Evidence-based clinical practice guideline for the use of pit-and-fissure sealants: a report of the American Dental Association and the American Academy of Pediatric Dentistry

BACKGROUND: This article presents evidence-based clinical recommendations for the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars in children and adolescents. A guideline panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Pediatric Dentistry conducted a systematic review and formulated recommendations to address clinical questions in relation to the efficacy, retention, and potential side effects of sealants to prevent dental caries; their efficacy compared with fluoride varnishes; and a head-to-head comparison of the different types of sealant material used to prevent caries on pits and fissures of occlusal surfaces. TYPES OF STUDIES REVIEWED: This is an update of the ADA 2008 recommendations on the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars. The authors conducted a systematic search in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other sources to identify randomized controlled trials reporting on the effect of sealants (available on the US market) when applied to the occlusal surfaces of primary and permanent molars. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the quality of the evidence and to move from the evidence to the decisions. RESULTS: The guideline panel formulated 3 main recommendations. They concluded that sealants are effective in preventing and arresting pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes. They also concluded that sealants could minimize the progression of noncavitated occlusal carious lesions (also referred to as initial lesions) that receive a sealant. Finally, based on the available limited evidence, the panel was unable to provide specific recommendations on the relative merits of 1 type of sealant material over the others. CONCLUSIONS AND PRACTICAL IMPLICATIONS: These recommendations are designed to inform practitioners during the clinical decision-making process in relation to the prevention of occlusal carious lesions in children and adolescents. Clinicians are encouraged to discuss the information in this guideline with patients or the parents of patients. The authors recommend that clinicians reorient their efforts toward increasing the use of sealants on the occlusal surfaces of primary and permanent molars in children and adolescents.(AU)

The details in the distributions: why and how to study phenotypic variability.

Phenotypic variability is present even when genetic and environmental differences between cells are reduced to the greatest possible extent. For example, genetically identical bacteria display differing levels of resistance to antibiotics, clonal yeast populations demonstrate morphological and growth-rate heterogeneity, and mouse blastomeres from the same embryo have stochastic differences in gene expression. However, the distributions of phenotypes present among isogenic organisms are often overlooked; instead, many studies focus on population aggregates such as the mean. The details of these distributions are relevant to major questions in diverse fields, including the evolution of antimicrobial-drug and chemotherapy resistance. We review emerging experimental and statistical techniques that allow rigorous analysis of phenotypic variability and thereby may lead to advances across the biological sciences.

Everything you always wanted to know about sex ... in flies.

'Everything you always wanted to know about sex' is a workshop organized as part of the annual Drosophila Research Conference of the Genetics Society of America. This workshop provides an intellectual venue for interaction among research groups that study sexual dimorphism from the molecular, evolutionary, genomic, and behavioral perspectives. The speakers summarize the key ideas behind their research for people working in other fields, outline unsolved questions, and offer their opinions about future directions. The 2010 workshop highlighted the power of the Drosophila model for understanding sexual dimorphism at levels ranging from cell biology and gene regulation to population genetics and genome evolution, and demonstrated the importance of cross-disciplinary interactions in the study of sex. In this respect, Drosophila sets a good example for research in other organisms, including humans and their mammalian relatives.

Nanoporous carbon films for gas microsensors.

We study nanoporous carbon (NPC) as an adsorbent coating on surface acoustic wave (SAW) chemical microsensors for a wide range of analyte gases. By use of pulsed-laser deposition in a controlled inert gas ambient, NPC grows at room temperature with negligible residual stress and, hence, can coat most surfaces to any desired thickness. Acetone adsorption isotherms for NPC-coated SAW devices with mass density ranging from 0.18 to 1.08 g/cm3 indicate that the device frequency response relates to NPC density. Data analysis suggests the possibility of detecting acetone below parts-per-billion concentrations. We find NPC to be highly sensitive to a variety of other volatile organic and toxic industrial compounds. Transmission electron microscopy reveals that lower-density NPC has both larger and greater numbers of nanopores than higher-density NPC and that decreasing NPC density also increases the interplanar spacing between graphene sheet fragments within the ultrathin carbon wall structures. These physical differences effectively increase the available surface area for analyte gas adsorption with decreasing NPC density, with only the structural integrity of the internal NPC wall structures a limiting factor in determining the lowest useful density NPC coating.

