Aim. Assessment of parents’ knowledge regarding the sealing as a preventive method for caries in first permanent molar (FPM).
Material and method. Observational study using electronic questionnaire method on a study group (SG) of 110 parents (105 women, 5 men) aged between 24 and 48 years (mean age=34.89±4.60 years). Parents’ knowledge on the moment and position of FPM eruption and about FPM sealing according to parents’educational level was assessed. Statistical analysis was performed using SPSS 20.0 program (p<0.05).
Results. a) 62.72% of parents knew the moment of FPM eruption, and 68.18% correctly indicated the place of its appearence; b) 75.45% of subjects mentioned sealing as a method to prevent caries, parents with higher education being statistically significantly more (p=0.001) ; c) 56.36% of the children of SG parents had at least one sealed molar; d) Most of the children of the surveyed parents (46.9%) had sealing performed at the age of 7; e) Most parents (96.87%) stated that the FPM sealing of their children was performed in private dental offices.
Conclusions. The level of Romanian parents’ knowledge about FPM and sealing as a caries prevention method has steadily improved over the last 20 years. However, the percentage of children with sealed FPM remains quite low. Greater efforts should be made by medical professional and government organizations to improve parents’ knowledge on oral health, but also to achive widespread sealing in school dental offices.
Key-words: sealing, first permanent molar, knowledge
Epidemiological studies carried out in Romania on various groups of children and adolescents have shown that they had caries the most frequently located on occlusal surfaces [1-3]. This localization is mainly favoured by the morphology of the occlusal surface, with retentive areas difficult to clean . Pits and fissures on the occlusal surface can favour the accumulation of bacterial plaque, a condition for occlusal caries occurence [5, 6].
A favouring factor for the occurrence of caries in pits and fissures, especially in first permanent molar (FPM) is its long eruption period, during which the enamel is immature [7, 8]. In addition, during this period FPM may coexist in the oral cavity with untreated carious primary teeth.
To prevent the occurrence of pit and fissure caries, the sealing of deep pits and fissures is recommended as soon as possible after tooth eruption. Pit and fissure sealing for caries prevention was introduced around 1960 and involves applying a fluid material on the occlusal surface of posterior teeth and forming a layer that is micromechanical bonded and acts mainly as a barrier against acids and subsequent loss of dental minerals [9-11].
This local method of preventing occlusal caries is among the four methods of caries prevention recommended by World Health Organization , and its effectiveness has been demonstrated in numerous studies in the specialized literature [13-15].
Considering both the importance of sealing as a local preventive method and cariovulnerability of FPM, the aim of the study was to assess parents’ knowledge on sealing as a method of caries prevention in FPM, parents being the main link between the child and the dentist.
Material and method
An observational study was performed using the electronic questionnaire method. The study group (SG) consisted of 110 parents (105 women, 5 men) aged between 24 and 48 years (mean age=34.89±4.60 years). Distribution of the SG according to age groups is showed in figure 1.
Fig. 1. Distribution of SG according to the age groups (n=110 parents)
The questionnaire included 17 questions, of which 12 with closed answers and 5 with open answers. The data collected were as follows:
– personal data of the parent: age, gender, occupation, living area, level of education
– personal data of the children: age, gender
– parents’ knowledge related on: the moment and the position of FPM eruption, methods of caries prevention at this level and source of information on FPM sealing.
– the information that the parent has about: the existence of sealings in FPM of own children, the age at which they were performed, the type of dental office where the sealing was performed and whether caries appeared on sealed molars. Parents were also asked if they knew if there is a dental office in the school where the child was studying.
The answers to the questionnaires were centralized in a table Excel Microsoft 2017 and were analysed using SPSS 20.0 program. ANOVA test was used for comparing the variables. The value p<0.05 was considered as statistically significant.
- Distribution of study group according to living area, level of education and occupation
Of the 110 parents, 8 (7.27%) lived in Bucharest, 88 (80%) in another city and iar 14 (12.72%) in rural area.
Regarding the level of education, 6 parents (5.45%) had 8 classes or less, 35 (31.81%) were high school graduates, 47 (42.72%) had a university degree and 22 (20%) had postuniversity studies.
64 (58.18%) of parents were employed, the rest being unemployed or students (fig.2).
Fig. 2. Distribution of study group accoding to parents’ occupation (n=110 parents)
- Data regarding the children
3 (2.72%) of the 110 children were aged under 5, 64 (58.18%) were aged between 5 and 10 years old and 43 (39.09%) were aged between 10 and 15 years old.
Out of a total of 110 children, 57 (51.81%) were boys and 53 (48.18%) were girls.
