Prevetion of Dental Caries – Dental Sealants

Introduction

Dental carries are an issue of concern as it is a common chronic disease that is responsible for a lot of pain and disability seen in all age groups. Untreated dental caries causes pain and infection and loss of some or all teeth. The last few decades have seen several advancements in the prevention of dental caries. Sealants are one such advancement and are used on teeth as a preventive measure against dental caries.

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Dental or Tooth Sealants

According to the American Dental Association, “Dental sealants act as a barrier, protecting the teeth against decay-causing bacteria. The sealants are usually applied to the chewing surfaces of the back teeth (premolars and molars) where decay occurs most often”.

Adults have thirty-two teeth classified into incisors, canines, premolars, molars. Dental caries can affect any of these teeth, but the premolar and the molars or the chewing teeth are the teeth most prone to dental caries. Dental caries is injuries and destruction of the calcified structures of the teeth by the Streptococcus species and other bacteria. Dental caries is extremely prevalent in the United States of America, with about fifteen percent of the population affected by it. (2).

Caries may develop on smooth tooth surfaces and chewing surfaces but are mostly seen in pits and fissures. Dental sealants were developed as a means to prevent caries in the pits and grooves of occlusal surfaces of the posterior teeth, meaning pre-molars and molars. Dental or tooth sealants are adherent materials most commonly consisting of plastic or resin. Dental sealants modify the resistance of the teeth to caries as they are coated on the occlusal grooves and seal them from exposure to the external elements including bacteria and bacterial action. With prevention the rationale behind the use of dental sealants, children are the main target for the use of sealants. However, current trends indicate that dental sealants are even used for newly erupted teeth that show marked pits and fissures and in adults with significant previous occlusal caries.

Permanent premolars and molars are the teeth that benefit most from the use of sealants for teeth. These teeth erupt between the ages of six and twelve. It is for this reason that children between the age of five and fifteen make up the target age group for sealants for teeth.

The objective is the use of a sealant is that the sealant should penetrate the pits and fissures of teeth and seal them from bacteria and bacterial action. The ideal sealant material should have properties that include prolonged retention properties, low solubility in the environment of the mouth, be bio-compatible with the oral tissues, and be easy and simple to apply to the teeth. Since 1967 several materials have been tried and tested. The most commonly used sealant currently is resin. The current sealants employed now are second and third-generation products that demonstrate a much higher retentive capacity than the first-generation materials used. The materials used currently as dental sealants are filled, unfilled, and fluoride-releasing filled cyanoacrylates, polyurethane resins, and bisphenol-A-glycidyl (bis-GMA) resins.

Dental sealants are cost-effective and yet are found to be underutilized in the prevention of dental caries. Studies have shown that seventy-four percent of permanent first molars that receive sealant treatment do display signs of dental caries.

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The initial problem faced with dental sealants was retention. These initial failures found to happen with dental sealants have been historically attributed to the errors in the technique for sealant application, with moisture contamination being the main culprit. Besides the proper application, the eruption status of the teeth is also important. In incompletely erupted teeth the retention rate of dental sealants is low. The loss of sealant occurs mostly from the lingual surfaces of the maxillary molars and the buccal surfaces of the mandibular molars, which is attributed to the shallower pits that make it more difficult for the etching required. Evidence has emerged that the retention of dental sealants is eighty percent at one year, seventy-one percent for two years, fifty-eight percent for three years, and forty-three percent for four years.

Traditionally sealants were targeted as a preventive measure for children and teenagers at their most cavity-prone period. However, age is not a restrictive factor for the use of dental sealants. Candidates suitable for the use of dental sealants irrespective of age include patients having xerostomia, undergoing orthodontic treatment, show evidence of incipient caries, and patients prone to dental caries.

Sealants do not provide benefits to all molars and pre-molars. Posterior teeth that show shallow or well-coalesced pits and fissures and/or low risk for dental caries are not suitable for the use of sealants. There are contraindications for the use of sealants and these include teeth with proximal decay and semi-erupted teeth, particularly molars with an operculum present.

Conclusion

Sealant on teeth is a cost-effective means to prevent dental caries. Improved sealant material and better sealant application techniques have increased the retention of sealants on teeth. There is growing evidence that shows that dental sealants are effective in the prevention of dental caries. Increased use of dental sealants will reduce the incidence of dental caries.

References

  1. Sealants”. AMERICAN DENTAL ASSOCIATION. Web.
  2. Wayne, Diane, B., Trajtenberg, Cynthia, P. & Hyman, David, J. “Tooth and Periodontal Disease: A Review for the Primary-Care Physician”. Southern Medical Journal, 94.9 (2001): 925-932.
  3. “Dental Sealants”. National Center for Chronic Disease Prevention and Health Promotion. 2001.
  4. Dental Sealants”. 2001. Web.
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