1. Dental Sealants Chapter 59 1
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2. Chapter 59 Lesson 59.1
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3. Learning Objectives Pronounce, define, and spell the Key Terms.
Describe the purpose of dental sealants.
Describe the clinical indications for dental sealants.
Describe the contraindications to dental sealants.
Describe the two types of polymerization.
(Cont’d)
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4. Learning Objectives
(Cont’d)
Discuss the rationale for filled and unfilled sealant materials.
Demonstrate the steps in the application of dental sealants.
Describe and demonstrate the safety steps necessary for the patents and the operator during sealant placement.
Explain the most important factor in sealant retention.
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5. Introduction
Dental sealants are highly effective in preventing dental caries in the pit and fissure areas of the teeth.
Dental sealants, made of a resin material, are applied to the pits and fissures of teeth to prevent dental caries.
A dental sealant is successful only if it firmly adheres to the enamel surface and protects the pits and fissures from the oral environment.
(Cont’d)
As part of a complete prevention program, dental sealants, sometimes called pit and fissure sealants, are indicated for selected patients.
Which dental caries preventive agent protects smooth surfaces best? (Topical fluoride.)
What dental caries preventive agent protects the pits and fissures found on occlusal surfaces and pits on buccal and lingual surfaces best? (Dental sealants.)
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6. Introduction
(Cont’d)
Pits and fissures are fossa and grooves that failed to fuse during development.
Bacteria accumulate in the narrow pits and fissures.
Even a single toothbrush bristle is too large to enter and clean pits and fissures.
The sealant acts as a physical barrier.
Dental sealants are a noninvasive means of preserving tooth structure and at the same time preventing dental decay.
Why are dental sealants the best defense against occlusal caries formation?
A barrier must be created between the vulnerable pits and fissures of the tooth and the oral environment.
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7. Fig Scanning electron micrograph (SEM) of occlusal pits and fissures. (From Daniel SJ, Harfst SA: Mosby’s dental hygiene: concepts, cases, and competencies–2004 update, St Louis, 2004, Mosby.)
Notice the crevice-type appearance of fissures and pits viewed on this occlusal surface.
Sealants are recommended for primary and permanent teeth that have pits and fissures.
Where are pits and fissures located on the teeth surfaces?
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8. Fig. 59-2 Micrograph showing toothbrush bristle in a groove.
Even though toothbrush bristles are thin and fine, access into the minute pits and fissures is impossible.
Areas that cannot be accessed during toothbrushing and flossing to remove harmful microorganisms are vulnerable to caries formation.
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9. Fig. 59-3 Molar with a properly placed sealant.
Notice that the deep, vulnerable pits and fissures viewed on the previous slides now are sealed and smooth for easier cleaning and removal of harmful microorganisms by toothbrush bristles.
The sealant material used on the molar pictured on the slide is opaque or white; opaque dental materials are often referred to as “tooth-colored” materials.
Dental sealants are made of a resin material; currently most sealants are made of bisphenol A diglycidylether methylacrylate, or Bis-GMA.
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10. Sealants and Existing Caries
During sealant placement, some bacteria will be trapped beneath the sealants.
Some teeth with very small initial carious lesions may be inadvertently sealed.
Numerous studies have shown that neither of these occurrences will increase the chance of caries development or that caries will grow beneath the sealant.
Several studies have shown that the number of bacteria in small, existing carious lesions that had been sealed decreased dramatically with time.
What is the most common microorganism responsible for the formation of dental caries? (Streptococcus mutans.)
What type of bacteria is a S. mutans? (Aerobic.)
If the microorganisms are cut off from oxygen after the placement of dental sealant, will they survive? Why or why not? (No, because they need oxygen to survive.)
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11. Indications for Dental Sealants
Pit and fissure sealants are especially useful for selected patients through the caries-active period (ages 6-15 years).
Sealants are indicated:
For teeth with deep pits and fissures
Preferably in recently erupted teeth (<4 years)
Sealants should be used as part of a prevention program that includes the use of fluorides, dietary considerations, plaque control, and regular dental examinations.
When current caries lesions and previous restored teeth exist, newly erupted teeth should be treated promptly with dental sealants.
Which other patients would benefit from the placement of dental sealants as part of a caries-prevention program?
