Sealants for pits and fissures prevent the progression of tooth decay. Pit and fissures pose a major risk for caries, the most common dental disease affecting people of all ages. Left untreated, they create significant dental complications, such as an infection called a tooth abscess, as the tooth decays through the surface enamel due to bacterial growth. If the inside of the tooth, or pulp, is destroyed extremely due to a developing cavity, it may have to be extracted.
Not only treating, but mitigating the burden of caries amongst patients with pits and fissures has become a crucial component of preventive dentistry. The morphology of fissures can make them difficult to clean; deep grooves trap food debris almost indefinitely even with careful, regular brushing.
As small, hole-like depressions on tooth enamel, pits are also unsurprisingly difficult to brush. Collectively, both create an opportune niche for bacterial growth, leading to the aforesaid decay and subsequent caries. Acting as physical and chemical barriers, sealants prevent the growth of bacteria that decays teeth.
Untreated dental caries in primary teeth is considered the 10th most prevalent condition amongst all ages. Pit and fissure sealants are a conservative and preventive approach to arrest such caries.
Considering individual patient profiles, administration of sealants should be increased along with other preventive interventions in patients at high risk of developing caries. Such preventive approaches significantly reduce the risk of tooth decay, subsequent infection, and ultimately extraction.
What are pits and fissures?
Pits are pinpoint depressions at the junction of grooves whereas fissures are deep clefts between adjoining cusps. Such morphology is commonly present within teeth at the back of the mouth, such as molars and premolars. Furthermore, narrow fissures become difficult to clean with a tooth brush making pits and fissures as ideal sites for harboring bacteria.
Biofilm and plaque easily form over these sites and certain bacteria produce acid from fermentable carbohydrates leading to demineralization of tooth structure. Consequently, pits and fissures become opportune sites for cariogenic activity, placing the associated teeth at risk of cavitation.
What are pit and fissure sealants?
Eradication of pits and fissures would eliminate them as caries causing sites and prevents tooth decay. Sealing occlusal surfaces of pits and fissures creates a physical barrier between bacteria and tooth enamel. This physical barrier prevents the nutritional consumption of the bacteria, thereby preventing the growth of biofilm and the release of tooth decay-causing acid by bacteria that ferment sugars.
The simpler, more common sealant is resin-based and has good bonding to enamel and is less soluble in oral fluids. They have good cariostatic activity and are resistant to wear. They cause minimal irritation to tissues and viscous enough to penetrate into deeper pits and fissures.
Glass ionomer cement (GIC) sealants are well-recognized for chemically binding to dental tissue. They produce an anti-cariogenic effect with a regular release of fluoride and act as physical barrier between detrimental bacteria and teeth with high cariogenic risk.
Indications for sealants:
- Newly erupted teeth with open or sticky fissures
- Stained pits and fissures with decalcification at early stages
- Presenting incipient caries
- The tooth in questions should have erupted within the last four years
Contraindications for sealants
- Teeth that are not at risk of caries.
- Not required in self-cleansable pits and fissures
- Tooth in question is partially erupted
- Low life expectancy of primary teeth
- Patient is allergic to sealant material
Technique of sealant application
The foremost step in the sealant application is thorough cleaning of surface of the tooth with water. Then the area is completely dried. The surface is then etched with an acid (30%-50% phosphoric acid liquid) for 60 seconds. Etching produces micro porosities in the enamel.
The sealant extends into these porosities and form tags which attach firmly to the tooth surface. Following etching, the surface is washed with water completely. Then the resin is applied and cured. Then the bite is checked and excess material is removed and then polishing follows. Thus the procedure seals all the pits and fissures making them caries resistant sites. These sealants are durable, long lasting and can be changed if needed.