All about Dental Sealants.

Tooth Sealants explained –

A dental sealant’s thin plastic coating fills in the grooves (pits and fissures) of teeth.

Table of contents.

• What are sealants?
• How do they work?
  • Are they always needed?
   
• When should they be applied?
  • What age? Which teeth?
   
• How effective are they in preventing cavities?
• How are dental sealants placed?
  • The steps. Illustrations.
   
• How long do they last?
  • Aftercare / Maintenance
   
• Potential risks and side effects.
  • Bisphenol A (BPA) exposure.
   
• How much do they cost?
  • Does insurance cover them?
  • Kids sealant programs.
   
• Cost-effectiveness.

A) What are dental sealants?

A sealant is a thin plastic coating that’s been bonded into the pits and grooves of a tooth. (The formal term for this preventive measure is “pit and fissure” sealants.) The most commonly used type of sealing material is plastic that is clear or white.

Sealants are most frequently placed on the chewing surface of teeth (because that’s where most of a tooth’s grooves lie). But they can also extend onto the cheek or tongue sides of teeth (either as a continuous or separate application), depending on whatever additional nooks and crannies are found there.

There’s nothing new about the use of sealants as a protective shield for teeth. Dentists have been placing them since the late 1960s (the decade when the science of bonding dental materials and restoratives to tooth enamel first became widely implemented in dentistry).

Why are they placed?

Dental sealant placement is a technique that can help to protect vulnerable areas of teeth from the formation of tooth decay. Here’s how they work:

The underlying concern.

As compared to a tooth’s smooth surfaces, its pits and fissures (grooves) tend to trap debris. This includes dental plaque and the cavity-causing bacteria it contains as well as food particles, which are a food source for oral bacteria. And when these items are present, they place the tooth at increased risk for cavity formation.

The remedy.

When placed, a dental sealant fills in a tooth’s pits and grooves and therefore acts as a barrier, literally a plastic shield, that prevents debris from accumulating. (See diagrams below.)

• It’s been estimated that 88% of tooth decay in school children occurs in pits and fissures.
• However, these areas only make up about 13% of a tooth’s total surface area.
• So by protecting just 13% of those teeth that are most at risk with dental sealants, you can substantially lower a child’s overall risk for cavity formation.

▲ Section references – Feigal

When compared to the expense and effort of having a cavity form and then a filling placed, placing dental sealants is a very simple and cost-effective measure.

Who makes a good candidate for sealant placement?

• Most sealants are placed on the teeth of children (see below for details about which teeth, at what age, etc…).
• However, any person who has a tooth that could benefit from this type of protection, no matter what their age, can and should receive one.

It’s the susceptibility of the tooth and not the age of the patient that should be the prime consideration.

When should they be considered?

a) Ideal conditions for sealant placement.

The most predictable scenario for the use of a sealant is one where it is placed before any sign of a cavity has had a chance to form.

For this reason, once a need has been identified, it’s a good idea to have a tooth sealed as soon as it is reasonably convenient.

b) Acceptable conditions for placement.

Even if vague signs of cavity formation have started to appear (referred to as incipient or non-cavitated decay), a dentist may determine that it’s still acceptable for a sealant to be placed. This simply needs to be determined on a case-by-case basis.

The general idea is that the tight seal of the sealant over the bacterial colony responsible for forming the lesion will cut off its food supply, thus arresting, or at least retarding, the progress of the decay process.

One study evaluated teeth with incipient decay over a 5-year period.

• Only 11% of the teeth that received sealants developed a cavity. (These would be cases where the sealant inhibited rather than arrested the decay.)
• In comparison, 52% of teeth that did not receive the protection of a sealant had a cavity form.

▲ Section references – Heller

B) How do dental sealants work?

In a nutshell, the thin plastic coating of a sealant creates a smoother tooth surface. One that’s easier to clean, and for that reason, less at risk for the formation of decay.

