Dental Sealants To Seal or Not to Seal

Dental Sealants To Seal or Not to Seal? Marie Mazzone, DDS Teresa Bretl, RDH 1

To Seal or Not to Seal: That is the Question v Dental sealants are a proven evidence-based method of reducing the incidence of dental caries in susceptible teeth and high-risk populations. Yet sealant utilization remains low. v In this webinar, the advantages of sealant placement will be presented and those concerns that deter their placement will be discussed. v 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. 2

After this presentation, participants will be able to: Recognize their specific dental concerns and philosophy of care. v Identify strategies to increase sealant placement. v Determine the type of sealant and placement best suited to their particular dental setting. v 3

Marie Mazzone, DDS My Biases v. I believe in sealants. v. I routinely place sealants. v. I want to motivate others to routinely place sealants, too. v. I understand that sealants are not a required procedure at Job Corps. 4

Pre test/poll 5

Caries in Pit and Fissures v Approximately 90% of caries in permanent teeth occurs in the pit and fissures. v Caries in pit and fissures increases dramatically in permanent teeth between the ages of 11 and 19. 6

Lower-Income Families v. 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. 7

Why Place Sealants? v They have been shown to prevent pit and fissure caries. v They reduce the percentage of noncavitated carious lesions that progressed to cavitation in children, adolescents and young adults. v They are effective in reducing bacteria levels in cavitated carious lesions in children, adolescents and young adults. v They are cost effective. v They reduce pain and suffering as well as time in dental chair. v They do not require continual patient compliance. 8

Success of Sealants v 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. v Higher-risk populations who do not receive sealants are more likely to obtain subsequent restorative care which costs more money, time and discomfort. 9

Concerned Dentists Why do some dentists, who genuinely have their patients’ best interest at heart, not place sealants on a routine basis? 10

Why Not Place Sealants? v Can seal over caries and the trapped caries will spread. v 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. v Sealants require maintenance. v Not a covered benefit of dental insurance. v Time is better spent treating carious lesions. v Technique sensitive. 11

No Caries Progression v 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. 12

No Harm Done v 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. v Sealants do no harm. 13

Long-Lasting v. While they may be lost over time, even without regular maintenance, 56% are still intact after 3 years. v. 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. 14

Maintenance or Improvement v. 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. v. 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. 15

Sealants at Job Corps v. In private practice, there is a financial disincentive for doing sealants. v. At Job Corps, we do not have constraints with regard to reimbursement for dental sealants. v. We do not get paid more for doing fillings. 16

Decrease Bacterial Levels v Time spent placing sealants is time spent treating caries. v Think infectious disease: the tuberculosis model 17

The Job Corps Dentist as Fire Fighter 18

Prevention v Prevention is important in fire fighting and in caries fighting. v Like Smokey the Bear, we promote prevention that starts in the home. 19

Only WE Can Place Sealants 20

Other Deterrents to Adopting Sealants v Maxwell Anderson, DDS, MEd v Clinical Research in Oral Health v Chapter 16: Adoption of New Technologies for Clinical Practice 21

Observability v Observability is the degree to which the results of innovation that is a candidate for adoption can be seen. v The more immediate the results, the more likely an innovation to be adopted. v Conversely, the longer it takes to realize the “advantage” of the innovation, the slower the adoption. 22

Compatibility v One of the major hurdles that any new technology must face is the “compatibility” issue. v Until very recently, dentistry has been primarily a surgical reparative science. When pathology occurred, it was surgically repaired. v Surgeons generally dislike waiting to see the outcome of a conservative, nonsurgical intervention such as sealants. 23

Changes Over the Years v “Extension for prevention” v “Watchful Waiting” v Sealants v Vaccines, STAMPs (Specifically-targeted antimicrobial peptides) 24

“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 25

Since the introduction in 1971 of the first dental pit and fissure sealant, materials and application techniques have evolved. 26

Teresa Bretl, RDH My Approach to Sealants v 27 years as dental assistant v 3 years as hygienist v Changes over the years in sealants v Incorporating into Job Corps setting/time management 27

