Protecting the Pediatric Patient with Dental Sealants
THE NEXT DDS
It is important also to explain the process of sealant application, to any concerns patients or parents may have. The dental hygienist can explain that he or she will clean and dry the tooth thoroughly, then apply an acidic solution to the occlusal surface. This solution allows the sealant to adhere to the tooth, and is generally applied with a cotton applicator. A thin layer of liquid plastic material (ie, the sealant) is then painted on and flows into the pits and fissures of the tooth. A curing light is next used to harden the material or, if a self-curing sealant is used, the sealant will harden itself within about a minute. Anxious patients or children will be comforted once they are informed that the process is painless. Despite the incredible pressures placed on molars, sealants will be able to protect the occlusal surfaces for five years or longer. Patients need to be aware that sealants do wear naturally or may become damaged over time, and will need to be continuously monitored by the clinician and reapplied if necessary.
Patients who are unfamiliar with dental sealants will most likely be curious as to whether there are any health risks associated with them; certainly a parent considering sealants for their child will want to be confident that the procedure is safe. One of the concerns that the practitioner may be familiar with is the release of the endocrine disruptor bisphenol A (BPA), a possible carcinogen, from the plastic in sealants. Parents may have heard of studies in the early 1990s that indicated detectable BPA leakage in dental sealants; the dental professional should provide reassurance that not only were these studies unable to be replicated, subsequent research--including investigations by the American Dental Association--indicated that BPA was present only in the saliva immediately after treatment and never in the bloodstream. Furthermore, the amount of BPA present, at its highest amount, was still 50,000 times lower than levels associated with oral toxicity in vivo. Certainly the practitioner should not shy away from such questions, and should be sure to address these concerns honestly. The concluding evidence, however, is that the ADA has determined no cause for concern regarding approved dental sealants, and supports continuing research in this arena.
Perhaps a greater concern for dental professionals and patients is the risk of decay associated with sealant damage or preexisting caries. Although some sealants have been known to last for a decade or more, it is more common for them to become worn at about four to five years. If bacteria or food particles are able to penetrate under weakened sealants, decay can begin to form without the patient or dental staff being aware. Furthermore, although a thorough cleaning and removal of decay takes place before sealant application, if a treated tooth had a miniscule amount of decay that went unnoticed, it can develop under the sealant, trapping bacteria in rather than keeping it out. Fortunately, new technologies in the field of dental materials allow for the development of sealants that can be used with diagnostic devices. In this way, patients with existing sealants or those preparing to receive treatment can be confident that any decay can be detected before serious tooth damage takes place.
Ultimately, the role of the dental professional is to stress quality oral care to the patient, both at home and in the operatory. Sealants are no substitute for regular brushing, interdental cleaning, healthy habits, and regular dental visits. They are however a wise investment in high-risk or pediatric molars in that they protect vulnerable occlusal pits and fissures from bacteria and plaque. By explaining the value of sealants, the procedure, and the developing technology in this field of dental care, hygienists can ensure that they will be encouraging their patients to make an informed, timely decision regarding their—or their children’s—dental health.
Pits and fissures, the miniscule grooves and depressions in posterior teeth, can be difficult to keep clean, even with vigorous brushing, interdental cleaning, and fluoridation. Many parents of pediatric patients may be unaware of the plaque, bacteria, and food particles that can be retained in these pits and fissures, even if they are cleaning their children’s teeth regularly and properly. Parents may also be unaware of the proven effectiveness of dental sealants, which can prevent decay in these regions. With almost two thirds of dental decay originating on occlusal surfaces, and with nearly 90% of decay in children’s teeth occurring in pits and fissures, it is important that hygienists as well as clinicians make their patients, or the parents of pediatric patients, aware of the value of dental sealants.
Since dental hygienists are generally the first to speak with their patients’ parents, it is important that they be prepared for questions regarding sealants, and that they are able to answer such questions with confidence. Parents may wish to know how sealants work, what sealant treatment consists of, how long they last, and, of course, if there are any risks involved. The importance of patient education on sealants is especially valuable when speaking to parents considering options to maintain healthy dentition in their children. By stressing the high risk of decay possible on occlusal molars, explaining how dental sealants can effectively prevent plaque and biofilm formation, and discussing the current advances in this field of restorative dentistry, practitioners have an opportunity to bring piece of mind to the parents of young patients.