FISSURE SEALANT

MATERIAL
Bolan medical college Quetta

Submitted by: Zoya Zubair

 FISSURE SEALANT MATERIAL

Submitted by: Zoya Zubair

Roll no. 12

Department Of Community and Preventive Dentistry

Bolan Medical College, Quetta.

(Session 2011-12)

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 Dedication

My hard work is dedicated to my

dearest mother, all that I am, or hope to
be, I owe to my angel mother. This
effort is dedicated to my dearest father,
who believed in me and my all inspiring
and helpful teachers especially faculty
of community and preventive dentistry.

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TABLE OF CONTENTS
DEFINITION …………………………………………………………………………………………..PAGE NO: 6

I. Definition according to Simonson…………………………………………………………..page no: 7

II. Definition according to Gordon………………………………………………………………page no: 7

MORPHOLOGY OF PITS AND FISSURES………………………………………………….PAGE NO: 7

I. According to Nango………………………………………………………………………………….page no: 8

II. ACCORDING TO GALIL & GWINETT, 1975………………………………………………….page no: 9

EPIDEMIOLOGY………………………………………………………………………………………PAGE NO: 9

DEVELOPMENT OF PIT AND FISSURE SEALANT……………………………………………….PAGE NO 10

HISTORY OF PITS AND FISSURE……………………………………………………………………….PAGE NO 10

ROLE IN ORAL HYGIENE……………………………………………………………………….PAGE NO 10

TYPES OF PITS AND FISSURE SEALANT……………………………………………………………PAGE NO 11

A TYPE FISSURE SEALANTS ……………………………………………………………………PAGE NO 11-12

I.THREE DIFFERENT KINDS OF PLASTICS HAVE BEEN USED AS OCCLUSAL

SEALANTS………………………………………………………………………………………………………….PAGE NO 12

1. POLYURETHANES…………………………………………………………………………………..PAGE NO 12

2. CYANOACRYLATES………………………………………………………………………………….PAGE NO 12

3. BISPHENOL A GLYCIDYL METHACRYLATE (BIS-GMA)……………………….PAGE NO 12-13

II. RESIN BASED SEALANTS…………………………………………………………………….PAGE NO 13-14

III. GLASS IONOMER SEALANTS……………………………………………………………….PAGE NO 15-17

IV. COMPOMER…………………………………………………………………………………………….PAGE NO 17

V. FLUORIDE CONTAINING SEALANTS…………………………………………………….PAGE NO18-19

B TYPE FISSURE SEALANTS……………………………………………………………………………PAGE NO 20-23

I. FILLED AND UNFILLED……………………………………………………………………………….PAGE NO 20

II. LIGHT CURE AND CHEMICALLY CURED…………………………………………………PAGE NO 20-21

III. CLEAR AND TINTED……………………………………………………………………………….PAGE NO 22-23

REQUISITES FOR SEALANT…………………………………………………………………………….…PAGE NO 23-26

1. Increasing the surface area……………………………………………………………………………..page no 23-24

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 2. Pits and fissure depth………………………………………………………………………………………page no 24
3. Surface cleanliness………………………………………………………………………………………….page no 24
4. Dryness……………………………………………………………………………………………………………page no25-26

PATIENT AND TOOTH SELECTION……………………………………………………………PAGE NO 27

I. INDICATIONS

II. CONTRA INDICATIONS

DIAGNOSIS OF PIT AND FISSURE CARIES……………………………………………………………PAGE NO27-28

TECHNIQUE FOR SEALANT APPLICATION………………………………………………PAGE NO 28-36

1. TIME TO SEAL
2. SURFACE CLEANING
3. ISOLATION
4. ETCHANTS AND CONDITIONERS
5. ETCHED ENAMEL AND RESIN PENETRATION
6. WASHING AND DRYING APPLICATION
7. MIXING THE RESIN
8. SEALANT APPLICATION
9. TESTING RETENTION

SEALANT RETENTION……………………………………………………………….................PAGE NO 37
FOLLOW UP AND REVIEW…………………………………………………………………………PAGE NO 37
MINIMALLY INVASIVE PREVENTIVE RRESTORATIONS (PPR)…………………….PAGE NO 37
SEALING OF CARIOUS FISSURE…………………………………………………………….....PAGE NO 38

PLACEMENTS OF SEALANTS OVER CARIOUS AREAS

BACKGROUND
DECREASE IN BACTERIAL GROWTH AND DENTIN SEALING
CONCLUSION

SEALANTS VERSUS AMALGAMS………………………………………………………………PAGE NO 39-40

COST EFFECTIVENESS OF FISSURE SEALANTS………………………………………..PAGE NO 40-44

DIFFERENT STUDIES IN CONTEXT OF COST EFFECTIVENESS OF FISSURE SEALANT SYSTEM

IRISH PUBLIC DENTAL SERVICES
SCHOOL-LINKED SEALANT PROGRAMMES
DIFFERENT SEALANT DELIVERY STRATEGIES
DEPLOYMENT OF DENTAL HYGIENISTS

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CONCLUSION

SEALANT AS A PART OF A TOTAL PREVENTIVE PACKAGE………………………..PAGE NO 44

PRESENT STATUS OF PIT AND FISSURE SEALANTS………………………………PAGE NO 44-46

CONCLUSION

SEALANTS IN CARIES MANAGEMENTPROGRAMME……………………………….PAGE NO47

PARENT EDUCATION
• SUMMARY

REFRENCES………………………………………………………………………………………….PAGE NO 48-51

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DEFINITION:
A fissure sealant is a material that is placed in the pits and fissures of teeth in order to arrest
or prevent the development of dental caries.

Fissure sealants are thin plastic coatings that are applied to the grooves on the chewing
surfaces of the back teeth to protect them from tooth decay. Most tooth decay in children and
teens occurs on these surfaces. Sealants protect the chewing surfaces from tooth decay by
keeping germs and food particles out of these grooves.

Figure no.1: Pits and Fissures on the molar tooth

DEFINITION ACCORDING TO SIMONSON:-

Material that is introduced into the pits and fissures of caries susceptible teeth, thus forming
micromechanically bonded protective layer cutting access of caries producing bacteria from
their source of nutrients.

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DEFINITION ACCORDING TO GORDON:-
A fissure sealant is a material applied to occlusal surfaces of teeth in order to
obliterate the occlusal fissures and remove the sheltered environment in which caries may
thrive.

