Background: Occlusal surfaces of erupting and newly erupted permanent molars are particularly susceptible to\r\ncaries.\r\nThe objective of the study was to assess and compare the effect of a single application of 38% SDF with ART\r\nsealants and no treatment in preventing dentinal (D3) caries lesions on occlusal surfaces of permanent first molars\r\nof school children who participated in a daily school-based toothbrushing program with fluoride toothpaste.\r\nMethods: The prospective community clinical trial in the Philippines was conducted over a period of 18 months\r\nand included 704 six- to eight-year-old school children in eight public elementary schools with a daily school-based\r\nfluoride toothpaste brushing program. Children were randomly assigned for SDF application or ART sealant\r\ntreatment. Children from two of the eight schools did not receive SDF or ART sealant treatment and served as\r\ncontrols. SDF or ART sealant treatment was applied on sound occlusal surfaces of permanent first molars. Surfaces\r\nthat were originally defined as sound at baseline but which changed to dentinal (D3) caries lesions were defined as\r\nsurfaces with new caries (caries increment). Non-compliance to the daily toothbrushing program in three schools\r\noffered the opportunity to analyze the caries preventive effect of SDF and sealants separately in fluoride toothpaste\r\nbrushing and in non-toothbrushing children.\r\nResults: In the brushing group, caries increment in the SDF treatment group was comparable with the\r\nnon-treatment group but caries increment in the sealant group was lower than in the non-treatment group with a\r\nstatistically significant lower hazard ratio of 0.12 (0.02-0.61). In the non-brushing group, caries increment in the SDF\r\ntreatment group and the sealant group was lower than the non-treatment group but the hazard ratio was only\r\nstatistically significant for the sealant group (HR 0.33; 0.20-0.54). Caries increment was lower in toothbrushing\r\nchildren than in non-toothbrushing children. Hazard ratios reached statistical significance for the non-treated\r\nchildren (HR 0.43; 0.21-0.87) and the sealant-treated children (HR 0.15; 0.03-0.072).\r\nConclusions: A one-time application of 38% SDF on the occlusal surfaces of permanent first molars of six- to\r\neight-year-old children is not an effective method to prevent dentinal (D3) caries lesions. ART sealants significantly\r\nreduced the onset of caries over a period of 18 months
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