dental sealants chapter 59 copyright © 2009, 2006 by saunders, an imprint of elsevier inc. all...

Dental SealantsDental Sealants

Chapter 59Chapter 59

Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Chapter 59Chapter 59

Lesson 59.1Lesson 59.1


Learning ObjectivesLearning Objectives

Pronounce, define, and spell the Key Terms.Pronounce, define, and spell the Key Terms. Describe the purpose of dental sealants.Describe the purpose of dental sealants. Describe the clinical indications for dental Describe the clinical indications for dental

sealants.sealants. Describe the contraindications to dental Describe the contraindications to dental

sealants.sealants. Describe the two types of polymerization.Describe the two types of polymerization.(Cont’d)(Cont’d)


Learning ObjectivesLearning Objectives

(Cont’d)(Cont’d)

Discuss the rationale for filled and unfilled Discuss the rationale for filled and unfilled sealant materials.sealant materials.

Demonstrate the steps in the application of Demonstrate the steps in the application of dental sealants.dental sealants.

Describe and demonstrate the safety steps Describe and demonstrate the safety steps necessary for the patents and the operator necessary for the patents and the operator during sealant placement.during sealant placement.

Explain the most important factor in sealant Explain the most important factor in sealant retention. retention.


IntroductionIntroduction

Dental sealants are highly effective in Dental sealants are highly effective in preventing dental caries in the pit and fissure preventing dental caries in the pit and fissure areas of the teeth. areas of the teeth.

Dental sealants, made of a resin material, are Dental sealants, made of a resin material, are applied to the pits and fissures of teeth to applied to the pits and fissures of teeth to prevent dental caries. prevent dental caries.

A dental sealant is successful only if it firmly A dental sealant is successful only if it firmly adheres to the enamel surface and protects the adheres to the enamel surface and protects the pits and fissures from the oral environment. pits and fissures from the oral environment.



IntroductionIntroduction


Pits and fissures are fossa and grooves that failed Pits and fissures are fossa and grooves that failed to fuse during development. to fuse during development.

Bacteria accumulate in the narrow pits Bacteria accumulate in the narrow pits and fissures.and fissures.

Even a single toothbrush bristle is too large to Even a single toothbrush bristle is too large to enter and clean pits and fissures. enter and clean pits and fissures.

The sealant acts as a physical barrier.The sealant acts as a physical barrier. Dental sealants are a noninvasive means of Dental sealants are a noninvasive means of

preserving tooth structure and at the same time preserving tooth structure and at the same time preventing dental decay.preventing dental decay.


Fig. 59-1 Scanning electron micrograph (SEM) of occlusal Fig. 59-1 Scanning electron micrograph (SEM) of occlusal pits and fissures. pits and fissures.

(From Daniel SJ, Harfst SA: (From Daniel SJ, Harfst SA: Mosby’s dental hygiene: concepts, cases, Mosby’s dental hygiene: concepts, cases, and competencies–2004 updateand competencies–2004 update, St Louis, 2004, Mosby.), St Louis, 2004, Mosby.)


Fig. 59-2 Micrograph showing toothbrush bristle in a groove.Fig. 59-2 Micrograph showing toothbrush bristle in a groove.


Fig. 59-3 Molar with a properly placed sealant.Fig. 59-3 Molar with a properly placed sealant.


Sealants and Existing CariesSealants and Existing Caries

During sealant placement, some bacteria will be During sealant placement, some bacteria will be trapped beneath the sealants.trapped beneath the sealants.

Some teeth with very small initial carious lesions may Some teeth with very small initial carious lesions may be inadvertently sealed.be inadvertently sealed.

Numerous studies have shown that neither of these Numerous studies have shown that neither of these occurrences will increase the chance of caries occurrences will increase the chance of caries development or that caries will grow beneath the development or that caries will grow beneath the sealant. sealant.

Several studies have shown that the number of Several studies have shown that the number of bacteria in small, existing carious lesions that had bacteria in small, existing carious lesions that had been sealed decreased dramatically with time. been sealed decreased dramatically with time.


Indications for Dental SealantsIndications for Dental Sealants

Pit and fissure sealants are especially useful for Pit and fissure sealants are especially useful for selected patients through the caries-active period selected patients through the caries-active period (ages 6-15 years). (ages 6-15 years).

Sealants are indicated:Sealants are indicated: For teeth with deep pits and fissuresFor teeth with deep pits and fissures Preferably in recently erupted teeth Preferably in recently erupted teeth

(<4 years) (<4 years) Sealants should be used as part of a prevention Sealants should be used as part of a prevention

program that includes the use of fluorides, dietary program that includes the use of fluorides, dietary considerations, plaque control, and regular dental considerations, plaque control, and regular dental examinations.examinations.