MORPHOLOGY OF PITS AND FISSURESACCORDING TO NANGO

1961:

•V shaped fissure: wide at top, narrow at bottom

•I shaped fissure: quite constricted and mayresemble a bottle neck

• U shape fissure: same width from top to bottom

• K shape fissure: extremely narrow slit with largerspace at bottom

 H shape fissure: seen mostly in premolars

Fig. no 2: V-Shaped fissure

Wide at top and gradually narrowing towards the bottom (30-35%)

Fig. no 3: U-shaped fissure

Almost the same width from top to bottom (12-15%)

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 Fig. no 4: I-shaped fissure

Extremely narrow slit (18-20%)

Fig. no 5: IK shaped fissure Fig. no 6: Inverted Y shaped fissure

Extremely narrow slit, (5-10%) with a larger space at bottom (24-26%)

ACCORDING TO GALIL & GWINETT, 1975

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•V shape

•U shape

•Tear drop shape

EPIDEMIOLOGY:-

 Tooth surfaces with pits and fissures are particularly vulnerable to caries development
observed that although the occlusal surfaces represented only 12.5% of the total surfaces
of the permanent dentition, they accounted for almost 50% of the caries in school
children.
 This can be explained by the morphological complexity of these surfaces, which favors
plaque accumulation to the extent that the enamel does not receive the same level of
caries protection from fluoride as does smooth surface enamel.
 The plaque accumulation and caries susceptibility are greatest during the eruption of the
molars, and caries susceptible individuals are therefore vulnerable to early initiation and
fast progression of caries in these sites, in fluoridated communities, over 90% of dental
caries is exclusively pit and fissure caries.

DEVELOPMENT OF FISSURE SEALANTS:-

Since the 1980s, in the United States, the incidence of tooth decay on the smooth surfaces
of teeth has declined, in part because of fluoridation becoming widespread in public water
supplies and because of improved dental hygiene among the public.
 However, because the teeth in the back of the mouth (molars and premolars) have
numerous pits and fissures on their biting surfaces, certain areas of these teeth are often
difficult to clean even with vigorous tooth-brushing.
 To remedy this, research into dental sealants began in the 1960s, and by the early 1970s
the first generation of sealants became available and were approved by the FDA.

HISTORY OF FISSURE SEALANT:-

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IN 1895: Wilson reported the placement of “dental cement” in pits and fissure.

IN 1905:application of silver nitrate by miller

IN 1923:Hyatt reported a technique named“prophylactic odontomy”.

IN 1929:Bodecker introduced fissure eradication.

IN 1955:Buanocare introduced a method of adhering resin to an acid etched enamelsurface.

IN 1965: Bowen & associates developed BIS- GMA resin.

IN 1970 & EARLY 1980’S: UV light with a wavelength of 365 nm was used to initiate
the setting reaction.

ROLE IN ORAL HYGIENE:-

 Dental sealants do not eliminate the need for fluoride treatment. Fluorides, such as
those used in toothpaste, mouth rinse, and community water supplies also help to
prevent decay, but in a different way.

 Sealants keep germs and food particles out of the grooves by covering them with a
safe plastic coating.

 Sealants and fluorides work together to prevent tooth decay.

 Sealants are one part of a child's total preventive dental care. A complete preventive
dental program also includes fluoride, twice-daily brushing, wise food choices, and
regular dental care.

 Sealing a tooth is better than waiting for decay and filling the cavity.

 Decay damages teeth permanently.

 Sealants protect them.

 Sealants can save time, money, and the discomfort sometimes associated with dental
fillings.

 Fillings are not permanent.

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  Each time a tooth is filled, more drilling is done and the tooth becomes a little weaker.

TYPES OF PIT AND FISSURE SEALANTS

Fissure sealants are marketed in variety of formats

 They can be filled, unfilled, tinted, clear, opaque.

 They may be polymerized in variety of ways.
 The first generation of fissure sealant are UV light cure,
 The second generation are chemically cured (autopolymerised) and
 The third generation are visible light cure.
 The fourth generation fissure sealant are those containing fluorides.

A type of fissure sealant

I. Three different kinds of plastics have been used as occlusal sealants:

1. Polyurethanes
2. Cyanoacrylates
3. Bisphenol A glycidyl methacrylate (Bis-GMA)
II. Resin based sealants
III. Glass ionomer sealants
IV. Fluoride containing sealants

B type of fissure sealants

I. Filled and unfilled

II. Light cure and chemically cured
III. Clear and tinted

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A TYPE OF FISSURE SEALANTS:-

Polyurethanes:-

 The polyurethanes were among the first to be commercially marketed.

 They proved to be too soft and totally disintegrated in the mouth after two or
three months.
 Despite this drawback, their use was continued for sometimes – not as a
sealant but as a vehicle with which to apply fluoride to the teeth.
 However it has been superseded by use of fluoride varnishes, which are easier
to apply.

Cyanoacrylates:-

 Cyanoacrylates have also been tried as sealants, but they too disintegrated
after a slightly longer time.
 Hence their use has been discontinued on account of low shelf life and high
unstability.

BISPHENOL A GLYCIDYL METHACRYLATE (BIS-GMA):-

 Bisphenol a glycidylmethacrylate (Bis-GMA) is now the sealant of choice.

 It is a mixture of Bis-GMA and methyl methacrylate.
 Its successful use was first reported by Buonocore in late 1960s.
 In 1972 Nuva-seal was the first successful commercial sealant to be placed on the
market.
 Since then more effective second, third generations sealants have become available.

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RESIN BASED SEALANTS:-

Fig no 7: Resin sealant

 Resin sealants are bonded to the underlying enamel by the use of the acid etch
technique.
 Their caries preventive property is based on the establishment of a tight seal which
prevents leakage of nutrients to the microflora in the deeper parts of the fissure.
 The resin sealants may be either pure resin, composites or compomers, and their
polymerisation may be initiated chemically or by light.
 Several studies reported the effectiveness of second generation chemical-initiated
sealants.
 Wendt and Koch (1988) reported under optimal dental office conditions 80%
complete retention after 8 years and combined partial and complete retention after 10
years of 94%.

