Pit and fissure decay is responsible for roughly 80% to 90% of all carious lesions in secondary teeth, and 44% of caries in primary teeth.1 These dismal statistics can be greatly reduced through the placement of sealants on teeth susceptible to caries.1 Not only can pit and fissure sealants be placed to prevent caries, they can also be placed over incipient lesions in order to arrest decay.2
Once the sealant material polymerizes and as long as the sealant remains in place, it is highly effective against Class I caries.3 The success of sealants is connected to their retention.4 As such, the materials and approach to surface preparation should be chosen carefully to support their retention and, thus, their ability to prevent decay. Timing of sealant placement is also important. Teeth are most susceptible to caries within the first 2 years to 3 years of eruption so sealants should be placed before the end of this critical window.5
The use of resin-based sealant materials is common. These products frequently comprise urethane dimethacrylate or bisphenol A-glycidyl methacrylate monomers, which requires a dry field during the application process.6–8 However, resin-based sealant products that do not require a dry field are also available. The most significant benefit to resin-based sealant materials is their improved retention rates over glass ionomer materials.7,9
Composed of aluminosilicate glass and polymeric water-soluble acid that react to form a paste, glass ionomer sealant materials are another option in the caries-prevention armamentarium. While they do not offer the same retention rates as resin-based sealants, they do offer some unique benefits.10,11 First, they release fluoride which can be helpful in high-risk patients. Second, glass ionomer sealants can be set in a moist field, so if isolation is difficult to achieve, glass ionomer may be the best option.12
PREPARING FOR THE TOOTH SURFACE
Sealant-placement technique is important in order to maximize retention. Preparing the tooth is one of the first steps. Numerous studies have been performed on the most effective way to prepare the tooth surface for a dental sealant.13–19
A meta-analysis concluded that air abrasion, polishing, and bur preparation were more effective than bristle brushing.13 The authors also determined that in order to be most effective, these preparation approaches should be used along with an acid-etch technique. Other studies have researched the difference between air abrasion and mechanically preparing the tooth surface with a bur. Enamoplasty prior to sealant placement reduces the amount of leakage around the sealants, and improves retention when compared with less invasive techniques, such as air abrasion.14 Bur preparation does not come without concerns. If bur preparation has been performed prior to sealant placement and the sealant is lost, the pits and fissures may become more susceptible to caries.13
The use of adhesives prior to sealant placement has been an area of interest for sealant research. In a recent meta-analysis, researchers evaluated the retention of dental sealants with an adhesive compared to those placed without an adhesive.15 The first half of the study looked at the effectiveness of preparing the tooth with an adhesive prior to sealant placement. They concluded that using an adhesive positively affected the retention of the dental sealants. In the second portion, researchers found that when an adhesive was used, an etch and rinse system is recommended over other types.15
Another meta-analysis aimed to determine if self-etch adhesive systems were effective in sealant retention. The authors found that because self-etch adhesives do not have the same level of acidity, they do not provide the same level of etching as phosphoric acid.4 They suggested that oral health professionals use the acid-etching technique for long-term sealant effectiveness.4 A separate study found that not only do adhesives help with retention percentages, but that they also assist in preventing microleakage around the sealants themselves.14
Etchant times is also of interest. Because etchant timing does not have an effect on retention, instances of contamination could be decreased by reducing the etchant time.16 If practitioners are not waiting for longer etchant periods, there is less likelihood of saliva contaminating the surface.
There was some belief that applying topical fluoride immediately before the sealant application may reduce the effectiveness and retention of the sealant. It has been determined that topical fluoride application prior to sealant placement does not impact the retention of the new sealant.14 This could help eliminate an additional appointment if the dental hygienist can apply the sealant after the exam at recare visits.
Isolation is an important factor during sealant placement for some resin-based sealant materials. If a tooth becomes contaminated with saliva during the procedure, and re-etching does not occur, the sealant will not be successful.17 Cotton rolls, saliva ejectors, rubber dams, and isolation systems help to maintain a dry field for sealant placement. Because most resin materials are only successful in a dry environment, a four-handed technique is superior to a two-handed technique in order to control the amount of moisture surrounding the tooth. With four-handed dentistry, high-volume evacuation is used by an assistant to maintain a dry field for those sealant materials that need one.1,6
Multiple studies have shown that dental auxiliaries have a high success rate with dental sealant placement.20–22 The retention of sealants should be checked regularly and repairs should be provided as needed.17
APPROPRIATE AGE FOR PLACEMENT
Research indicates that overweight/obesity can cause acceleration of permanent molar emergence.19 Due to the rise in childhood obesity throughout the United States, research is needed to investigate whether this affects when teeth typically erupt. Further studies will help determine at what age school-based sealant programs should begin.19 Many sealant programs take place in second and sixth grade. Now that eruption time may be changing, it would be important to consider completing such programs 6 months to 12 months earlier.19
Materials, surface preparation, and timing are all important considerations for dental sealant placement. Oral health professionals are charged with helping patients achieve and maintain their dental health. Dental sealants are an effective strategy in the prevention of dental caries. Unfortunately, sealant utilization remains low. According to research conducted by Pew Charitable Trusts, 6.5 million low-income children ages 6 to 11 do not have dental sealants.23 Promoting the use of sealants as an effective way to reduce caries is important to improving the oral health of all Americans.
