Friday, January 16, 2009

Dental Sealants

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.

More Here: Dental Sealants previous post


Anonymous said...

Hi. This has nothing to do with this blog, in fact i didnt even read it.

but I am 17 years old and i have Amelogenesis Imperfecta my teeth are pretty straight, but ive never been allowed to have braces because my dentists are always too afraid of what might happen. i was also told my teeth would fall out by the time i was 16. this has not happened.

What can i do to cause my Amelogenesis Imperfecta to go away?

thanks. :]

Dr. Dean Brandon said...


I have treated a few patients with AE. Each case seems to be different. The enamel simply does not form properly sort of a more severe form of enamel hypoplasia (see my post on white spots enamel hypoplasia).

Orthodontics can be done if there is enough root structure there...Sometimes (often) the teeth can be restored (crowns or something). Good luck. I am sure something can be done. Sounds like you need to get good advice on your particular case.

Anonymous said...

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Cullman, Al

dental services california said...

Well, i was totally agree that its a nice recommendation of placing dental sealants on t6he first permanent molars. Very informative blog keep up the good work.

by: florence

Ruminator in Residence said...

Hi -- my five year old received sealants on her molars. It was not covered by insurance so had to be paid out of pocket -- a fiarly painful cost because I was in grad school and not working at the time, but I felt it was important. Two visits later (12 months from when the sealants were placed) my dentist said it was time to do the sealants again. I was shocked, since I have my own sealants and they have lasted quite a few years. The dentist told me a "normal" sealant only lasts 6-12 months. Needless to say, I could not afford to do them again. I feel the dentist either did a poor job applying them or was not telling me the truth. Any thoughts?

Dr. Dean Brandon said...

The anatomical variation of the teeth, the conditions under which they were placed, the fact that children's mouths and occlusion (bite) are constantly changing dure to growth, and what the child eats chews (like ice), can affect the longevity of sealants. I have seen them come off fairly rapidly (even ones I have done myself under the best of conditions), and others seem them last a long time. I have noticed than most anything (fillings, etc) in children's mouths seems not to last as long as adults. They are simply rougher on their teeth. Still, for the time they are in place, they do have a benefit. I know that does not answer all of your concern, but it is what I have noticed. Sometimes it is helpful to reapply them or "patch " certain areas after some wear. Just so you know, I placed sealants on my own children's teeth.

Dr. Dean Brandon said...

Oh, read one of my other post on sealants here:
Is there a higher caries risk from lost sealants?

deborama said...

I'm sorry if this is a little off topic, but I have a 9 year old son with autism and pica. We went to our ped. dentist today and he recommended a crown on a six year molar that does not appear to my untrained eye to be completely grown in (they didn't erupt until age 8.5). I am worried because I understand that this is a permanent tooth and when he had his previous stainless crowns placed, he was so bothered that he literally picked his gums bloody daily for two years! It was terribly disruptive to all facets of his daily living and learning. I have one gold crown and one stainless and I know from personal experience that the stainless does bother my gums on occasion while the gold felt virtually unnoticeable from the very beginning. When I asked if my son could have a gold crown for that tooth, his dentist replied that it would require two separate appointments and it is just not done until 21 years of age. Of note, my son is a medicaid recipient. Is this a matter of financing or are gold crowns never used in a pediatric practice?
Thanks in advance!

Dr. Dean Brandon said...

Cast (gold or porcelain) crowns are not usually done on growing children, however, one reason they are not routinely done (as in adults) is dental development. Teeth are usually not fully erupted, nor are they in their final position. Difficulty in placement and the need for re-placement in a few years (after more growth), make them not an ideal restoration till later on. In addition, you have to remove more tooth structure with a cast crown. Each case is different, but I have not seen many problems at all with stainless steel crowns on growing children. If they are placed, they are replaced with a cast crown when the patient is older and growth is completed.

On adult patients (or teens), yes, I would likely recommend a cast crown as the best option long term. It's not a financing issue-although parents are always concerned about financing issues.

Anonymous said...

Hello Dr. Brandon,

I'm saddened that my daughter's new first (six-year molars) are showing signs of early decay. They are near full eruption,but already her lower left one was cavitated on the cusp and filled. The dentist also told me she has weak spots in all her new molars and he said the lower right has a white lesion of early decay in a fissure. He wants her back in three months to seal them at that time, but I am afraid that if we wait that long, she will need more fillings. Can these teeth be sealed now at approximately 90% eruption to arrest further decay?

