Marie Mazzone, DDSTeresa Bretl, RDH

Dental Sealants

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Dental sealants are a proven evidence-based method of reducing theincidence of dental caries in susceptible teeth and high-risk populations. Yet sealant utilization remains low.

In this webinar, the advantages of sealant placement will be presented and those concerns that deter their placement will be discussed.

The process of adopting a new procedure into one’s armamentarium will be explored as well as the specific challenges and opportunities found in the Job Corps dental setting that affect treatment.

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Recognize their specific dental concerns and philosophy of care.

Identify strategies to increase sealant placement.

Determine the type of sealant and placement best suited to their particular dental setting.

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I believe in sealants.I routinely place

sealants.I want to motivate

others to routinely place sealants, too.

I understand that sealants are not a required procedure at Job Corps.

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Approximately 90% of caries in permanent teeth occurs in the pit and fissures.

Caries in pit and fissures increases dramatically in permanent teeth between the ages of 11 and 19.

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Although children from lower-income families are almost twice as likely to have decay as those from higher-income families, they are only half as likely to have sealants.

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They have been shown to prevent pit and fissure caries.

They reduce the percentage of noncavitated carious lesions that progressed to cavitation in children, adolescents and young adults.

They are effective in reducing bacteria levels in cavitated carious lesions in children, adolescents and young adults.

They are cost effective. They reduce pain and suffering as well as time

in dental chair. They do not require continual patient

compliance.8

Sealants are placed to prevent caries initiation and to arrest caries progression by providing a physical barrier that inhibits microorganisms and food particles from collecting in pit and fissures.

Higher-risk populations who do not receive sealants are more likely to obtain subsequent restorative care which costs more money, time and discomfort.

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Why do some dentists, who genuinely have their patients’ best interest at heart, not place sealants on a routine basis?

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Can seal over caries and the trapped caries will spread.

Over time, the sealant will be lost and the loss of sealant will place the tooth at greater risk than if it had never been sealed.

Sealants require maintenance. Not a covered benefit of dental insurance. Time is better spent treating carious

lesions. Technique sensitive.

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When bacteria become trapped underneath an intact sealant, they are deprived of fermentable carbohydrates. When bacteria are deprived of nutrients, they are unable to produce acid and caries cannot progress. 

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The caries rate in formerly sealed teeth, with partial or complete loss of sealant, is less than or equal to the caries rate in non-sealed teeth.

Sealants do no harm.

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While they may be lost over time, even without regular maintenance, 56% are still intact after 3 years.

For the Job Corps population, sealants can confer caries prevention during the time these young adults are beginning to comprehend the importance of regular home care and professional visits.

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Sealants offer the Job Corps dental staff an opportunity to fulfill the PRH mandate to maintain or improve the oral health of the students while they are in Job Corps.

Since the dental exam may be the last (or only) time the student comes to the dental clinic, placing sealants before or at that time offers the greatest benefit to the greatest number of students.

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In private practice, there is a financial disincentive for doing sealants.

At Job Corps, we do not have constraints with regard to reimbursement for dental sealants.

We do not get paid more for doing fillings.

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Time spent placing sealants is time spent treating caries.

Think infectious disease: the tuberculosis model

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Prevention is important in fire fighting and in caries fighting.

Like Smokey the Bear, we promote prevention that starts in the home.

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Maxwell Anderson, DDS, MS, MEdClinical Research in Oral HealthChapter 16: Adoption of New

Technologies for Clinical Practice

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Observability is the degree to which the results of innovation that is a candidate for adoption can be seen.

The more immediate the results, the more likely an innovation to be adopted.

Conversely, the longer it takes to realize the “advantage” of the innovation, the slower the adoption.

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One of the major hurdles that any new technology must face is the “compatibility” issue.

Until very recently, dentistry has been primarily a surgical reparative science. When pathology occurred, it was surgically repaired.

Surgeons generally dislike waiting to see the outcome of a conservative, nonsurgical intervention such as sealants.

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“Extension for prevention”“Watchful Waiting”SealantsVaccines, STAMPs (Specifically-

targeted antimicrobial peptides)

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“A new scientific truth does not triumph by convincing its opponents and making them see the light but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”

- Max Planck (1858–1947); Winner of Nobel Prize in Physics in 1918

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Since the introduction in 1971 of the first dental pit and fissure sealant, materials and application techniques have evolved.

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27 years as dental assistant

3 years as hygienist

Changes over the years in sealants

Incorporating into Job Corps setting/time management

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The term pit and fissure sealant is used to describe a material that is introduced into the occlusal pits and fissures of caries susceptible teeth, thus forming a micromechanically bonded, protective layer cutting access of caries-producing bacteria from their source of nutrients.

