Dental Sealants for RDH Students

Dental Sealant Course

Proper technique and modalities for dental professionals - Dental Hygienists

Start

Objectives

• Recognize and identify factors contributing to dental caries and their increased patient risks.
• Know the appropriate dental sealant procedure and recall the precise steps for optimal placement and retention.
• Understand the need for dental sealants by providing supporting evidence for their use.
• Recommend the clinical strategies for the successful placement of sealants.

To access the closed captioning feature, click on CC in the video and click here to see image.

Modules and Summary

Activity - Practice

Index

Assessment

Conclusion

References

Clinical Significance & Indication Module

Understanding benefit and protection of properly sealed teeth

Modules

Procedural Steps & Clinical Armamentarium Module

Dental Sealants are a clinical preventive procedure that provides a barrier between harmful microbes and the tooth

Proper technique increases sealant retention and longevity

&Clinical Complications Increase Failure Module

Patient complications can exacerbate clinician errors and retention

Clinical Significance & Indication Module

Protecting Occlusal Surfaces

AKA - Pits & Fissures

The posterior teeth have pits and grooves. The enamel cannot benefit from fluoride if the grooves are too deep. These deep grooves can harbor

and plaque, which are two contributing causes of

Streptococcus mutans

Molar Pits & Grooves

tooth decay. Streptococcus sobrinus is a lessor but another well-known microorganism, followed by lactobacillus. These microorganisms are mainstays in the oral cavity, so good oral hygiene may not be enough, which is why we use sealants to provide a protective barrier.

+Info

Benefits of Fluoride

Benefits of sealant

Significance and Indication Module

Indicators and Significance

Occlusal Surface

Wide variety of shapes, broad, narrow, hourglass, inverted Y-shape, and irregular funnels

Preventative Treatment

Patients with moderate or greater caries risk or a secondary prevention for incipient caries

Identification of Tooth Anatomy

Occlusal surface identification complications for sealant recommendations.

Signfigance

The posterior teeth are the most susceptible area to cavity development due to anatomy and morphology

(Sreedevi et al., 2022, p. 1)

Procedural Steps & Clinical Armamentarium Module

Sealant Procedure Steps

Resin-Based

1. Prepare tooth - (Clean with brush or air-polish-prophy jet)
2. Isolate (moisture control, e.g., cotton rolls) and dry tooth
3. Apply Etch* (37% orthophosphoric acid) on all pits and grooves for 15 seconds permanent /15-30 seconds primary
4. Rinse and dry until frosty white opaque appearance
5. Re-isolate (replace cotton rolls)
6. Apply sealant material with a fine brush in all pits and grooves (mandibular teeth distal to mesial, maxillary teeth mesial to distal) to ensure no air bubbles
7. Cure tooth (3 to 5mm above tooth surface)
8. Rinse and evaluate (visually and tactically)
9. Check occlusion (articulating paper) smooth high areas

Resin-based and glass ionomer are the two primary materials used in sealants.

* Glass ionomer does not require etch instead apply conditioner to tooth (PAA - 20% polyacrylic acid) for 10 seconds

Click for images

+ Video Glass Ionomer

Procedural Steps and Clinical Armamentarium

Clinical Armamentarium

Forceps -articulating paper

Air/Water Syringe

Cotton Rolls

Mouth Mirror

Micro Brush Applicator

Curing Light

Excavator tip

Explorer

Hand-piece

Dry Angles

Gauze Squares

Pumice

Clinical Complications Increase Failure Module

Clinical Complications

Defective sealants must be reapplied to maintain marginal integrity. Sometimes sealants fail initially; over time, they fracture and fall out partially or entirely. Unsuccessful placement may be due to the following reasons:

• Saliva, cleaning agent (pumice), or calicum phosphate products contamination occurs
• Poorly (inadaquately) preparation of tooth surface
• Too slow or incomplete curing (photopolymerization)
• Air bubbles (entrapment of air in seal material)
• Overfill (overextension) of seal material beyond the etch tooth surface, leaving a void or weakness of sealant

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Activity

Sealant Procedure Sequence

Identify the sealant steps

Practice your knowledge

+Info

Solution

Sealant Placement Sequence Activity

Apply sealant material and allow it to flow into the pits and fissures. Use a micro brush to smooth and remove excess, ensuring there are no air bubbles.

