Sealants are decay preventing agents which are bonded to the top of the back teeth to seal out germs and sugar.The large back teeth (molars) have deep grooves called as pits and fissures on their biting surfaces which are most susceptible to decay. Because of their depth, sticky foods like raisins and candies, etc. get stuck in them and remain there for 30-40 minutes. The enamel at the bottom of the grooves is very thin. Thus they are often the first places to be decayed. Sealants placed on back teeth are therefore highly effective in preventing their decay.

Morphology of Pit and Fissure

There are different shapes of pits and fissures

 
V        
U
I
K
 

K type – very susceptible to caries. V and I types are also considered to be prone to caries if deep. U type is considered to be caries resistant.

 

What Are the Sealants

These are materials used to seal the pit and fissures present on the tooth and makes the tooth resistant to the caries. In a way it is said that the pit and fissure sealants seal the tooth.

 

Why Sealants Are Used?

 

Deep pits and fissures present on the tooth causes the accumulation of food. The food accumulated in pits and fissures is not able to be cleaned by the cleaning aids and the self cleansing ability of the saliva. The bacteria present in the oral cavity ferment these food particles and secrete the acid. This acid demineralizes the tooth and causes the decay of the tooth resulting in the cavity formation.

 

Prevention is better than cure. That is why it is better to prevent the tooth from getting carious than treating it afterwards many preventive measures are taken for that like brushing , flossing, fluoride application. Sealing the tooth is also one of the preventive measure in which the teeth prone to caries are sealed. Deep pits and fissures present on the tooth are the main cause of food accumulation and hence the breeding ground for the bacteria. These bacteria ferment the food accumulated in these deep pits and fissures and secrete the acid. The acid secreted causes the demineralization of the tooth and causes caries. If we seal these pits and fissures the teeth can be saved.

 

Classification of Sealants

 
According to Polymerisation Method
 
1st generation 
Cured by Ultraviolet Light
II generation   
Chemical cured
IIIrd generation                
Activated by visible light
IV generation
Containing fluoride
 
Depending upon presence of filers:
 
Unfilled
Better flow
Use for very deep pit and fissure
 
Semi filled
More resistant to wear
 
Depending on colour
           
Tinted    : Easy to detect
Clear      : Esthetic
Opaque  : Easy to detect
Pink        : Easy to detect
 

Requisites of Effective Sealant

For a material to be effective as the sealant, it should have following properties
 
Flow – It should have good flow so that it can properly seal the deep pits and fissures  
Wear Resistance – It should have wear resistance  
Soluble- It should not be soluble in oral fluids.
No Toxicity
Adequate Working Time
Rapid Cure
Good and prolonged adhesions
Sufficient strength and dimensional stability
Same thermal conductivity as tooth
Bond strength equal to tooth
Chemically inert
 

Criteria for the Use of Pit and Fissure Sealants

 
According to Age
 
At 3-4 years all the baby molars are sealed
 
At age 6-7 years - 1st permanent molars are sealed.
 
11-13 years – all premolars and second permanent molars are sealed
 

Classification of Patients

 
Simmon divide the patient into 3 groups
 
Group 1 – Caries free
Group 2 – at moderate risk of decay
Group 3 – at High risk of decay
 

Pit and fissures sealants are recommended for group 2 Patients. Group 1 and Group 3 are not treated with this as group 1 patients are not prone to caries and in group 3 patients the incidence is so high that the tooth becomes carious before the sealant is applied.

 

Other Criteria Used

 
Oral Hygiene status
Familial and Individuals history
Fluoride environment
Dietary Habits
Tooth type and morphology
 

Procedure of Pit and Fissure Sealant Application

 

Polish the Tooth surface - Necessary to remove plaque and debris from the enamel and pit and fissures of tooth, by using prophylaxis cup and pumice.

 

  
 
Isolate and dry the tooth surface - Rubber dam provides the best isolation, to keep the tooth free from saliva
 

Etch the tooth surface with 37% orthophosphoric acid for 15-30 seconds, to create microporosities, to permits a low-viscosity resin to penetrate and to produce mechanical lock of resin tags)

 

 

Rinse the tooth for approximately 15 seconds.

 

Isolate and dry the tooth with compressed air, until chalky, frosted appearance.

 

Apply Bonding Agent

 

Material application according to the manufacture direction, not incorporate Bubbles

Evaluate the sealant visually and tactically, take explorer and attempt to dislodge it.

Check Occlusion for occlusal high points and if present, correct them.
 
Retention and Periodic Maintenance - If any sealant loss, new sealant can be applied over the old material.

Life of Sealants

 

The success of the sealants depends mostly on child’s cooperation when the sealants are done. In most cases they are applied when the child is 12 years old and many have remained on the teeth as the patient grew into their early 20s.

Success of Dental Sealants

The success of the dental sealants depends on the cooperation of the child during the procedure.

 

The child must understand the importance of the sealant and thereafter should be willing to keep his mouth open and teeth dry for the duration of procedure. If the teeth get wet between the time the acid gel is washed off, and the time the final cure is done with the light, the sealant will either not adhere to the etched surface, or may partially adhere.

 

For the success of the sealant, it should be applied at an age when the child is mature enough to cooperate.

 
 

Which Teeth Are Usually Sealed?

 

Generally only adult back teeth are sealed. Baby teeth are not sealed because at that age (below 6 years) the child is unable to cooperate and also the enamel of baby teeth does not etch well. All adult back teeth benefit from applying sealant. This includes 8 premolars, and 8 molars per patient.

 

What Is The Oldest A Patient Can Be To Have His Teeth Sealed?

 

The placement of sealants on the back teeth causes the teeth to bite differently. The child can adapt easily to the change but adults do not.

 

Incase the sealants are placed on the adult teeth, the patients usually begin to grind their teeth together leading to problems like headaches, neck aches, ear aches, sore teeth, teeth sensitive to cold.

 

It is generally recommended that teeth should not be sealed beyond 17 years of age unless the patient is undergoing adult orthodontic treatment.

 

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Comments

  • shilpa

    shilpa 30 - August - 2012, at 18:56 PM

  • awesome work thanks a lot!!!

  • mohd

    mohd 02 - December - 2011, at 23:44 PM

  • thanks alot

  • dr. vaishnavi naik

    dr. vaishnavi naik 11 - September - 2011, at 02:34 AM

  • thanks you

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