Many of us know the stereotypical grandmother’s house. Plastic runners on the floor to protect the carpet, plastic covers on the couch for the upholstery and the clear plastic tablecloth to protect the actual table cloth. Funny as it sounds, couches floors and tables protected by a plastic cover stay looking like new for many years. Kids teeth are exactly the same, protected with a plastic sealant they can remain cavity free through those tough adolescent years and beyond.
Let’s begin with a little history of dental sealants. Dr. Michael G. Buonocone is credited with the introduction of dental sealants in the 1960’s. The practice was first called enamel bonding and started to slowly spread through the dental community. In 1971 the ADA officially recognized sealants and endorsed their placement. Today sealants are routinely placed on erupting adult teeth.
But why do we place dental sealants? Adult teeth are formed from 5 “lobes” of enamel that grow together. Think of 5 balloons that are pushed together, where two balloons meet you have a fissure, where three or more meet you have a pit. Unfortunately these pits and fissures do not fully seal together. If you were to pour water on top of the 5 balloons it would seep through the pits and fissures. Just like water seeping through the balloons bacteria can penetrate deep into the tooth.
Even with perfect oral hygiene these pits and fissures are impossible to clean. Pit and fissure decay makes up a majority of childhood cavities. Placing a plastic cover to seal the pits and fissures prevents bacteria from penetrating in the tooth and from causing decay in these highly susceptible areas.
How are sealants placed? The original method to place sealants has changed little over the years. The tooth is acid etched to roughen the surface and allow proper bonding of the sealant. A runny resin is then placed over the surface of the tooth and light cured. There is no need for numbing and, other than having to open really wide, it is painless and quick. Occasionally sealants come off and need to be replaced.
What teeth do you place a sealant on? Normally the adult posterior adult teeth are at the most risk; they are in the mouth the longest and have the largest pit and fissure area. For that reason they are the most important teeth to seal. The premolars can be sealed if the pits and fissures are deep and susceptible to cavities. Baby teeth usually do not need sealants because they do not develop deep fissures like the adult teeth.
The Problem With Sealants
New research has shown some weakness in the way sealants have been placed in the past. Cavities can be found under approximately 90% of sealants according to research done by Dr. Gordon Christensen of Clinical Research Associates. The previous idea that bacteria caught under the sealant would be trapped under the sealant and die due to lack of food and oxygen is frankly wrong. Studies show that there is enough crud caught in the fissures and pits to allow the bacteria to penetrate into the tooth where a new food source is found in the dentin. In addition most of the bacteria can live both with and without oxygen so they don’t suffocate.
The "New Sealant
The new method to place sealants solves these problems. Sealants by Dr. Nathan Saydyk are placed as follows. First the tooth is cleaned with an air/water/pumice polisher, basically a sandblaster. This cleans all of the “bug poop” and plaque out of the pits and fissures. The clean tooth is then inspected; if bacteria still remain in the pits or fissures as indicated by remaining stain then removal of the bacteria is necessary prior to sealing. The bacteria are removed using a very small “fissurotomy” bur or drill bit that cleans and widens the fissures and pits. If the decay goes past the enamel and into the dentin then a small filling is needed.
If the tooth is clean of bacteria and stain then the tooth is cleaned and etched with an acid solution. The tooth is then bonded and sealed using the same filling material that we use in a normal filling. This material is very strong and long lasting. A sealant placed in this manner should be expected to last the life of the tooth with proper maintenance, i.e. 6 month cleanings and good home care.
When Should a Tooth be Sealed?
Ideally we want to seal a tooth no longer than 6 months after it erupts. The first molars will erupt around age 6 and the second molars around are 12.
How Much Does a Sealant Cost?
A sealant is priced at around $50 per tooth. With insurance that price is usually lower and many time covered at 100%. A filling costs $153 at the cheapest, 3 times more than a sealant, and is usually not fully covered by insurance.
If your you have any questions about sealants or any other dental topic you can contact us ask Dr. Saydyk at Stoneridge Dental.