- Parents’ knowledge on FPM
69 (62.72%) of parents knew the moment of appearence of FPM in the oral cavity, 22 (20%) gave a wrong answer to this question and 19 (17.27%) admitted that they did not know (fig. 3).
Fig. 3. Distribution of SG according to the parents’ knowledge on the moment of FPM eruption (n=110 parents)
75 (68.18%) of parents knew to correctly indicate the position of FPM eruption, while 20 (18.18%) of them considered that it replaces a primary molar and 15 (13.63%) did not know to indicate the position where FPM erupts.
Parents were questioned about the methods of caries prevention on FPM through a multiple choice question. Most of the parents (82.72%) mentioned daily tooth brushing using fluoridated toothpaste, while pit and fissure sealing was mentioned by 75.45% of them (table I).
Table I. Distribution of SG according to the parents’ knowledge on methods of caries prevention on FPM (n=110 parents)
|Methods of caries prevention on FPM||n||%|
|Daily tooth brushing with fluoridated toothpaste||91||82.72|
|Few sweets as desert||50||45.45|
|Few sweets between meals||38||35.54|
|Regular dental check-up||67||60.90|
|Pit and fissure sealing||83||75.45|
Related to parents’ education level, the results showed that 81.15% of parents with university or postgraduate education knew that sealing is a caries preventive method on FPM, 71.42% of those with secondary education and only 33.33% of parents who had 8 classes or less (p=0.001).
Regarding the source of parents’ information about FPM sealing, 85 (77.27%) of subjects mentioned the dentist, 3 (2.72%) – the pediatrician, 4 (3.63%) -TV/ radio and 18 (16.36%) – magazines.
- Data about the sealing of children’ FPM
According to the answers received from the parents, of the 110 children, 46 (41.81%) had no sealed FPM, 62 (56.36%) had at least one sealed FPM and the parents of 2 (1.81%) children did not know if their children had sealed molars.
Most of the children of the surveyed parents (46.9%) had sealing done at the age of 7 (fig. 4.).
Fig. 4. Children distribution by age at which they were FPM sealed (n=62 children)
The majority of parents (96.87%) stated that their children’s FPM sealing was done in a private dental office, 1.56% – in a schoold dental office and 1.56% answered that they did not know where the FPM sealing were done.
It is important to note that in 11 (10%) of children’s schools there is a dental office, in 84 (76.36%) there is none and 15 (13.63%) of parents do not know if the school where their children are enrolled has a dental office.
In children with sealed FPM, in 12 (18,8%) of them the parents stated that caries appeared on the sealed molars, in 47 (73.4%) they did not occured and 5 (7.8%) of parents did not have this information.
Related to the parents’ educational level, the results showed that 68.11% of parents with university or post-graduate education went to the dentist for sealing of FPM of their children, 37.14% of those with secondary education and 33.33% of parents who had graduated from general school (p=0,001).
This study aimed to assess parents’ knowledge on FPM and its sealing as a caries prevention measure.
Amedican Academy of Pediatric Dentistry and European Academy of Pediatric Dentistry cite the results of numerous studies demonstrating that sealed molars are less affected by caries compared to unsealed molars [16, 17].
Considering the importance of FPM sealing as early as possible to prevent caries occurrence in pits and fissures, in a study conducted in 2001, Luca et al. found that only almost one third (31,11%) of the dentists surveyed performed sealings, most of them applying between 1 and 10 sealings per week . In change, Cornea et al., in a study conducted in 2014 on a sample of 175 dentists from Cluj, showed that 85.7% of them stated that they apply dental sealants .
Analyzing parents’ knowledge about the moment and the position of FPM eruption in the present study compared to the results of studies also carried out in Bucharest in 2003 and 2013, respectively, it is noticed that this knowledge has improved in time. Thus, the percentage of parents who provided correct answers regarding the moment and the position of FPM eruption doubled from 2003 to 2013, and in present study, conducted in 2022, about two third of parents have correct information about this subject (tab. II).
Table II. Parents’ knowledge regarding the moment and the position of FPM eruption – comparative data
Regarding the methods of preventing caries on FPM, comparing the results of present study with those of a similar research conducted in 2003 by Luca et al.  on a group of 215 mothers and with those obtained by Sfeatcu et al.  on a sample of 410 parents of preschool children during 2010-2012, it is observed that in the current study pit and fissure sealing is mentioned by parents in a 7 times higher percentage (tab. III).