Step 1

Check occlusion with explorer and articulating paper (use round finishing bur to adjust high spots); any defects re-seal if necessary

Step 2

Isolate the tooth, dry it, and apply etch (Resin) or conditioner (glass ionomer) in all grooves and pits for 15 to 30 seconds.

Step 3

Rinse well with air-water spray, removing all etch from pits and fissures. Next, replace dry aids (e.g., cotton rolls).

Step 4

Activate the curing light about 3 to 5 mm above the seal. The approximate exposure time is 10 to 20 seconds. Then, wipe to remove the sealant taste.

Step 5

Step 6

Prepare tooth - motor polish with brush with pumice or use of air polisher follow with a thorough rinsing.

Step 7

Dry tooth with air until frossty white (opaque) appearance, if does not re-apply etch; glass ionomer tooth is not dried excess moisture is removed.

Evaluation

Next

1/5

Next

Etched Successfully

Etched Unsuccessfully

Evaluation

Next

2/5

Evaluation

Next

3/5

Microorganisms in Dental Caries

Next

Figure 1. The oral microbiome. The normal homeostasis of oral microecology is characterized by a variety of microorganisms, such as viruses, bacteria, archaea, and fungi. Following high sugar intake, Streptococcus mutans secretes virulence factors via sucrose and non-sucrose pathways, which act in concert with other oral commensal flora, the pH in the oral environment decreases due to changes in the dominant flora, the oral microbial community is altered, the oral flora becomes dysbiosis and promotes biofilm formation, ultimately leading to the development of caries.

(Zhu et al., 2023, sec. 2)

Evaluation

Next

4/5

Evaluation

Next

5/5

Sealant procedural steps are critical for success!

Step 1: Clean Step 2: Isolate and Dry Step 3: Acid Etch or Condition (Glass Ionomer) Step 4: Rinse/Suction and Resin Only Dry till Chalky Step 5: Apply Sealant Material Step 6: Cure Step 7: Examine Sealant Step 8: Wipe Tooth

Dental sealants prevent 80% of cavities over 2 years on posterior teeth, where 9 in 10 cavities occur.

(Dental Sealant Facts, 2024, p. 1)

