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The Other Face of Enamel Sealants

October 11th, 2005 · No Comments

    Leinfelder_smallPit and fissure sealants have been a routine part of dental practice for over three decades. The concept of sealnats was an offshoot of the enamel etching concepts of Michael Buonocore. Although his initial efforts were published in the mid 50’s. the idea of sealing enamel pits and fissures took a while to get started.

    Although sealants have been tested, evaluated and clinically judged, their true cost effectiveness has never been agreed upon. In principle, a properly sealed tooth under the most ideal conditions is fairly uniformly accepted by the profession. The big question however is: “when should they be used?” By the time their effectiveness had been demonstrated, the level of caries incidence coincidentally (through the influence of fluoride added to the water) had begun to subside. In ealier years if was common practice to routinely place sealants on all primary teeth as well as the permanent dentition in pre-adult patients. Since the caries rate  is considerably lower currently as compared to the  pre-fluoride days, such a practice presently would not be considered appropriate.

    Today the use of sealants should be prescribed for very specific reasons. Such reasons would include patients with a higher than average caries index. Molars which take considerably longer timer to erupt than normal would be another example. Furthermore, patients, particularly adolescents who are less than scrupulous about keeping their teeth clean, are good candidates for the general application of sealants. This group wold certainly include those patients who through some type of physical and/or mechanical handicap cannot be completely responsible for their oral hygiene.

  In general therefore, the use of sealants should be restricted to those patients who would benefit the most. Regarding cost effectiveness, one could safely state without the fear of contradiction that the need for pit and fissure sealants currently is far less than that in the past. Since currently the level of caries pales by that of yesteryear, their routine application could not be recommended.

     In the last several years it has been suggested that small carious lesions (i.e. occlusal surfaces of molars) could be sealed over; and the caries process would be arrested (Mertz and Fairhurst). Although this statement can be verified, there are some conditions attached. Should for example, the sealant begin to undergo leakage (due to a partial defect in adhesion along a margin), the old latent caries defect will become activated and the caries process will regenerate with the same degree of vigor it originally possessed. The bottom line here is that sealing in of small carious lesions is strongly discouraged.

    Incidentally, the traditonal method of using UDMA (Caulk) or Bis-GMA (most others) resins in a sealant in conjunction with acid etching has been obscured by another concept. Specifically, it is recommended that the composite resin sealant be replaced by a dentin bonding agent. After acid etching, washing and drying for approximately two seconds, the bonding agent is placed and air dispersed. Two applications are recommended. The procedure is followed by light-curing for 15 seconds. Such a technique is superior over the traditional method because the bonding agent not only deals with the ends of the enamel rods but also the interprismatic space. This differential in diffusion ability relates to comparative differences in viscosity Since the surfaces sealed with the dentin bonding agent may not be visibly detectable, it may be necessary to place a conventional sealant on top (not for function but for verification)

    In conclusion the sealnts are still recommended. Rather than using them as a form of general treatment they should be employed only when a specific need has been identified. It can be concluded that the role of sealnats has diminished considerably but certainly not outmoded.

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