Last year, I joined a team of volunteer dental hygienists on the Seal Grenada dental outreach program that aimed to place 1000 sealants on children in Grenada over 5 days. Not only did we reach our goal, we almost tripled it! While that’s something to cheer about, here’s something we shouldn’t. Every day I was there, I pulled a permanent molar from a child under 10 years old. Why; Because the gum disease was so extensive and deep that the teeth would not restore. It was devastating. These extractions could have been prevented with dental sealants.
Dental sealants work and we need to do more of them. Read answers to common questions about sealants. Let’s aim to save teeth by placing more dental sealants.
How effective are dental sealants?
- The Centers for Disease Control and Prevention states, “Dental sealants prevent 80% of cavities over 2 years in back teeth, where 9 out of 10 cavities occur.”1
- The American Academy of Pediatric Dentistry (AAPD) states, “…sealants are effective in preventing and arresting occlusive caries with pits and fissures of primary and permanent molars in children and adolescents compared to no sealants or the use of fluoride varnishes ».2
- A Cochrane systematic review states, “Our review found moderate-quality evidence that resin-based sealants reduced caries by between 11% and 51% compared with no sealant when measured at 24 months.”3
Who can place dental fillings?
- Dentists
- Registered Dental Hygienists
- Certified dental assistants
What are the indications for sealants?
- Primary or permanent teeth
- Teeth with deep grooves
- Any age
- No dentine decay
- Moderate to high risk of caries
- Cooperative patient
What are the contraindications for sealants?
- Decay in dentin
- Allergy to materials
- Uncooperative patient
How do I determine if the tooth needs a filling?
- Assess the tooth using visualization and an explorer
- X-rays are not required, but can be helpful along with other ways to detect tooth decay
- Determine the depth of decay
- Determine if sealants can be placed based on the International Caries Detection and Assessment System (ICDAS). Sealants can be placed on teeth with ICDAS 0-3 (resonant tooth surface to enamel caries)4
- Determine your caries risk using a guide such as the ADA Caries Risk Assessment5
Which sealant should I use?
A report by the American Dental Association and the AAPD does not recommend one material over another.6
The various materials that can be used for sealants are:
- Glass Ionomer
- Resin based
- Resin modified glass ionomer sealant
- Polyacid modified resin sealant (compomer)
Choose the material that works best in your hands.
Glass ionomer has the advantage of being moisture resistant. A glass ionomer sealant should be chosen when it is difficult to isolate the tooth.
Which of the following teeth should get a sealant?
ONE)
SI)
DO)
HEY)
Answer: All of them.
- This tooth has deep cavities and fissures with enamel caries. Suitable for sealant.
- This tooth has deep pits and fissures with partial loss of sealant. Some parts of the pits and cracks have intact sealant while other parts are unsealed. A sealant can be placed over the existing sealant and unsealed pits and cracks.
- This tooth is partially elongated with decalcification. A glass ionomer sealer should be used as it cannot be isolated for a resin based sealer.
- This tooth has healthy tooth structure with deep pits and fissures. The client has caries on other teeth. A dental sealant is indicated as the client has a high risk of caries.
conclusion
Let’s place more dental sealants! They are effective, painless, inexpensive and can be installed quickly. Placing sealants prevents the unnecessary need to restore and extract teeth due to decay and cracks.
I will be returning to Grenada in August to volunteer in the second year of Seal Grenada. I hope to place more seals and export less. We need more volunteers to achieve our goal of preventing tooth decay in a country with low access to dental care. Would you like to come with me? Contact me at sanjuktamohanta@hotmail.com or send me a DM on Instagram @drsanjmohanta
bibliographical references
- Centers for Disease Control and Prevention. (2021, March 29). Dental sealants. Centers for Disease Control and Prevention.
- Clinical practice guideline for the use of hole and fissure sealants. Pediatr Dent. 2016 Oct;38(6):263-279. PMID: 27931466.
- Cochrane Library. (2017, July 31). Hole and fissure sealants to prevent caries in…
- Gugnani, N., Pandit, IK, Srivastava, N., Gupta, M., & Sharma, M. (2011). International caries detection and assessment system (ICDAS): A new concept. International Journal of Clinical Pediatric Dentistry.
- American Dental Association. (2023, July 18). Caries risk assessment and management. American Dental Association.
- American Academy of Pediatric Dentistry. (2016). Use of sealing holes and cracks.
About the Author
Dr. Sanjukta Mohanta is a general dentist practicing in Brampton, Ontario. He graduated from the University of Toronto, School of Dentistry in 1999. He founded the New Dentist Study Club and hosts their podcast. You can contact her on Instagram @drsanjmohanta @newdentiststudyclub