- American Academy of Pediatric Dentistry. Clinical Affairs Committee—Restorative Dentistry Subcommittee. Guideline on pediatric restorative dentistry. Pediatr Dent. 2012;34:173.
- Griffin SO, Oong E, Kohn W, et al. The effectiveness of sealants in managing caries lesions. J Dent Res. 2008;87:169–174.
- Kitchens DH. The economics of pit and fissure sealants in preventive dentistry: a review. J Contemp Dent Pract. 2005;6:95.
- Botton G, Morgental CS, Scherer MM, Lenzi TL. Montagner AF, Rocha RO. Are self‐etch adhesive systems effective in the retention of occlusal sealants? A systematic review and meta‐analysis. Int J Paediatr Dent. 2016;26:402–411.
- Azarpazhooh A, Main PA. Pit and fissure sealants in the prevention of dental caries in children and adolescents: a systematic review. J Can Dent Assoc. 2008;74:171–177.
- Olmsted JL. Strategies to improve sealant retention. Dimensions of Dental Hygiene. 2017;15(6):14–16.
- Uncapher A, McGuinness M. Sealant success. Dimensions of Dental Hygiene. 2016;14(11):24–26.
- Powers J, Wataha J. Dental Materials: Properties and Manipulation. 10th ed. St. Louis: Mosby; 2013.
- Ahovuo-Saloranta A, Forss H, Walsh T, et al. Sealants for preventing dental decay in the permanent teeth. Cochrane Database Syst Rev. 2013;3:CD001830.
- Antonson SA, Antonson DE, Brener S, et al. Twenty-four month clinical evaluation of fissure sealants on partially erupted permanent first molars. J Am Dent Assoc. 2012;143:115–122.
- Wright JT, Crall JJ, Fontana M, et al. Evidence-based clinical practice guideline for the use of pit-and-fissure sealants. J Am Dent Assoc. 2016;147:672–682.
- Moore T. Sealant selection. Dimensions of Dental Hygiene. 2017;15(11):26–29.
- Shirazi AS, Bagherian A. Preparation before acid etching in fissure sealant therapy: Yes or no? A systematic review and meta-analysis. J Am Dent Assoc. 2016;147:943.
- Simonsen RJ. Pit and fissure sealant: Review of the literature. Pediatr Dent. 2002;24:393.
- Bagherian A, Sarraf Shirazi A, Sadeghi R. Adhesive systems under fissure sealants: Yes or no? J Am Dent Assoc. 2016;147:446–456.
- Duggal MS, Tahmassebi JF, Toumba KJ, Mavromati C. The effect of different etching times on the retention of fissure sealants in second primary and first permanent molars. Int J Paediatr Dent. 1997;7:81–86.
- Naaman R, El-Housseiny AA, Alamoudi N. The use of pit and fissure sealants- a literature review. Dent J (Basel). 2017;5:E34.
- Primosch RE, Barr ES. Sealant use and placement techniques among pediatric dentists. J Am Dent Assoc. 2001;132:1442–1451.
- Pahel BT, Vann WF, Divaris K, Rozier RG. A contemporary examination of first and second permanent molar emergence. J Dent Res. 2017;96:1115–1121.
- Folke BD, Walton JL, Feigal RJ.Occlusal sealant success over ten years in a private practice: comparing longevity of sealants placed by dentists, hygienists, and assistants. Pediatr Dent. 2004;26:426–432.
- West NG, Ilief-Ala MA, Douglass JM, Hagadorn JI. Factors associated with sealant outcome in 2 pediatric dental clinics: a multivariate hierarchical analysis. Pediatr Dent. 2011;33:333–337.
- Foreman FJ, Matis BA. Retention of sealants placed by dental technicians without assistance. Pediatr Dent.1991;13:59–61.
- Pew Charitable Trusts. When Regulations Block Access to Oral Health Care, Children at Risk Suffer. Available at: pewtrusts.org/en/research-and-analysis/issue-briefs/2018/08/when-regulations-block-access-to-oral-health-care-children-at-risk-suffer. Accessed October 22, 2018.
From Dimensions of Dental Hygiene. November 2018;16(11):21–22.