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  Romcke et al (1990) in a Canadian study after 10 years reported 41% complete
retention and 8% partial retention.
 85% of the sealed teeth were caries free after 8-10 years. Simonsen reported 57%
complete retention 10 years after a single sealant application (Simonsen 1987) and
28% after 15 years (Simonsen, 1991).
 After 15 years 74% of surfaces that had been sealed were caries free. Chestnutt et al
(1994) reported on more than 7000 sealants after 4 years and 57% of the sealed tooth
surfaces remained fully sealed with 18% scored as deficient or failed and 24%
completely missing.
 23% of the surfaces originally scored as deficient at baseline were scored as carious
compared with 21% of surfaces not sealed.
 Only 14.4% of the sound/sealed surfaces at baseline became carious.
 Wendt et al (2001a), reported 95% complete or partial retention without caries in
second permanent molars after 15 years and 87% complete or partial retention without
caries in first permanent molars after 20 years.
 In a different study the same authors (Wendt et al 2001b), reported that 74% of first
permanent molars that had been sealed were caries free after 15 years.
 Rapa (1993) reviewed numerous studies that have been carried out comparing the
retention rates between third and first and/or second generation sealants.
 The results indicate that the performance level for chemical initiated sealants and
visible light photoinitiated sealants are similar within an observation period of up to 5
years.
 However, in three comparison studies of longer duration, greater longevity was
reported for the chemically cured pit and fissure sealants (Rock and Evans, 1983,
Rock et al, 1990; Shapira et al, 1990).
 The addition of filler particles to the sealant likewise appears to have little effect on
clinical results (Waggoner and Siegal, 1996). Filled and unfilled sealants penetrate
the fissures equally well, (Feldens et al, 1994), and have similar retention rates (Barrie
et al, 1990; Boksman et al, 1993).
 Pit and fissure sealants are available as clear, opaque or tinted. No product has
demonstrated a superior retention rate but the tinted and opaque sealants have the

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 advantage of more accurate evaluation by the dentist at recall (Waggoner and Siegal,
1996).
 Rock et al (1989) found significant differences in the accuracy with which three
dentists identified a clear and an opaque fissure sealant.
 During the mid-1990's safety concerns were expressed regarding leaching of
bisphenol-A (BPA) and bisphenol-A dimethacrylate (BPA-DMA) from sealants, and
a possible oestrogenic effect.
 However Soderhom and Mariotti (1999) concluded that the short-term risk of
oestrogenic effects from treatments using bispenol-A-based resins is insignificant and
Fung et al (2000) showed that BPA released orally from a dental sealant may not be
absorbed at all or may only be present in non-detectable amounts in the systemic
circulation.

GLASS IONOMER CEMENT (GIC):-

 One of the main clinical advantages of GIC is their ability to bond chemically to
dentin and enamel without the use of the acid-etch technique (Aboush et al, 1986),
which makes them less vulnerable to moisture.
 This, in conjunction with active fluoride release into the surround enamel (Komatsu
et al, 1986), has led to the development and evaluation of GIC as an alternative fissure
sealant system, particularly in cases where moisture control is difficult to achieve.
 Experiments have established that the fluoride release in distilled water is very high
during the first 24 hours (burst effect) and it drops rapidly during the following 48
hours before reaching a relatively constant level during the second week.
 This pattern of fluoride release is common for all the conventional and resin modified
GIC's (De Moor et al, 1996; Grobler et al, 1998).

Studies of the use of GIC:-

 Studies of the use of GIC (Raadal et al, 1996; Boksman et al, 1987; Forss et al, 1992),
and resin modified glass ionomers (Smales and Wong 1999) as fissure sealants
indicate significantly lower retention rates than resin-based pit and fissure sealants.

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  However, several studies have found that GIC's exert a cariostatic effect even after
they had disappeared macroscopically, and that this effect might be based on
remnants of the cement in the fissure as well as increased levels of fluorides on the
enamel surface (Williams and Winter, 1981; Shimokobe et al, 1986; Ovrebo and
Raadal, 1990; Skartveit et al, 1990; Mejare and Mjör, 1990).
 However fluoride varnish (Duraphat) alone (Bravo et al. 1996), and toothbrushing
technique alone (Carvalho et al. 1992), have been shown to be specifically beneficial
in reducing occlusal caries.
 The use of GIC has been suggested for erupting teeth where isolation is a problem
(Gilpin, 1997; Raadal et al, 2001), especially in the high caries risk individuals.
 In this situation they can be considered more a fluoride vehicle than a traditional
fissure sealant.

Fig. no 8: Glass ionomer sealant

COMPOMERS:-

 Compomers are currently being investigated widely in both in vitro and in vivo
studies.

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  Since the amount of fluoride released in distilled water is considerably less than GIC,
and that three year clinical results show comparability with resin sealants, their
properties should be estimated as comparable to the resins.

FIG. NO 9: Compomer sealant

FLUORIDE CONTAINING SEALANTS:-

Fig. no 10: Fluoride releasing material

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  Addition of fluoride to sealants was considered about 20 years ago and it was probably
attempted based on the concept that the incidence and severity of secondary caries are
reduced or minimized around fluoride releasing materials.
 Because fluoride uptake increases enamel resistance to caries, use of fluoridated resin
based sealant may provide an additional anti cariogenic effect if the fluoride released
from its matrix is incorporated into the adjacent enamel.
 Fluoride-releasing sealants have shown antibacterial properties as well as greater
artificial caries resistance compared to a non-fluoridated sealant.
 Hence if the addition of fluoride to the sealants proves beneficial, it will greatly
increase the value of sealants in preventive and restorative use of sealant.
 The durability of fluoride containing sealants would now appear to be comparable to
conventional resin sealants (Lygidakis and Oulis, 1999, Morphis et al 2000).
 However, further long-term clinical trials are necessary to determine that the clinical
longevity of the sealant retention is not adversely affected by the presence of
incorporated fluoride.
 Also the clinical importance of the fluoride in the fluoride containing sealants in terms
of caries prevention remains to be shown.

Fig. no 11: Maximum cavity protection by sealant and fluoride

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B TYPE OF FISSURE SEALANTS:-

FILLED AND UNFILLED:-

 Addition of filler particles to the sealant likewise appear to have little effect on
clinical results.
 Filled and unfilled sealants penetrate the fissures equally well, and have similar
retention rates.
 The filler makes the sealant more resistant to abrasion. The filler are coated with
products such as silane, to facilitate their combination with Bis GMA plastic.

LIGHT CURED AND CHEMICALLY (SELF) CURED:-

 Two methods have been employed to catalyse polymerization:-

 Light curing by use of a visible blue light.
 In the manufacturing of these products, a catalyst, such as camphoroquinone, which is
sensitive to visible blue light frequencies, is placed in the monomer at the time of
manufacture.
 Later, when the monomer is exposed to visible blue light, polymerization is initiated.
 Self-curing, in which a monomer and a catalyst are mixed together.
 With the auto polymerizing sealants, the catalyst is incorporated with monomer.
 In addition, another bottle contains an initiator- usually Benzoyl peroxide.
 When initiator and monomer are mixed, polymerization begins.
 Advantage of the light cured sealant:-
 The main advantage of the light cured sealant is that operator can initiate
polymerization at any suitable time.
 Polymerization time is shorter with light cured products than with self -cured
sealants.
 The light-cure process does require the purchase of light source whichever is the same
one that is used for polymerization of composite restorations making it available in all
dental offices.

