Objective: Evaluation of sealant effectiveness in prevention of caries. Methods: Iowa Fluoride Study participants (N=160) who had dental examinations at approximately age 9 and again at age 13 were evaluated for presence of caries and sealants by trained and calibrated dentists. Caries outcome (D2+F) on the permanent 1st molar occlusal surfaces (age 13 exam) was compared by sealant status. Questionnaires mailed at 6 month intervals to participants/parents recorded the children's home water source; daily tooth brushing frequency; and whether the child had a dental checkup within the previous 6 months. Documented water fluoride levels from municipal sources and assay of private sources were used to obtain subject-specific water fluoride levels. Questionnaire variables were averaged over all returns from age 7 to 9 and age 9 to 13. Generalized linear logistic regression models assessed D2+F association with sealant status (none, partially retained, fully retained), gender, home water fluoride level, estimated number of dental visits, and tooth brushing frequency. Results: Among 1st molar occlusal surfaces (n=640), 33.0% had no sealants at both the age 9 and age 13 exam, 21.4% had fully retained sealants at both exams, and 45.6% had some sealants, but not fully retained at both exams. D2+F caries rates differed (p=0.003) between teeth with no sealants (26.5%); teeth that had fully retained sealants at both exams (7.3%); and teeth that had some sealants, but not fully retained at both exams (9.2). Logistic regression models confirmed that the teeth with no sealants had significantly higher caries rates than the other two categories (p=0.001), even after adjusting for differences in gender (p=0.001), and for age 7-9 home water fluoride level (p=0.04), estimated dental visits (p=0.06) and tooth brushing frequency (p=0.08). Conclusion: Sealants, even when not fully retained, are associated with reduced caries prevalence. Supported by NIH grants R01-DE09551, R01-DE12101, and M01-RR00059.

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