Chapter 59 Dental Sealants Copyright 2003, Elsevier Science (USA). All rights reserved. No part of this product may be reproduced or transmitted in any form or by any means, electronic or mechanical, including input into or storage in any information system, without permission in writing from the publisher. PowerPoint ® presentation slides may be displayed and may be reproduced in print form for instructional purposes only, provided a proper copyright notice appears on the last page of each print-out. Produced in the United States of America ISBN

Copyright 2003, Elsevier Science (USA). All rights reserved. Introduction Dental sealants are highly effective in preventing dental caries in the pit and fissure areas of the teeth. Dental sealants are made of a resin material, and 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. Dental sealants are highly effective in preventing dental caries in the pit and fissure areas of the teeth. Dental sealants are made of a resin material, and 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.

Copyright 2003, Elsevier Science (USA). All rights reserved. Introduction to Dental Sealants  cont’d  Pits and fissures are the 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 technique that preserves the tooth structure and at the same time prevents dental decay.  Pits and fissures are the 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 technique that preserves the tooth structure and at the same time prevents dental decay.

Copyright 2003, Elsevier Science (USA). All rights reserved. Fig Micrograph showing toothbrush bristle in a groove. Fig. 59-1

Copyright 2003, Elsevier Science (USA). All rights reserved. Fig Molar with a properly placed sealant. Fig. 59-2

Copyright 2003, Elsevier Science (USA). All rights reserved. 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 will increase the chance of caries development or caries growing 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.  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 will increase the chance of caries development or caries growing 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 2003, Elsevier Science (USA). All rights reserved. Indications for Dental Sealants  Pit and fissure sealants are especially useful for selected patients through the caries-active period (ages 6 to 15 years).  Sealants are indicated for teeth with Deep pits and fissures Preferably in recently erupted teeth (less than 4 years)  Sealants should be used as part of a preventive program that includes the use of fluorides, dietary considerations, plaque control, and regular dental examinations.  Pit and fissure sealants are especially useful for selected patients through the caries-active period (ages 6 to 15 years).  Sealants are indicated for teeth with Deep pits and fissures Preferably in recently erupted teeth (less than 4 years)  Sealants should be used as part of a preventive program that includes the use of fluorides, dietary considerations, plaque control, and regular dental examinations.

Copyright 2003, Elsevier Science (USA). All rights reserved. Types of Sealant Materials  There is a wide variety of sealant material on the market from which to chose.  The dental assistant should have a thorough understanding of the types and characteristics of the various sealant products available.  There is a wide variety of sealant material on the market from which to chose.  The dental assistant should have a thorough understanding of the types and characteristics of the various sealant products available.

Copyright 2003, Elsevier Science (USA). All rights reserved. Fig Sealants should be used as part of a comprehensive preventive program. Fig. 59-3

Copyright 2003, Elsevier Science (USA). All rights reserved. Method of Polymerization  The major difference among the materials is the method of polymerization. Both types are comparable in bond strengths and rates 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). Light-cured sealants do not require mixing. After the material has been placed, it hardens during exposure to a curing light.  The major difference among the materials is the method of polymerization. Both types are comparable in bond strengths and rates 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). Light-cured sealants do not require mixing. After the material has been placed, it hardens during exposure to a curing light.

Copyright 2003, Elsevier Science (USA). 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 when applying, and when checking for sealant retention on subsequent office visits.  Some brands have a tint that is visible during the application, but the sealant turns clear after polymerization.  Sealants may be clear, tinted, or opaque (white).  Tinted or opaque sealants are more popular because they are easier to see than clear sealants when applying, and when checking for sealant retention on subsequent office visits.  Some brands have a tint that is visible during the application, but the sealant turns clear after polymerization.

Copyright 2003, Elsevier Science (USA). All rights reserved.  Sealant materials are available as filled or unfilled resins.  The purpose of filler material in the sealant is to reduce the occlusal wear.  Filled and unfilled sealants penetrate the fissures equally well and there is no difference in microleakage.  Some dentists believe 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 the occlusal wear is insignificant.  Sealants should not be placed on the cuspal slopes.  Sealant materials are available as filled or unfilled resins.  The purpose of filler material in the sealant is to reduce the occlusal wear.  Filled and unfilled sealants penetrate the fissures equally well and there is no difference in microleakage.  Some dentists believe 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 the occlusal wear is insignificant.  Sealants should not be placed on the cuspal slopes. Fillers