Sources of performance on theory of mind tasks in right hemisphere-damaged patients.

Patients with right hemisphere (RHD) or left hemisphere brain damage (LHD) were tested on Theory of Mind (ToM) tasks presented with visual aids that illustrated the relevant premises. As a measure of pragmatic ability, patients were also asked to judge replies in conversation that violated Gricean maxims. Both RHD and LHD patients performed well on the ToM tasks presented with visual aids, but RHD patients displayed difficulty when the same tasks were presented only verbally. In addition, RHD patients showed reduced sensitivity to pragmatic violations. These findings point to the role of right hemisphere structures in processing information relevant to conversations. They indicate that a crucial source of RHD patients' errors in ToM tasks may involve difficulties in utterance interpretation owing to impairments of visuospatial processing required for the representation of textual information.

Mind over grammar: reasoning in aphasia and development.

Research on propositional reasoning (involving 'theory of mind' understanding) in adult patients with aphasia reveals that reasoning can proceed in the absence of explicit grammatical knowledge. Conversely, evidence from studies with deaf children shows that the presence of such knowledge is not sufficient to account for reasoning. These findings are in keeping with recent research on the development of naming, categorization and imitation, indicating that children's reasoning about objects and actions is guided by inferences about others' communicative intentions. We discuss the extent to which reasoning is supported by, and tied to, language in the form of conversational awareness and experience rather than grammar.

Severe impairment in grammar does not preclude theory of mind.

Debates about the role of language in human thinking are increasingly prominent in the cognitive sciences. There are claims that certain forms of reasoning can only be performed through access to the resources of the language faculty. In particular, a component of social cognition involving the representation of the mental states of others ('theory of mind' reasoning) has been claimed necessarily to involve propositions of natural language. A recent case study reported a man (SA) with severe agrammatic aphasia who was unable to understand or produce language propositions in any modality of language use, but who was able to complete theory of mind tasks. We report a replication of this finding using a modified picture theory of mind task with a second patient (MR). Despite severe aphasia and impaired performance on a test of executive function, MR demonstrated retained theory of mind reasoning. These results reveal the functional autonomy of theory of mind from the capacity for propositional/grammatical language, and support its independence from executive function.

The evolution of dosage-compensation mechanisms.

Dosage compensation is the process by which the expression levels of sex-linked genes are altered in one sex to offset a difference in sex-chromosome number between females and males of a heterogametic species. Degeneration of a sex-limited chromosome to produce heterogamety is a common, perhaps unavoidable, feature of sex-chromosome evolution. Selective pressure to equalize sex-linked gene expression in the two sexes accompanies degeneration, thereby driving the evolution of dosage-compensation mechanisms. Studies of model species indicate that what appear to be very different mechanisms have evolved in different lineages: the male X chromosome is hypertranscribed in drosophilid flies, both hermaphrodite X chromosomes are downregulated in the nematode Caenorhabditis elegans, and one X is inactivated in mammalian females. Moreover, comparative genomic studies demonstrate that the trans-acting factors (proteins and non-coding RNAs) that have been shown to mediate dosage compensation are unrelated among the three lineages. Some tantalizing similarities in the fly and mammalian mechanisms, however, remain to be explained.

Evidence for cognition without grammar from causal reasoning and 'theory of mind' in an agrammatic aphasic patient.