Contraindications to Dental SealantsContraindications to Dental Sealants

Lack of pits and fissuresLack of pits and fissures Apparent occlusal decayApparent occlusal decay Interproximal decayInterproximal decay Insufficient eruption of a toothInsufficient eruption of a tooth Soon-to-be-lost primary teethSoon-to-be-lost primary teeth Poor patient cooperation in the Poor patient cooperation in the

dental chairdental chair


Types of Sealant MaterialsTypes of Sealant Materials

A wide variety of sealant materials are A wide variety of sealant materials are available on the market. available on the market.

The dental assistant should have a thorough The dental assistant should have a thorough understanding of the characteristics of the understanding of the characteristics of the various sealant products that are available.various sealant products that are available.


Fig. 59-4 Sealants should be used as part of Fig. 59-4 Sealants should be used as part of a comprehensive preventive program. a comprehensive preventive program.

(Courtesy of Ivoclar-Vivadent, Amherst, N.Y.)(Courtesy of Ivoclar-Vivadent, Amherst, N.Y.)


Method of Polymerization Method of Polymerization

The major difference among the materials is The major difference among the materials is the method of polymerization (setting). The the method of polymerization (setting). The two types are comparable in bond strength two types are comparable in bond strength and rate of retention. and rate of retention. Self-cured materials are supplied as a two-part Self-cured materials are supplied as a two-part

system (base and catalyst). When these pastes system (base and catalyst). When these pastes are mixed together, they quickly polymerize are mixed together, they quickly polymerize (harden). (harden).

Light-cured sealants do not require mixing. After Light-cured sealants do not require mixing. After the material has been placed, it hardens during the material has been placed, it hardens during exposure to a curing light. exposure to a curing light.


Color of Sealant MaterialColor of Sealant Material

Sealants may be clear, tinted, or opaque Sealants may be clear, tinted, or opaque (white).(white).

Tinted or opaque sealants are more popular Tinted or opaque sealants are more popular because they are easier to see than clear because they are easier to see than clear sealants during application during checks for sealants during application during checks for sealant retention on subsequent office visits. sealant retention on subsequent office visits.

Some brands have a tint that is visible during Some brands have a tint that is visible during the application but turns clear after the application but turns clear after polymerization.polymerization.


Fillers Fillers

Sealant materials are available as filled or unfilled resins. Sealant materials are available as filled or unfilled resins. The purpose of filler material in the sealant is to reduce The purpose of filler material in the sealant is to reduce

occlusal wear. occlusal wear. Filled and unfilled sealants penetrate the fissures equally Filled and unfilled sealants penetrate the fissures equally

well, and there is no difference in microleakage.well, and there is no difference in microleakage. Some dentists believe that a filled sealant is better Some dentists believe that a filled sealant is better

because of a lower wear rate on occlusal surfaces. because of a lower wear rate on occlusal surfaces. Other dentists believe that because sealants flow deep Other dentists believe that because sealants flow deep

into the pits and fissures to form a barrier that ensures into the pits and fissures to form a barrier that ensures that the occlusal wear is insignificant.that the occlusal wear is insignificant.

Sealants should not be placed on the cuspal slopes. Sealants should not be placed on the cuspal slopes.


Fluoride ReleaseFluoride Release

Some types of sealants release fluoride after Some types of sealants release fluoride after polymerization.polymerization.

The theory is that the fluoride released from the The theory is that the fluoride released from the sealant creates a fluoride-rich layer at the base of the sealant creates a fluoride-rich layer at the base of the sealed groove.sealed groove.

Clinical studies comparing the effectiveness of these Clinical studies comparing the effectiveness of these two types of sealants are still under way. two types of sealants are still under way.

Topical fluoride should not be applied to the enamel Topical fluoride should not be applied to the enamel surface immediately before a sealant procedure but surface immediately before a sealant procedure but may be applied immediately after sealant application. may be applied immediately after sealant application.

Always follow the sealant manufacturer’s instructions.Always follow the sealant manufacturer’s instructions.


Storage and UseStorage and Use

General tips on sealant materials: General tips on sealant materials: Replace caps on syringes and bottles immediately Replace caps on syringes and bottles immediately

after use. after use. Do not expose the materials to high temperatures. Do not expose the materials to high temperatures. Do not store the materials in proximity to eugenol-Do not store the materials in proximity to eugenol-

containing products. containing products. Most etchant and sealant materials are designed to Most etchant and sealant materials are designed to

be used at room temperatures. be used at room temperatures. Check the manufacturer’s recommendations. Check the manufacturer’s recommendations. The shelf lives of most sealant products at room The shelf lives of most sealant products at room

temperature range from 18 to 36 months.temperature range from 18 to 36 months.