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12. Contraindications to Dental Sealants
Lack of pits and fissures
Apparent occlusal decay
Interproximal decay
Insufficient eruption of a tooth
Soon-to-be-lost primary teeth
Poor patient cooperation in the dental chair
What tools or methods can be used to determine whether contraindications to dental sealants exists?
Who can determine whether an area viewed clinically or radiographically may have dental caries or is susceptible to dental caries formation?
Who can diagnose dental caries and determine which teeth should or should not be sealed? (The dentist.)
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13. Types of Sealant Materials
A wide variety of sealant materials are available on the market.
The dental assistant should have a thorough understanding of the characteristics of the various sealant products that are available.
Sealants are classified by their method of polymerization, their sealant content, and their color.
What does the term “polymerization” mean? (It is the process of changing a simple chemical into another substance containing the same elements.)
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14. Fig Sealants should be used as part of a comprehensive preventive program. (Courtesy of Ivoclar-Vivadent, Amherst, N.Y.)
Pictured on this slide is Helioseal Clear sealant material.
Sealant kits contain all of the dental materials needed to place the sealant; additional disposable equipment may be included.
Accessory materials and instruments may be needed as well, including cotton roll, gauze, a saliva ejector, a dental mirror, cotton forceps/pliers, an explorer, dental floss, a disposable prophy angle, and articulating paper.
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15. Method of Polymerization
The major difference among the materials is the method of polymerization (setting). The two types are comparable in bond strength and rate of retention.
Self-cured materials are supplied as a two-part system (base and catalyst). When these pastes are mixed together, they quickly polymerize (harden).
Light-cured sealants do not require mixing. After the material has been placed, it hardens during exposure to a curing light.
Self-cured materials usually set within 1 minute of application. It is important to place the material before the initial stage of hardening or curing begins.
Light-cured materials are available in a one-step delivery system in which the material is provided in a light-protected preloaded syringe and is ready for direct application to the tooth.
What is an advantage to using light-cured sealant material?
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16. Color of Sealant Material
Sealants may be clear, tinted, or opaque (white).
Tinted or opaque sealants are more popular because they are easier to see than clear sealants during application during checks for sealant retention on subsequent office visits.
Some brands have a tint that is visible during the application but turns clear after polymerization.
Why are clear sealant materials still used even though tinted or opaque materials are easier for the clinician to use and identify later?
Does the color of the sealant affect retention?
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17. Fillers Sealant materials are available as filled or unfilled resins.
The purpose of filler material in the sealant is to reduce occlusal wear.
Filled and unfilled sealants penetrate the fissures equally well, and there is no difference in microleakage.
Some dentists believe that a filled sealant is better because of a lower wear rate on occlusal surfaces.
Other dentists believe that because sealants flow deep into the pits and fissures to form a barrier that ensures that the occlusal wear is insignificant.
Sealants should not be placed on the cuspal slopes.
What is microleakage? (Leakage between the tooth surface and the sealant material.)
Unfilled sealants are recommended for use in school-based sealant programs because there is no or limited access to a dentist’s handpiece.
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18. Fluoride Release
Some types of sealants release fluoride after polymerization.
The theory is that the fluoride released from the sealant creates a fluoride-rich layer at the base of the sealed groove.
Clinical studies comparing the effectiveness of these two types of sealants are still under way.
Topical fluoride should not be applied to the enamel surface immediately before a sealant procedure but may be applied immediately after sealant application.
Always follow the sealant manufacturer’s instructions.
What type of material is a fluoride releasing sealant made of? (Glass ionomer, because it contains slow-release fluoride.)
What is a disadvantage of using glass ionomer sealant materials? (Glass ionomer sealants may crack readily when placed and show high occlusal wear.)
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19. Storage and Use General tips on sealant materials:
Replace caps on syringes and bottles immediately after use.
Do not expose the materials to high temperatures.
Do not store the materials in proximity to eugenol-containing products.
Most etchant and sealant materials are designed to be used at room temperatures.
Check the manufacturer’s recommendations.
The shelf lives of most sealant products at room temperature range from 18 to 36 months.
Why is it important to read and follow the specific instructions for the brand being used?
Storage of some sealant materials in a cool, dry place such as a refrigerator will increase shelf life.
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20. Etching Precautions for Patients and Dental Personnel
Etching agents contain phosphoric acid.
Patients and dental personnel should wear protective eyewear when etchants are being used.
Avoid contact with oral soft tissue, eyes, and skin.