Understanding the inter-relationship between language and thought is fundamental to the study of human cognition [1] [2] [3]. Some investigators have proposed that propositions in natural language serve to scaffold thinking, by providing, for example, a sequential structure to a massively parallel process [4]. Others have maintained that certain thoughts, such as inferring the mental states of others, termed 'theory of mind' (ToM) reasoning, and identifying causal relationships, necessarily involve language propositions [5]. It has been proposed that ToM reasoning depends upon the possession of syntactic structures such as those that permit the embedding of false propositions within true statements ('Mary knows that John (falsely) thinks chocolates are in the cupboard') [6]. The performance on reasoning tasks of individuals with severe agrammatic aphasia (an impairment of language following a lesion of the perisylvian areas of the language-dominant hemisphere) offers novel insights into the relation between grammar and cognition. We report the unusual case of a patient with agrammatic aphasia of such severity that language propositions were not apparently available at an explicit processing level in any modality of language use. Despite this profound impairment in grammar, he displayed simple causal reasoning and ToM understanding. Thus, reasoning about causes and beliefs involve processes that are independent of propositional language.

Oviposition-site preference in Drosophila following interspecific gene transfer of the Alcohol dehydrogenase locus.

The preference of Drosophila females to lay eggs on substrates that do or do not contain alcohol is an excellent system to study the evolutionary genetics of behavior, because (1) there is variation in this behavior within and among species, (2) the behavior is amenable to laboratory investigation, and (3) the behavior presumably has a direct relationship to reproductive fitness. Moreover, a key genetic component of the system, the Alcohol dehydrogenase (Adh) locus, is arguably the most well characterized gene known. However, because the Adh gene and its genetic background are inseparable in reproductively isolated species, it is difficult to establish its role in behavioral divergence. By transgene coplacement, we created pairs of strains of D. melanogaster expressing an Adh allele from either D. melanogaster or D. affinidisjuncta, a Hawaiian species with very low levels of ADH in adults. When raised on ethanol-containing medium, the affinidisjuncta-Adh strains experience high mortality relative to the melanogaster-Adh strains. However, affinidisjuncta-Adh females show the same preference for oviposition on ethanol-containing medium as melanogaster-Adh females. Thus, preference for ethanol in these strains is not determined primarily by Adh genotype.

An experimental test for lineage-specific position effects on alcohol dehydrogenase (Adh) genes in Drosophila.

Independent transgene insertions differ in expression based on their location in the genome; these position effects are of interest because they reflect the influence of genome organization on gene regulation. Position effects also represent potentially insurmountable obstacles to the rigorous functional comparison of homologous genes from different species because (i) quantitative variation in expression of each gene across genomic positions (generalized position effects, or GPEs) may overwhelm differences between the genes of interest, or (ii) divergent genes may be differentially sensitive to position effects, reflecting unique interactions between each gene and its genomic milieu (lineage-specific position effects, or LSPEs). We have investigated both types of position-effect variation by applying our method of transgene coplacement, which allows comparisons of transgenes in the same position in the genome of Drosophila melanogaster. Here we report an experimental test for LSPE in Drosophila. The alcohol dehydrogenase (Adh) genes of D. melanogaster and Drosophila affinidisjuncta differ in both tissue distribution and amounts of ADH activity. Despite this striking regulatory divergence, we found a very high correlation in overall ADH activity between the genes of the two species when placed in the same genomic position as assayed in otherwise Adh-null adults and larvae. These results argue against the influence of LSPE for these sequences, although the effects of GPE are significant. Our new findings validate the coplacement approach and show that it greatly magnifies the power to detect differences in expression between transgenes. Transgene coplacement thus dramatically extends the range of functional and evolutionary questions that can be addressed by transgenic technology.

Preschoolers' understanding of lies and innocent and negligent mistakes.

It has often been proposed that young children are not capable of distinguishing mistakes from lies and that they do not discriminate between the reactions that are generated by innocent and negligent mistakes. In our investigation, children aged 3 to 5 years were asked to choose whether a perpetrator had made a mistake or had lied about a food's contact with contaminants and were required to indicate whether this choice would produce a neutral or a negative reaction in the facial expression of a bystander. In this context, many children distinguished mistakes from lies and displayed an incipient ability to discriminate between lies and negligent mistakes that often generate negative reactions and innocent mistakes that do not.