References

Air/Water syringe. (n.d.). Net32. https://www.net32.com/ec/dunlin-3way-air-water-syringe-standard-2-d-166337?vid=20740&frt=13&gad_source=1&gbraid=0AAAAADyk8s19Q_-JhIXhwhEa-e1TuaPBh&gclid=CjwKCAjw2Je1BhAgEiwAp3KY7yLicCtCg-qEQcTiw1s1RmEYqiLisOxuE3swzuZmXVnC0GW6H-UTzhoChzEQAvD_BwE Bisected molar. (n.d.). Manara University. https://manara.edu.sy/downloads/files/1686655052_7.pdf Cotton rolls. (n.d.). HenrySchein. https://www.henryschein.co.uk/gb-en/dental-gb/p/disposables/cotton-products-cotton-pellet/hs-cotton-pellets-size-1-10g/9001881 Christensen, G. (2021, June 1). Air Polisher. Dental Economics. Christensen, G. (2021, June 1). Failed sealant. Dental Economics. Curing light. (n.d.). Azdentall. https://azdentall.com/products/dental-led-curing-light-lamp-wireless-1500mw-cm2-simple-mode-convenient-operation Dental Sealant images (figure 1- 5). (n.d.). AEGIS. https://www.aegisdentalnetwork.com/ida/2011/12/dental-sealants-a-cornerstone-of-preventive-care Dry angle. (n.d.). net32.com. https://www.net32.com/ec/driangle-cotton-substitutes-plain-assorted-sizes-360-d-167753?vid=130&frt=13&gad_source=1&gbraid=0AAAAADyk8s1cXQynZk6DS3vHAxp7_OGDk&gclid=Cj0KCQjw-5y1BhC-ARIsAAM_oKm_UpARzOc9D7tMD0grosKW6nF0g3LusHUoANJv-_zBJNo3ydxoDfsaAgOsEALw_wcB Explorer. (n.d.). MVP Dental Supplies. https://mvpdentalsupply.com/products/hu-friedy-exd56-5-double-end-dental-explorer-6-satin-steel-handle Fluoride. (2023, August 23). MDPI. https://www.mdpi.com/1996-1944/16/19/6453 Gauze. (n.d.). skydentalsupply.com. https://www.skydentalsupply.com/2x2-gauze-cotton-filled-sky.htm Greenlee, M. (2022, August 23). Closed captioning. Business Insider. https://www.businessinsider.com/guides/streaming/how-to-turn-on-subtitles-on-youtube Handpiece. (n.d.). Net32.com. https://www.net32.com/ec/promate-cl-cordless-hygiene-handpiece-includes-1-d-174874?vid=20841&frt=13&gad_source=4&gbraid=0AAAAADyk8s1CEcygry3s9nkxMKXGVYegG&gclid=Cj0KCQjw-5y1BhC-ARIsAAM_oKlAokPaEuSJkRd3FBQp9RnOAP0n_UPYLg6E0fYq0B_DSdZcNSjgKPMaAtLyEALw_wcB Hygiene Edge. (2020, January 31). Increasing sealant effectiveness and retention [Video]. YouTube. https://www.youtube.com/watch?v=8bhA6peh28A Mouth mirror. (n.d.). Percision Dental Usa. https://precisiondentalusa.com/shop/diagnostics/mouth-mirror/22mm-mouth-mirrors-with-handle-10-pk/ Physical barrier. (2023, August 23). MDPI. https://www.mdpi.com/1996-1944/16/19/6453 Pumice. (n.d.). dentalcity.com. https://www.dentalcity.com/product/10456/preventech-nada-pumice-paste Replaced sealant. (n.d.). Happykidsdentistry. https://www.happykidssmiles.com/common-procedures Resin vs. Glass ionomer. (n.d.). Dental-Update. https://www.dental-update.co.uk/content/preventive-dentistry/indications-for-fissure-sealants-and-their-role-in-children-and-adolescents/ Sreedevi, A., Brizuela, M., & Mohamed, S. (2022, September 26). Pit and Fissure Sealants. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK448116/ Streptococcus mutans. (n.d.). BacDive. https://bacdive.dsmz.de/strain/14736 Zhu, Y., Wang, Y., Zhang, S., Li, J., Li, X., Ying, Y., Yuan, J., Chen, K., Deng, S., & Wang, Q. (2023). Association of polymicrobial interactions with dental caries development and prevention. Frontiers in Microbiology, 14. https://doi.org/10.3389/fmicb.2023.1162380

Placement Indications

"On any deciduous or permanent tooth with an increased risk of experiencing caries or incipient carious lesions (non-cavitated) or patients with medical, physical, or intellectual disabilities when systemic health could be jeopardized by dental disease or need for treatment" (Sreedevi et al., p. 2 2022).

Identifying the specific grooves and pits (aka, fissures) type through visual clinical examination or even x-rays may not be possible; therefore, clinicians must consider sealant indications.

Diagnosis difficulties ...

National Health and Nutrition Examination Survey (NHANVES) 2011-2012 data shows that 21% of children six to eleven years and 58% of adolescents aged twelve to nineteen had experienced carious lesions in their permanent teeth (American Academy of Pediatric Dentistry & American Dental Association, 2016, p. 264).

Did you know...

MORPHOLOGY VIRATIONS...

V-TYPE shallow and wide (gradual narrowing toward the bottom), fairly decay-resistant, noninvasive recommendations U-TYPE shallow and wide, fairly decay-resistant, noninvasive recommendations I-TYPE is a sigificant narrow and dip slit (bottleneck), high caries risk, invasive recommendations IK-TYPE is a narrow slit with larger shape at bottom, high caries risk, invasive recommendations (Sreedevi et al., 2022, p. 1)

Resin-based treatments are the first choice; however, when isolation issues occur (moisture control), glass ionomer should be used with the added benefit of dispersing fluoride.

Increasing Sealant Effectiveness and Retention

Microscopic view of Streptococcus mutans

Seal or not to Seal?

General Recommendations

• Anyone with a high risk for decay
• Children
• Poor dental hygiene
• Deep pits and fissures (grooves)

Recommendations for Common Complications

• Inability to maintain adequate moisture control use Resin-based Embrace WetBond or Glass Ionomer materials
• Four-handed dentistry (two professionals - one to perform procedure other assists (e.g., suction, retraction, hand-off of tools)

Pits and Grooves

They are found on molar and premolar (bicuspid) teeth. Due to their morphological complexities, they are more susceptible to enamel breakdown than smooth surfaces of teeth.

Glass Ionomer Sealant Application