Sunday, August 06, 2006

Dental Sealants

What can you do to prevent cavities? Well, you can brush, that's good. You can Floss. You can use Fluoridated toothpaste. What else? Dental sealants have been proven to prevent decay in the pits and fissures of teeth. Sealants are usually placed on the first and second permanent molars. You can also seal the bicuspids. You also can seal baby molars, but it is not usually done as the anatomy is different and it can be unnecessarily difficult to work on a very young child just for a sealant. Most kids need sealants, but if the grooves of the teeth are smooth and the child is not cavity prone, I may not recommend it. Oh, adults can benefit from sealants as well, but they are most useful on teeth that are newly erupted, you know, the cavity prone years.

The idea is to seal up the little grooves, which the brush can't reach. Here is a brush bristle that can't reach down into that really small groove on a molar. Fluoride helps prevent decay as well by strengthening the enamel. Fluoride seems to work best, however, on the smooth surfaces of the teeth. Sealants are for the grooves, so you usually don't use them on front teeth for instance.

They are really easy to do. You just sort of paint it on (well, there are several steps, but still fairly easy like using a fiberoptic "flash light") The only thing that can make it harder is if the child has a small mouth or a gag reflex or a wiggly tongue that makes it hard to get back there and keep things dry.


If sealed well, the "cavity bugs" can't get down in there. Sealants last several years and may need to be patched or replaced from time to time. If the kid doesn't chew ice or stuff like that, they will hold up fairly well. If they chip or come off, the "Bugs" can get back in there. My kids have sealants and have never had a cavity!

Here is another post I made on the same subject:

The American Academy of Pediatric Dentistry recommends placing dental sealants on the first permanent molars (at around 6 years of age) and the second permanent molars (which come in around 12 years of age).

Why? --Well, basically there are a lot of studies that say placing sealants helps reduce the incidence of cavities. Does it mean you will never get cavities?--no, it still can happen, but sealants can reduce the kind of cavities that form in the pits and grooves of the back teeth, you know on the top of the tooth--you still can get them in between the teeth and on the smooth surfaces.

How long do they last?--Even with a well placed sealant I have seen cavities form in areas previously sealed. Sometimes the sealant wears off (chewing ice for instance), or sometimes just because someone is very prone to cavities. They say they last from 5 to 7 years if you take care of them--even adults can get sealants, but they seem to be most effective in the cavity prone years of youth. What is the material? Well, it's basically the same material as used in white fillings without as much filler/reinforcing material, it's a bis-GMA resin, With less filler the sealant can flow into the grooves better. Sometimes we use "flowable" composite which is kind of in between in it's characteristics.

How are they placed? Does it hurt?--I like to say it's like painting fingernails--you basically just paint it on the tooth--now that can be harder than you think as these teeth are in the back of the mouth. Most of the effort is keeping the area dry.

Do you put them on baby teeth?--you can, but generally no. The enamel in baby teeth is different microscopically, they don't seem to stay as well, but sometimes if there is lots of grooves there, so there may be a benefit to placing them. Another thing to think about is that in preschoolers, placing a sealant is just about as difficult as a small filling because little kids, well it's harder to place the sealants. It is often better to simply have regular checkups to catch things early. Also, like I said many cavities in baby teeth are in between the teeth which sealants do not prevent.

I'm going to try and make a video on this some day.

33 comments:

Anonymous said...

Why do they have to put my 2-yr-old grandson under general to apply dental sealants? He is having it done @ Womens' and Childrens's Hospital in Bflo, NY. Is there anything we should know or ask beforehand?
many thanks, Sue Caferro
scaferro@yahoo.com

Dr. Dean Brandon said...

I do not put children under GA just for sealants as they are a preventive treatment. Now if there is justification due to other work needed like extensive restorations AND sealants, then I would take the opportunity to do them while the child is asleep.

Anonymous said...

My five year old has had eight cavities with four crowns put on earlier this year. She also had two lower back molars come in and they put dental sealants on during her hospital visit. I notice that her upper back molars are now coming in and would like to get sealants on these as well since she is cavity prone. How long does it take for a back molar to fully come in so I can get the sealants put on? I am worried to wait too long due to getting any more cavities. Can multiple sealants be done at one office visit?

Dr. Dean Brandon said...

Sealants can be done once the tooth erupts, usually about two months or so after it pops through--depends, sometimes can be longer than that. Check with your dentist.

Anonymous said...

Why would they put sealants on a 2-yr old?? Most dentists only recommend sealants on permanent teeth, meaning 6-yr molars or older.And general anesthesia is a little excessive. It is a very painless procedure.

Anonymous said...

My child is 3 1/2. Her dentist said she would need sealants on her back morlars because she has deep grooves. The office handed me a paper stating she was going to get nitrous oxide, a novacaine shot and 2 fillings. When I called to ask them what the fillings were about, they are saying she has cavaties. Why would the dentist tell me sealants not fillings? And tell me she dosen't have cavaties YET? I'm a confused and concerned. I don't think she should get nitrous oxide. Too much drugs for such a small body. Any advice?

