Flashcards in Fissure sealants Deck (20)
what is a fissure sealant
A protective plastic coating used to seal fissures and pits to prevent food and bacteria getting caught in them and causing decay.
Why are fissures vulnerable to caries
Fissures are less protected by fluoride than interproximal or smooth surfaces.
It is not possible to clean the base of fissures with a tooth brush.
What material do we use for fissure sealants
Mostly bis-GMA resin applied following acid etch of the fissure pattern.
Occasionally we use glass ionomer cement (see indications for this later).
indications for fissure sealant placement
- Children deemed to be at high risk of caries should have their permanent molars and premolars sealed upon eruption.
- Medically compromised children, children with learning difficulties or those with physical and mental disabilities should all have teeth sealed.
- If a child is of low caries risk they do not need to have their first permanent teeth sealed routinely, rather these fissures should be closely monitored.
- Guidance from SIGN 138 and SCDEP– seal all pits and fissures of permanent molars in children as soon as possible after eruption.
Where should you seal?
- Greatest benefit on occlusal surfaces of permanent molar teeth.
- Should also seal cingulum pits of upper incisors, buccal pits of lower molars and palatal pits of upper molars.
- Sealing of primary molars may be advised in high caries risk children.
- A child with caries in one first permanent molar should have the other 3 sealed immediately.
- Occlusal caries in first permanent molars indicates that second permanent molars must be sealed on eruption.
how do you isolate a tooth for fissure sealant placement/ why is it difficult with children
- dental dam
- dry guards/ cotton wool
- have your nurse help with retraction and aspiration
- work with efficient speed to reduce moisture contamination
- clean occlusal surface (preferably with pumice and water)
outline fissure sealant placement
1. etch with 35% ortho-phosphoric acid on enamel surface (avoid soft tissues as could burn)
2. wash etch into aspirator and dry occlusal surface with 3in1
(etched surface should appear chalky white when dry)
3. add resin to depths of dry fissure pattern using brush, micro-brush or small excavator. Ensure material is in base of fissure and avoid overfilling as decreases long term retention
4. light cure
how do you check a fissure sealant has been placed correctly
- use sharp probe and try to dislodge
- no air blows present, if there are, remove part of sealant and re-do
- no material has flowed interproximally (if it has remove with a sharp probe and dental floss)
- no excess material distal to the tooth in the soft tissues
how often should you review fissure sealants
every 4-6months (low risk every 12-18 months)
what are indications for glass ionomer fissure sealant
- where good moisture control cannot be achieved (high risk children with partially erupted molars, special needs children, poorly cooperating children)
- Where there is a high degree of sensitivity due to developmental or hereditary enamel defects. In these cases drying the tooth can be extremely painful.
- Useful as release fluoride but are poorly retained and require regular reapplication.
how do you place a glass ionomer fissure sealant
- Attempt to dry tooth with air or cotton wool.
- Apply GI from applicator.
- Smooth into fissures using gloved finger or thumb.
- Keep finger over GI until set or place petroleum jelly to decrease moisture contamination until set.
define a stained fissure
A fissure that is discoloured, brown or black. Also included are fissures where there is an area of white or opaque enamel i.e. its normal translucency is lost but it has no evidence of surface breakdown (cavitation).
how do you diagnose a stained fissure
Visual (dry tooth)
Fibre optic transillumination
if the caries doesn't enter the dentine what do you do
If investigation reveals that caries does not enter the dentine, provide a fissure sealant and monitor.
(In some cases where diagnosis is inconclusive it is prudent to clean the stained fissure with a small slow speed bur- if only hard material is encountered then fissure seal.)
if the caries enters the dentine what do you do
When diagnostic methods have established that a stained fissure is a carious lesion into dentine, restorative treatment is indicated.
If the lesion remains small a preventive resin restoration (PRR) or sealant restoration (SR) can be provided- this is where the defect is filled with a small amount of composite then sealed over the top with a fissure sealant.
If the defect is found to be large then a conventional composite restoration will be required.
what teeth do you prioritise in mixed dentition
the permanent teeth (deal with them first before any primary)
how do you manage virgin caries in FPMs
- Maximise prevention
- Always prioritise FPM’s in any mixed dentition treatment plan (i.e. restore 6’s prior to dealing with lesions in primary molars)
- Caries most commonly affects the pits and fissures of the FPM’s but may also develop proximally below the contact point
- When caries in the FPM’s is extensive always consider the long term prognosis
- Remember that the pulp is much more likely to be exposed on caries removal due to its size (may wish to consider stepwise caries removal in order to induce calcific barrier formation over the pulp- section 10.5 in SCDEP Guidance)
- Paediatric dentistry clinics are likely to be the first place you come across previously uncut lesions.
- Always seek advice re the best place to make your initial cut and always aim to keep the cavity as small as possible whilst obviously removing the caries.
- Initially form your cavity shape by ensuring that margins are clear at the ADJ before extending deeper towards the pulp.
- In many cases it is not feasible to have a child sit the length of time necessary for the completion of a quality composite restoration under rubber dam
Bulk fill composite may be useful in these cases
how old does someone have to be to have amalgam
Cannot use amalgam in under 15s, therefore sometimes have to consider preformed metal crowns on first permanent molars as intermediate restoration
when might you consider extraction of FPMs
In some situations extraction of FPM’s of poor prognosis at the correct time can allow the development of a caries free dentition in the adolescent, without spacing.