It has long been established that prevention is the cornerstone to containing dental diseases.
Studies show that 95% of all carious lesions (dental decay) occur on the occlusal/biting surfaces of the teeth. The occlusal surfaces of teeth comprise 12% of the total number of tooth surface, which means the pit and fissures of the occlusal surfaces of teeth are eight times more susceptible to decay as the smooth surfaces of the teeth. The teeth at highest risk for carious lesions are the first and second molars. It has been observed that 90% of all dental caries in school children occurs in pits and fissures of the occlusal surfaces of the molars.
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.
These nutrients are present in the form of plaque in the inaccessible area of the pit and fissure cavity. If left without treatment they lead to enamel demineralisation and eventual cavitation. Hence, Pits and fissure sealants basically act as a barrier to shield enamel structures from cariogenic bacteria contained in the saliva. Application of the sealant material to the developmental pits and fissure areas inhibits decay in non-carious teeth. It has also been proved to curtail early incipient caries in developing teeth.
The utilisation of sealants has many positive long-term ramifications. More specifically, sealants:
- Act as a preventive measure that may benefit a significant share of the population (especially children) in the reduction of tooth decay
- Aid significantly in preventing the destruction of vital tooth structure due to caries, especially in the occlusal pit area, which is microscopically too small to be cleaned by a single toothbrush bristle
- Are financially economical
- Are proven safe and effective in cooperative children
Pit and fissure sealants can be of two types:
- Glass ionomer sealant ( temporary fissure sealants)
- Composite resin sealant
When to seal:
- Stained pits and fissures with minimum appearance of decalcification or opacification
- Deep, retentive pits and fissures, which may cause wedging or catching of an explorer
- Pit and fissure caries
- No radiographic or clinical evidence of inter-proximal caries in need of restoration on teeth to be sealed
- Use of other preventive treatment such as systemic or topical fluoride therapy, to inhibit inter proximal caries formation
- Tooth considered for sealant application erupted less than 4 years ago
- Possibility of adequate isolation from salivary contamination
When not to seal:
- Well-coalesced, self-cleansing pits and fissures
- Radiographic or clinical evidence of inter-proximal caries in need of restoration
- Presence of many inter-proximal lesions or restorations and no preventive treatment to inhibit inter proximal caries formation
- Tooth partially erupted and no possibility of adequate isolation from salivary contamination
- Pit and fissure surface that has remained caries-free for 4 years or longer and has no clinical indications for sealant placement
Periodic evaluation:
Regular evaluation of sealants for retention is critical to their success. 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 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.
Conclusion:
- Sealants should be placed on all permanent teeth without cavitation (i.e., teeth that are free of caries, teeth that have deep pit and fissure morphology, teeth with “sticky” fissures or teeth with stained grooves) as soon after eruption as isolation can be achieved.
- Sealants should not be placed on partially erupted teeth or teeth with cavitation or caries of the dentin.
- Sealants should be placed on the primary molars of children who are susceptible to caries (i.e., those with a history of caries).
- Sealants should be placed on first and second molars within 4 years after eruption.
- Resin-based sealants should be preferred, until such time as glass ionomer cements with better retention capacity are developed.
- Sealants should be placed as part of an overall prevention strategy based on assessment of caries risk.
Sealing is a recommended procedure to prevent caries of the occlusal surfaces of permanent molars. Though the effectiveness of sealants is obvious at high caries risk groups there is still some degree of latitude in operators preference for sealant placement and material selection.
Article written by,
Dr. Shilpa Hiremath
BDS, MDS,
Senior Lecturer,
Paediatric Dentist.