Sealants

 

Sealants have been around for many years.    Their intended purpose has been to prevent bacteria from entering the grooves on the tops of back teeth, thereby preventing cavities.   While the American Dental Association is a proponent of dental sealants, I have actually stopped performing this procedure in my office.   I will state now that my opinion is in contrast to the opinion of most dentists and that of the American Dental Association so read my opinion with an open and critical mind.

 

First of all, let’s discuss the procedure of sealants.   The tops of teeth vary from individual to individual with respect to the shape and depth of the grooves.   Some people have very shallow grooves rendering the top of the tooth to be almost smooth in nature.   Other individuals have such deep and craggy grooves that the surface might resemble the general contour of a steep mountain range.   Most people have grooves that are in between these two extremes.   The deepest, narrowest grooves are the ones most likely to harbor bacteria in places that the tooth brush bristles cannot clean.   The first step in performing a sealant is to isolate the teeth to be sealed so that bacteria containing saliva can be kept away from the tooth until the procedure is over.    This step can be challenging in some individuals compromising the procedure right from the start.   The second step is to clean the top of the teeth with a mild acid called etchant.   This acid can dissolve some layers of bacteria and is also meant to roughen the surface creating more surface area,  thus enhancing the gluing (bonding) effect.   The sealant material which is essentially a liquid plastic filling material, is then brushed onto the surface filling the grooves and leaving a smoother surface which should be less likely to trap bacteria  and which should be easier to brush clean. Once the sealant has had the opportunity to flow into the grooves, a light is used to harden the sealant.    In a nutshell, a sealant is a filling which does not require any drilling or anesthetic.

 

If you were to ask any dentist if they have ever seen sealants “pop out” exposing a cavity that had been under the sealant, I feel certain that the vast majority of dentists will have seen this.   While there is no way to be sure what happened with this scenario (i.e. the sealant became loose and then a cavity followed or the sealant was placed over bacteria or a cavity that had already started), I am of the opinion that in many instances, the sealant was placed over bacteria which may or may not have already started a cavity.   

 

I first became aware of this philosophy in 1987 when one of my instructors would do “preventative fillings”.   The difference between a sealant and a preventative filling is that there is no drilling with a sealant.   With a preventative filling, a drill is used to open the grooves to allow visual inspection and cavity removal if there is some present.   Then, a sealant like material is used to fill the tooth and create the smooth surface that is the desired outcome.   With modern technology, I am more comfortable with my ability to determine which grooves have small cavities started and which are deep grooves without decay.   So, if they never get cavities, great.   If cavities have started, then I do a filling.   Each dentist will use her/his/their own judgement for each individual tooth based on their experiences so please defer to the opinion of your dentist.