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.