Seal the Deal: Everything You Need To Know About Sealants

What are dental sealants?  

Dental sealants represent one of the greatest advances in modern dentistry. Unfortunately, too many children do not receive the protective benefits of dental sealants. Dental sealants are clear protective coatings that are easily applied; they cover the tooth surface, preventing bacteria and food particles from settling into the pits and fissures (grooves) of the teeth. It is a thin coat of plastic that is painted on the surface of teeth, usually the premolars and molars in order to prevent caries.

Decay on back teeth, premolars, and molars usually begins in the grooves and fissures that normally exist on the biting surfaces of the back teeth.  Dental sealants, available since the 1960s, are clear plastic coatings that can be placed on the biting and grinding surfaces of posterior teeth.  These sealants prevent the formation of decay on the treated surfaces.  Sealants can even be placed of teeth with small areas of decay known as incipient carious lesions.  The sealants will stop the customary progress of tooth destruction.  

Effectiveness
It can remain on the tooth from 3 to more than 20 years, depending on the tooth, type of sealant used, and the eating habits of the patient.  It can only be placed on teeth that have not been previously restored.
It is well known that the use of fluoride increases the resistance of enamel to decay. Unfortunately, the pits and fissures of the teeth do not benefit from the effects of fluoride as greatly as smooth enamel surfaces do. Scientific studies have proved that properly placed dental sealants are 100% effective in protecting development of cavities in sealed tooth surfaces. 

Why sealants are necessary
The narrow width and uneven depth of pits and fissures make them ideal places for the accumulation of food and acid-producing bacteria. Saliva, which helps to remove food particles from other areas of the mouth, cannot clean deep pits and fissures. Pits and fissures on the teeth are so tiny that even a single toothbrush bristle is too large to enter for cleaning purposes. Another difficulty associated with deep pits and fissures is that the enamel that lies at the base of the fissures is thinner than the enamel around the rest of the tooth. This means that not only can deep narrow fissures make it more likely that tooth decay will occur, but any decay that does form will penetrate through the thin enamel and progress more quickly into the pulp.

We, at this office, are dedicated to the prevention of oral disease.  It is clear that if the initial decay is prevented from beginning or is small enough to use a sealant, there is a great savings in time, money, discomfort, and tooth structure.  Decayed teeth must have the decay removed by drilling, then they must be filled.  This drill and fill may have to be done several times over the patient's lifetime as the filling ages and needs replacement.  We strongly suggest that patients who have teeth that can be successfully protected with a sealant material consider having this procedure performed as soon as possible.

How sealants work
The sealant acts as a physical barrier that prevents decay. Small food particles and plaque (bacteria) cannot penetrate through or around a sealant. As long as the sealant remains intact, the tooth is protected. However, if part of the sealant or bond is broken, the sealant protection is lost. 

A study completed in 1991 found that one application of sealant reduced biting surface decay 52% over a 15-year period.  Another study, completed in 1990, showed that decay on biting surfaces could be reduced 95% over 10 years if 2% to 4% of the sealants were routinely repaired each year.  We expect sealants to last many years. After a sealant is applied it can last up to ten years, however regular check-ups are recommended since they can chip or wear off. Replacing or repairing sealants, as needed, on an ongoing basis will give the best protection. 

A sealant is not meant as a substitute for proper brushing and flossing habits. The effectiveness of the sealant is reduced if oral self-care is neglected. Also, cavities can still form on untreated surfaces. Therefore, a topical fluoride treatment remains an essential and necessary preventative aid.

Application of sealants
The sealant is placed on the tooth through a chemical/mechanical bonding procedure.  There is not drilling or local anesthesia required for the sealant application procedure.  It is entirely painless.

Problems with sealants
On occasion, teeth with very small initial carious lesions may be inadvertently sealed, or some bacteria may remain beneath the sealant. It was one believed that if this were to occur, decay would develop under the sealant. However, numerous studies have shown that this does not occur. Bacteria cannot survive beneath a properly placed sealant because the carbohydrates that they need to survive cannot reach them. Studies have shown that the number of bacteria in small, existing carious lesions that had been sealed actually decreased dramatically over time. The most important factor is that the sealant must be properly placed.

When sealants are used
Sealants are used primarily on children, but in certain circumstances, adults also can benefit from their use. Children and teenagers are the best candidates for sealants. Children are prone to caries from age 6-14 and applying a sealant as soon as a child’s permanent molars and premolars erupt can be a great way to protect your child from tooth decay. Some maxillary central and lateral incisors may have deep pits that could be protected by sealants. Sealants are indicated for teeth with deep pits and fissures, preferably in recently erupted teeth (i.e., within previous 4 years). Sealants should be used as part of a prevention program that includes the use of fluorides, dietary considerations, plaque control, and regular dental examinations.

We especially advise that children have the sealant applied to their teeth as soon as the teeth break through the gum and the biting surfaces of the teeth are no longer covered with gum tissue.  If the teeth cannot be totally isolated from the moisture in the mouth during the bonding process, it is likely that the sealant will not remain on the tooth for as long a period of time as expected.  The sealant is most often applied to permanent teeth, but sometimes a situation arises in which it would be beneficial to have the sealant applied to a primary tooth.

In both 1984 and 1994, sealants have been recommended by the U.S. Public Health Services and Surgeon General of the United States, among others. We know that sealants are one of the most important treatments available for prevention of dental decay.

If you have any questions about sealants, please feel free to ask us.