dental Care

How is dental pit and fissure sealing performed?

Dental sealing is a preventive method of dental caries in childhood. It consists of placing a mechanical barrier on the surface of the tooth to protect it from being affected by caries due to changes in saliva and ingested nutrients.

What did you sew dental fissure sealing on?

To seal the teeth , a thin layer of a specific material (similar to the material used for fillings or fillings), called resin, is placed on the surface of the tooth that contacts the tooth of the opposite arch (occlusal surface of the tooth). As we already know, this surface has an anatomical shape characterized by the presence of pits and fissures, very sensitive to caries colonization , especially in patients with poor hygiene and children.

Fissure sealants are part of the global caries prevention program together with other therapeutic measures: control of bacterial plaque, use of fluoride toothpastes, control of hygiene techniques , control of intake (especially of refined sugars), etc.

Sealing or fluorinated treatment?

If we had to choose between a fluoridated treatment or a fissure seal within the caries prevention program, which would we choose? Despite not being exclusive, the statistics tell us that fluoride provides less protection against caries on occlusal surfaces than fissure sealing, therefore, at school age we would opt for sealing.

When analyzing the effectiveness of said prophylactic treatment , it has been concluded that the most benefited population is the school population, given that occlusal caries are more frequent in this group. Likewise, we must assess hygiene habits ( normally children usually brush the lateral faces, but do not insist on the occlusal faces, which are precisely those with the highest risk of caries).

This procedure is very effective, especially in medically compromised children (with immunosuppression, heart disease, kidney disease, autoimmune diseases…), in people affected by a physical or mental handicap and in marginalized social groups. In all of them, hygiene can be compromised for different reasons.

Keep in mind that we will never apply it to a tooth that has not completed its eruption . For this reason, it is important to carry out an exhaustive examination of each candidate tooth for sealing before performing the procedure. If we detect a suspicious lesion of incipient caries, we will take an X- ray of that tooth before treating it. The main risk of a sealing is precisely the possibility of masking a caries and its subsequent progression . If there is caries at the time of sealing and it is not detected, it is likely that when it shows symptoms it is in an advanced stage.

Proper sealing

To make a correct sealing of fissures, a correct technique is necessary in conditions of maximum asepsis.

  • Before placing the material on the tooth, we must proceed to an exhaustive cleaning of its surface to ensure the correct adherence of the sealing material.
  • The fixation of the sealing material (or prophylactic layer) on the occlusal surface of the tooth requires a technique very similar to that of a filling, having to use similar products such as: acid etching (or preparation of the surface with an acid material) and sealant material itself (which is placed on the occlusal tooth surface). Some sealant materials polymerize or harden automatically while others require the application of a specific light (halogen) to compact.

We have to mention that the sealing material can become detached from the dental surface, although a remnant usually remains at the bottom of the fissure.

Are there contraindications?

Despite the absence of absolute contraindications, patients with healthy mouths and no history of caries could be excluded.

On the other hand, in case of radiographic or clinical evidence of caries on the dental surface, treatment or restoration would be indicated.

As we have mentioned, we will not proceed to seal those teeth in the process of incomplete eruption either. As the child’s molars erupt, we will proceed to seal them. The first molar usually appears at the age of 6 in the mouth, so it will be sealed 1-2 years later. The time to seal the second molar would be around the age of 12. In high-risk children we will also apply the seal on the premolars.

Likewise, we must bear in mind that the sealants used in pediatric dentistry are reviewed at least annually . If a partial or total loss of the sealing material is detected, the area will be retreated . Obviously, fissure sealants are an effective method of caries prevention as long as they are technically well placed and remain attached to the tooth. They are attributed an effectiveness of up to 90% a year and 60% at seven years. It is a very little bloody and effective treatment and highly recommended for the groups mentioned.

What you should know…

  • Fissure sealants are part of the global caries prevention program together with other therapeutic measures: control of bacterial plaque, use of fluoride toothpastes, control of hygiene techniques, control of intake (especially of refined sugars), etc.
  • Despite the absence of absolute contraindications, patients with healthy mouths and no history of caries could be excluded.
  • Fluoride provides less protection against caries on occlusal surfaces than fissure sealing, therefore, at school age we would opt for sealing.
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