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. 28

Sealant Choices SELF-CURED SEALANTS LIGHT-CURED SEALANTS Auto-polymerized No special equipment required Mixing required and working time limit Photo-polymerized Curing light needed Protective eye shied required 29

Sealant Choices v Classification by filler content: Filled: Abrasion resistance increased, requires occlusal adjustment Unfilled: Wears down to correct height, no occlusal adjustment required v Classification by color: Clear Opaque Tinted Purpose: quick identification for evaluation 30

Sealant Choices RESINS v v v v Acrylic monomer Micro retention Require acid etching Moisture sensitive More retentive Abrasion resistant With or without fluoride GLASS IONOMERS v v v Fluoro-aluminum silicate glass Ionic bonds No acid etching Hydrophilic Lower retention rate Permeable to calcium and phosphate 31

Fluoride-Releasing v Enhances caries resistance v Recharged by fluoride treatments v Highest fluoride release from glass ionomers 32

Double Protection v When comparing the caries incidence/increment of glass ionomers to resin-based sealants both materials exhibited significant caries preventive effects. v Available evidence suggests that there is an additive effect when topical fluoride programs are combined with dental sealant programs. 33

Unnecessary Enameloplasty v 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. 34

Suggested Technique v Four-handed technique when possible v Debride with: a. b. c. prophy brush hydrogen peroxide oil-free pumice a. b. rubber dam cotton rolls and Garmer holders dry angles saliva ejector v Isolate with: c. d. 35

Dry Toothbrush v 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. 36

Sealant Application v Follow manufacturer’s instructions v Avoid over manipulation to prevent producing air bubbles v Use disposable implements supplied v Cover all pits and fissures but do not overfill v After placement: leave in place for 10 seconds to allow for optimum penetration 37

Choosing a Sealant v 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 38

Resin Sealant v Fluoride releasing v Special 27 G tip for direct penetration v Contains filler for high strength 39

Optimum Strength v Thixotropic resin sealant v Special spiral brush tip allows for shear thinning effect of sealant v 58% filled for optimum strength v Fluoride releasing v Four shades v Radiopaque v No Bisphenol-A 40

Resin Hydrophilic Sealant v Light-cured v Fluoride releasing v Radiopaque v Bonds to moist tooth v No bonding agent required v No Bisphenol, no BISGMA, no BIS-DMA v 36. 6% filled 41

Hydrophilic Sealant v Bisphenol-A free v Bonding step removed v Contains fluoride 42

More Sealant Choices v Wet bonding resin v Clear and opaque v No bonding or drying agents 43

More Sealant Choices v Fluoride releasing v 30% filled v Opaque yet translucent 44

More Sealants v Low viscosity v Fluoride releasing v Color-change technology: goes on pink, cures to natural white 45

Glass Ionomer v Sealant and surface protectant v No isolation or bonding required v Hydrophilic v Convenient capsule v 10 sec. mix, can seal in half time of resin v Higher fluoride release of any resin 46

Glass Ionomer v. Low viscosity v. High fluoride release v. Use in moist or dry environment v. Pink or white in unit capsules v. Powder/liquid sets in regular set v. BPA and HEMA free 47

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Mix and Match v Many types of sealants for the many types of: Patients Operators Practice settings 49

Multiple Uses v Prevention v Preservation v Temporization v Revitalization 50

Prevention The U. S. Preventive Services Task Force has identified fluoridation and school-based and schoollinked 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

The Paradigm Shift v Greater use of auxiliaries v Treatments that reach a greater number of people 52

Public Health Approach v 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 53

The Shift: A School–Based Sealant Program v Job Corps is a school with population risk (i. e. , caries susceptibility). v Population risk IS the diagnosis for the routine placement of sealants. v Therefore, all Job Corps students receive sealants. 54

Re-Envision Sealant Delivery v From dentist to dental auxiliary staff v From individual diagnosis to group treatment v From rubber dam, four–handed to moisture friendly, single -person placement 55

Your Sealant Program v. How that model will look at my Job Corps location will be different than it does at yours. v. With a fresh point of view come new goals, strategies and outcomes. 56

Colleagues v 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. 57

“And those who were seen dancing were thought to be insane by those who could not hear the music. ” -Friedrich Nietzsche 58

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