Inside Dental AssistingNovember/December 2011, Volume 7, Issue 6Published by AEGIS Communications
Understanding the role and placement of dental sealants for your patients.
Mary J. Hayes, DDS
Good oral health starts with a sound prevention program in the office. Preventive dental interventions—including early and routine care, fluoridation, and sealants—are cost-effective in reducing disease burden and associated expenditures. The dentition should be evaluated periodically for developmental defects, deep pits, and fissures that may contribute to caries risk.
As a cornerstone of preventive care, dental sealant application supplements the basic elements of effective oral hygiene, good dietary choices, and regular dental examinations and prophylaxis. Fluoride is also an important foundation of an office’s prevention plan, but it is not as effective at promoting remineralization in pits and fissures (where as much as 90% of all caries occurs in school-aged children). Sealants are used to prevent caries developing in the pits and fissures of the dentition, especially the molars; they act as a barrier to acid and plaque, protecting the enamel of the tooth from decay. Since 1987, sealants have been included in the American Dental Association’s (ADA) policy statement as a procedure to be covered by insurance.
The procedure is most commonly done to permanent molars within the first several years of their eruption. An older patient may be a candidate to treat caries-susceptible pits and fissures, as long as there has not been a previous restoration on the tooth.
Having been trained during their education programs, dentists and dental hygienists are licensed to perform this service. Dental assistants are also presently able to place sealants in 38 states, which have training and supervision requirements.
When possible, a four-handed technique should be used for the placement of resin-based sealants. Regardless of which member of the dental team is placing the sealant material, there are key general principles to be followed for successful technique.
1. It is important to keep the patient comfortable during the procedure. Because the teeth to be sealed must be kept dry from the moisture of the mouth, isolation techniques such as cotton roll or rubber dam isolation are required. A patient with a sensitive tongue or tendency to gag may react negatively to the isolation required. Often, sealant placement may be the first significant procedure young children are asked to tolerate in the dental office. Prompting the patient’s cooperation through positive communication is critical. The dental assistant should practice calming behavioral techniques, such as distraction, to help promote the patient’s comfort.
2. The tooth to be sealed must be cleaned, etched, washed, dried, conditioned, and cured properly for effective bonding to occur. The tooth must not become wet at any of the stages of placement or the sealant will fail.
3. The sealant material should be an even, thin film over the occlusal surface; a bulky, thick sealant may cause occlusal interference and pain later from an artificially high occlusion.
4. Before the patient is dismissed, the exposed sealant surface should be cleaned by wiping with a gauze or a cotton pellet or washing with a stream of water for 10 seconds.
When a patient presents for sealant placement, having the proper setup for efficient use of the chair is essential. Instruments include a mirror, explorer, water syringe tip, and cotton pliers. In addition, bend-a-brushes, a well for the bonding agent, sealant material, and isolation aids such as cotton rolls, rubber dam equipment, or other aids, must be placed and readied before the patient is seated (Figure 1).
The choice of sealant material will vary according to the patient’s needs. Resin-based sealants, whose chemistry is light-cured, are the first choice for sealants.5 Sealants may be clear or white, and there are different handling consistencies.
Applying the sealant is a simple and painless process. It takes only a few minutes to apply the sealant to seal each tooth. The patient should be prepared through a demonstration of the process so that each step can be anticipated.
1. The teeth to be sealed are observed for general condition. If plaque and/or food debris obscures the occlusal surface, it may be removed with a toothbrush and pumice. The occlusal surface should be entirely above the level of the gingiva. Sometimes, when teeth have recently erupted, the distal of the occlusal surface still has gingiva close to or over the marginal ridge of the tooth. In this case, in spite of isolation, saliva and moisture may jeopardize the requirement for a dry tooth surface for successful bonding. If this is observed, the dental assistant should ask the dentist to assess the tooth’s capability for successful sealant placement.
2. The tooth to be sealed is isolated from the saliva of the mouth with a rubber dam, cotton roll isolation, or an aid (Figure 2).
3. An acid-etch conditioner is placed with a syringe onto and around the entire occlusal surface of the tooth, including all areas meant to be sealed. This is left on for 20 to 30 seconds (Figure 3).
4. Water is sprayed for 20 to 30 seconds to rinse off the conditioner, using suction to make sure the water is evacuated (Figure 4).
5. The air syringe dries all moisture off the tooth, leaving a uniform etched surface. The presence of moisture at this step is a critical error. If the surface is contaminated by an unetched or moisture-contaminated area, the etching step must be repeated (Figure 5).
6. With an applicator, the bonding agent is flowed thinly onto the enamel surface, followed by “painting” the sealant onto the etched enamel, where it bonds directly to the tooth. The sealant must be allowed to flow gently into the pits and fissures without rubbing the enamel. Agitating the sealant is to be avoided, as air bubbles can be introduced into the sealant, weakening it. A thin coat to cover all the pits and fissures is ideal; it is not necessary to place a bulky sealant, which may result in occlusal interferences.
7. To finish the bonding process, a blue-spectrum curing light is directed to the occlusal surface for 5 to 30 seconds, depending on the brand of light. The light promotes the polymerization of the sealant material. Due to its intensity, neither the patient nor those chairside should ever look directly at the light (Figure 6).
8. The surface of the sealant is checked with an explorer for voids or surface irregularities. If these are detected, the sealant may be touched up or reapplied.
9. Concluding treatment, the occlusal surfaces of the newly sealed teeth are brushed or washed clean with suction. This minimizes the exposure of the patient to byproducts of the process.
10. The occlusion is checked for comfort; it is expected that the teeth will feel different because of the addition of a thin coating of sealants. If necessary, high spots may require adjustment by the dentist. The patient is advised to rinse if desired. After treatment, there are no eating restrictions.
The dental assistant is an integral team member for sealant procedures. Additionally, when setting skill competencies, the steps for sealant application are the beginning of handling bonded composite resins: Therefore, training for additional restorative procedures may build from sealant placement. With technical competency, the dental assistant brings an extra level of professional expertise to the clinical setting. Quality sealant placement provides proven caries prevention to patients, which is central to dentistry’s mission of promoting optimal oral health.
1. Sinclair SA, Edelstein B. Children’s Dental Health Project. Cost effectiveness of preventive dental services. February 2005. http://www.cdhp.org/resource/cost_effectiveness_preventive_dental_services_0. Accessed January 2011.
2. American Academy of Pediatric Dentistry. Policy on Third-Party Reimbursement of Fees Related to Dental Sealants. http://www.aapd.org/media/policies_guidelines/p_3rdpartsealants.pdf. Accessed August 2, 2011.
3. ADA Council on Access, Prevention, and Interprofessional Relations; ADA Council on Scientific Affairs. Dental sealants. J Am Dent Assoc. 1997;128(4):485-488.
4. Dental Assisting National Board, Inc. State-specific dental assisting information. http://danb.org/main/statespecificinfo.asp. Accessed October 2011.
5. Beauchamp J, Caufield PW, Crall JJ, et al. Executive summary of evidence-based clinical recommendations for the use of pit-and-fissure sealants. J Am Dent Assoc. 2009;140(11):1356-1365.
6. Szabo, L. USA Today. Dental sealants temporarily raise BPA levels. September 6, 2010. www.usatoday.com/yourlife/health/medical/oralcare/2010-09-07-dental07_st_N.htm. Accessed January 2011.
About the Author
Mary J. Hayes, DDS
Private Practice Specializing in Pediatrics