Dental Sealants Chapter 59 Copyright 2009 2006 by

Chapter 59 Lesson 59. 1 Copyright © 2009, 2006 by Saunders, an imprint of

Learning Objectives Pronounce, define, and spell the Key Terms. Describe the purpose of dental sealants. Describe the clinical indications for dental sealants. Describe the contraindications to dental sealants. Describe the two types of polymerization. (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Learning Objectives (Cont’d) Discuss the rationale for filled and unfilled sealant materials. Demonstrate the steps in the application of dental sealants. Describe and demonstrate the safety steps necessary for the patents and the operator during sealant placement. Explain the most important factor in sealant retention. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Introduction Dental sealants are highly effective in preventing dental caries in the pit and fissure areas of the teeth. Dental sealants, made of a resin material, are applied to the pits and fissures of teeth to prevent dental caries. A dental sealant is successful only if it firmly adheres to the enamel surface and protects the pits and fissures from the oral environment. (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Introduction (Cont’d) Pits and fissures are fossa and grooves that failed to fuse during development. Bacteria accumulate in the narrow pits and fissures. Even a single toothbrush bristle is too large to enter and clean pits and fissures. The sealant acts as a physical barrier. Dental sealants are a noninvasive means of preserving tooth structure and at the same time preventing dental decay. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 59 -1 Scanning electron micrograph (SEM) of occlusal pits and fissures. (From Daniel SJ, Harfst SA: Mosby’s dental hygiene: concepts, cases, and competencies– 2004 update, St Louis, 2004, Mosby. ) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 59 -2 Micrograph showing toothbrush bristle in a groove. Copyright © 2009, 2006

Fig. 59 -3 Molar with a properly placed sealant. Copyright © 2009, 2006 by

Sealants and Existing Caries During sealant placement, some bacteria will be trapped beneath the sealants. Some teeth with very small initial carious lesions may be inadvertently sealed. Numerous studies have shown that neither of these occurrences will increase the chance of caries development or that caries will grow beneath the sealant. Several studies have shown that the number of bacteria in small, existing carious lesions that had been sealed decreased dramatically with time. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Indications for Dental Sealants Pit and fissure sealants are especially useful for selected patients through the caries-active period (ages 6 -15 years). Sealants are indicated: For teeth with deep pits and fissures Ø Preferably in recently erupted teeth (<4 years) Ø Sealants should be used as part of a prevention program that includes the use of fluorides, dietary considerations, plaque control, and regular dental examinations. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Contraindications to Dental Sealants Lack of pits and fissures Apparent occlusal decay Interproximal decay Insufficient eruption of a tooth Soon-to-be-lost primary teeth Poor patient cooperation in the dental chair Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Types of Sealant Materials A wide variety of sealant materials are available on the market. The dental assistant should have a thorough understanding of the characteristics of the various sealant products that are available. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 59 -4 Sealants should be used as part of a comprehensive preventive program. (Courtesy of Ivoclar-Vivadent, Amherst, N. Y. ) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Method of Polymerization The major difference among the materials is the method of polymerization (setting). The two types are comparable in bond strength and rate of retention. Self-cured materials are supplied as a two-part system (base and catalyst). When these pastes are mixed together, they quickly polymerize (harden). Ø Light-cured sealants do not require mixing. After the material has been placed, it hardens during exposure to a curing light. Ø Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Color of Sealant Material Sealants may be clear, tinted, or opaque (white). Tinted or opaque sealants are more popular because they are easier to see than clear sealants during application during checks for sealant retention on subsequent office visits. Some brands have a tint that is visible during the application but turns clear after polymerization. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fillers Sealant materials are available as filled or unfilled resins. The purpose of filler material in the sealant is to reduce occlusal wear. Filled and unfilled sealants penetrate the fissures equally well, and there is no difference in microleakage. Some dentists believe that a filled sealant is better because of a lower wear rate on occlusal surfaces. Other dentists believe that because sealants flow deep into the pits and fissures to form a barrier that ensures that the occlusal wear is insignificant. Sealants should not be placed on the cuspal slopes. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fluoride Release Some types of sealants release fluoride after polymerization. The theory is that the fluoride released from the sealant creates a fluoride-rich layer at the base of the sealed groove. Clinical studies comparing the effectiveness of these two types of sealants are still under way. Topical fluoride should not be applied to the enamel surface immediately before a sealant procedure but may be applied immediately after sealant application. Always follow the sealant manufacturer’s instructions. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Storage and Use General tips on sealant materials: Replace caps on syringes and bottles immediately after use. Ø Do not expose the materials to high temperatures. Ø Do not store the materials in proximity to eugenolcontaining products. Ø Most etchant and sealant materials are designed to be used at room temperatures. Ø Check the manufacturer’s recommendations. Ø The shelf lives of most sealant products at room temperature range from 18 to 36 months. Ø Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Etching Precautions for Patients and Dental Personnel Etching agents contain phosphoric acid. Patients and dental personnel should wear protective eyewear when etchants are being used. Avoid contact with oral soft tissue, eyes, and skin. In case of accidental contact, flush the exposed area immediately with large amounts of water. If eye contact is involved, immediately rinse the eye with plenty of water and seek medical attention. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Sealant Material Precautions for Patients and Dental Personnel Do not use sealants on patients with known acrylate allergies. To reduce the risk of an allergic response, minimize exposure to these materials. Use protective gloves and a no-touch technique. If skin contact occurs, wash the exposed skin with soap and water. Acrylates may penetrate gloves. If the sealant makes contact with a glove, remove and discard the glove, wash your hands immediately with soap and water, and then reglove. If accidental eye contact or prolonged contact with oral soft tissue should occur, flush with large amounts of water. If irritation persists, contact a physician. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Protective Eyewear Protective eyewear should be used by operators when using either an ultraviolet or a visible light–cured resin. Protective eyewear should also be provided for the patient during sealant procedures. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Factors in Sealant Retention Moisture contamination is the primary cause of failure of sealant retention. Inadequate etching is also a factor in loss of sealant retention. Dental sealants should be examined at each recall visit to be certain that the sealant material has not been partially or totally lost. When dental sealants are properly placed, it is not uncommon for them to last 5 to 10 years. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Important Information Always read and carefully follow the manufacturer’s instructions when applying dental sealants. Application technique and etching times may vary between manufacturers. For example, some manufacturers discourage the use of a polishing paste that contains fluoride. Other manufacturers do not consider fluoride polishing pastes to be contraindicated. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.