Flossing or not is done the dental question of the summer. However, there is not much strong evidence to support its ability to prevent tooth decay or gum disease dentists point out that this does not mean It does not suit do these things. (Plus, do you really want that bit of spinach in your teeth all afternoon?)
However, there is something that has been shown to be very effective in preventing tooth decay, reducing the risk of developing it in children’s permanent teeth by 76 percent: dental sealants, which coat the biting surfaces of molars to protect their corners and crevices from the plate and wear. “In my world of public health, these results are amazing,” he said Jane Kopelman, director of research for the Pew Charitable Trusts’ dental campaign. The problem is that sealants, which have been around for decades, are underutilized, especially for children who need them most.
Data from the Centers for Disease Control and Prevention show that 41 per cent of children aged 6 to 11 had at least one dental filling on a permanent tooth in 2011-12. But the real indicator that sealants aren’t being used enough is that many children and teens still have cavities in their permanent molars, said William Maas, a public health consultant and former director of the oral health division at the CDC. Government figures show that 21 per cent of children aged 6 to 11 and 58 per cent of young people aged 12 to 19 had cavities in permanent teeth in 2011-12.
Decay leading to cavities is a process. Early on, the bacteria release acids that erode the tooth, causing damage that can appear as white spots. If the decay persists, it can lead to tiny holes called cavities. But when a dentist applies a liquid sealant to the cavities and crevices of the molars, it hardens to create a protective barrier. And according to recently updated practice guidelines by the American Dental Association and the American Academy of Pediatric Dentistry, sealants can prevent the onset of tooth decay and can also prevent early stage tooth decay from progressing into a cavity. Ideally, they are applied immediately after the tooth comes in, before tooth decay begins, and last for several years.
The team’s analysis of nine randomized trials finds that, assuming a 30 percent risk of tooth decay, every 1,000 sealant applications would prevent 207 cavities after two or three years of follow-up. They recommend that clinicians “redirect efforts toward increasing the use of sealants” on the occlusal surfaces of primary and permanent molars in children and adolescents. (There is less data on their use in primary teeth.) The groups did not make a recommendation for adults, saying there were no studies that applied to them.
While the practice recommendations apply to all children and adolescents, dentists say some children will benefit more. “The population I’m most concerned about are those we’re not sure will come [to the dentist] every year,” Maas said. In 2011-12, about 22 percent of children ages 6 to 9 had untreated caries in primary or permanent teeth. A whopping 44 percent of children in that age range without insurance coverage had untreated tooth decay. (The Affordable Care Act requires plans to include dental coverage for children, but those requirements were in effect until January 1, 2014.)
Even low-income children whose health care is covered by Medicaid, which mandates dental benefits, often don’t get regular care, Koppelman said. “We know where we can reach these kids – at school,” he said. Pew monitors the performance of state school sealant programswhich typically involve dental hygienists bringing equipment to schools to provide sealants to at-risk second- and sixth-graders. Research has shown that children who get sealants through these programs had an average of 50 percent fewer cases of tooth decay four years later compared to kids who didn’t.
If your child sees a dentist regularly, sealants may be a good idea because “we don’t know which kids are at risk,” she said. Richard Niederman, professor and chair of epidemiology and health promotion at New York University College of Dentistry. Not every child needs them. if he doesn’t seem prone to cavities, doesn’t eat a lot of sugar, or doesn’t have deep fissures, for example. (The American Dental Association and the American Academy of Pediatric Dentistry say clinicians need tools to be able to assess which teeth are most likely to develop cavities down the road.)
The ODA and the AAPD note that there was concern about bisphenol A, or BPA, which is in some sealants and has estrogen-like effects that some worry could harm health. But they say the chemical is only present in very small amounts, for a short time after the sealant is applied. ONE 2008 review determined that the data do not indicate a risk of exposure and a 2010 literature review recommended the use of sealants, although it also recommended reducing exposure with measures that include gargling or cleaning the mouth after application.
But you may need to ask for sealants. Research shows that dentists don’t always follow the ADA’s lead, particularly when it comes to recommending that early signs of tooth decay can be safely treated with sealants. ONE survey of dentists published in 2011 in the Journal of the American Dental Association found that 40 percent of respondents said it was not good practice to seal early lesions, despite the ADA’s recommendations, which were first published in 2008. (They may think it won’t stop wear and tear and that it will continue under the sealant.) “There may be a lack of awareness or familiarity with the elements,” he said Marisol Tellez-Merchánassociate professor at Temple University’s Kornberg School of Dentistry and author of the study.
Sealants are also about one-third the cost of a filling, according to Pew. And in the long run, filling instead of sealing an early lesion can lead to a cycle of ever-larger fillings and eventual tooth replacement. “Once you open a tooth, you lead to more restorations over time,” Tellez-Merchán said.
DDS is a surgical degree and it can be difficult to change the mindset away from drilling when it comes to decay. “A lot of people feel in their heart that this is an infection and you have to get rid of it,” he said. Tim Wright, distinguished professor of pediatric dentistry at the University of North Carolina at Chapel Hill School of Dentistry and author of the updated guidelines for sealants. But change isn’t impossible: this 2011 study also found that 24 percent of dentists surveyed didn’t seal early damage but were willing to consider it.