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 Fig. no 12: Self- cure fissure
sealant

Fig no 13: LED light curing unit

Fig. no 14: Visible light cure material

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Precautions:-

1. When using a light-cured sealant in the office, it is advisable to store the product away
from light, which sometimes initiate polymerization.
2. Conversely, self-curing resins donot require an expensive source of light. However,
they have the great disadvantage that once mixing has started, if some minor problem
is experienced during application procedure, the operator must continue mixing or
stop and make a new mix. While using the autopolymerizing resin, time allowed for
sealant manipulation and placement must not be exceeded, even though the material
might still appear liquid once the hardening begins, it occurs very rapidly, and any
manipulation of the material during this critical time jeopardizes retention.
3. Light-cured sealants have a higher compressive strength and a smoother surface,
which is probably due to air being introduced into the self-cure resins during mixing.
Despite these differences, both photo cured and auto polymerizing products appear to
be equal in retention.

CLEAR AND TINTED (CLEAR VERSUS COLORED

SEALANTS):-

Fig. no 15: Clear, Opaque, tinted material

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  Both colored and clear sealants are available.

 They vary from translucent to white, yellow and pink. Both colored and clear sealants
in either the light curing or auto polymerizing forms are available. Selection of a
colored versus a clear sealant is a matter of individual preference. The colored
products permit a more precise placement of the sealant, with the visual assurance that
the periphery extends half way up the inclined place.

 The retention can be more accurately monitored by both the patient and the operator
placing the sealant may be considered more aesthetically acceptable.

REQUISITES FOR SEALANT RETENTION:-

The surface of the tooth must have following conditions for good sealant retention:

1. Have a maximum surface area

2. Have deep irregular pits and fissures
3. Be clean, And

Be absolutely dry at the time of sealant placement and contaminated with saliva.

These are the four commandments for successful sealant placement and they cannot be
violated.

1. INCREASING THE SURFACE AREA:-

 Sealants do not bond directlyto the teeth. Hence they are made to retain by adhesive
forces.
 This can be done by using tooth conditioners or etchants normally which are composed
of 30-50% concentration of phosphoric acid.
 These acids are placed on tooth surface prior to the application of sealant. Hence they
are made to retain by adhesive forces.
 This can be done by using tooth conditioners or etchants normally which are composed
of 30-50% concentration of phosphoric acid.

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  These acids are placed on tooth surface prior to the application of sealant. Hence they
are made to retain by adhesive forces.
 This can be done by using tooth conditioners or etchants normally which are
composed of 30-50% concentration of phosphoric acid.
 These acids are placed on tooth surface prior to the application of sealants.
 The etchant may be either liquid or gel form.
 The former is easier to applied and easier to remove.
 Both are equal in abetting retention.
 If any etched area on the tooth surface is not covered by sealant or if the sealant is not
retained, normal appearance of enamel returns to the tooth within 1 hour to a few
weeks due to re-mineralization from constituents in the saliva.

2. PITS AND FISSURE DEPTH:-

 Deep, irregular pits and fissures offer a much more favorable surface contour for
sealant retention compared with broad and shallow.
 The deeper fissures protect the plastic sealant from the shear forces occurring as a
result of masticatory forces.

3. SURFACE CLEANLINESS:-
 Thorough prophylaxis is advocated prior to sealant placement. Polishing prophylactic
paste should be preferably non-fluoridated and oil free mixture to avoid contamination
from the tooth surface, and also to get better etching in the enamel surface.
 Irrespective of the cleaning preferences i.e. either by acid etching or other methods, all
heavy stains, deposits, and debris should be off the occlusal surface before applying
the sealant.

4. DRYNESS:-
 The teethmust be dried at the time of sealant placement because present sealants are
hydrophobic.

 Presence of saliva on the tooth is even more detrimental than water because of its
organic components interpose a barrier between tooth and the sealant.

 Precautions:-

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 i. Whenever the teeth are dried with an air syringe, the air stream should be
checked to ensure that it is not moisture laden.
ii. It is advised to check for moisture, and it can be accomplished by directing the
air stream onto a cool mouth mirror; any fogging indicates presence of moisture.
 Methods maintaining dry field:-
i. Rubber dam:-
 The rubber dam provides ideal way to maintain dryness for an extended time.
 Under most operating conditions, however it is not feasible to apply the dam to the
different quadrants of the mouth; instead it is necessary to employ cotton rolls.

Fig. no 16: Rubber Dam

ii. Cotton rolls:-

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 Fig. no 17: method of placing cotton rolls

 Cotton rolls are the rolls for absorbing moisture from the oral cavity.
 Under routine operating conditions, cotton rolls with/ without the use of absorbent
pads can usually be employed as effectively as rubber dam for relatively short time
needed for the procedure.
 The most successful sealant studies have used cotton rolls for isolation.

Fig no 18: Cotton Rolls

PATIENT AND TOOTH SELECTION:-

 INDICATIONS:-
1. Presence of deep occlusal pits and fissures of newly erupted teeth
(molars and premolars).

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 2. Presence of lingual pits or palatal pits in relation to upper lateral
incisors and molars.
3. Presence of incipient lesions in the pit and fissure system.
4. Children and young people with medical physical or intellectual
impairment with high caries risk.
5. Children and young people with signs of higher caries activity and
coming with non-fluoridated area.
 CONTRAINDICATIONS:-
1. Presence of shallow pit and fissures of molars and premolars.
2. An open occlusal caries lesion with extension into dentine
3. Presence of large occlusal restoration.
4. Presence of proximal caries extending on to the occlusal
surface.
5. Partially erupted tooth where in isolation is problem.
6. Unco-operative children (getting adequate dry field is
problem).

DIAGNOSIS OF PIT AND FISSURE CARIES:-

 Visual dental examination is the starting point for dental assessment and treatment
planning.
 The assessment of occlusal surfaces is particularly challenging, due to their complex
morphology.
 The basic prerequisites for visual caries detection are clean, dry teeth and good
illumination.
 A systematic review of the accuracy of various caries-detection methods found that visual
methods for detecting enamel or dentine lesions on occlusal surfaces tend to be more
accurate at detecting surfaces without caries (specificity) rather than surfaces with caries
(sensitivity).
 Visual assessment using a probe also had high specificity and low sensitivity, which
suggests that the use of a probe does not improve the accuracy of detection of occlusal
dentine lesions.

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 Additionally, the use of a sharp probe has been shown to cause irreversible traumatic
defects in demineralized areas in occlusal fissures, favoring conditions for isolated lesion
progression.

