Are sealants always the answer?

Photo: Getty Images / Mike Kemp

Sealants have become quite popular and a number of programs have surfaced to help ensure that school children and other young patients have access to sealants to help protect them from tooth decay.

Both the ADA and the Centers for Disease Control and Prevention help educate the public on the benefits of sealants and plenty of information on the topic can be found on their respective Web sites (ada.org and cdc.gov/ORALHEALTH). The use of sealants is a staple at most practices that treat children. Adults can benefit from sealants as well.

But Dr. Gordon Christensen, headlining a panel of six experts in a variety of dental fields, pointed out that studies have shown cases where some serious decay was found after dentists removed sealants. At a CE course titled “Panel-Controversies in Dentistry-2010” at the Chicago Dental Society’s Midwinter Meeting in February, Dr. Christensen said, “Everybody has taken out sealants and found caries under them.”

While not suggesting their use be stopped, Dr. Christensen warned against “arbitrarily placing them on kids with low caries risks.”

Do them right
When done well, sealants have been shown to last as long as 5 to 10 years. But as in the case with all oral health treatment plans, it is key to have sealants checked on a regular basis. Dental sealants are basically thin plastic coatings applied to the chewing surfaces of the back teeth to protect from decay. These sealants protect the chewing surfaces by keeping germs and food particles out of the grooves. If they are found not to be in place, they can be reapplied to ensure their continued effectiveness.

Matthew Messina, DDS, Consumer Advisor for the American Dental Association, said sealants have their place in caring for patients who are at risk for caries.

“The decisions on sealants are really an easy one for the dentist,” the Ohio dentist said. “A sealant is a protective covering for teeth without decay, to help the patient get safely through a cavity prone period-usually adolescence into adulthood. If there is decay present in the tooth, then the decay needs to be removed, at which time the restoration is no longer a sealant. A well-placed sealant protects the deep grooves, pits and fissures in the biting surfaces of the teeth. It remains the clinical decision of the dentist, chairside in examination and consultation with the patient and/or parent, as to whether decay is present and whether a sealant is indicated.”

A hygienist’s perspective
Chicago hygienist Kasia Jimenez, BS, RDH, said all the children at the practices where she has worked have gotten sealants as a preventive measure. She also has seen her share of decay under sealants, just as Dr. Christensen conveyed. 

“Sealants are very common in practices I work at. There are no specific age group we start placing sealants, however we place sealants on permanent teeth,” Jimenez said.  “Every child/teenager/adult is treated as an individual case. There were a couple instances where I sealed primary teeth. That particular patient was congenitally missing permanent molars.

“Once again, our goal is to maintain those primary teeth as healthy as possible and as long as possible. I did a rotation at Boys and Girls Club where sealants played an important preventive feature. I also applied as a volunteer at Community Health Clinic and Goldie’s Place (shelter for homeless) and I hope to implement patient education on sealants there.”

Patients with sealants are not expected to return more frequently to have them checked, rather Jimenez says they are evaluated at the patient’s scheduled recare visit. At her practices, sealants get examined with an explorer and with radiographs (if the patient is due for them), and for a virgin tooth Jimenez said they’ll also use KaVo’s DIAGNOdent (kavousa.com) for the examination.

According to the ADA, children and teenagers are obvious candidates for sealants since the likelihood of developing caries in pits and fissures begins at a young age. But that’s not to say older patients can’t be protected by them.

“Absolutely! I am a strong believer in prevention,” Jimenez answered when asked if adults should use sealants. “If I see an individual with a caries problem I strongly recommend sealants in this case. If I can prevent further damage in patient’s oral health I will place sealants on adults if necessary. That said, evidence of incipient occlusal caries would qualify for a sealant. Dentinal caries need to be restored and not sealed.”

She added that when placed properly, patients are satisfied with the longevity of sealants. She has noticed strong results, in particular from Ultradent products (ultradent.com).

But important steps need to be followed to help the sealants work their best. Jimenez has seen her share of caries under failed sealants. That’s why she stresses the importance of placing them properly.

“Number one step that is not executed correctly is the isolation of the tooth,” she said. “Rubber dam or Dri-Angles will help in this step. The area has to be dry in order for the sealant to bond properly and ensure the longevity of it.”

The other critical factor is the cleanliness of the surface. “I always pumice the area and secondly etch the isolated and dried area to increase surface irregularities for maximum sealant retention,” she said. “Once the tooth is prepared it is crucial that it’s dry before placing the sealant.”

She also recommends you wait several seconds after the sealant is placed to allow the sealant to flow into the pits and fissures.

Jimenez also has talked to colleagues unaware of the importance of pumicing, so she wants to make sure that step is not skipped. “Usually patients come for their recare visit and at the same visit they receive sealants,” she said. “If you polished teeth with prophy paste you just placed flavoring agents, glycerin and fluoride which may interfere with sealant bonding. It is crucial to pumice teeth that will be sealed on the same visit or polish after sealants are placed.”

Do far too many dentists open up sealants and find decay? Yes. Does this mean that they’re not a beneficial tool in fighting decay? No.

When done well and when checked on a regular basis, sealants do just what they’re intended to do-that is they act as a barrier in protecting enamel from plaque and acids.