By Dr Kiran Koora, MDS
(Paediatric Dentist)
Over the last few decades, several advances have been made in caries prevention. Along with systemic and topical fluoride, the increased acceptance and use of pit and fissure sealants has had an impact on the prevention of caries. Fluorides have been found extremely effective in preventing caries on smooth surfaces of the teeth, but less effective on the chewing surface of the teeth. Sealants protect the chewing surfaces, inhibiting bacterial growth and providing a smooth surface that increases the probability that the surface will stay clean.
Why are sealants necessary? By the nature of their anatomy, pit and fissure surfaces are often thin, deep and tortuous. (Figs 1 & 2)
When you chew, food particles can be trapped in these pits and fissures, thereby causing difficulty in cleaning and increasing the risk for getting cavities. Decay develops in the grooves because toothbrush bristles are too large to reach into these areas to remove the food and bacteria. Thus, even excellent home care efforts may not be successful in cleaning a deep fissure, leading to tooth decay. So the tooth cavities in pits and fissures can be prevented by using dental sealants. A sealant is a clear or shaded plastic coating that is ‘painted’ on the chewing surfaces of the back teeth, which is highly effective in preventing dental caries.
Fig: 3 (Clinical procedure of sealant placement)
Advantages of Sealants:
Lock out harmful bacteria and food from the pits and fissures.
Can save you from having dental treatment such as fillings, crowns, root canal treatments, extractions, or dentures.
Are applied by using a small brush to paint a clear or white liquid on the tooth. A special light is usually used to help harden the coating.
Are checked at your annual exam to be sure they haven’t chipped or fallen off.
Age ranges for application:
Ages 3-4yrs are most important times for sealing primary molars (Back teeth), ages 6-8yrs for first permanent molars, and ages 11-13yrs for second premolars and second permanent molars. These ages correspond with normal eruption patterns. Sealant should be considered for adults also, if there is evidence of impending caries susceptibility, for example following excessive intake of sugar, cookies, etc.
Sealants placement is a one-appointment procedure in the dental office, which doesn’t need any injection and is well accepted by children. Applying sealants does not require drilling or removing a tooth structure. The process is short and easy. After the tooth is cleaned, a special gel is placed on the chewing surface for a few seconds. The tooth is then washed off and dried. Then, the sealant is painted on the tooth. The dentist uses a UV light on the tooth to help harden the sealant. It takes about a minute for the sealant to form a protective shield.
Dentists usually recommend 6-12 monthly check-ups so that tooth decay or sealant loss can be monitored. Sealed teeth generally do not require any changes at home, or dietary changes. Although fissure sealants help with decay prevention on back teeth especially, it is important to regularly brush and floss teeth and avoid the factors that can lead to tooth decay. During routine recall examinations, it is necessary to re-evaluate the sealed tooth surface both visually and tactually for loss of material, exposure of voids in the material and caries development. The need for the reapplication of sealants is usually highest during the first six months after placement. When sealants are partially lost and require repair, the clinician should vigorously attempt to dislodge the remaining sealant material with an explorer. If it remains intact to probing, there is no need to completely remove the old material before placing the new.
Dental sealants are a proven tool in caries prevention. So the goal of the dental profession is to help individuals to achieve and maintain maximum good oral health throughout their lives.
Prevention is better than cure.