1. Pit and Fissure Sealants
Jan 2, 2008
Abdullah S. Al-Swuailem BDS, MS, MPH, Dr PH

2. Pit and Fissure Sealants
Learning objectives:
Know the rationale for using PF Sealants.
Determine the efficacy of PF Sealants.
Examine the cost-effectiveness of PF Sealants.
Similar to adding Vit C to prevent scurvy etc

3. Pit and Fissure Sealants
PF Sealant: It is a plastic, professionally placed material used to occlude the pits and fissures of teeth
Rationale?
Deprived bacteria from nutrients by preventing the impaction of substrate for cariogenic bacteria
Prevent future colonization of new bacteria from oral cavity into pits and fissures
83% of all decayed or filled surfaces in permanent teeth of 5-17-year old individuals were in in PF surfaces
Similar to adding Vit C to prevent scurvy etc

4. Pit and Fissure Sealants
Historical background:
Hyatt (1923) advocated placing a small amalgam restoration before caries develop in deep fissures (prophylactic odontotomy)
Bödecker (1929) suggested modifying deep fissure anatomy by a large round bur (enameloplasty)
Cyanoacrylate was used with some success
In late 1960s, resin material (bis-GMA) was used as PF Sealant
ADA approved first PF Sealant (Nuva-seal, a bis-GMA) in 1972 (provisional) and 1976 (full acceptance)
Current PF Sealants are either bis-GMA resin or urethane based
Clinical trials (half-mouth, no placebo, no examiner blindness,
Technique for PF Sealants
Buonocore etching tech 1955

5. Pit and Fissure Sealants
Sealant efficacy:
First clinical trial (Buonocore 1971) reported 99% caries reduction
Sealants are generally retained better in mandibular molars
Sealants are retained better in older children
Retention seems better on bicuspids than molars
Loss of sealant is greatest in the first 6 months
Challenges in PF sealants
Buonocore etching tech 1955

6. Pit and Fissure Sealants
Clinical issues:
Placement of PF sealant over incipient caries?
Placement of PF sealant on primary teeth?
Placement of PF sealant on primary teeth?
Retention + tooth anatomy + caries usually interproximal

7. Pit and Fissure Sealants
PF sealants in dental health programs:
PF sealants are effective in reducing PF caries
Trained dental auxiliaries (assistants) are as good as dentists in placing PFS.
Targeting most Vulnerable children
Timing of PFS Placement:
1st molar is between age of 7-8 years
2nd molar is between age of years
Sealing bicuspid or primary molars may not be part of dental health programs

8. Pit and Fissure Sealants
Cost effectiveness of PFS:
PFS vs. water fluoridation?
Are sealants expensive?
Targeting (both at children and tooth levels) will reduce cost

9. Pit and Fissure Sealants
Reference:
Burt, BA and Eklund, SA. Dentistry, Dental Practice, and the Community. 5th edition, W.B Saunders Company