Thanks very much.

Dr. Dean Brandon said...

It is difficult to seal a tooth if it is not fully erupted. There are cases where decay gets a foothold before a sealant can be placed. Often, I wait till all four molars are erupted and seal them all at once just for convenience sake. Although sometimes I will seal the two, for instance, erupted teeth and wait to seal the other two which may not be fully ready yet. If there is a real worry, one can seal the partially exposed part of the tooth knowing you will have to go back again and reseal the remaining tooth once it has erupted fully.

Some kids/teeth are much more vulnerable to decay and it can form rapidly. A patient with a high caries rate, or one with really ddeply fissured grooves can be at particular risk.

If decay does occur by the time you are waiting for full eruption, then the dentist might be able to clean out any affected decayed pits and grooves and place a small white filling and seal the unaffected parts. Some people call this a "clean and seal", a "fissurotomy" or simply a filling, albeit a small conservative one. That is the advantage of modern composite materials. Flowable composite, sealants and composite fillings are very similar and can be used is as conservative manner as may be indicated.

Anonymous said...

Hi Dr. Brandon,

Thank you very much for answering back about my daughter's new molars, I really appreciate all of the information you provided; it has given me peace-of-mind. Your blog is so educational for parents--I have read it long before this occurred.

I look forward to continued reading...

Many thanks from Los Angeles.

Alisha Gray said...

Hi Dr Brandon,

I have a 4 year old autistic son, that has just seen a Pediatric dentist; who recommends several composite fillings, and 4 stainless steel crowns for his back teeth. I was disturbed by this. About the crowns...Does stainless steel cause ANY harm that you know to autism patients (especially this young)? And, are there any other options? By the way..thank you for your wonderful blog. It is one of the best that I have seen, for dental parents and patients that have questions.

Dr. Dean Brandon said...

The quick answer is that they pose no problem at all for Autistic patients. Please look over on the sidebar. There are several posts on crowns there. Look under General Topics--fillings crowns, etc.

Kristen said...

My Pediatric dentist told me she will not do sealants on children because she has seen too many children's teeth with undetected decay because of the sealants. She said that bacteria can seep under the sealant and eat away at the tooth undetected until it has done harm. Is there any research on this? I see you recommend sealants, so I am trying to figure out why there is such a difference of opinion. Thank you!

Dr. Dean Brandon said...

There IS research on this and there is no significant concern. In fact there is a movement by some to place sealants on obviously carious teeth, stopping the progression of decay. I think most dentists would place a filling in those cases.

The academy of pediatric dentistry does still recommend placement of sealants.

My children have them.

Anonymous said...

So I am having a cavity in my second molar and I'm worried if I should fill it. It's not very big and I was wondering if I should have to dentist put sealants on it. It's about to come out; it's a little loose. My concern is that if I don't fill it, the cavity will go into the tooth under the second molar. Do you think I should fill it or just let it stay?

Dr. Dean Brandon said...

a baby tooth that is loose and about to come out usually does not need treatment unless it is not falling out in time, has infection and swelling or is just bothering too much. Otherwise generally, cavities need fillings, teeth with deep grooves benefit from sealants.

Anonymous said...

Dr. Brandon,
Hi my name is Kerri and my seventeen year old daughter has an appointment tomorrow for sealants. As we all know this procedure is not covered under insurance. I would like to get your opinion on whether you feel it is still necessary for someone her age to still have this done. Thank You very much,I'm so glad I found this page:)

Dr. Dean Brandon said...

Sealants can be beneficial at any age. The most benefit is right when the teeth come in, but anytime is good, even in adults. It is preventive in nature, so it is up to you.

Unknown said...

Hi. My son had a coupl fillings and sealents on his first permanent molars yesterday. We spent the whole day eating soft, sugarless foods. This morning after breakfast we flossed and brushed and when my son spit into the sink some hard white material came out. I am not sure if it was his filling or part.of the sealant. Is it normal for excess sealant to maybe some off a following day? The dental office is bot open for 2 days and I am a little concerned.

Dr. Dean Brandon said...

Amy, occasionally there might be a small bit of excess material that might come off fairly soon after sealant placement. Bigger pieces can come off at any time, but of course we hope they last as long as possible. You can always have your dentist check. Such a thing is not an emergency.