Copyright 2003, Elsevier Science (USA). All rights reserved. Fluoride Release  Some types of sealants release fluoride after polymerization, and others do not.  The theory is that the fluoride released from the sealant may create a fluoride-rich layer at the base of the sealed groove.  Clinical studies are still underway comparing the effectiveness of these two types of sealants.  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.  Some types of sealants release fluoride after polymerization, and others do not.  The theory is that the fluoride released from the sealant may create a fluoride-rich layer at the base of the sealed groove.  Clinical studies are still underway comparing the effectiveness of these two types of sealants.  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 2003, Elsevier Science (USA). All rights reserved. Storage and Use  The following are some general tips on sealant materials Replace caps on syringes and bottles immediately after use. Do not expose materials to elevated temperatures. Do not store materials in proximity to eugenol- containing products. Most etchant and sealant materials are designed to be used at room temperatures of approximately 21˚ to 24˚ C or 70˚ to 75˚ F. Check the manufacturer’s recommendations. Shelf-life of most sealant products at room temperature range from 18 to 36 months.  The following are some general tips on sealant materials Replace caps on syringes and bottles immediately after use. Do not expose materials to elevated temperatures. Do not store materials in proximity to eugenol- containing products. Most etchant and sealant materials are designed to be used at room temperatures of approximately 21˚ to 24˚ C or 70˚ to 75˚ F. Check the manufacturer’s recommendations. Shelf-life of most sealant products at room temperature range from 18 to 36 months.

Copyright 2003, Elsevier Science (USA). All rights reserved. Etching Precautions for Patients and Dental Personnel  Etching agents contain phosphoric acid.  Patients and dental personnel should wear protective eyewear when using etchants.  Avoid contact with oral soft tissue, eyes, and skin.  In case of accidental contact, flush immediately with large amounts of water.  If eye contact is involved, immediately rinse with plenty of water and seek medical attention.  Etching agents contain phosphoric acid.  Patients and dental personnel should wear protective eyewear when using etchants.  Avoid contact with oral soft tissue, eyes, and skin.  In case of accidental contact, flush immediately with large amounts of water.  If eye contact is involved, immediately rinse with plenty of water and seek medical attention.

Copyright 2003, Elsevier Science (USA). 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 the exposure to these materials.  Use protective gloves and a no-touch technique.  If skin contact occurs, wash skin with soap and water. Acrylates may penetrate gloves.  If the sealant contacts the gloves, remove and discard the glove, wash hands immediately with soap and water, and then re-glove.  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.  Do not use sealants on patients with known acrylate allergies.  To reduce the risk of an allergic response, minimize the exposure to these materials.  Use protective gloves and a no-touch technique.  If skin contact occurs, wash skin with soap and water. Acrylates may penetrate gloves.  If the sealant contacts the gloves, remove and discard the glove, wash hands immediately with soap and water, and then re-glove.  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 2003, Elsevier Science (USA). All rights reserved. Protective Eyewear  Protective eyewear should be used by operators when using either the ultraviolet or visible light cured resins.  Protective eyewear should also be provided for the patient during sealant procedures.  Protective eyewear should be used by operators when using either the ultraviolet or visible light cured resins.  Protective eyewear should also be provided for the patient during sealant procedures.

Copyright 2003, Elsevier Science (USA). 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 is not partially or totally lost.  When dental sealants are properly placed, it is not uncommon for them to last from 5 to 10 years.  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 is not partially or totally lost.  When dental sealants are properly placed, it is not uncommon for them to last from 5 to 10 years.

Copyright 2003, Elsevier Science (USA). All rights reserved. Important Information  Always read and carefully follow the manufacturer’s instructions when applying dental sealants.  The application technique and etching times may vary between manufacturers.  For example, some manufacturers recommend against using a polishing paste that contains fluoride. Other manufacturers do not consider fluoride polishing pastes to be contraindicated.  Always read and carefully follow the manufacturer’s instructions when applying dental sealants.  The application technique and etching times may vary between manufacturers.  For example, some manufacturers recommend against using a polishing paste that contains fluoride. Other manufacturers do not consider fluoride polishing pastes to be contraindicated.

Copyright 2003, Elsevier Science (USA). All rights reserved. Fig Setup for placement of dental sealants. Fig. 59-4

Copyright 2003, Elsevier Science (USA). All rights reserved. Fig Isolate and dry the tooth. Fig. 59-5

Copyright 2003, Elsevier Science (USA). All rights reserved. Fig Etch the enamel. Fig. 59-6

Copyright 2003, Elsevier Science (USA). All rights reserved. Fig Throughly dry the etched surface. Fig. 59-7

Copyright 2003, Elsevier Science (USA). All rights reserved. Fig After sealant placement, cure the enamel. Fig. 59-8

Copyright 2003, Elsevier Science (USA). All rights reserved. Fig Evaluate the sealant. Fig. 59-9