The present recommendations are suggested for use in individual care programs, in which the caries risk assessment of the individual should have a strong influence in determining who receives sealants. In community-based programs the recommendations should be based on additional factors, such as the assessment of the oral health needs, the resources of the community and the availability of other preventive measures.
The decision to apply a fissure sealant should be made on clinical grounds based on a thorough clinical examination, supported by radiographs where appropriate, and taking into account risk factors such as medical and social history as well as past caries experience and present caries activity. Sealants may be used to prevent caries in teeth estimated to be at risk, or to arrest the progression of caries lesions limited to enamel.
Patient and tooth selection
1. Children and young people with medical, physical or intellectual impairment: The application of sealant to all susceptible sites of primary and permanent teeth should be considered, especially when systemic health could be jeopardised by dental disease or the need for dental treatment.
2. Children and young people with signs of acute caries activity: All susceptible pit- and fissure sites should be considered for sealing including the buccal fissures of permanent molars
3. Children and young people with no signs of caries activity: Only deeply fissured (extremely plaque retaining fissures) and thus potentially susceptible surfaces should be considered for sealing.
It should be mentioned that all children, irrespective of caries activity, should be regularly monitored for any change in risk factors and/or clinical or radiographic evidence of a change in their caries status.
Clinical considerations
1. When there is an indication for placement, then sealants should be placed as soon as possible since the tooth is most caries susceptible during the post-eruption period. However, susceptible sites of teeth can be sealed at any age depending on assessment of risk factors.
2. The choice between resin/composite and glass-ionomer sealants should be based on adequacy of moisture control. Since the resins are most durable they should generally be preferred, while glass ionomer cements should be used in cases where moisture control is difficult, e.g. in erupting or newly erupted teeth. GIC sealants in these cases are regarded more as a temporary sealant or a fluoride release vehicle, rather than a true fissure sealant.
3. Where there is a real doubt about the caries status of a susceptible site on clinical examination, e.g. a stained fissure, then a bitewing radiograph should be obtained. If there is unequivocal evidence that the lesion is confined to enamel then the surface can be sealed and monitored clinically and radiographically. When the evidence is equivocal, then removal of the stained areas in the fissures (enamel biopsy) should be performed, using rotating instruments.
4. If the lesion extends into dentine after removal of staining then a sealant restoration ("preventive resin/glass ionomer restoration") may be placed. A more extensive cavity will require a conventional restoration.
Follow up and review
1. All sealed surfaces should be regularly monitored clinically and radiographically. Bitewing radiographs should be taken at a frequency consistent with the patient's risk status, especially where there has been doubt as to the caries status of the surface prior to sealant placement. The exact intervals between radiographic review will depend not only on the risk factors, which may change with time, but also on the monitoring of other susceptible sites, for example approximal surfaces (Rushton et al, 1996).
2. Defective sealants and/or preventive resin or glass ionomer restorations should be investigated and the sealant reapplied in order to maintain the marginal integrity, provided the surface is caries free (Walker et al, 1996; Gray and Paterson, 1998; Wendt et al. 2001a ).
Login
Forgotten password