•When the explorer catches or resists removal after insertion into a pit and fissure with
moderate to firm pressure.

• softens at the base of area

•Opacity adjacent to the pit & fissure asevidence of demineralization.

•Softened enamel adjacent to the pit & fissurethat can be scraped away with the explorer.

•By xero-radiographic & digital radiography, dyepreparation,fiberoptictrans-

illumination,ultrasonic.

TECHNIQUE FOR SEALANT APPLICATION:-

 The application of pit and fissure sealant, while inherently simple, is very technique-
sensitive, requiring attention to detail at all stages.
 There is very limited evidence on the best technique for each stage of the process.

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 Fig. no 19: Technique for fissure sealant

1. Time to seal
2. Surface cleaning
3. Isolation
4. Etchants and conditioners
5. Etched enamel and resin penetration
6. Washing and drying application
7. Mixing the resin
8. Sealant application
9. Testing retention
1) TIME TO SEAL:-
 There is good evidence for success rate of prevention of occlusal caries with use of pits
and fissure sealants if they are used early soon after eruption ofteeth.However application
of fissure sealant should be delayed until teeth are fully erupted.
 Recommendation:-
 In children and adolescents, priority should be given to sealing first and
second Permanent molar teeth.
 Routine application of sealants on primary molar teeth is not recommended, but may be
considered for selected high caries risk children.

2) SURFACE CLEANING :-

Fig. no 20: cleaning of tooth Fig. no 21: Cleaned tooth VS non-cleaned tooth

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  The surface to be etched and sealed must be thoroughly cleaned. A pointed bristle
brush, in a slow speed contra angle hand piece, is excellent for gross plaque
removal. It can be used with pumice, and it should be oil and fluoride free,
otherwise it may interfere with etching.
 After the occlusal pit and fissures with a pointed brush, it is frequently beneficial
to pull an explorer tine through all grooves. This will remove same of the deeper
plaque where the brush cannot reach. Then the tooth should then be washed with
water, and dried carefully prior to acid application.

3) ISOLATION:-
 Adequate isolation is the most critical aspect of sealant application.
 If enamel porosity created by the etching procedure is filled by any kind of
liquid, including saliva, formation of resin tags in the enamel is blocked or
reduced, and thereby the resin is poorly retained,
 Salivary contamination during and after etching also allow precipitation of
glycoproteins onto the enamel surface,greatly decreasing bond strength to the
sealant.
 If this occur re-etching is needed. Use of rubber dam is obviously the safest
way of securing optimal moisture control, however it is not practicable or
feasible in case of public health programmes.
 Keeping dry field must be obtained by the use of cotton rolls and isolation
shields.

Fig. no 22: Isolation

 Isolation procedure may frequently be extremely challenging, particularly in
the partially erupted tooth or in those children with poor co-operation.

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  After isolation teeth are thoroughly dried to remove any remaining saliva that
may hinder acid coverage of the enamel.

4) ETCHANTS AND CONDITIONERS:-

 Phosphoric acid in the range of 30-50% is best etching solution.
 It is important to etch approximately 2mm of either side of exposed groove such
as the buccal groove on mandibular molars or the lingual groove on maxillary
molars. So that there is sufficient areas of etched enamel for sealant application.
 If sealant is applied to un-etched enamel it will not bond or will eventually either
lift off the surface or fracture away from the main body of sealant.

Fig no.23 gel etchant

 DIRECTION OF USE:-

 It is best applied using a small mini sponge, but a cotton pellet and brush can also
be used.

 Tooth surface area is to be etched with acid for 20-60 seconds ( in accordance
with manufacturer’s instructions).

5) ETCHED ENAMEL AND RESIN PENETRATION:-

 Care must be taken, as the etching progresses, to treat the enamel surface very
carefully or not to rub the cotton pellet or sponge on the surface during acid
application, because this may damage the fragile enamel lattice work being
formed.

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  In the case of primary teeth and fluorosed teeth another 15 to 60 seconds of acid
etching is advocated, this is to compensate for greater acid resistance of enamel.
 The goal of etching is to produce an un-contaminated, dry and good etched
surface, which appear as frosted surface.
 Small variations in the concentration phosphoric acid do not appear to affect the
quality of the etched surface and showed no significant difference in retention of
pit and fissures sealants after one year follow up on second primary and first
permanent molar when 15, 30, 45, 60 seconds etching times were used.

6) WASHING AND DRYING:-

 The tooth is vigorously with water for about 20 seconds and dried with
uncontaminated compressed air for 20 seconds.
 Following this procedure dried tooth surfaceshould have a white, dull, and frosty
appearance. This is due to etching must have removed 5-10 microns of the
original surface, although at times inter-rod penetration of upto 100 micron may
occur.
 The etching does not always involve the inter-rod areas; sometimes central
portion of rod is etched and the periphery is unaffected. Hence this type of
etching greatly increases the surface area.

7) MIXING THE RESIN:-

 Special care should be taken to avoid the mixing of air bubbles during mixing of
the resins (chemical resins)
 Bubbles if present at the margin of tooth, resin can lead to marginal leakage at the
later period of time.

8) SEALANT APPLICATION:-
 Sealant material is then applied to the tooth according to manufacturer direction.
 Be careful not to corporate air bubbles in the material.
 With mandibular teeth apply the sealant at the distal aspect and allow it to flow
mesial and with maxillary teeth vice versa.
 After the sealant has set, the operator should wipe the sealant surface with a wet
cotton pellet.
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  With auto polymerizing sealants working time varies from 1-2 min & with
photoactive sealants 10-20 sec. for complete setting.
 A brush is preferred for sealant application to an etched surface.

Fig. no 24: Application of sealant with brush

 It is possible to pick up the sealant with certain small metal intruments, but
touching the fragile V-etched surface may result in damage to the etched enamel
prisms.
 Sealant application for UV curing system:-
 In ultraviolet curing systems, a brush can be used many times over, since the un-
polymerized resin can be easily cleaned from the brush.
 Sealant application for auto polymerizing:-
 In case of auto polymerizing systems, disposable brushes should be used as it is
not possible to completely remove all the resin from the bristles prior to
polymerization, and after one and two applications, the brush become clogged
with resin and un usable.
 Correct technique for material placement:-
 With either light cured or auto polymerized sealants, the material should first be
placed in the fissures where there is maximum depth.
 At times of penetration of the fissures is negated by the presence of debris, air
entrapment, narrow orifices, and excessive viscosities of the sealant.