Table III. Parents’ knowledge on methods of caries prevention on FPM – comparative data
Most parents (77.27%) in our study group stated that the source of information about pit and fissure sealing was the dentist. Comparatively, Lakshmanan & Gurunathan in a study published in 2020 in India showed that 41% of parents received knowledge about sealing from the dentist and 32% from the Internet or TV . Several studies have shown that parents who frequently take their child to the dentist often have more knowledge about oral care means, which can be attributed to the effectiveness of face-to-face education made by the dentist to the parent [21-23].
According to the responses provided by the parents, 56.36% of children had at least one sealed FPM, most parents stating that sealing was performed in private dental offices. This percentage is higher than the percentage of children with sealed FPM reported in recent studies from various cities in Romania. Thus, Munteanu et al. (2019) found in a sample of 186 children aged between 6 and 10 years from Galați that 7.78% of them had sealed FPM , and Georgescu et al. (2019) reported a percentage of 10.2% in a group of 188 schoolchildren aged 5-10 years from Pitești . It is important to note that the percentage of children with sealed FPM was much higher than the percentages reported in studies conducted at least 10 years age. Thus, the percentage of children with sealed FPM reported by Luca et al. in a study carried out in Bucharest in 2002 was 1,95%  and the percentage obtained in 2010 on a sample of children with mean age of 7.32±0.36 ani was 1,39% . In another study, Bereșescu et al. (2012) performed examinations in 385 first-grade schoolchildren and of the total number of erupted molars, 2.29% were sealed and 22.01% already had carious lesions .
In change, a study carried out in a pedodontic clinic, Tănase et al. (2016) noticed that 27.31% of caries free molars were sealed .
Epidemiological studies published in recent years have shown that there is an increase in the caries prevalence, especially due to socio-economic differences between the different classes of the community . These differences lead to inequalities in oral and general health. In the present study, a correlation between the parents’ level of education and knowledge on sealing as a preventive method on FPM showed that most of the parents who know this aspect had higher education. Ravera et al. (2012) stated that there is a significant relationship between the parents’ level of aducation and children’ oral status, and this fact is consistent to our study . Also, Akpabio et al. (2008) showed that mothers with higher education were more aware of their children’ oral problems. It has been shown that mothers’ education, as well as fathers’ education, can influence their awareness and can improve children’s oral health .
In the present study, the majority of parents who obtained information on oral health from the dentist had often secondary or higher education. Consequently, according to the results of this study, it can be verified that children who are more in contact with a dentist have a better oral health. Kowash et al. (2000) showed that maternal dental health education can have a significant effect on preventing caries in children .
The present study showed that the level of Romanian parents’ knowledge about FPM and sealing as a caries prevention method has steadily improved over the last 20 years. However, the percentage of children with sealed FPM remains quite low. Greater efforts should be made by medical professional and government organizations to improve parents’ knowledge on oral health, but also to achieve widespread sealing in school dental offices.
- Bereșescu L, Păcurar M, Petcu B. Clinical-statistical study regarding the decay frequency of the first permanent molars. Romanian Journal of Oral Rehabilitation 2012; 4(4):22-26.
- Chirca EM, Luca R, Georgescu DE. The prevalence of caries in first permanent molar in a group of school children aged 6 to 7 years in Pitești. Proc Rom Acad 2015; (Supplement 1):41-44.
- Tănase M, Zmarandache D, Luca R. Experiența carioasă a molarului unu permanent la un lot de copii tratați într-un serviciu de specialitate. Romanian Journal of Stomatology 2016; 62(4):198-203.
- Papageorgiou SN, Dimitraki D, Kotsanos N, Bekes K, van Waes H. Performance of pit and fissure sealants according to tooth characteristics: A systematic review and meta-analysis. Journal of Dentistry 2017; 66: 8–17.
- Luca R, Ivan A, Stanciu I. Sigilarea în practica stomatologică curentă. Revista Naţională de Stomatologie 2001; 4(2):12-18.
- Macek MD, Beltrán-Aguilar ED, Lockwood SA, Malvitz DM. Updated comparison of the caries susceptibility of various morphological types of permanent teeth. J Public Health Dent 2003; 63(3):174-182.
- Feigal RJ. The use of pit and fissure sealants. Pediatric Dentistry 2002; 24: 415–422.
- Nupur N, Ullal NA, Khandelwal V. A 1-year clinical evaluation of fissure sealants on permanent first molars. International Journal of Paediatric Dentistry 2012; 3: 54–59.
- Kantovitz KR, Pascon FN, Nociti Jr FH, Tabchoury CP, Puppin-Rontani RM. Inhibition of enamel mineral loss by fissure sealant: An in-situ study. Journal of Dentistry 2013; 41: 42–50.
