Pit and Fissure Sealant Application

Rules / Regulations Must be EFDA Expanded Function Dental Assistant. Certified by: DANB Dental Assisting National Board CE class required Lecture / lab 6 hours Pt. must have exam by Dentist. Sealant must be indicated / prescribed. Placed within 45 days. “Indirect supervision” A dentist must be on the premises while the procedures are performed.

Pt. Health History We’re only doing sealants…..why check the health history????? Medications…? Allergies……..? Latex Can cause: Anaphylactic shock  Severe allergic reaction that can cause death. Review / update At every visit. Should be current. Pediatric pts. Review w/ parent or guardian. Other health considerations…? Emotional Psychological Behavioral

Infection Control Universal precautions Treat / assume All patients as if they are infectious.  Family  Friends  Seniors  Kids  Co-workers That they have;  Any and all diseases. Disease transmission Cross contamination Contamination =  Presence of an infectious agent (pathogen). Cross contamination  The spreading of an infectious agent.  Direct contact  Indirect contact  Inhalation

Personal Protective Equipment Gown Fluid resistant Laundered Disposable Mask Earloop or tie Should protect mucus membranes.  Doesn’t work if worn below the nose or under the chin.

Personal Protective Equipment Goggles / Safety glasses / eye protection. Should be shatter resistant. Face shield is OK. Side shields on Rx eyeglasses. Pt’s should be offered / encouraged to use. Orange UV Tinted

Personal Protective Equipment Gloves Must be worn anytime working in the oral cavity. Handling any item expected to be used in the oral cavity. Latex Vinyl Nitrile Latex Vinyl (synthetic) Nitrile

What are pits and fissures? Areas in the fossa’s and grooves that have failed to form Found on occlusal surfaces of posterior teeth Found on lingual surfaces of anterior teeth Narrow and deep grooves Can’t be reached by brushing Acid producing bacteria in these areas cause demineralization

What do Sealants do? Act as a barrier Used to arrest incipient decay Blocks carbohydrates Used with good oral hygiene habits and fluoride provides and effective method of preventing tooth decay

Diagnosing / Indications All Dx must be done by a licensed dentist. Indications (reason to use, do) Non-invasive Deep pits / fissures Recently erupted teeth Hx of high # of occlusal caries. Preventive Tx. Acts as a barrier to plaques and bacteria Seals composite margins

Contra-indications Reasons not to use or do something. No caries Four or more years Shallow grooves Blended pits and fissures Caries present Restoration present Primary tooth will be lost soon Poor cooperation Blended Fissures Caries Restoration

Enamel Sealant Material Most common BIS-GMA bisphenol A diglycidylether methacrylate Main component of dental composites and sealant material. Diluted to allow “flow-ability” Clear, opaque, color changing. Other Material Glass ionomer Used for restorative Contain fluoride Wear down faster Filled Contains small particles to add strength  Must adjust occlusion Un-filled  Will wear down 2-3 days

Enamel Sealant Material Light cure Single component No mixing required Control set time Cure light Aka ‘light cure unit’ Causes…..? Polymerization Hardening of the material

Enamel Sealant Material Chemical cure Aka (self-cure) Two components Base and catalyst Must mix together Will polymerize in about 1minute. Dual cure Will start to polymerize chemically, can finish with a cure light.

Isolation Necessary to: Keep acid etch from contacting other tissue Keep saliva from contaminating the tooth surface. Keep the tooth dry. Essential for the retention of the sealant Rubber dam Preferred method Especially for partially erupted teeth Cotton rolls May have to change if saturated or pack / add dry cotton rolls on top of the saturated ones

Acid Etch / Conditioning Steps necessary to retain the sealant. Phosphoric acid Gel Liquid Microscopically roughens the enamel surface. Creates “mechanical” retention. Not chemical Gel Liquid Non-etched Etched Frosty dull

Acid Etch / Conditioning Tooth should be isolated. Rubber dam Cotton rolls Dried Air-water syringe Apply etch According to Dr. or manufactures directions.

Acid Etch / Conditioning Application Brush Cotton pellet Applicator tip Small sponge Should extend beyond area (2-3mm) of where sealant is placed. Motion Dabbing DO NOT RUB Rinse 30 sec. (HVE) Evaluation of the etch Tooth should appear Frosty Dull Chalky If not, Re-etch for 15 – 30 seconds. Re-etch if saliva contacts the tooth Rinse 30 seconds  With HVE

Sealant Placement With an applicator Place material so it flows into Pits Fissures Etched area of the tooth An applicator tip Or an explorer Can be used to move the material and prevent air bubbles.

Evaluating the Sealant After the sealant has cured. Check for….. Hardness Smoothness Voids Irregularities Retention Occlusion Contacts Adjustments Re-cure If not set Re-isolate If sealant comes off Re-etch If area is contaminated Re-apply If void or irregularity

Evaluating the Sealant Occlusion Articulating paper Have pt. bite and grind Evaluate for ‘high’ spots Filled material Assistant can adjust  With a slow-low speed handpiece  Round bur / Stone bur Unfilled  Will wear down 2-3 days (chewing) Floss Sealants are usually applied to Occlusal of post. teeth Lingual of ant. teeth Buccal or lingual grooves or pits. So why floss……? To ensure material did not get into the proximal area and close a contact.

Post operative instructions. Preventative treatment. (only temporary) Should last 5-7 years Can brush / floss Eat anything. (Hard stuff too) (do not have to wait 24 hrs. etc) Pay attention to ‘bite’ Call office if any questions or concerns.

Success vs. Failure Success depends on good isolation Failure can be due to moisture contamination Success depends on a good mechanical bond Failure can be due to incomplete etching

Conclusion Placing sealants is a treatment / procedure. You are the provider. Be aware of laws, rules and regulations regarding sealant placement. Never diagnose any treatment. Don’t be afraid to ask questions or ask for help. Any questions…….?