Dental Sealants

Sealants

Introduction

• Sealants are a preventive measure used in dentistry.
• Development of sealants is a key aspect.
• The purposes of sealants include:
  • Protection of tooth surfaces.
• Acid etching is a crucial step in sealant application; refer to Figure 35-1 to visualize the difference between sealant application on smooth versus etched surfaces.

Sealant Materials

• Criteria for an ideal sealant:
  • Prolonged bonding to enamel.
  • Biocompatibility with oral tissues.
  • Simple application procedure.
  • Free-flowing, low-viscosity material for entering narrow fissures.
  • Low solubility in the oral environment.
• Classification of sealant materials:
  • By method of polymerization (e.g., self-cured, light-cured).
  • By filler content (e.g., filled, unfilled).
  • By color (e.g., clear, tinted).

Indications and Contraindications

• Indications for sealant placement:
  • Patients at risk for dental caries, regardless of age.
  • Selection of teeth, such as molars with pits and fissures (refer to Figure 35-2).
  • Use the decision tree in Figure 35-3 to guide sealant placement decisions.
• Contraindications for sealant placement:
  • When the tooth surface is caries-free and at low risk.

Penetration of Sealant

• Pit and fissure anatomy:
  • Shape and depth vary (see Figure 35-4).
• Contents of pits and fissures:
  • Dental biofilm.
  • Pellicle.
  • Debris.
• Effect of cleaning:
  • Cleaning affects the amount of penetration.

Clinical Procedures

• Step-by-step placement of photopolymerized dental sealant (see Table 35-1).
• Patient preparation.
• Tooth preparation.
• Tooth isolation (see Figure 35-5).
• Acid etch.
• Rinse and air dry tooth.
• Evaluate for complete etching.
• Place sealant material (see Figure 35-6).
• Cure sealant.
• Evaluate cured sealant.
• Check occlusion.
• Follow-up.

Maintenance

• Retention:
  • Check sealant at least every 6 months.
  • Properly placed sealants can be retained for years.
• Factors affecting retention:
  • Precision of technique and moisture/contamination exclusion.
  • Patient self-care.
  • Dental hygiene care.
• Replacement:
  • Consult manufacturer instructions.
  • Tooth preparation: same as for original placement.
  • Removal of firmly attached residual sealant is not needed.
  • Re-etch.

School-Based Dental Sealant Programs

• Healthy People 2030 objectives call for an increase in dental sealants.
• Many states are not meeting the goal for delivering dental sealants to low-income children.
• School-based delivery of dental sealants is a proven strategy.
• These programs provide additional preventive services.
• School-based programs often use portable dental equipment (see Figure 35-7).

Documentation

• Documentation should include:
  • Reason for selection of certain teeth for sealants.
  • Informed consent of patient, parent, or caregiver.
  • Type of sealant used.
  • Preparation of tooth.
  • Manner of isolation.
  • Patient cooperation during administration.
  • Post-insertion instructions given.
• Sample documentation can be reviewed in Box 35-1.

Factors to Teach the Patient

• Sealants are part of a total preventive program and not substitutes for other measures.
• Limitations of dietary sucrose, use of fluorides, and dental biofilm control are major factors with sealants for prevention of dental caries.
• Explain what a sealant is and why a meticulous application procedure is required.
• Discuss what can be expected from a sealant, how long it lasts, and how it prevents dental caries.
• Emphasize the need for examination of the sealant at frequent, scheduled maintenance appointments and the need for replacement when missing or chipped.
• Advise patients to avoid biting hard items such as pencils, hard candy, or ice cubes to increase sealant retention.