Sealants as a Standard of Care I read the article about sealants “Making the Most of Sealant Usage” in the July 2004 issue by Robert J. Feigal, DDS, PhD. It was a great article. I am very frustrated because, for the past 17 years, we have been placing sealants fairly successfully. Recently our DDS purchased a hard/soft tissue laser and Diagnodent. We are now NOT placing sealants even if we use the Diagnodent and get a reading under 20. I was not aware that placing sealants was a standard of care as the first paragraph of the article states. I am so glad to know this so I can talk to the DDS about doing sealants again. I don’t feel that I am providing the best care if I do not suggest sealants for my patients.
–Patti Gannon, RDH, Philadelphia
Robert J. Feigal, DDS, PhD, professor of Pediatric Dentistry and chair of the Department of Preventive Dentistry at the School of Dentistry, University of Minnesota, Minneapolis, responds:
The detection and management of the early occlusal surface carious lesion is an area of dental care filled with controversy. A full discussion of the issues is space prohibitive, but following are a few pertinent points:
1. New diagnostic methods for early lesions may be of great value to dentistry, yet:
a) Presently, the methods measure some aspect of mineral change in the tooth tissue. This alone is not enough, since many early lesions are not progressing. Rather, the lesions are remineralizing or are quiescent and stable as shown by a clinical study by Hamilton et al 20021 —even though these areas may register as “cavities” on new technology.
b) Scientists involved in early development and testing of the laser fluorescence technology have said that it is best used to show changes in lesions over time, not to be used as a one-time decision point for surgical intervention.
c) A recent study shows that using a low threshold to declare that a lesion needs surgical intervention, particularly in cases of stained fissures, may lead to overtreatment.2 As technology allows us to find smaller and earlier carious lesions, we must determine ways to keep from overtreating lesions or misdiagnosing normal stained fissures as active caries.
2. Early lesions in pits and fissures that remain in enamel are best treated with sealant application to stop further caries advancement.3,4 In fact, the best cost-to-benefit ratio for sealant placement is to place them on “at risk” fissures (fissures with early evidence of enamel decay).5
3. Sealants do prevent caries in pits and fissures. While our new perspective on sealant success clearly states that sealants need observation, maintenance, and repair, they are still the best method to hold the line on decay in the areas of teeth most susceptible to caries.
There may be some excellent reasons for recent changes in policy. Yet, it is worth revisiting the facts in dental research before making major treatment policy decisions using new technology.
References
- Hamilton JC, Dennison JB, Stoffers KW, Gregory WA, Welch KB. Early treatment of incipient carious lesions: a two-year clinical evaluation. J Am Dent Assoc. 2002;133:1643-1651.
- Francescut P, Lussi A. Correlation between fissure discoloration, Diagnodent measurements, and caries depth: an in vitro study. Pediatr Dent. 2003;25:559-564.
- Siegel MD. Workshop on guidelines for sealant use. J Public Health Dent. 1995;55(special issue):259-311.
- Feigal RJ. The use of pit and fissure sealants. Pediatr Dent. 2002;24:415-422.
- Heller KE, Reed SG, Bruner FW, Eklund SA, Burt BA. Longitudinal evaluation of sealing molars with and without incipient dental caries in a public health program. J Public Health Dent. 1995;55:148-153.
Guidelines for Radiology I was just reading the February 2004 issue and the “Right of Refusal” article by Rebecca S. Wilder, RDH, BS, MS, caught my eye. The final paragraph mentioned that the Guidelines for Prescribing Dental Radiographs would be released jointly by the Food and Drug Administration (FDA) and the American Dental Association (ADA) in the spring and posted on your website. I wasn’t able to find the link. Can you tell me what the status is? I’m a huge fan of your journal, by the way. The content is wonderful. Thank you for helping me to stay at the top of my game!
–Dee Vecchione, RDH, Stow, Ohio
Editor’s Response: Dimensions was informed by the ADA that the guidelines have been delayed for a possible fall release. We will post them as soon as they become available so keep checking back at www.dimensionsofdentalhygiene.com.
Online Subscriptions Thank you for the opportunity to renew my subscription online. I am temping now as a hygienist, which can be difficult because of the tight scheduling. I hope my body holds up so I can continue working in the dental hygiene field. Your professional magazine helps keep me informed!
–Penni Biehl, RDH, Spring, Tex
Congrats I read every issue of this journal. It is a wealth of information! Thank you!
–Kathleen J. Peplin, RDH, Valley City, Ohio