In case of accidental contact, flush the exposed area immediately with large amounts of water.
If eye contact is involved, immediately rinse the eye with plenty of water and seek medical attention.
Why is acid etchant used during the placement of a dental sealant?
Etchant usually comes in a gel form that can be painted on with a small brush or delivered in a preloaded syringe.
It is important to avoid touching the etched enamel surface with an instrument after etching has taken place to avoid smoothing the micropores.
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21. Sealant Material Precautions for Patients and Dental Personnel
Do not use sealants on patients with known acrylate allergies.
To reduce the risk of an allergic response, minimize exposure to these materials.
Use protective gloves and a no-touch technique.
If skin contact occurs, wash the exposed skin with soap and water. Acrylates may penetrate gloves.
If the sealant makes contact with a glove, remove and discard the glove, wash your hands immediately with soap and water, and then reglove.
If accidental eye contact or prolonged contact with oral soft tissue should occur, flush with large amounts of water. If irritation persists, contact a physician.
What are some signs and symptoms of an allergic reaction? (Skin irritation, rash, burning sensation of the area exposed to the allergen, swelling of the mucosa, breathing difficulty, dyspnea, cyanosis, sweating, dilation of pupils, and cardiovascular involvement.)
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22. Protective Eyewear
Protective eyewear should be used by operators when using either an ultraviolet or a visible light–cured resin.
Protective eyewear should also be provided for the patient during sealant procedures.
Many light-curing wands also have an UV light shield near the tip of the light wand to protect the operator’s and dental assistant’s eyes from exposure to the UV light.
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23. Factors in Sealant Retention
Moisture contamination is the primary cause of failure of sealant retention.
Inadequate etching is also a factor in loss of sealant retention.
Dental sealants should be examined at each recall visit to be certain that the sealant material has not been partially or totally lost.
When dental sealants are properly placed, it is not uncommon for them to last 5 to 10 years.
Moisture-control techniques enhance retention of the sealant.
What are some isolation moisture-control techniques used during the placement of a dental sealant?
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24. Important Information
Always read and carefully follow the manufacturer’s instructions when applying dental sealants.
Application technique and etching times may vary between manufacturers.
For example, some manufacturers discourage the use of a polishing paste that contains fluoride. Other manufacturers do not consider fluoride polishing pastes to be contraindicated.
Why is it important to read and follow manufacturer guidelines when using dental sealant materials and products?
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25. Setup for Placement of Dental Sealants (Procedure 59-1)
The tray contains examination instruments, articulating paper and holder, sealant material (etchant and sealant), dental floss with which to check contact areas after sealant placement, a disposable prophy angle with which to prepare the tooth, moisture-control items (cotton rolls and a high-volume evacuator), and a dappen dish to hold liquid materials such as the pumice.
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26. Isolate and Dry the Tooth (Procedure 59-1)
Remember, moisture contamination during sealant placement can cause the sealant to fail.
What isolation technique is shown in the slide? (Use of a dental dam.)
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27. Etch the Enamel (Procedure 59-1)
Apply a generous amount of etchant to all enamel surfaces to be sealed, extending slightly beyond the anticipated margin of the sealant.
Etchant is usually placed for a minimum of 15 seconds but no longer than 60 seconds.
What is a consequence of incomplete etching of the enamel surface? (Decreased retention of the sealant.)
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28. Thoroughly Dry the Etched Surface (Procedure 59-1)
After the allotted time for exposure of the enamel to the etchant, rinse the etched teeth thoroughly.
Dry the surfaces with the air/water syringe.
When the surface of the enamel is etched, the dried etched surface will take on a frosty white matte appearance.
What if the frosty white matte enamel surface is not evident? (Repeat the etch step.)
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29. After Sealant Placement, Cure the Enamel (Procedure 59-1)
Place the sealant using the delivery method recommended by the manufacturer.
Slowly introduce the sealant material to the pits and fissures to avoid damaging the micropores and to avoid the formation of air bubbles.
Next, cure the sealant using the UV light.
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30. Dental Sealant Is in Place. Evaluate the Sealant. (Procedure 59-1)
Always evaluate the sealant after placement:
Use an explorer to ensure that all margins have been sealed and that no microleakage can occur.
Floss the contacts to ensure that no excess sealant materials flowed into interproximal areas.
Check the occlusion with the use of articulating paper to ensure that the patient is comfortable when biting on the newly placed sealant.
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