1. Dental Sealants Chelsea Huntington, RDH, BS University of Bridgeport, MSDH Student Intern

2. Definition Sealant- A pit and fissure sealant is an organic polymer (resin) that flows into the pit or fissure and bonds to the enamel surface mainly by mechanical retention when the acid etch process precedes the application of the sealant material.

3. Purpose of the Sealant Provide a physical barrier to seal off the pit or fissure. Prevent oral bacteria and their nutrients from collecting within the pit and fissure to create acid and dental caries. To fill pit and fissure as deep as possible, providing tight and smooth margins with the enamel.

4. Purpose of the Acid Etch To produce surface irregularities or micropores in the enamel rods. To allow liquid resin to penetrate into the micropores and create a retention bond or mechanical locking.

5. Indications for Sealant Placement 1.PATIENTS AT HIGH RISK FOR DENTAL CARIES (ANY AGE) a)Xerestomia b)Patient undergoing Ortho c)Patient with Incipient caries (with no radiographic evidence of caries on adjacent proximal surface) (Dentist will determine)

6. Indications cont… 2.TEETH a)Newly erupted: place sealant as soon after eruption as possible. b)Occlusal Contour: when pit and fissures of posterior teeth are deep and irregular. c)Mainly posterior teeth, commonly 6 and 12 yr molars and sometimes premolars. d)Caries History: many other teeth with carious lesions or restorations.

7. Contraindications Radiographic evidence of proximal dental caries. Carious lesions that are no longer incipient. Low caries risk patients, pit and fissures are well coalesced and easily self-cleansing.

8. Evaluate Pit and Fissure Sealants Don’t SEAL SEAL Incipient or enamel caries Deep pits and fissures High Caries Risk Low Caries Risk Dentin Caries

9. Sealant Application and Procedure General Rules: Treat each quadrant separately. Use 4- handed dentistry when available. Success of treatment depends on precision in each step of application. Retention of sealant depends on maintaining a dry field during etching and sealant placement.

10. Sealant Application Tooth Preparation Remove all debris, deposits and stains. Cleanse the tooth with either toothbrush and water, polishing cup with pumice, or air abrasion polisher. Rinse thoroughly.

11. Sealant Application Ensure Proper Isolation Rubber Dam Dry Angles Cotton Roll Isolation Saliva Ejector Prepare tooth for etch, by drying for 10 seconds. http://images.practicon.com/images/products/1_38546_FS.jpg

12. Sealant Application Acid Etch Apply etch only to pits and fissures. Leave for 15- 60 seconds (varies depending on manufacture instructions) Rinse thoroughly and suction all remaining etch. Dry and examine etched surface for chalky white appearance. ( Repeat etch process if not) Dry for 15-20 seconds and maintain isolation.

13. Sealant Application Applying the sealant Cover all pits and fissures Do not overfill, spread evenly Try to break or reduce air bubbles Light cure for 20-30 seconds Check for voids Vigorously use explorer to check retention of sealant. Use articulating paper to check for occlusion, adjust with slow speed hand piece if necessary.

14. Retention Reexamination Sealants can be retained for many years, in some patients up to 10 yrs. Always check sealants at maintenance visits. Reseal when necessary (sometimes removal of existing sealed areas is necessary. Repeat all original sealant application steps).

15. References Esther Wilkins, 2009. Clinical Practice of the Dental Hygienist 10 th Edition. © 2009, Lippincott Williams & Wilkins.