Here’s the whole story explained:

1) Background.

• Cavities are caused by bacteria that live in dental plaque (the white film that forms on teeth).
• Tooth brushing helps to prevent decay by scrubbing this film away.

(If you’re interested, here’s more in-depth coverage about how and why cavities form.)

Grooves that are too narrow for toothbrush bristles to clean should be sealed.

The problem is that deep tooth grooves can be hard to clean.

That’s because the individual bristles of a toothbrush are literally too large to reach into the depths of these pits and fissures (as illustrated in our graphic). And because some plaque is left behind, the tooth remains at risk for cavity formation.

The dental sealant is bonded into the grooves of a tooth.

2) How the protective shield of a tooth sealant solves this problem.

As a result, there are no longer any locations where the bristles of a toothbrush can’t reach and clean. And as such, the tooth is now at less risk of developing a cavity.

Sealants can help to protect vulnerable tooth locations.

3) A side benefit of sealing a tooth.

4) Fluoride release.

Some sealants are formulated with fluoride. Its release, right at a tooth’s surface, can also help to lower its chances for decay.

Should the protective coating of a sealant always be placed?

No, not all teeth require the protection that dental sealants can provide.

▲ Section references – Beauchamp

After an examination, your dentist can report to you what they feel is indicated.

Narrow tooth grooves tend to accumulate stains and debris.

Narrow, unbrushable tooth grooves place a tooth at increased risk for cavity formation.

Factors that a dentist will look for and consider.

• Any tooth that has pits and fissures that tend to accumulate debris is a candidate for a sealant.

  It’s literally the shape of the grooves that the dentist must evaluate. Teeth that have deep, narrow ones are typically considered to be at high risk for decay formation and therefore will have a more urgent need for sealing than teeth whose grooves are naturally shallow and rounded.

• Back teeth (premolars and molars) typically have the most pronounced grooves and therefore are the most often sealed.

  But any kind of tooth might have some type of surface irregularity that tends to trap debris and therefore makes it a good candidate for this procedure.

• Beyond just tooth anatomy, a dentist will evaluate additional factors that may place the person at high risk for pit and fissure decay.

  This can include the overall amount of dental plaque they find present on the person’s teeth, the types of foods eaten and eating habits of the person, the amount of decay that’s been experienced in the past, and the person’s current exposure to an appropriate amount of fluoride.

• As explained above, any tooth that has already developed incipient decay is certainly a candidate for a sealant. Placing one may avoid the need for a filling later on.

C) At what age should sealants be placed? On which teeth?

While a dental sealant can be placed on any tooth at any age, most are placed on the teeth of children. For this group, certain rules of thumb apply.

Age-related considerations.

• A tooth must be kept dry during sealant application. That means the portion of the tooth receiving treatment must have erupted through its surrounding gum tissue enough that this is possible.
• The patient must be able to provide at least some degree of cooperation.

The specific age at which this combination of events occurs will vary from tooth to tooth and child to child. It typically rests upon the dentist to make a recommendation as to when any specific tooth can and should be sealed.

General guidelines for dental sealant placement.

• Permanent first molars (6-year molars) – These teeth usually come in between ages 5 to 7 years of age. At this age, most children are cooperative enough to allow this procedure to be performed, so as soon as the molar has penetrated its gum line far enough a sealant can be placed.

  Common recommendations: 1st molars are probably the most frequently sealed teeth and it’s easy to understand why. While they are intended to serve a child for their entire lifetime, they come in at an age when eating and brushing habits are typically lax. In fact, molars are the type of tooth that’s the most likely to experience decay.

  Most dentists probably prefer to err in favor of recommending sealants for 1st molars, as opposed to not. A properly placed and maintained dental sealant has no potential to cause harm, whereas not placing one may have consequences.

• Permanent second molars (12-year molars) – These teeth typically come in between the ages of 11 to 14 years of age. With these early teenagers, there should be little concern about patient cooperation. So, it’s just a matter of waiting until the tooth has erupted far enough through the gums to apply the sealant.