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SELF-CURED SEALANTS

Auto-polymerized

No special equipment required

Mixing required and working time limit

LIGHT-CURED SEALANTS

Photo-polymerized

Curing light needed

Protective eye shied required

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Classification by filler content: Filled: Abrasion

resistance increased, requires occlusal adjustment

Unfilled: Wears down to correct height, no occlusal adjustment required

Classification by color: Clear Opaque Tinted Purpose: quick

identification for evaluation

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RESINS

Acrylic monomer Micro retention Require acid etching Moisture sensitive More retentive Abrasion resistant With or without

fluoride

GLASS IONOMERS

Fluoro-aluminum silicate glass

Ionic bonds No acid etching Hydrophilic Lower retention rate Permeable to calcium

and phosphate

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Enhances caries resistanceRecharged by fluoride treatmentsHighest fluoride release from glass

ionomers

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When comparing the caries incidence/increment of glass ionomers to resin-based sealants both materials exhibited significant caries preventive effects.

Available evidence suggests that there is an additive effect when topical fluoride programs are combined with dental sealant programs.

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Enameloplasty may allow deeper sealant penetration and superior sealant adaptation but there is minimal clinical evidence to indicate that it improves long-term caries reduction.

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Four-handed technique when possible

Debride with:a. prophy brushb. hydrogen peroxide c. oil-free pumice

Isolate with: a. rubber damb. cotton rolls and

Garmer holders c. dry angles d. saliva ejector

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Recent studies report that the levels of sealant retention after surface cleaning with a dry toothbrush were at least as high as those associated with handpiece prophylaxis.

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Follow manufacturer’s instructionsAvoid over manipulation to prevent

producing air bubblesUse disposable implements suppliedCover all pits and fissures but do not

overfill After placement: leave in place for

10 seconds to allow for optimum penetration

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There are many choices of sealants available to help overcome the following challenges of sealant placement: Moisture control Time management/dental clinician Occlusal adjustment Patient cooperation

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Fluoride releasing Special 27G tip for

direct penetration Contains filler for

high strength

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Thixotropic resin sealant

Special spiral brush tip allows for shear thinning effect of sealant

58% filled for optimum strength

Fluoride releasingFour shadesRadiopaqueNo Bisphenol-A

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Light-cured Fluoride releasing Radiopaque Bonds to moist

tooth No bonding agent

required No Bisphenol, no

BIS-GMA, no BIS-DMA

36.6% filled41

Bisphenol-A free Bonding step

removed Contains fluoride

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Wet bonding resin Clear and opaque No bonding or

drying agents

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Fluoride releasing 30% filled Opaque yet

translucent

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Low viscosity Fluoride releasing Color-change

technology: goes on pink, cures to natural white

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Sealant and surface protectant

No isolation or bonding required

HydrophilicConvenient capsule10 sec. mix, can seal

in half time of resin Higher fluoride release

of any resin

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Low viscosityHigh fluoride

releaseUse in moist or dry

environmentPink or white in unit

capsulesPowder/liquid sets

in regular setBPA and HEMA free

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Many types of sealants for the many types of: Patients Operators Practice settings

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Prevention Preservation Temporization Revitalization

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The U.S. Preventive Services Task Force has identified fluoridation and school-based and school-linked sealant programs as the only community -based oral health interventions recommended for caries prevention.

“An ounce of prevention is worth a pound of cure.”-Benjamin Franklin 51

Greater use of auxiliaries

Treatments that reach a greater number of people

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From a patient-to-patient to a public-health approach for sealant placement Individual Risk - Caries susceptibility based

on the anatomic findings of a clinical examination of the dentition (e.g., deep occlusal anatomy or open occlusal grooves)

TO Population Risk - Caries susceptibility

based on demographic information identifying high caries risk (e.g., economic disadvantage) or lack of oral health practices

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Job Corps is a school with population risk (i.e., caries susceptibility).

Population risk IS the diagnosis for the routine placement of sealants.

Therefore, all Job Corps students receive sealants.

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From dentist to dental auxiliary staff

From individual diagnosis to group treatment

From rubber dam, four–handed to moisture friendly, single-person placement

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How that model will look at my Job Corps location will be different than it does at yours.

With a fresh point of view come new goals, strategies and outcomes.

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Other reasons cited for the sparse use of sealants in caries prevention and management include the contention that findings from scientific studies are usually not transferred into practice, with dentists more influenced about sealants by opinions of colleagues than by findings published in research journals.

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“And those who were seen

dancing were thought to be

insane by those who could not

hear the music.”

-Friedrich Nietzsche

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