Appréciation du risque carieux et indications du scellement prophylactique des sillons des premières et deuxièmes molaires permanentes chez les sujets de moins de 18 ans - Assessment of caries risk - Quick reference guide

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Posted on Nov 01 2005 Describe how to assess individual caries risk Provide indications for pit and fissure sealing (first and second permanent molars) Propose a clinical protocol for applying materials and monitoring sealants Posted on Nov 01 2005

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Publié par

haute-autorite-sante-maladies-bucco-dentaires

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Économie de la santé Pédiatrie

CI D E L I N E U G R A C T I C E PL I N I C A L Q E F E R E N C E RU I C K G U I D E1 Assessment of caries risk and indications for pit and fissure sealants (1st and 2nd permanent molars) in children and in adolescents under 18  Key messages 1. Assess Individual Caries Risk (ICR) 2. Seal the 1st and 2nd permanent molarsin patients aged under 20 years who have a high ICR; if possible, use a resin-based sealant if tooth isolation is unsatisfactory 3. Monitor patients -a year if ICR is high2-4 times - at least once a year if ICR is low 4.Maintain other caries prevention measures

1. Assessing Individual Caries Risk (ICR) one or more of the following risk factors have a high ICRPatients with ·No daily tooth brushing with fluoride toothpaste ·Regularly eating sugary snacks between mealtimes (sugar-containing foods, sugar-containing drinks, sweets) ·Long-term use of sugar-containing medicines or medicines causing hyposalivation ·Deep fissures2in the molars ·Plaque visible without applying a disclosing agent ·Presence of caries (dentine affected) and/or early reversible lesions (enamel affected). of these risk factors have a low ICRPatients with none

1For full guidelines (in English) and supporting scientific evidence (in French), seeAppréciation du risque carieux et indications du scellement prophylactique des sillons des premières et deuxièmes molaires permanentes chez les sujets de moins de 18 ans (November 2005) -www.has-sante.fr 2Fissures: all grooves, pits or clefts in the enamel surface; deep fissures: fissures that appear deep and narrow on simple clinical examination

2. Sealing

Caries-free surfaces and enamel caries

Isolation satisfactor

Apply a resin-based sealant

Clean (dry brush or air polishing)

Etch with 35-37% orthophosphoric acid for at least 15 sec, then wash for 15 sec and dry

Apply resin-based sealant

Check sealant retention using a probe

Isolate the toothwith a dental dam (or cotton wool rolls and suitable aspiration)

Isolation unsatisfactory

Apply glass ionomer sealant

Apply fluoride varnish

Isolation not possible

Postpone sealing and insist on other preventive measures

Reassess ICR after 3 months

ICR still high

Apply a resin-based sealant (unless previously-appliedglassionomer sealant is still intact) (isolation now satisfactory)

Questionable carious lesions Open fissures and use an aedhesive system and restoration material. Fissure sealing is no longer an option.

3. Monitoring  

Check integrity of sealantand repair if necessary Reassess ICR

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