Overview of Pit and Fissure Sealants
The grooves and indents on the biting surfaces of your back teeth are more susceptible to tooth decay. This is because their unique complex shape makes them harder to clean, allowing plaque, a sticky film of bacteria, to build up more easily. While the smoother surfaces of your teeth can be effectively protected by fluoride, the uneven surfaces cannot receive the same level of protection.
To combat this, dentists can apply what’s known as ‘pit and fissure sealants’. These create a physical barrier over your teeth, hindering the ability for bacteria and food particles to accumulate and cause tooth decay. These sealants are especially effective for your first and second permanent molars, which are more prone to tooth decay. These teeth can affect your oral health a lot, as tooth decay often starts soon after they have emerged fully into your mouth. The effectiveness of these sealants depends on how long they can be retained on the tooth surface.
Anatomy and Physiology of Pit and Fissure Sealants
The shape of the top surface of our molars, the teeth at the back of our mouth, can vary a great deal from person to person. There can be deep grooves in the tooth’s enamel layer (the hard, outer layer of the tooth). These grooves, known as occlusal fissures, can come in a wide variety of shapes—some are wide or narrow funnels, others resemble an hourglass shape, and some have an irregular shape with Y-shaped splits.
Generally, there are four common types of fissures including:
- V type: These fissures are wide at the top and gradually become narrower towards the bottom. They are shallow and wide, which allows them to clean themselves to a degree, offering some resistance to dental decay (cavities). Non-invasive techniques, meaning techniques that don’t involve cutting into the tooth, are recommended.
- U type: These also are shallow and wide, with similar self-cleaning properties and resistance to cavities. Again, non-invasive treatment techniques are usually enough for these types.
- I type: This type is an extremely narrow slit. These fissures are deep, narrow and constricted, looking like a bottleneck. Because of their shape, they are more susceptible to cavities and may require more intensive (invasive) procedures to treat.
- IK type: This is a narrow slit that gets wider towards the bottom. These are also very susceptible to cavities and may require invasive techniques for proper care.
But remember, our teeth are very unique! So the different shapes and combinations make it not always possible to strictly assign one type of fissure to a particular molar.
Why do People Need Pit and Fissure Sealants
Pit and fissure sealants are used to protect teeth from cavities, a condition also known as caries. They can be used in cases where a tooth, or the whole individual, is prone to developing cavities. In some cases, these sealants can also help halt the progression of early cavities.
Doctors may recommend using these sealants in several situations:
1. On children’s primary teeth (also known as “baby” or “deciduous” teeth) if the tooth or the child is prone to cavities.
2. On the permanent teeth of children and teenagers, again if they are likely to develop cavities.
3. On the permanent teeth in adults if there is an increased risk of cavities.
4. On the teeth of children, adolescents, and adults with early signs of cavities – these appear as tiny spots on the teeth that have not yet formed a cavity (these are known as “noncavitated” incipient carious lesions).
It is particularly important to consider applying these sealants on primary and permanent teeth of children and young adults with medical, physical, or intellectual disabilities. Dental issues can pose additional health risks for these individuals, and the sealants can help lower the risk of those issues developing.
When a Person Should Avoid Pit and Fissure Sealants
Dentists make a decision on whether to apply a pit and fissure sealant – a substance used to prevent tooth decay – based on your risk level, and not on your age or how long ago your tooth grew in. If you have little or no factors making you prone to tooth decay, then there’s no need for this preventative step right now. But, it’s important to remember that all children should regularly check for any changes in their risk of tooth decay or any changes seen during dental check-ups or X-rays.
Equipment used for Pit and Fissure Sealants
There are two types of materials that doctors usually use in treating the pits and fissures of teeth: resin-based sealants and glass ionomer sealants. Resin-based sealants are the top choice for this treatment. However, if the doctors are unable to fully isolate the area which is required to keep it moisture-free, they might use glass ionomer sealants. This type of sealant is beneficial as it contains fluoride which can slowly be released over a long period of time and can help in preventing tooth decay.
When performing this procedure, doctors usually make use of the following instruments:
- Air/Water Syringe: This tool can rapidly cool and clean surfaces with a stream of air, water, or a combination of both.
- Mouth Mirror: This is used to allow doctors to see the inside of the mouth from different angles.
- Explorer: This instrument is used to examine the teeth and gums.
- Excavator Tip: This tool is used to remove a damaged part of the tooth or the decayed area.
- Two by Two Gauze Squares: This acts like a small soft cloth that can soak up blood and fluids.