Dr. Dean Brandon said...

Anon
-I cannot say what your dentist intends, but sounds like you have some sort of communication problem between what they said and what you heard or something like that. Sometimes the difference between the term "filling" and "sealant" can become blurred.

A sealant is a preventive covering placed when there is no cavity present to prevent decay. The material is very similar however, to that used in "fillings". A filling is decay that is removed leaving a hole to be filled with a material very much like a sealant.

The problem comes in when a tooth may have deep grooves, not a cavity necessarily but really deep grooves, once they are "cleaned out" sometimes with a bur just like in a filling procedure, there may be such a large groove or hole just in one spot that filling material may be placed instead of the sealant-or maybe a flowable composite which is a material that is used for both sealants and small fillings.

Is it a sealant? Is it a filling? Sort of a grey area there.

Anonymous said...

Thank you for your response. I spoke to her dentist and he said he won't know if her right molar has a cavity until he starts the process? And that insurance won't pay for the sealant, hence the fillings.

I'm even more confused.

He cleaned her teeth and he couldn't tell if she had a cavity on the right, but could tell on the left ... I'm going to look into another pediatric dentist ...

Dr. Dean Brandon said...

Yes, I have had situations where a tooth was initially planned as a sealant, but once the appointment was made some time later and the grooves were cleaned out as uaual, there was a deep groove. Then when that was cleaned out there was a bigger spot--eventually the cavity became large enough and more evident and was restored with filling material. Other times a cavity (carious lesion) is so shallow that I would place a sealant rather than a composite filling. Cavities can be very small on the surface but deeper down they can be much larger. Usually you can tell, but sometimes you cannot tell for sure until you begin a procedure.

Anonymous said...

Can you please tell me what the difference between sealing a tooth and placing a silver crown on it would be? I have a 3 1/2 year old who has to have work done on his molars and they wanted to do silver crowns on all 8. He has cavities back there, so is this the common procedure for that or can they do sealants?

Dr. Dean Brandon said...

Sealants are only for teeth without cavities--Cavities must be restored with fillings/crowns etc. Sealants are a preventive measure.

Anonymous said...

Thank you so much for helping me earlier. You have no idea how wonderful this website has been for me as a first timer at this pediatric dental "stuff." My 3 1/2 year old son will be put under next Monday for stainless steel caps and a pulpotomy on his molars. He's starting to have a runny nose and coughing. He was initially cleared in his pre-op exam, but now I'm nervous that this may affect his anesthesia. Is this normally a concern?

Dr. Dean Brandon said...

We always follow a protocol for general anesthesia cases. The kids must see a physician to have a health and physical a day or two before the procedure. If kids get "sick" then cases should be postponed. If a child has a fever a chest cold, I would let the dentist know and any phyician involved so they can make a determination if it is a serious thing necessitating postponement or just a non consequential thing. Anesthesiologists also check out the kids just prior to the procedure just to make sure the kids are good to go.

Anonymous said...

My dentist put sealant on my two front teeth about 3 months ago because I have an overbite. Since having this done I have been back twice to have some of the sealant taken away because my teeth don't feel like there aligned properly. For the last month I have developed some mild pain in my right side of my jaw. I assumed it was something to do with the sealents but when my dentist examined my jaw he says that I have a mild dislocation to the jaw. Has the sealant caused this?

Dr. Dean Brandon said...

Sealants are not usually placed on front teeth, however, sometimes they are placed on the groove on the tongue side of the upper front teeth. Sealants, even if they are placed incorrectly or too thickly will wear down quickly with normal wear. So, no, I have never sen a sealant cause dislocation of the jaw.

jennifer said...

My 4 year old just left the dentist and he said she has 2 cavities each on her back baby molars.. both surface very small I couldnt even see them but he could feel them with his pic... They want to fill them and use anesthesia? Is ok to wait or should I have this done now, seems like a lot for a four year old? Thanks!

Dr. Dean Brandon said...

Sedation is usually indicated if there is a certain level of anxiety, resistance or the concern dental work might elicit such a reaction. Read more on this blog about behavior management and sedation many 4 year olds do just fine.

Anonymous said...

I jus had a question. My dentist placed a sealant on my tooth and after telling me to bite down, said it might be too thick. He said wait a month and then if its still thick, will re do it. He buffed it down but i guess that wasn't enough. My question is how does the sealant thin out on its on? And by it being too thick is that more damaging to my tooth, is my tooth still even protected? Why a month? Couldn't he have redone it the same visit?

Dr. Dean Brandon said...

Hey, just sitting at my computer when your comment came through---Sealant material will wear down with time with no damage to any tooth structure. If it comes off in one big chunk, the protective effect might be reduced-so, might need a redo at some point. If it is really bothering you like it's really thick or high, smoothing it down can help.