- Cocco AR, Cuevas-Suarez CE, Liu Y, Lund RG, Piva E, Hwang G. Anti-biofilm activity of a novel pit and fissure self-adhesive sealant modified with metallic monomers. Biofouling 2020; 36: 245–255.
- Garcia, I.M.; Rodrigues, S.B.; de Souza Balbinot, G.; Visioli, F.; Leitune, V.C.B.; Collares, F.M. Quaternary ammonium compound as antimicrobial agent in resin-based sealants. Clinical Oral Investigation 2020; 24: 777–784.
- Luca R. Metode locale de prevenire a cariei în șanțuri și fosete. Ed. Cerma, București, 1999: 14-54.
- Bereșescu L, Păcurar M. Studii clinice privind eficiența unor materiale de sigilare. Acta Medica Transilvanica 2013; 2(1):141-143.
- Riziwaguli A, Liu J, Ma Y, Zou J. Pit and fissure sealant for caries prevention in 457 children in Uygur city: results of 2-year follow-up. Shanghai Kou Qiang Yi Xue. 2014; 23(2):201-203.
- Kucukyilmaz E, Savas S. Evaluation of Different Fissure Sealant Materials and Flowable Composites Used as Pit-and-fissure Sealants: A 24-Month Clinical Trial. Pediatr Dent. octombrie 2015; 37(5):468-473.
- Welbury R, Raadal M, Lygidakis NA. EAPD guidelines for the use of pit and fissure sealants. European Journal of Pediatric Dentistry. 2004; (3):179-184.
- Wright JT, Crall JJ, Fontana M, Gillette EJ, Nový BB, Dhar V, et al. Evidence-based Clinical Practice Guideline for the Use of Pit-and Fissure Sealants. Pediatr Dent. 2016; 38(5):E120-136.
- Cornea D, Oprean R, Dudea D. The Use of Dental Sealing in Cluj, Romania: Frequency, Materials and Techniques – A Questionnaire Study. Clujul Med. 2014;87(3):182-5.
- Luca R, Stanciu I, Ivan A, Vinereanu A – Knowledge on the first permanent molar – audit on 215 Romanian mothers. Oral Health and Dental Management in the Black Sea Countries 2003; 2(4): 27-32.
- Sfeatcu R, Dumitrache A, Petre A, Dăguci C, Lupuşoru M, Măru N. Oral health of preschool children – study of parents`knowledge. Medicine in evolution 2013; 19(2): 406-409.
- Lakshmanan L, Gurunathan D. Parents’knowledge, attitude, and practice regarding the pit and fissure sealant therapy. J Family Med Prin Care 2020; 9(1): 385-389.
- Mafeni JO, Messer LB. Parental knowledge and attitudes towards pit and fissure sealants. Aust Dent J1994;39:172–180.
- Blumer S, Ratson T, Peretz B, Dagon N. Parents’ attitude towards the use of fluorides and fissure sealants and its effect on their children’s oral health. J Clin Pediatr Dent2018;42:6–10.
- Munteanu A, Boza A, Kritikou C, Luca R – Experiența carioasă la un lot de școlari din municipiul Galați. Revista Română de Medicină Dentară 2019; XXII(4): 521-533.
- Georgescu EM, Georgescu DE, Luca R. Considerations regarding the sealing of first permanent molars on a lot of pupils from Pitești. Romanian Journal of Stomatology 2019; 65:321-326.
- Luca R, Vinereanu A, Stanciu I, Ivan A – Sealing of the first permanent molar – applicability on the patients’ first visit to the Pediatric Dentistry Department. Oral Health and Dental Management in the Black Sea Countries 2002; 2: 42-47.
- Luca R, Prelipcean D, Farcaşiu T, Farcaşiu C, Stanciu I-A. Studiu epidemiologic privind patologia odontală la un lot de copii de 6-7 ani. Medicina Stomatologică 2010; 3(16):90-93.
- Dumitrache AM, Sfeatcu IR, Buzea CM, Dumitraşcu LC, Lambescu DG. Concepte şi tendinţe în sănătatea orală. Ed. Universitară „Carol Davila”, Bucureşti, 2009.
- Ravera E, Sanchez GA, Squassi AF, Bordoni N. Relationship between dental status and family, school and socioeconomic level. Acta Odontologica Latinoamericana 2012;25(1):140–149.
- Akpabio A, Klausner CP, Inglehart MR. Mothers’/guardians’ knowledge about promoting children’s oral health. Journal of Dental Hygiene2008;82(1):12.
- Kowash MB, Pinfield A, Smith J, Curzon ME. Effectiveness on oral health of a long-term health education programme for mothers with young children. British Dental Journal 2000;188(4):201–205.