Sealants

Question 1

What are Sealants in definition?

Answer 1

Thin resin coatings bonded to enamel to act as a physical barrier to bacteria

Question 2

2 types of sealants?

Answer 2

1. Some sealants are unfilled resin
   - Bis-GMA
2. Some have filler in the resin
   - Quartz or silica

Question 3

2 types of curing for sealants

Answer 3

1. Chemical-cured
   - Auto-polymerizing, 2 components must be mixed
2. Light-Cured
   - Photo-polymerizing, 20 second setting

Question 4

Sealant prevalence on permanent teeth of children is how much

Answer 4

• About 30%

This is Low

Question 5

How effective are sealants?

Answer 5

• 60-75% caries reduction at 4 years roughly

Question 6

What is the effect of sealing incipient caries?

Answer 6

1. Bacteria cut off from nutrients
2. Caries process reduced or arrested
3. Bacteria become dormant

***Seal must be a good one

Question 7

What teeth should have sealants placed?

Answer 7

1. Pits and fissures of children’s primary teeth when at risk of developing caries
2. Pits and fissures of children’s and adolescent’s permanent teeth when at risk of developing caries
3. Pits and fissures of adults’ permanent teeth when at risk of developing caries

Question 8

What are the first choice of material for dental sealants?

Answer 8

Resin-based sealants

Question 9

Is there one thing that can be used to diagnose caries?

Answer 9

No, nothing has been shown to be completely diagnostic. Many things such as explorer, radiographs, technology etc.

Question 10

6 criteria for sealant use?

Answer 10

1. Age
2. Oral hygiene
3. Current caries or recent history
4. Diet
5. Fluoride history
6. Tooth type and morphology

Question 11

Caries susceptible pits & fissures by tooth type

Answer 11

1st - Lower molars (about 50%)
2nd - Upper molars (35-40%)
3rd - U/L 2nd premolars
4th - Upper laterals & 1st premolars
5th - Upper centrals & lower 1st premolars

Question 12

Why are deep pits and fissures susceptible to decay?

Answer 12

• bristles too large to clean fissures

- collect food debris & bacteria

Question 13

Examples of teeth that should be sealed

Answer 13

1. Teeth with deep, narrow pits & fissures
2. Occlusal surfaces of premolars & molars
3. Buccal grooves & pits on Mandibular 1st & 2nd molars
4. Lingual grooves & pits on Maxillary 1st & 2nd molars
5. Lingual pits on upper anterior teeth
6. Recently erupted, susceptible teeth

Question 14

Teeth not indicated for sealants

Answer 14

1. Occlusal or proximal caries present (no proximal)
2. Well coalesced pits and fissures
3. Teeth caries free for many years

Question 15

Seal fissures with obvious caries?

Answer 15

No, do not seal

Question 16

8 steps for application of sealants

Answer 16

1. Isolate with rubber dam
2. Cleanse with pumice and brush
3. Rinse and dry thoroughly
4. Apply acid for 20 seconds
5. Rinse and dry completely. If contaminated, re-etch 15 sec.
6. Apply sealant with brush or syringe
7. Cure 20 sec. each area
8. Check retention, occlusion, and contacts

Question 17

T or F, Working with an assistant to apply sealants will improve the overall retention rate

Answer 17

True

Question 18

4 advantages to rubber dam isolation

Answer 18

1. Maintains dry field
2. Keeps moisture from breath off etched surfaces
3. Keeps tongue away
4. Barrier for infection control

Question 19

4 disadvantages to rubber dam isolation

Answer 19

1. Difficult to clamp partially erupted teeth
2. May require anesthesia for placement
3. Patient phobias - suffocation
4. Allergy to latex

Question 20

T or F, it is ok to use flavored polishing pastes to clean surface of tooth

Answer 20

False, Do not use flavored polishing pastes

Question 21

T or F, pumice removes smear layer, biofilm and pellicle

Answer 21

True

Question 22

T or F, Rinse well and dry the tooth after pumice

Answer 22

True

Question 23

2 approaches to sealants

Answer 23

1. Non-invasive - just seal
   - -> 90% of sealants are performed this way
2. Invasive - Open fissure & clean out before sealing

Question 24

What two burs can be used to explore suspicious fissures

Answer 24

1/4 round bur

132 F Diamond bur

Question 25

How long do you apply the acid etch?

Answer 25

20 seconds

Question 26

Which etch is preferred?

Answer 26

Gels are better, better control of placement with gel

Question 27

Resin tags create what?

Answer 27

Micromechanical retention

Question 28

T or F, use of self-etch is contraindicated for sealants?

Answer 28

True, use of bonding agent may enhance retention

Question 29

What does the tooth look like after it has been etched and dried

Answer 29

Frosty, etched and clean enamel

Question 30

What happens to the wettability on an etched surface vs an un-ethced surface

Answer 30

Etched: low contact angle | Un-etched: High contatact angle

Question 31

What happens if too much sealant is applied?

Answer 31

Bite will be high, occlusion will be off

Question 32

What is the minimum for light curing a sealant

Answer 32

Minimum is 20 seconds but you can go longer, cannot overcure

Question 33

Why do you rinse teeth or swipe with gauze immediately after light cure?

Answer 33

- To remove oxygen inhibited layer of sealant - Remove bad taste - Reduce xenoestrogen exposure of BPA

Question 34

What bur is used to adjust contacts after rubber dam is removed?

Answer 34

``` A football ultrafine diamond #7404 bur ```

Question 35

T or F, Do not floss teeth after sealant is placed

Answer 35

False, floss teeth to make sure sealant flash has been removed.

Question 36

T or F, Sealants may not be visible over the years but they are still effective

Answer 36

True

Question 37

What is the chart entries for sealants?

Answer 37

1. Date 2. Teeth and surfaces sealed 3. Diagnosis and rationale for Tx 4. Isolation and material used 5. Post Op Instructions

Question 38

How long until failures show up?

Answer 38

Most failures occur within the first 3-6 months | - All or part of sealant may come off

Question 39

What is the worst failure in sealants?

Answer 39

A sealant that leaks, does not come off, goes undetected & decays underneath

Question 40

What is visible in a leaking sealant

Answer 40

1. Look for discoloration at the margins | 2. Dark appearance under the sealant