Etching Precautions for Patients Etching Precautions for Patients and Dental Personneland Dental Personnel

Etching agents contain phosphoric acid.Etching agents contain phosphoric acid. Patients and dental personnel should wear Patients and dental personnel should wear

protective eyewear when etchants are being used. protective eyewear when etchants are being used. Avoid contact with oral soft tissue, eyes, and skin.Avoid contact with oral soft tissue, eyes, and skin. In case of accidental contact, flush the exposed In case of accidental contact, flush the exposed

area immediately with large amounts of water. area immediately with large amounts of water. If eye contact is involved, immediately rinse the If eye contact is involved, immediately rinse the

eye with plenty of water and seek medical eye with plenty of water and seek medical attention. attention.


Sealant Material Precautions for Sealant Material Precautions for Patients and Dental PersonnelPatients and Dental Personnel

Do not use sealants on patients with known acrylate Do not use sealants on patients with known acrylate allergies.allergies.

To reduce the risk of an allergic response, minimize To reduce the risk of an allergic response, minimize exposure to these materials. exposure to these materials.

Use protective gloves and a no-touch technique. Use protective gloves and a no-touch technique. If skin contact occurs, wash the exposed skin with soap and If skin contact occurs, wash the exposed skin with soap and

water. Acrylates may penetrate gloves.water. Acrylates may penetrate gloves. If the sealant makes contact with a glove, remove and If the sealant makes contact with a glove, remove and

discard the glove, wash your hands immediately with soap discard the glove, wash your hands immediately with soap and water, and then reglove. and water, and then reglove.

If accidental eye contact or prolonged contact with oral soft If accidental eye contact or prolonged contact with oral soft tissue should occur, flush with large amounts of water. If tissue should occur, flush with large amounts of water. If irritation persists, contact a physician. irritation persists, contact a physician.


Protective EyewearProtective Eyewear

Protective eyewear should be used by Protective eyewear should be used by operators when using either an ultraviolet or a operators when using either an ultraviolet or a visible light–cured resin.visible light–cured resin.

Protective eyewear should also be provided Protective eyewear should also be provided for the patient during sealant procedures.for the patient during sealant procedures.


Factors in Sealant RetentionFactors in Sealant Retention

Moisture contamination is the primary cause Moisture contamination is the primary cause of failure of sealant retention.of failure of sealant retention.

Inadequate etching is also a factor in loss of Inadequate etching is also a factor in loss of sealant retention. sealant retention.

Dental sealants should be examined at each Dental sealants should be examined at each recall visit to be certain that the sealant recall visit to be certain that the sealant material has not been partially or totally lost.material has not been partially or totally lost.

When dental sealants are properly placed, it When dental sealants are properly placed, it is not uncommon for them to last 5 to 10 is not uncommon for them to last 5 to 10 years. years.


Important InformationImportant Information

Always read and carefully follow the Always read and carefully follow the manufacturer’s instructions when applying manufacturer’s instructions when applying dental sealants. dental sealants.

Application technique and etching times may Application technique and etching times may vary between manufacturers.vary between manufacturers.

For example, some manufacturers For example, some manufacturers discourage the use of a polishing paste that discourage the use of a polishing paste that contains fluoride. Other manufacturers do not contains fluoride. Other manufacturers do not consider fluoride polishing pastes to be consider fluoride polishing pastes to be contraindicated. contraindicated.


Setup for Placement of Dental Sealants Setup for Placement of Dental Sealants

(Procedure 59-1)(Procedure 59-1)


Isolate and Dry the Tooth Isolate and Dry the Tooth (Procedure 59-1)(Procedure 59-1)


Etch the Enamel Etch the Enamel (Procedure 59-1)(Procedure 59-1)


Thoroughly Dry the Etched Surface Thoroughly Dry the Etched Surface (Procedure 59-1)(Procedure 59-1)


After Sealant Placement, Cure the Enamel After Sealant Placement, Cure the Enamel (Procedure 59-1)(Procedure 59-1)


Dental Sealant Is in Place. Evaluate the Dental Sealant Is in Place. Evaluate the Sealant. (Procedure 59-1)Sealant. (Procedure 59-1)


dental sealants chapter 59 copyright © 2009, 2006 by saunders, an imprint of elsevier inc. all...

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