Clinical Advice: Using Pit and Fissure Sealants

By Hilarie Galloway, DMD

Dental caries account for most dental problems faced by patients in private practice and public healthcare settings. Although pit and fissures do not encompass the majority of dental surfaces in the mouth, they do make up most dental caries in permanent teeth (as high as 90%, according to some studies).

The prevalence of dental caries is linked to ethnicity and income level, specifically with lower socioeconomic class experiencing a higher incidence of dental caries. Pit and fissure sealants are a relatively simple and cost-effective procedure to reduce primary dental caries and prevent progression of primary caries to frank cavitation. They function regardless of continuity of dental care and therefore can be used in community health settings as well as private practice dental offices.

One study found a 37% decrease in risk of dental caries in children with pit and fissure sealant placement. When used in conjunction with regular dental check-ups and good home care, pit and fissure sealants have been found to successfully reduce the incidence of carious lesions. This article will discuss the benefits and controversy associated with pit and fissure sealing and best-use methods.

Pit and Fissure Sealants: Controversy and Benefits

This form of preventive dentistry can ward off dental decay and protect tooth surfaces. Here’s what you need to know.

Controversy

Although pit and fissure sealants have been a part of dentistry since the early 1980s, the procedure has also had a few concerns described throughout numerous comprehensive scientific studies (including a systemic review by the Cochrane Collaborative). One such concern is the potential lack of retention. Although 5-10% of dental sealants require annual replacement or repair, the procedure is relatively simple and cost-effective. It has also been found that as the bulk of sealant materials wear away over time, small portions of sealant material tend to remain in the base of the pit or fissure and offer continued caries prevention.

More recently, the concern of bisphenol A (BPA) release through the materials used in sealants has come to light as a concern. A few studies have shown these components to interfere with animal development and reproductive systems. However, according to the ADA, FDA, and AAPD guidelines, low BPA exposure from dental sealants provides no known health risks.

Benefits

The numerous benefits associated with pit and fissure sealants vastly outweigh the risks. The relative simplicity of the procedure itself creates a positive, pain-free dental experience. This is critical to developing a healthy relationship with the dentist, particularly with young patients. Similarly, this procedure comes at a significantly lower cost than single surface fillings. It is a procedure that can be easily performed in public health settings to help prevent caries in patients at highest risk based on several factors, including socioeconomic status and ethnicity.

Numerous studies have found these sealants to be safe and effective in reducing caries in parts of teeth and deepest pits that are otherwise very difficult to keep clean from food and bacteria impaction. These sealants have been found not only to reduce primary occlusal caries but also to stop progression from incipient caries to cavitation.

When To Use Pit and Fissure Sealants

Pit and fissure sealant use is indicated in both adult and pediatric patients with caries risk. In children they can be used on primary teeth in instances of increased caries risk.

In permanent teeth with risk of developing pit and fissure dental caries, preventative sealants should be placed regardless of age. Sealants are also indicated in teeth with incipient carious pit and fissure lesions for both adults and children.

Finally, anyone with a mental or physical disability that may render them unable to maintain good oral hygiene should be considered for sealants on any at-risk permanent or primary teeth.

Treatment Techniques

There are two major classes of pit and fissure sealant materials available: resin based and glass ionomer.

Resin based sealants are light cured and hydrophobic, thus keeping the field isolated from moisture is critical to procedural success. Glass ionomer cement sealants are hydrophilic and therefore moisture tolerant, but they are generally auto-cure. Glass ionomer sealants also release fluoride and can be high viscosity or low viscosity, with low viscosity wearing out more quickly than resin based or high viscosity sealants. Whether using glass ionomer or resin-based sealant material, it is always crucial to follow manufacturers’ instructions to ensure the greatest chance of success.

Tray set-up is based on provider preference but should always be set-up ahead of time as placing pit and fissure sealants is a time-sensitive procedure. A basic set-up includes a:

• mirror,
• explorer,
• cotton rolls/isolation materials,
• cotton pliers,
• saliva ejector,
• slow speed or high speed handpiece with finishing burr,
• sealant material,
• curing light and articulating paper.

Sealant Instructions

Here are the resin based sealant instructions (glass ionomer cement sealants require steps outlined in their manufacturer’s instructions):

1. Clean occlusal surface with toothbrush or prophy cup and pumice – products containing fluoride or glycerin are contraindicated.
2. Isolate well – this step is critical to success. If the patient allows, a rubber dam is ideal, but in many cases cotton roll or dri-angle isolation will suffice.
3. Etch with 38% phosphoric acid for 20 seconds and rinse. It is important to avoid contact with skin (rinse and advise patient/parent to monitor for skin irritation if contact occurs) and to suction all etchant to avoid a foul taste for the patient.
4. Suction/air – avoid salivary contamination of the etched surface. Use proper moisture control procedures. If contamination occurs remineralization will begin immediately. In this case re-etch for 5 seconds and rinse.
5. Optional bonding step (check manufacturer recommendations).
6. Place sealant material – avoid adding too much material and wait 10-20 seconds to allow the ideal viscosity material to flow into pits and fissures.
7. Cure for the recommended time, usually 20 seconds at 3-5mm from the surface of the sealant.
8. Evaluate sealant for clinical success – check for retention, voids and bubbles, check occlusion and adjust with handpiece if necessary.
9. Monitor sealant at regular dental appointments with clinical and radiographic examination. Replace or repair sealants as necessary.

Handling Possible Complications

While dental sealants can provide successful prevention against pit and fissure caries, there are a few important steps to take should complications arise. Occasionally the sealant will fail immediately after placement – this is most likely due to salivary contamination, insufficient cleaning/preparation of tooth, incomplete material curing or bubbles/voids in the sealant material.

Should this occur, it is important to remove the remaining material and begin the procedure again – starting with cleaning of the surface and re-etching the tooth in question.

Stomadent Dental Lab

Do you still have questions about pit and fissure sealants and which material is best for your patients? At Stomadent Dental Lab, we are here to help. From our dental milling to CAD/CAM design to premier dental materials, we’re the dental laboratory that’s ready to support you.

Check out our website for more information. or reach out today.