A contemporary perspective on dental sealants.

In spite of significant improvements in the oral health of Americans, dental caries still affects a majority of school-aged children. Its distribution is uneven, with a small proportion of the children experiencing a greater burden of the disease. In addition, caries in children's permanent teeth is predominantly a disease of the pits and fissures. The use of dental sealants has the potential to significantly reduce the disease burden. Although sealants are safe and effective, their use continues to be low. Efforts are needed to make sealants a covered benefit under all insurance plans and to encourage their appropriate use. This paper provides a review of the changes in the prevalence and distribution of dental caries, the effectiveness of sealants, and guidelines for the appropriate use of sealants in public health programs and private practice.

Explicitly questioning the nature of suggestibility in preschoolers' memory and retention.

In research designed to investigate children's suggestible responses on memory tests, 190 preschoolers were read a short story. The same day or six days later, they were exposed to information that was either consistent with the original story details or inconsistent and misleading. One and seven weeks after hearing the story, the children were tested on two types of recognition tasks that involved a choice either between the original and misleading information or between the original and new information with questions that were either explicit or nonexplicit as to the time of the information to be reported. At the 1-week test, children who were exposed to misleading information were significantly less accurate under nonexplicit questioning in recognizing the original from the misleading information than were children presented with consistent information. With explicit questioning, this difference was not significant. When the choice for the children was between original and new items following exposure to delayed misleading postevent information, explicit questioning resulted in significantly more accurate responses at the 7-week test than did nonexplicit questioning. Children questioned explicitly rather than nonexplicitly were more likely to maintain correct responses on both tests. The results are discussed in terms of conversational processes and competing forms of representation in memory retention.

Dental sealants. Who needs them?

Most childhood tooth decay is preventable with a combination of fluoride--which protects the smooth surfaces of a tooth--and dental sealants--which protect tooth surfaces with irregularities called pits and fissures. Sealants are plastic coatings that protect these vulnerable areas, often narrower than a single toothbrush bristle, from decay-causing bacteria and food in the mouth. Yet, 1988-1991 data from the National Health and Nutrition Examination Survey showed that while many children still had cavities, over 80% of which were related to pits and fissures, relatively few children had sealants applied to permanent teeth. As caries has gone from a ubiquitous disease to one affecting only half of children in early elementary school and two-thirds of those who are 15 years of age, dentists must consider how to best target sealants to individual children who are at greatest risk for new disease. Most sealants are placed in private dental offices, but children at greatest risk for problems resulting from tooth decay are least likely to get private care. State and local health departments, therefore, have gone after hard-to-reach children and adolescents through school-based and school-linked sealant programs, often using portable dental equipment. This article focuses on public health strategies for community-based prevention.

Establishing maternal and child health data collection priorities for state and local oral health programs.

OBJECTIVE: This paper identifies specific data items for use by state and local agencies in a maternal and child oral health needs assessment model. METHODS: A modified Delphi approach was used to develop consensus on items for inclusion in the data set and their relative importance. Initially, 31 data items were chosen from several national sources. All state dental directors, along with other selected administrators and advisory committee members for this process, were asked to categorize each of the data items as core (essential), important but optional, or of lesser importance. Short comments about each data item were accepted, as were additions to the list of data items. Two rounds of comments were held. RESULTS: Eleven data items/types of information were selected as core items to be included in all needs assessments. All but one of these items were determined by the scores of the respondents. The advisory committee strongly recommended that at least one core item relate to the public's perception of oral health. Some differences in perceived importance of several items existed among the state dental directors, local dental directors, and the advisory committee. Twenty-one items were identified as being important, but optional, and seven were considered less than important and not included in the model data set. CONCLUSIONS: A modified Delphi approach facilitated the development of core and optional data items for a model oral health needs assessment. This model has potential for a common reporting mechanism so that states and local dental programs can share data.