pit and fissures

Question 1

define fissure sealant

Answer 1

substance placed in P&F to prevent plaque, bacteria and fermentable foods like sugars, starches from entering fissures and causing caries

Question 2

how to do patient selection

Answer 2

based on caries risk assessment: either algorithm or judgement
criteria:
high caries risk: seal primary molars and perm posteriors
medium: perm molars
low: teeth with deep retentive fissures

children w special needs: not able to clean teeth very well, extensive caries in primary teeth

Question 3

tooth selection (local factors)

Answer 3

sound teeth with deep fissures
molar-incisor hypomineralisation
if occlusal caries formed in a 6, seal all other 6s and assess need to seal 7s when they erupt sufficiently

Question 4

when does fissure sealant vs PRR

Answer 4

seal when: chalky/stained looking p&f, no radiographic evidence of caries
restore when: discolouration radiating, exposed dentine, lesion beneath enamel, cavitated (too deep then sealant doesnt go all the way and theres a void)

Question 5

composite resin vs GIC

Answer 5

unfilled resin flows better, no need to be filled as its not in occlusion
clear fissure allow monitoring of fissures sealed under sealant, opaque used to prevent subsequent dentist from removing sealant thinking theres caries
GIC: flowable GIC

Question 6

brand of sealants

Answer 6

CR: cleanpro
GIC: fuji vii

Question 7

retention between CR and GIC

Answer 7

resin retention rate: 84% at 5 years

GIC retention rate: <19% cos GIC not great retention

Question 8

caries incidence CR and GIC

Answer 8

incidence at 48 months
10% GIC (high F release)
20% CR

Question 9

what to do with stains

Answer 9

use pumice and ultrasonic to remove stains
air abrasion removes some enamel so not that great
then if you cannot bops

Question 10

effectiveness of sealant

Answer 10

reduce caries 86% after 1 year

57-48% at 48-54 months (effective till 4 years)

Question 11

monitoring

Answer 11

xrays and probe and appropriate intervals

Question 12

PRR indication

Answer 12

preventive resin restoration
shallow caries into dentine, complex fissures prone to new caries
prophylactic treatment of dens evaginatus
removal of isolated carious lesions within p&f, restore with CR and seal remaining fissure

Question 13

how do you apply sealant

Answer 13

2mm up cuspal inclines, use syringe tip or dycal applicator ensures no bubbles

Question 14

what to do if tooth is partially erupted and theres operculum

Answer 14

no moisture control, GIC interim (maybe put adhesive as a pro move)
cut operculum off (sad)