive Care for Caries Using Hybrid Sealants

Authors: Dora-Ann Oddo, RDH, MA and Laura Andreescu, MBA

Introduction: pits and fissures are deeper, making it dif- to better view the extent of the lesion. How-
Dental medicine is advancing through the ficult to maintain good oral hygiene which ever, it is contraindicated to use a sharp
applications of revised and innovative clin- can result in harmful bacteria being trapped instrument for evaluation for caries as the
ical and restorative technologies, includ- into those areas causing the development of instrument can contribute to further dam-
ing new dental materials. By implement- caries. The implementation of preventive aging the demineralized enamel lesion. 9
ing measures to expand preventive dental care measures, such as early detection of
care, by adopting procedures to reduce dental lesions and caries can considerably This system is important in detecting the
or eliminate the development of caries in improve clinical management outcome, caries activities including the depth and
children and young adults to this end, we leading to better patient health and reduced the location on the tooth surfaces, but it
are addressing the World Health Organiza- treatment costs. lacks other critical assessing tools such as
tion’s focus on changing the dental caries biological risk factors, disease indicators
rate that currently affects 60-90% of school Early detection starts with the clinician’s or proactive measures. Since the ICDAS
aged children. In August 2020, the US evaluation of each patient’s risk factors II system is mostly based on the visual
1, 2
Department of Health and Human Services for developing caries, by using one of sev- identification of caries, dental researchers
through the Office of Disease Prevention eral available detection tools, such as the developed Caries Management by Risk
and Health Promotion launched the Healthy International Caries Detection Assessment Assessment system (CAMBRA), which is
People 2030 Initiative, to promote preven- (ICDAS II) and the Caries Management similar in detecting caries, but, in addition,
tive care measures, using evidence-based by Risk Assessment system (CAMBRA). it evaluates the patient’s risk level of devel-
resources and science-based methods to de- These are the two most commonly utilized oping caries.
velop guidelines and recommendations that in a clinical setting. ICDAS is a clinical
the medical community can apply to ensure scoring system in the form of worksheets Caries management by risk assessment
patients’ health and well-being. One major used to assess the coronal and root tooth (CAMBRA) evaluates the patient’s caries
objective regarding the oral health stipulat- surfaces, dentin, and enamel caries, and risk as low, moderate, high, and very high/
ed in the Healthy People 2030 Initiative is cavitated or non-cavitated lesions in order extreme high risk. CAMBRA is part of the
the Oral Health-10 Initiative, which aims to accurately prognose, diagnose, and de- dental assessment process which helps de-
to “Increase the proportion of children and velop a treatment plan. termine the risk of dental caries for a pa-
adolescents who have dental sealants on 1 tient. This creates an opportunity to engage
or more molars.” The WHO and Healthy This initial system ICDAS I, was devel- with the patient and guide them on their
3
People 2030 are aligned in addressing these oped in 2002 and updated in 2005 to In- management and prevention of dental car-
specific oral health concerns. ternational Caries Detection Assessment II ies. One method of engaging in conversa-
(ICDAS II). 5, 6 The update was developed tion with the patient is using motivational
Dental sealants are restorative dental mate- by a designated team of international re- interviewing as in CAMBRA.
rials placed on the occlusal surface of pos- searchers studying caries and aiming to
terior teeth with the purpose of isolating the create standards on how to assess, detect, The CAMBRA forms were updated in Jan-
healthy tooth structure from harmful bac- and manage carious lesions. The ICDAS II uary 2021. The forms are age dependent;
teria and other biological risk factors con- system assesses caries using a coded sys- form 1 is from 0-6 years old and form 2
tained in the oral cavity, including poor diet tem from 0 to 6, as follows: is 6 years old through adult. The updated
4
and/or deficient oral hygiene. This article CAMBRA form categories include biolog-
presents a review of updated dental mate- 0 indicates visual healthy tooth surface ical risk factors (salivary dysfunction) or
rials currently used in the clinical and re- with no change in enamel translucency environmental risk factors (health literacy,
storative care, which are breakthroughs for after 5 seconds of air drying; access to care), biological protective fac-
detecting and preventing cavities, includ- 1 indicates initial visual lesions after air tors, and disease indicators (as observed
ing the new generation of bioactive hybrid drying; through clinical exam). One example in the
aesthetic restorative materials. Untreated 2 indicates visual well-defined change in category of biological risk factors is “deep
dental caries can lead to pain, affect speech enamel when wet; pits and fissures,” which is also identified
and lead to low self-esteem that may affect 3 indicates visual small enamel lesions as one of the risk factors for dental caries
an individual’s quality of life. with no damage to the dentin; and a rationale for patients to proactively
4 indicates moderate lesions in the enamel receive dental sealants.
Discussion: and darkening of the dentin;
Dental caries is a multifactorial disease 5 indicates caries with visual dentin; According to several epidemiological stud-
affecting a large portion of the popula- 6 indicates sizable and distinctive caries ies, 60% to 90% of all patients with cari-
tion, however, of increasing concern is the that have progressed into the dentin. 7, 8 ous lesions occur on occlusal surfaces. 10-13
growing number of children and young Therefore, as a dental health provider it
adults affected worldwide. Therefore, it According to the ICDAS II guidelines, a vi- is important to discuss with the patient or
4
is important to accurately assess each pa- sual and/ or tactile examination can be per- their parent/guardian preventative mea-
tient’s risk level of developing caries be- formed either with or without a ball-ended sures for the reduction of dental caries by
fore personalizing their preventive care and probe on the tooth’s occlusal surface. Prior the use of dental sealants on the occlusal
treatment. In general, younger people have to this visual and tactile exam it is essential surfaces of the teeth.
more accentuated tooth anatomy where the to remove any remaining plaque or debris

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