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  The sealant should not only fill the fissures but should have some bulk over the
fissure.
 After the fissures are adequately covered, the material is then brought to knife
edge approximately half way up to the inclined plane.
 Following polymerization, sealants should be examined carefully before
discontinuing dry field.
 If any voids are evident, additional sealant can be added without the need for any
additional etching.
 Polymerization:-

Fig. no 25: Curing with

Blue Light

 The key
factor for

polymerization include curing time, distance of the light guide fromthe material
being cured, and thickness, shade and composition of the material being cured.
 Position the light-curing tip as close as possible to the surface being sealed and
curefor at least the recommended curing time

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 Fig no. 26: Googles for protection from blue light
 If more than one surface on the same tooth is being sealed, e.g. occlusal
andbuccal/palatal, cure each surface separately

 Protocols for testing the light output and curing performance of light curing
unitsshould be implemented in accordance with the manufacturer’s instructions.
 Manufacturer’s instructions for sealant materials and for curing lights should
beavailable in all dental surgeries.

9) TESTING RETENTION AND EVALUATING SEALANT

QUALITY:-

Fig. no 27: Testing of retention of sealant with probe

 Sealant retention should be checked with a probe after polymerization to ensure
that all fissures are completely sealed and evaluate sealant quality on the
following citeria
a) Marginal integrity
b) Pits and voids in the sealant
c) Overhangs
d) Heavy occlusion
 If any material is dislodged, the sealant should be reapplied after re-cleaning (if
necessary) and re-etching the exposed fissure.
 Recommendation:-

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  Sealant retention should be checked with a probe after application, and the
sealantre-applied, if necessary, repeating each step of the sealant application
procedure.

RETENTION OF SEALANTS:-
 Plastic sealants are retained better on recently erupted teeth than in teeth with more
mature surfaces.
 They are retained best on first molars than second molars.
 They are better retained on mandibular than on maxillary teeth. This is latter finding is
possibly due to the fact that the lower teeth are more accessible, direct sight is possible,
isolation of teeth is easier, and gravity aids the flow of the sealant into the fissures.

FOLLOW UP AND REVIEW:-

 All sealed surfaces should be regularly monitored clinically and radio-graphically.

Bitewing radiographs should be taken at a frequency consistent with the patient's risk
status, especially where there has been doubt as to the caries status of the surface prior
to sealant placement. The exact intervals between radiographic review will depend not
only on the risk factors, which may change with time, but also on the monitoring of
other susceptible sites, for example approximal surfaces.

 Defective sealants and/or preventive resin or glass ionomer restorations should be

investigated and the sealant reapplied in order to maintain the marginal integrity,
provided the surface is caries free.

MINIMALLY INVASIVE PREVENTIVE RESTORATIONS

(PREVENTIVE RESIN RESTORATIONS):-

 The choice between resin/composite and glass-ionomer sealants should be based on

adequacy of moisture control. Since the resins are most durable they should generally
be preferred, while glass ionomer cements should be used in cases where moisture
control is difficult, e.g. in erupting or newly erupted teeth. GIC sealants in these cases

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 are regarded more as a temporary sealant or a fluoride release vehicle, rather than a true
fissure sealant.

 Where there is a real doubt about the caries status of a susceptible site on clinical
examination, e.g. a stained fissure, then a bitewing radiograph should be obtained. If
there is unequivocal evidence that the lesion is confined to enamel then the surface can
be sealed and monitored clinically and radio-graphically.

 When the evidence is equivocal, then removal of the stained areas in the fissures
(enamel biopsy) should be performed, using rotating instruments.If the lesion extends
into dentine after removal of staining then a sealant restoration ("preventive resin/glass
ionomer restoration") may be placed. A more extensive cavity will require a
conventional restoration.

SEALING OF CARIOUS FISSURES:-

PLACEMENTS OF SEALANTS OVER CARIOUS AREAS:-

BACKGROUND:-
 It has been found that areas of incipient or overt caries often occur under many fissures,
which cannot be detected with the explorer.
 In some studies sealants have been purposely placed over small, overt lesions.
 When compared with control teeth, many of the sealed carious teeth have been
diagnosed as sound 3 and 5 years later.

DECREASE IN BACTERIAL GROWTH AND DENTIN SEALING:-

 In sealed lesions, no of bacteria recovered from the sealed area decreased rapidly.
 Resin sealants are able to stop further progression of carious lesions in pits and fissures,
even dentin lesions.
 The rationale for this approach is that the placement of a sealant isolates the carious
lesion from the surface biofilm.
 This suggests a therapeutic use for sealants in addition to a preventive one.
 However, it seems to be a general convention that the use should be limited to fissures
where the lesion seems to be confined to the enamel, and that dentin lesions should be

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 restored, preferably by the use of minimal intervention techniques, like the preventive
resin restoration.

Conclusion:-

 These studies appear to substantiate that there is no hazard in sealing carious lesion.

SEALANTS VERSUS AMALGAMS:-

 Comparing sealant and amalgams is not an equitable comparison because sealant are
used to prevent occlusal lesions that could have been prevented. Yet, comparisons is
necessary.
 One of the major drawbacks to more extensive use of sealants has been the belief that
amalgams not sealants,
 should be placed in anatomically defective fissure ;
 that belief stems from mis-informations that amalgams can be placed in less time,
and that once placed they are permanent restoration.
 Several studies have been addressed these suppositions.
 For example, sealants required approximately 6 to 9 minutes to place initially, whereas
amalgams 13 to 15 minutes.
 Many studies on amalgam restorations have longevityfrom only A few years to an
average life span of 8 to 10 years.
 In recent years, using later generations of sealant, along with the greater care in
technique used for their insertion, much longer retention periods have been reported.
 When properly placed, sealant are no longer a temporary expedient for prevention;
instead, they are the only effective predictable clinical procedure available for
preventing occlusal caries.
 Hence average life span of sealants can be comparable with that of amalgam.
 The most common cause for sealant replacement is loss of material, which mainly
occurs during the first 6 months;
 The most common cause of amalgam replacement is marginal decay, with 4-8 years
being the average life span.
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  To replace the sealant, only re-sealing is necessary.
 No damage occurs to the tooth.
 Hence it takes totally non-invasive.
 Whereas amalgam replacement usually requires cutting more tooth structure with each
replacement and it is totally invasive procedure.
 Hence placement of amalgam and replacement of amalgam restorations certainly
weakens the tooth structure and may be ultimately leads to loss of tooth
 Even if longevity merits are equal, sealant has advantage of being painless to applied to
apply and aesthetic, as well as emphasizing the highest objective of the dental
profession-prevention and sound teeth.

