Dental sealant

Dental sealants (also termed pit and fissure sealants, or simply fissure sealants) are a dental treatment intended to prevent tooth decay. Teeth have recesses on their biting surfaces; the back teeth have fissures (grooves) and some front teeth have cingulum pits. It is these pits and fissures which are most vulnerable to tooth decay because food and bacteria stick in them and because they are hard-to-clean areas. Dental sealants are materials placed in these pits and fissures to fill them in, creating a smooth surface which is easy to clean. Dental sealants are mainly used in children who are at higher risk of tooth decay, and are usually placed as soon as the adult molar teeth come through. Dental sealants (also termed pit and fissure sealants, or simply fissure sealants) are a dental treatment intended to prevent tooth decay. Teeth have recesses on their biting surfaces; the back teeth have fissures (grooves) and some front teeth have cingulum pits. It is these pits and fissures which are most vulnerable to tooth decay because food and bacteria stick in them and because they are hard-to-clean areas. Dental sealants are materials placed in these pits and fissures to fill them in, creating a smooth surface which is easy to clean. Dental sealants are mainly used in children who are at higher risk of tooth decay, and are usually placed as soon as the adult molar teeth come through. Dental caries is an upset of the balance between loss and gain of minerals from a tooth surface. The loss of minerals from the teeth occurs from the bacteria within the mouth, fermenting foods and producing acids, whereas the tooth gains minerals from our saliva and fluoride that is present within the mouth. When this balance is skewed due to frequent intake of fermentable carbohydrates, poor oral hygiene, and lack of fluoride consumption, there is a continuous loss and little gain of minerals over a long period of time, which can ultimately cause what is known as tooth decay. Dental sealants are a preventive treatment that is part of the minimal intervention dentistry approach to dental care. These sealants are a plastic material placed in the pits and fissures (the recesses on the chewing surfaces) of primary (baby) or permanent (adult) molar and premolar teeth at the back of the mouth. These molar teeth are considered the most susceptible teeth to dental caries due to the anatomy of the chewing surfaces of these teeth, which inhibits protection from saliva and fluoride and instead favours plaque accumulation. This approach facilitates prevention and early intervention, in order to prevent or stop the dental caries process before it reaches the ends stage of the disease, which is also known as the 'hole' or cavitation of a tooth. Once the tooth is cavitated, it requires a dental restoration in order to repair the damage, which emphasizes the importance of prevention in preserving teeth for a lifetime of chewing. Preventing tooth decay from the pits and fissures of the teeth is achieved by dental sealants providing a physical barricade to protect natural tooth surfaces and grooves, inhibiting build-up of bacteria and food trapped within such fissures and grooves. Dental sealants also provide a smooth surface that is easily accessible for both our natural protective factor, saliva and the toothbrush bristles when cleaning our teeth. Multiple oral health care professionals including dentists, dental therapists, dental hygienists, oral health therapists and dental assistants (in some states in the USA) are able to apply dental sealants to teeth. Preventive treatment options for dental caries besides dental sealants, involve promoting and education on toothbrushing technique with fluoride toothpaste, use of fluoride supplements and application of topical fluorides onto tooth surfaces. There have been many attempts made within past decades to prevent the development of caries, in particular occlusal caries as it was once generally accepted that pits and fissures of teeth would become infected with bacteria within 10 years of erupting into the mouth. G.V. Black, the creator of modern dentistry, informed that more than 40% of caries incidences in permanent teeth occurred in pits and fissures due to being able to retain food and plaque. One of the first attempts to prevent occlusal caries occurred as early as 1905 by Willoughby D. Miller. Miller, a pioneer of dentistry, was applying silver nitrate to surfaces of teeth, chemically treating the biofilm with its antibacterial functions against both Streptococcus mutans and Actinomyces naeslundii, which are both carious pathogens. Silver nitrate, which was also being practiced by H. Klein and J.W. Knutson in the 1940s, was being used in attempt to prevent and arrest occlusal caries. In 1921, T.P. Hyatt, a pioneer researcher, was the first person to recommend prophylactic odontotomy (preventive operation). This procedure involved creating Class 1 cavity preps of teeth that were considered at risk of developing occlusal caries, which included all pits and fissures. The widening of the pits and fissures were then filled with amalgam. C.F Bödecker, a dentist and researcher, also made attempts to prevent occlusal caries. Initially, in 1926 Bödecker would use a large round bur to smooth out the fissures. 1929, Bödecker attempted to prevent occlusal caries by cleaning the pit and fissures with an explorer and then sealing the pits and fissures with dental cement, such as oxyphosphate cement. Bödecker then later became an advocator for prophylactic odontotomy procedures (preventive operations).