The Failures of Dental Sealants: Weigh the Pros and Cons with Dental Patients

“Too often when a sealant fails, the decay has already reached the pulp resulting in extensive, expensive restorative work. In retrospect, a patient who had a healthy, virgin tooth now has a diseased one.”

The importance of a dental sealant is to protect and prevent tooth decay. Dental sealants are one of the most widely used protective materials, as well as the most mistakenly used product today. Sealants have a lifespan of five to 10 years, but it’s imperative that you check them at every dental check-up visit to make sure they haven’t chipped or worn down over time. The slightest chip or break can lead to a leak and trap food and bacteria underneath, which can cause rot.

Dental caries by definition “is a disturbance of the balance between loss and gain of mineral elements from the surface of the tooth”.¹ Nutrient deficiency from our teeth develops from the collection of bacteria found in our mouth from daily consumption of foods and drinks that develop acids while saliva and fluoride provide minerals to our teeth. While this is happening, there is a counterbalance and if this is altered due to continued intake of fermentable carbohydrates, poor oral hygiene and/or insufficient fluoride intake, the loss of minerals is significantly greater than the gain which can cause tooth decay. .

Dental sealants are a preventive procedure, minimally invasive, that promotes early intervention to avoid the creation of carious lesions in the cavity and fissures of premolars and molars. These pits and crevices are the biting surfaces of the teeth and are most susceptible to harboring plaque and bacteria. causing carious lesions. Dental sealant seals these cavities and fissures to prevent plaque and bacteria from collecting. Some indications and contraindications for placement are:

Indications for sealants

• History of dental caries
• Deep grooves and cracks
• Poor oral hygiene
• Enamel defects

Contraindications for sealants

• Shallow pitting and split grooves
• Teeth that have been restored
• Good oral hygiene
• Patients at high risk of caries

What happens when a dental sealant fails?

The most critical integral step in sealant placement and the rationale for most sealant failures is placement efficiency. “Eighty percent of tooth decay in young permanent teeth occurs in pitted and fissured areas, and sealants have proven to be a very useful preventative tool.”¹

However, the success of the application does not always go smoothly. Most sealants are placed on children and a dry, clean environment is required for the sealant to adhere and work effectively. It is difficult to keep a child not only stable and still, but also the mouth area dry and free of drool. “For this reason sealant success is now measured by the length of time a sealant remains on the tooth, rather than by the wear that occurs on sealed and unsealed teeth. A pit and fissure sealant’s ability to prevent caries is largely dependent on its ability to adhere to the tooth surface.’¹

The use of acid etching systems or adhesives prior to the application of dental sealants may increase retention. However, improper application is the leading cause of dental sealant failure. In a four-year clinical evaluation of sealants, “the sealant was fully retained in 50% of all paired permanent teeth at 48 months. Of the 689 pit areas that retained sealant, 95% were rated as having severe substance loss.”²

The main cause of dental sealant failure is improper placement that allows saliva contamination. This may be due in part to the lack of experience of the clinician, the lack of cooperation with the patient, and the insufficient amount of sealant used. When a sealant fails, overtime bacteria leaks and lodges underneath releasing acids that eat away at the enamel. Under a sealant, the color changes to brown or dark brown and grows over time and eventually assimilates into the pulp of the tooth causing pain as well as extensive treatment such as a possible pulpotomy. There are several factors that can help the sealant retain.

These include:

• Isolation and prevention of saliva.
• Operator experience and proper technique.
• Proper tooth preparation: cleaning bacteria and debris before placing the sealant. and
• Not applying sealants to partially erupted teeth.¹

Dental sealants areit is not permanent and usually lasts about five years. They act as natural barriers to the surface of the teeth and, if not properly fitted, can lead to enamel removal. After placement, normal wear may occur on the occlusal surface and possibly chip off. It becomes dire when a sealant wears or cracks due to its ability to harbor bacteria underneath, causing decay.