COST EFFECTIVENESS OF FISSURE SEALANTS:-

 There are no of factors to take into account when considering the cost effectiveness of a
procedure.
 It is difficult to be dogmatic about whether or not fissure sealant are cost effective.
 It depends on the value in terms of money that is placed on intangible benefits such as
the prevention of pain and suffering, the adoption of reversible, non-traumatic
procedure for the treatment of sticky fissures, and a change in attitude on the part of
both public and dental profession.
 Pits and fissures are generally recognized as highly susceptible to caries and least likely
to benefit from systemic or topical fluoride, and sealants to prevent caries and are
therefore considered cost effective.
 In one study 78% of first permanent molars that had had a single application of sealant
placed in pits and fissures were caries free compared with 31.8% for the unsealed
matched pairs.
 However, it is also recognized that the cost-effectiveness is dependent upon a number
of factors that are related to its use, e.g. the caries prevalence in the population; the
different tooth types (premolars, molars) sealed; whether all teeth and fissure sites are
routinely sealed or based on specific indications; the retention of the sealants; and to
what extent other caries preventive methods are used (e.g. fluoride varnish).
 The caries rate in premolars are generally lower than in molars, and in populations with
an average caries rate it has been calculated that 25-40 sealants must be placed in

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 premolars to save one surface from becoming carious, while the corresponding rate is 5-
10 for molars.
 If the retention rate is low, which is frequently the case if many 'difficult-to-seal-teeth'
are treated, the need for re-sealing and restorative treatment of carious fissures
increases, which reduces the cost-effectiveness.
 It has therefore been suggested that fissure sealants should not be routinely used in all
children and all teeth, but based on an individual risk-evaluation (Workshop on
Guidelines for Sealant use: recommendations, 1995).
 In the future Professions Complementary to Dentistry (PCD's) will play a significant
role in improving even further the cost effectiveness of sealants.

DIFFERENT STUDIES IN CONTEXT OF COST EFFECTIVENESS OF

FISSURE SEALANT SYSTEM:-

IRISH PUBLIC DENTAL SERVICE:-

 In the context of the Irish public dental service, where the interval between dental
assessment often exceeds two years, one of the key questions for this guideline
concerned the cost-effectiveness of providing pit and fissure sealants to all children
(‘seal all’ approach) or only to those at high caries risk (‘risk-based’ approach).
 A systematic review of the cost-effectiveness of fissure sealants undertaken for the
Haute Autorité de Santé guideline on fissure sealants32 analysed 13 economic studies
from the United States, Canada and Australia.
 Taking into account differences in study design and analysis, the limitations of
theevidence and of transposing findings from different health systems, the overall
conclusions were:
 Sealing the first permanent molars was cost-effective for children with high caries risk
 Data were contradictory when the population was not selected on any risk basis
 For children with low caries risk, cost-effectiveness was not shown in the medium
term, and long-term data were lacking.
 Follow up after several years was needed to see an effect.
 The available evidence did not allow the cost-effectiveness of fissure sealants to be
assessed for France.

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  SCHOOL-LINKED SEALANT PROGRAMMES:-
 Another systematic review which included only economic studies of school-based or
school-linked sealant programmes estimated that a programme sealing first permanent
molars would be cost saving if these molars were decaying at an average rate greater
than 0.47 surfaces per year.
 The authors suggested that decision makers could compare this threshold to caries
levels in their area, whilst admitting that “almost no data exist on annual caries
increment by type of surface”.

 DIFFERENT SEALANT DELIVERY STRATEGIES:-

 Two economic analyses compared the cost of three different sealant delivery
strategies:
a. ‘seal all’,
b. ‘risk-based’ and
c. ‘seal none’.
 Both studies found that, under baseline assumptions, the ‘riskbased’approach was the
most cost-effective strategy over a simulated 9 or 10 year period.
 The ‘sealall’ approach was the most effective, but also the most costly strategy.
Although both studies used published literature to inform their baseline assumptions,
their methodologies differed considerably, which may have contributed to the very
different costs reported for moving from a ‘risk-based’ to a ‘seal all’ strategy: $73.96
per saved tooth surface in the study by Griffin et al. and $0.96 for every year a cavity
was delayed in the study by Quinonez.
 However, the sensitivity of the results of both studies to changes in the baseline and
other assumptions reflects the uncertainty of these estimates.
 STUDY FROM FINLAND:-
 A third study from Finland compared treatment costs over approximately six years for
children who received dental treatment in two communities – one with a ‘seal all’
policy and the other with a ‘risk based ’ sealant policy.

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  The treatment provided was obtained from patient documents and the costs per child
(including sealant) were calculated using the private dental health care fee schedule
used in Finland.
 Costs per child were 21% higher in the ‘seal all’ area (€234.30) compared to the ‘risk-
based ’area (€184.20), due mainly to the higher costs for restorative treatment
required by children who had not attended for sealant in the ‘seal all’ area.
 However, there may have been fundamental differencesin the caries profile and risk
status of the ‘non-sealed’ children in the two areas: in the ‘seal all’ area, children
without sealant were non-attenders, which would suggest that they were likely to have
greater treatment needs when they did attend; in the ‘risk-based’ areas, children
without sealant were assessed as low risk.
 Differences in background preventive programmes and caries levels between the two
communities could also have biased the results of this study.
 Only one cost-utility analysis of fissure sealants has been published.
 This retrospective cohort study of,132 children continuously enrolled in the Iowa
Medicaid programme over a 4-year period found that while the cost of treatment
associated with sealed first permanent molars was higher than that for unsealed teeth,
the utility was also slightly higher. Sealing first permanent molars in low utilisers of
dental services (i.e. children with one preventive visit or less per year) was found to
be the most cost effective approach for prioritising resources.
 The applicability of economic analyses from other countries, which are based on
assumptions thatmay not pertain to the Irish context, is limited.
 The only Irish cost data on providing fissure sealants in the public dental service
comes from a thesis by O’Connor, which found that the labour cost persealant was
lower when the sealant was applied by a dental hygienist rather than a dentist.
 When updated to January 2010 salary scales, the cost per sealant was €3.66 for a
dentist/dental nurse team and €2.58 for a dental hygienist/dental nurse team, a cost
difference of 30%.

 DEPLOYMENT OF DENTAL HYGIENISTS:-

 In a public dental service, increased deployment of dental hygienists would be an
efficient way to ensure provision of fissure sealants to children who need them, both

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 in terms of direct labour cost, and the opportunity gain in ‘freeing up’ the more
expensive clinical time of dentists.
 Lack of data on other factors influencing the cost-effectiveness of providing pit and
fissure sealants within the public dental service, such as caries increment on first
permanent molars, rate of sealant loss and replacement, cost of assessing children for
a risk-based programme, cost of restoration (tooth colored and amalgam), and the
value of a sound tooth versus a restored tooth, indicate that primary economic
evaluation of sealant delivery in the public dental service is required.

