pit_fissuremonograph.pdf - PIT AND FISSURE SEALANTS AN...

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P IT AND F ISSURE S EALANTS A N O VERVIEW OF I SSUES R ELATED TO D IAGNOSIS AND T REATMENT D ECISIONS Prepared by William F. Vann, Jr., D.M.D, M.S., Ph.D., Professor and F. Thomas McIver, D.D.S., M.S., Professor Department of Pediatric Dentistry University of North Carolina School of Dentistry A Maternal and Child Health Center of Leadership in Pediatric Dentistry Education
1 Figure 1. Fissure filled by sealant Figure 2. Even a single tooth brush bristle is too large to clean fissure P IT AND F ISSURE S EALANTS Definition A sealant is a clear or opaque plastic material that is applied to the pits and fissures of teeth where decay occurs most often. The purpose of the sealant is to provide a physical barrier to occlude pits and fissures and to protect them from bacteria and food. Because the sealant obliterates the deeper and more tortuous anatomy, it also facilitates oral hygiene efforts because the sealed tooth is easier to clean. Note Figure 1. Sealants have been used in clinical practice for nearly 30 years. The first generation sealants were liquid resins placed on the tooth, then polymerized with an ultraviolet light. The ultraviolet light has been replaced today by chemically-cured materials or materials that are cured with a more safe and efficient source of light polymerization than ultraviolet light waves. Most sealants today are made of Bowen's formula called BIS- GMA, an acronym for a monomer that is the reaction product of bisphenol A and glycidyl methacrylate. This is the same material that comprises the matrix of composite resin filling materials. All sealants can be assigned to two basic categories according to the method of polymerization: (1) autopolymerizing or chemically-cured sealants, which are referred to also as second generation sealants and (2) photopolymerizing or light-cured sealants, which are referred to as third generation sealants . Rationale Why are sealants necessary? By nature of their anatomy, pit and fissure surfaces are often difficult to clean and thus at higher risk for caries. As illustrated in the magnification of an occlusal tooth surface cross- section in Figure 2, this deep and tortuous anatomy lends itself to the entrapment of food debris, plaque formation and bacterial growth. The illustration shows that the fissure is so small that a toothbrush bristle will not reach the depth of the fissure. Thus, even excellent home care efforts may not be successful in cleaning a deep fissure. Another concern with pits and fissures is related to their susceptibility to fluoride protection. Research demonstrates that topical fluorides are less effective in protecting the pit and fissure surfaces than the smooth surfaces of enamel. This does not imply that fluorides are ineffective on pit and fissure surfaces; however, topical fluorides selectively benefit the smooth surfaces to a greater extent than pit and fissure surfaces and this difference is believed to be related to tooth anatomy.

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