- Cotton Rolls/Pellets: These are placed in your mouth to keep it dry during the procedure.
- Forceps/Cotton Pliers: This tool is used to hold or place cotton rolls.
- Articulating Paper: This special paper is used to check how well your teeth match up when you bite down.
- Curing Light: This tool is used to harden or “cure” the sealants quickly.
- Handpiece: This is a drill-like tool used to work on the teeth.
- Dappen Dish with Pumice: Pumice is a type of grit used to clean teeth, and it’s held in a small dish, called a dappen dish.
Preparing for Pit and Fissure Sealants
There’s some debate on the best way to clean the grooves and pits of your tooth before applying a dental sealant. Some experts suggest using a fine, gritty paste called pumice or a tool that sprays a mix of air and powder to prepare the tooth surface, as they believe this results in a better pattern for the sealant to bond with the tooth. However, others feel that using only an acid solution to rough up the surface of the tooth is enough to clean it properly before applying a sealant.
How is Pit and Fissure Sealants performed
It’s crucial to keep the tooth dry when you’re having a procedure like getting a pit and fissure sealant. That’s why dentists often use a rubber dam to keep your tooth away from saliva. If this isn’t possible, for example, if the tooth is newly grown, your dentist might use cotton rolls and special shields to keep the tooth dry. They might also use a tool to suck away the saliva. In some cases, they might apply a temporary material called glass ionomer.
Before applying the sealant, your dentist will clean the tooth using a special gel, usually containing orthophosphoric acid. They’ll apply it to the tooth with a small brush, leave it for around 15 seconds (sometimes longer for baby teeth), and then rinse it off with a water spray. Then they’ll dry the tooth until it looks frosty and white. If your tooth isn’t completely dry, they might need to repeat this process. If your dentist is using the glass ionomer instead, they might not need to clean the tooth with the acid.
The sealant fluid is then applied. It needs to flow into the tiny pits and grooves that are on the surface of the tooth. Where it’s applied depends on whether the tooth is in the upper or lower jaw. A fine brush or a small sponge is used to ensure the sealant covers the right areas. It’s important not to have any air bubbles in the sealant.
To harden the sealant, a special light is used for about 10 to 20 seconds. After the sealant is hardened, the dentist will wipe the surface of the tooth with a wet cotton pellet to remove any non-hardened resin, as this could leave a bad taste in your mouth.
Your dentist will then check the sealant both visually and by touching it. They may also check how you bite down on the tooth. They’ll look for any issues every year at your regular check-up, as sometimes sealants need to be repaired or replaced.
It’s important to have regular check-ups after getting a sealant to ensure that it’s working as it should. This could involve X-rays. If the sealant is damaged, your dentist will reapply it to make sure the sealant continues to do its job.
Possible Complications of Pit and Fissure Sealants
Sometimes, dental sealants, which are used to protect teeth from cavities, might not work properly. This can be due to various things like:
* Contamination from saliva or from tooth cleaning products
* Not preparing the surface of the teeth well enough before placing the sealant
* Not letting the sealant harden for enough time
* Trapping air bubbles under the sealant layer
* Spreading the sealant beyond the area where it should be.
Moreover, there have been some concerns about the safety of dental sealants. Certain studies showed that a component used in sealant, known as bisphenol A (BPA), may cause health issues in animals. However, don’t worry. Major health and dental organizations such as the American Association of Pediatric Dentistry, the US Food and Drug Administration, and the American Dental Association have all said that the trace amount of BPA from dental sealants is too small to be harmful.
What Else Should I Know About Pit and Fissure Sealants?
Around a quarter of children and over half of adolescents have cavities (also known as dental caries) in their permanent teeth. Cavities are especially common on the chewing surfaces of back teeth. These areas have tiny grooves and indentations that are the perfect place for cavities to develop.
Luckily, there is a way to help prevent these cavities. A treatment method known as dental sealants can be applied to these chewing surfaces. Sealants are like a protective coating that keeps food and bacteria from settling into these tiny grooves, reducing the risk of cavities.
Studies have found that sealants are very effective. In fact, one study found a 37% lower risk of cavities in children who had sealants applied, compared to children without sealants. Another study found a 44% lower risk of cavities after three years in the first permanent molars with sealants, compared to teeth without sealants.
It’s important to note that everyone’s risk of developing cavities is different. That’s why it’s important for your dentist to regularly assess your personal risk of cavities, so they can make the best recommendations for the health of your teeth. So, don’t forget to keep up with your regular dental check-ups!