DryShield vs Cotton Roll Isolation During Sealants Placement: Efficiency and Patient Preference

Pit and fissure caries account for 80 to 90 percent of all caries in permanent posterior
teeth. Pit-and-fissure sealants can be used effectively to prevent caries. By
micromechanically bonding to the teeth, they provide a physical barrier that keeps
microorganisms and food particles from collecting in susceptible pits and fissures, thus
preventing caries initiation and arresting caries progression. The effectiveness of sealants
for caries prevention depends on long-term retention, which is largely a function of
meticulousness of application: keeping the tooth surface free from saliva contamination
during application and polymerization is critical. Low retention of sealants has been
attributed to insufficient moisture control. Therefore, proper isolation of the teeth is one
of the most important steps when placing sealants to ensure their retention. Cotton roll
isolation (CRI) has been widely used for sealant placement, and is the most common method
among pediatric dentists. Although very effective, CRI can be a challenging technique
especially when used in young children: the cotton rolls can be cumbersome for both the
patient and the clinician. A previous study demonstrated that new moisture control systems
such as Isolite, produce sealant retention rates comparable to cotton roll isolation, while
decreasing procedure time. DryShield (DS) has recently been introduced as an all-in-one
isolation system. It is similar to the Isolite as it combines the tasks of fluid evacuation,
tongue and cheek retraction, and serves as a bite block, but differs in that it's
autoclavable and does not provide illumination. Its design allows it to suction and isolate
half the oral cavity at a time. Therefore, it should presumably facilitate sealants
placement under a more controlled environment, while reducing chair time for the dentist.

The goals of this study are to determine if 1) placement times of pit and fissure sealants
using the DryShield system differ from those when using the cotton roll isolation technique;
and 2) there is a significant difference in patient preference between Dryshield and the
cotton roll technique.

Inclusion Criteria:

- The target population will include healthy (ASA I/II), cognitively normal children
who present to one of the Montefiore pediatric dental clinics for an intake or a
recall visit who are determined to benefit from sealants application, or patients who
present solely for a sealant application appointment, when their examination was done
at a previous date (within 6 months). The sample of patients will range from 5 to 14
years of age. They will be selected based on their cooperative behavior displayed
during their visit or recorded at the previous encounter (classified as 3 or 4
according to the Frankl Behavioral Rating Scale). Patients included in the study need
to have at least one erupted caries-free permanent molar in each quadrant. Subjects
must be able to speak English or Spanish. There will be no exclusions based on race,
gender, and ethnicity.

Exclusion Criteria:

- Uncooperative, medically compromised patients requiring fewer than four sealants on
permanent molars will be excluded. Those who do not provide appropriate assents or
consents will be excluded.