 Conclusion:-
 Such evaluation should take into account the cost of early identification of high
caries risk children and subsequent recall until their permanent molars are sufficiently
erupted to be sealed, and should also consider the cost-effectiveness of outreach
programmes, such as the use of mobile units, to facilitatethe provision of sealants to
low utilisers of dental services.

SEALANT AS A PART OF A TOTAL PREVENTIVE

PACKAGE:-

 The sealant is used to protect the occlusal surface.

 A major effort should be made to incorporate the use of sealants along with other
primary preventive dentistry procedures such as plaque control, fluoride therapy, and
sugar discipline.

 Whenever a sealant is placed, a topical application of fluoride should follow if at all

possible.

 In this manner, whole tooth can be protected.

 In many public health programmes, however, it is not possible to institute full scale
prevention programmes, either because of apathy or lack of time and money.

 In such cases, there is some consolation in knowing that at least the most vulnerable
of all tooth surfaces (the occlusal)is being protected.

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PRESENT STATUS OF PIT AND FISSURE SEALANTS:-

By the mid of 1980’s most of the answers were available as to the need and effectiveness of
Bis-GMA sealants to reduce the incidence of occlusal caries, and technique of placement of
pits and fissures sealants were known.

The safety of their placement had been demonstrated that when placed over incipient and
minimally overt caries sites, there was no progression of caries as long as the sealant
remained intact. Finally, the sealants could be applied by properly trained auxiliaries, thus
providing an economical source of man power, both for private and government practices as
well as for large school and public health programmes.

It has been observed that there had been an increase in knowledge, but little change in
attitude concerning sealant use. And also it was found that pediatric dentists, who are
continually involved in treating children, placed more sealants than did general dentist again,
probably on account of negative attitude and lack of willingness among general practitioners.

The concepts and action of prevention are not being fully implemented in dental schools
faculties not to be educated about the effectiveness and methods of applying sealants.
Possibly acceptance of a model curriculum for teaching sealant usage would help.

The biggest concerns to a general dentist regarding pit and fissure sealant are:

Sealant do not lasts long in the mouth

Decay can be initiated or progresses under sealant. Based on the available scientific literature,
it would appear that concern of clinicians regarding poor longevity of sealant and problems
associated with inadvertent sealing of un-detected carious lesion is not justified.

Furthermore, there appears to be general agreement in the published literature that there
exists a positive relationship between sealant retention and occlusal caries protection. It is,
therefore, most unfortunate that such a large number of practitioners do not use pit and fissure
sealant.

Dental community must develop a consensus about the value and economic effect of
preventive measures.

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Other barriers to effective delivery include: state board restrictions on auxiliary placement of
sealant, lack of consumer knowledge of effectiveness of sealant and resultantly a lack of
demand for the product.

Economics and education of the profession and of public are the prime requisites for
expanded sealant acceptance.

Conclusion:-

Approximately 90-95% of all carious lesions that occur in the mouth occur on the occlusal
surfaces. Which teeth will become carious cannot be predicted: however, if the surface is
sealed with a pit and fissure sealant, no caries will develop as long as sealant remains in the
place. Recent studies indicate approximate 90% retention rate of sealant 1 year after
placement. Even when sealants are eventually lost, most studies indicate that the caries
incidence for teeth that have lost sealants is less than that of control surfaces that has never
been sealed.

Research data also indicates that many incipient and small overt lesions are arrested when
sealed.

Sealants are easy to apply, but the application of sealants is an extremely technique sensitive
procedure.

The surfaces that are to receive sealant must be completely isolated from the saliva during the
entire procedure, and etching, flushing and drying procedures must be timed in such a way
that it should ensure adequate preparation of the surface of sealant.

Sealants are competitive with amalgam restorations for better survival and longevity and do
not require the cutting of tooth structure. Sealants should not cost as much to place as
amalgams. Despite their advantages, use of sealants has not been embraced by the dental
profession.

Even when small and overt pits and fissure lesions exist, they can be dealt with
conservatively by use of preventive dentistry restorations. What now appears to be required is
that the dental schools should teach sealant usage, the dental profession should use them, the
hygienist and the auxiliary personnel must be permitted to apply them more judiciously?

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The accurate documentation of clinical trial and education of practitioners and general public
must be under taken regarding dental health benefits, especially of school going children who
are at risk of development of fissure caries, while using pit and fissure sealants.

SEALANTS IN CARIES MANAGEMENTPROGRAMME:-

 Identification of a patient at risk of decay.

 A thorough assessment of all aspect of patient’s life affecting the development of
caries.
 Appropriate examination to determine the tooth surface at risk.
 Appropriate technique and manufacturers guidelines need to be followed.
 Step need to be taken to ensure reversal of the decay balance from demineralization to
re-mineralization.
 Monitoring and repair just like any other caries management programme.

PARENT EDUCATION:-

 Educating parents and patients on the importance of dental sealants is critical.

 Dental sealants are cost effective treatment modalities when placed on the teeth of
children at high risk for dental caries.

SUMMARY:-

 Sealant will be adopted as a standard of care for prevention of pit and fissure caries.
 To make significant gains in caries reduction in child and adult population is
necessary for the dental profession to educate and inform the general public.

……………………….THE END……………………….

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REFERENCES

1. Teeth sealants for children and young people informedhealthonline.org

2. Resin Dental Sealants and Bisphenol A Oral Exposure bisphenol a.org
3. Environmental Health Perspectives. Chemical Exposures: No Dental Dilemma for
BPA nlm.nih.gov
4. Researchers Analyze Impact of Chemical BPA in Dental Sealants Used in Children.
Summary statement of research at Mount Sinai School of Medicine sciencedaily.com
5. CDA position statement cda-adc.ca
6. ADA position statement ada.org

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 7. Boksman L. Gratton DR. McCutcheon E. Plotzke OB. Clinical evaluation of a glass
ionomer cement as a fissure sealant. Quintessence International 1987; 18(10): 707-
709.
8. British Society of Paediatric Dentistry. Policy Document on Fissure Sealants in
paediatric dentistry. International Journal of Paediatric Dentistry 2000; 10:174-177
9. Carvalho JC, Ekstrand KR, Thylstrup A. Dental plaque and caries on occlusal
surfaces of first permanent molars in relation to stage of eruption. Jounal of Dentalt
Research 1989; 68(5): 773-779.
10. Carvalho JC, Thylstrup A, Ekstrand KR. Results after 3 years of non-operative
occlusal caries treatment of erupting permanent first molars. Community Dentistry
and Oral Epidemiology 1992 ; 20 : 187-192.

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