Anonymous said...

Hi I was wondering what is the cost of the sealant if my insurance does not cover it

Anonymous said...

Hi I have a question. I was talking to a friend and she noticed I have silver filling in my teeth and informed me that they do not use silver anymore and if I go to the dentist they will replace them with the clear ones. I'm just wondering if this is true and if so does it depend on the type of insurnace I have? I also want to know if you get adult wisdom teeth removed do they put you to sleep or just numb the area and do it while awake. Does this also depend on my insurance?

Dr. Dean Brandon said...

Cost vary, but they generally are about a fourth or a third of what a small filling costs.

Dr. Dean Brandon said...

Anon,

You may want to read my post on White fillings:
White fillings vs. Silver fillings

Insurance status should not matter.
Wisdom teeth, well it depends. Most of the time oral surgeons will put you asleep. If they are already erupted and accessible, sometimes you can just numb up and remove like other teeth.

Dr. Dean Brandon said...

Oh, and here too:


Silver fillings

Anonymous said...

My 7 yr old has a cavity on her molar that is scheduled to be filled but her dentist also wants to put a sealant on top of the filling. My insurance will not cover a sealant when being placed over a filling. Is it necessary to have a sealant added with a filling? Thank you

Dr. Dean Brandon said...

Composite, or white tooth color fillings are the same material (well pretty much) as a sealant. Sealants are used to protect the parts of the tooth not filled by the actual filling material--usually a larger area. So putting a sealant "over" a filling is not a dental concern. Sometimes there is a small filling on one part of the tooth, say on the side of the tooth, but you also want to place a sealant on the occlusal or top part of the tooth at the same time. This is done often on the lower permanent molars. When insurance gets involved it can complicate things, meaning they just don't get it when you are talking two procedures even though both are of benefit. I'd just ask your dentist, what they are planning.

Unknown said...

I'm 37 years old and I have never had a cavity. My grandfather was a dentist and sealed my adult teeth when I was a child and it has made all of the difference. We recently moved and found a new dentist. He looked at my last molar on the left side and thought it looked funny. Nothing came up in the X-ray but he's concern that the deep crack will form a cavity in the future. He says it's not a matter of if, but when. As a mother of three, he said my diet is probably not that great and I probably don't have time to really care for my teeth the way they need to be cared for, so this is a preventative measure. I brush daily and floss occasionally. I rarely eat sugar and have a highly nutritious diet. If I add ACT to my routine and start flossing daily, will I be in the clear? Or should I just get the filling and resign myself to my new situation?

Anonymous said...

My six year old has her bottom 6 year old molars. A few months ago I was told they had deep grooves but no cavities. I asked about sealants and was told she didn’t need them (but I also asked about the sealants “safety” as in plastics so he may have thought I didn’t want them). Now a few months later, they say she has sticky cavities (but very shallow) on these two teeth. My questions: Can a molar be sealed after a cavity is cleaned and filled? If they are indeed shallow would there be a benefit to waiting a month or two to see if they can “remineralize” or heal (at home use of xylitol, ACT rinses, etc). I read about possibly getting decay under the sealants and making the problem worse. I read that new teeth are soft and in need of hardening (xylitol, calcium, fluoride) and if so, would the sealant keep this from happening (which wouldn’t be a bad thing right?) Also, do you feel that I could have transmitted bacteria that cause cavities from my mouth to my child’s? I have had lots of cavities in my life (and I do tend to share water cups etc with her but now I am trying not to). Thank you in advance. I appreciate your input.

Dr. Dean Brandon said...

If a filling is a composite (white filling) whether it be shallow or large, well, it is its own sealant--it's the same material, so the tooth is sealed if it is filled. So, there is no additional benefit to sealing after a filling if it encompasses all the grooves. If there is a cavity--a carious process, I would not wait, it will progress. We only "wait and watch" areas that are suspicious, but not yet cavities. Those areas, yes, they might remineralize--those are usually the smooth surface areas, not the pit and fissure areas.

Anonymous said...

My almost 4 year old has 8 cavities all between her baby molars. One pediatric dentist recommended fillings and another pediatric dentist recommended silver crowns. So which is better?????? Please help me make a decision. I want what's best for my daughter. Thanks for your help.

Dr. Dean Brandon said...

Basically, it depends. Fillings are generally fine IF the cavity is minimal and there is little chance of future decay on the same tooth. Crowns are best for larger cavities--they hold up better. Here are several of my posts on things like this:

Dental Restorations, fillings, crowns, etc

Anonymous said...

My 12 month old has 4 cavities aka bottle rot from breastfeeding. His teeth look really bad. Should I get them crowned?

Dr. Dean Brandon said...

I would advise seeing a pediatric dentist. They can tell you if crowns are needed, or perps just fillings or some other option. Decay at such a young age will likely be aggressive, but the situation can be fixed.