Sealant application is a non-invasive technique that prevents tooth decay by sealing the pits and fissure of the teeth. They are not only carried out in clinics but also in schools and community levels for the prevention of caries. Sealants or dental sealants are materials that are used in the procedure of teeth sealing.
These materials look like plastic that is applied on the top chewing (occlusal) surface for the protection of the teeth that are at back i.e. molars and premolars. Application of sealants is considered one of the easiest dental procedure and usually completes in a single visit.
Why should you go for teeth sealing?
We know that brushing our teeth is important. But the application of dental sealants acts as extra protection.
Sealants cover our teeth like a film to avoid the tooth decay process. A newly erupted tooth in children requires dental sealants since the tooth won’t be resistant to decay as compared to an adult tooth.
An adult tooth becomes resistant over time with the help of fluorides present in drinking water, toothpaste, or any other source.
If the sealants are applied on time, then they can help to save our time and money that are spent on treating a decayed tooth.
How do sealants work?
Anatomical grooves, also called as pits and fissures, are present on molars and premolars. They can trap food particles and promote the presence of bacterial biofilm, thereby increasing the risk of developing caries.
Sometimes, even proper and regular brushing habits might not be enough as bristles may or may not reach caries prone areas.
Dental sealants act as a protective barrier that makes the tooth surface smooth enough to avoid the entrapment of the food particles.
How are sealants applied?
The application of sealants is as easy as painting with a paintbrush. The process usually completes in a single visit and it is a pain-free procedure. The following steps are involved –
Cleaning of Tooth
The dentist first removes the plaque or food debris entrapped in the pits and fissures of the teeth. The cleaning can be done using toothbrush prophylaxis by using a bristle brush or pumice with water rinsing.
It is not suggested to use fluoride toothpaste for cleaning teeth since fluoride makes the tooth surface less reactive to the applied etchant which would further reduce the bond strength of the sealant. (1)
Air abrasion technique can also be used to prepare the tooth surface for sealant application. (2)
Adequate isolation is the most crucial aspect of the process of sealant application. Any form of salivary contamination during or after the acid etching will affect the bond strength.
The cleaned tooth is now air-dried using compressed air and proper isolation is achieved by putting cotton rolls around the tooth.
The best way to isolate is by using a rubber dam. Rubber dams if placed correctly will provide the most controllable isolation, especially for an operator working alone.
Acid etching or acid conditioning technique is a vital step in the sealant application. The introduction of acid etching technique has proved to be very useful in bonding the sealant to the tooth surface.
An etchant is a solution that is applied to the tooth surface to roughen the surface. A rough surface is required for the sealant to adhere to the tooth surface. The etchant material is allowed to stay on the tooth for 15-20 seconds.
Primary teeth require more etching time than permanent teeth. It is because primary teeth have more organic content in the enamel than the permanent ones.
The tooth is sensed with water for proper removal of the etchant. The duration of rinsing should be enough for the removal of the etchant.
The tooth is rinsed with water and dried again using compressed air. A fresh cotton roll is placed around the tooth to achieve proper isolation for the sealant application. The surface of an etched tooth, when completely dried, will exhibit a chalky and frosty appearance.
The application of sealant to all the pits and fissures of the tooth is performed to obtain maximum caries protection. The liquid sealant is applied on the tooth surface using a brush and cured with a UV lamp. This sealant sets as a solid plastic film on the tooth surface.
Sometimes, small bubbles may arise in the sealant when applied. They should be removed using a probe or a brush before placing the UV light on it.
In a study, it was found that the longer the sealant was allowed to sit on the tooth surface, the more the sealant penetrated the microporosities, which is vital for the retention of sealant. (3)
The applied sealant on the tooth is inspected for complete coverage, the absence of bubbles and voids. It should be done visually and tactfully using an explorer.
For evaluating the strength of sealant, an attempt should be made to dislodge the sealant.
If the sealant dislodges, then the tooth should be inspected for any debris in the fissures, which would be responsible for the weak bonding of sealant to the tooth. If there are small voids, then they can be refilled by reapplication of the sealant.
CCC system of evaluation
Assessment of the sealant can be done using the CCC sealant evaluation system (4).
- C – Colour – To indicate the color of the sealant (clear, tinted or opaque).
- C – Coverage – To indicate the areas covered/missing parts of sealant.
- C – Caries – To indicate the caries status on the surface.
Who can go for dental sealants?
Children between the age group of 6-13 years are the ones who are most benefitted from sealants. It is the perfect time to apply the sealants as new permanent teeth erupt in the oral cavity which needs extra attention and protection. (5)
Even adults can go for dental sealants if they have no caries. Susceptibility to caries should always be a prime consideration over the age of the patient.
Other factors which are considered based on clinical judgment are –
- Oral hygiene.
- Familial history of dental caries.
- Fluoride environment (daily intake).
- Tooth morphology.
- Dietary habits.
What makes sealants good?
Sealants do meet some necessary yet important requirements for their maximum potential. The Dentist should check these requirements before using them on their patients. Some of these requirements are –
- Good flow.
- Short setting time.
- Chemically inert.
- Reduced polymerized shrinkage.
- Anti- Cariogenic.
- Good bond strength with enamel.
- Thermal conductivity- should be the same as the tooth.
- High abrasion resistance.
- Decreased water solubility.
Dental sealants usually last for several years but regular dentist visits are required to ensure that they do not wear away easily.
Even if they wear away, you must get a reapplication done by the dentist to prolong the protection for your teeth.
Sealants don’t replace or substitute proper oral hygiene routine which you must follow regularly. Proper brushing and flossing will always be essential for our teeth, with or without sealants.