  Common recommendations: As compared to age 6, at age 12 years the dentist will have a clearer picture of their patient’s risk for cavities.

  For children who have comparatively shallow tooth grooves, display good eating and oral home care habits, have no history of decay, and dental costs are a concern for the family, a dentist might not feel strongly about the need for sealant placement on the child’s 2nd molars.

  For families where finances are not a concern, since statistically, molars are the teeth most likely to experience decay, protecting one from square one might be something they’re eager to do.

• Other permanent teeth. – A recommendation for sealant placement on other types of permanent teeth is typically made on a case-by-case basis.

  Premolars (bicuspids) – These teeth may very well display the same deep groove anatomy as their neighboring molars. If so, sealants should be placed. After molars, bicuspids are the teeth most likely to receive a sealant.

  Incisors – While relatively uncommon, front teeth may need the protection of a sealant. For example, upper incisors are well known for having a pit on their backside that is often deep and accumulates plaque.

• Baby teeth (deciduous teeth) – While there is no question that baby teeth are important (they hold space for their permanent replacements), recommendations for protecting them tend to vary.

  Besides just pit and groove depth, a number of other issues must be considered too. This includes available patient cooperation, how long before the tooth will fall out on its own, etc… You’ll simply need to seek your dentist’s advice on this matter.

• Teeth of adult patients – Any permanent tooth can be sealed, at any time.

  Common recommendations: A need for this type of protection for adults is not all that common.

  In most cases, one would expect that a tooth whose deep pits and fissures place it at great risk for cavity formation would have already developed decay by the time adulthood is reached. Of course, there can always be exceptions. This issue simply needs to be determined on a case-by-case basis.

D) How effective are sealants in preventing cavities? – Research findings.

Numerous studies have documented the prevention benefits of placing dental sealants. Here’s a sampling:

• Jodkowska (2008) – This study followed the dental histories of 360 seven to eight-year-old children over a 15-year period.

  Findings: Sealing all of a child’s 1st molars resulted in a 36% reduction in the total number of cavities ever experienced by them. When all posterior teeth had been sealed (molars and premolars), the overall reduction in cavities was found to be 54%.

• Bravo (2005) – This study evaluated 36 six to eight-year-olds over a 9-year period. While participating in the clinical aspect of the study, the children had sealants placed on their permanent 1st molars. Then, for the following 3 years, periodic observations and needed repairs were performed. After that, the study itself provided no further checkups or repairs.

  At 9 years, 27% of the sealed teeth vs. 77% of the 1st molars in the control (unsealed) group had developed occlusal decay (decay on the part of the tooth that sealants protect), for a comparative reduction of 65% (sealed vs. unsealed).

• American Academy of Pediatric Dentistry (2002) – This organization published a paper in conjunction with their Pediatric Restorative Dentistry Consensus Conference.

  Nine randomized controlled trials involving permanent molars and 2 to 3-year follow-up periods were evaluated, documenting a 76% reduction in occlusal cavities for sealed teeth. (Cvikl)

▲ Section references – Jodkowska, Bravo, Cvikl

E) How are dental sealants placed?

Dental sealant placement is a very simple and straightforward process. For any one tooth, its treatment can be completed in just a minute or two. The procedure is painless. No anesthesia is required.

Note: For a more detailed description, use this link:  Dental sealant placement   The steps. | Illustrations.

The steps of dental sealant placement.

• As an initial step, the tooth that will receive the sealant is isolated either by way of placing a rubber dam or using cotton rolls.
• The surface of the tooth is then thoroughly cleaned (typically using a small spinning brush and pumice) to remove any plaque, debris, or stains. Afterward, the tooth is washed and dried.
• The areas on the tooth that will be sealed are prepared using an etching gel that contains phosphoric acid (etch time – 13 to 30 seconds). This etching process creates a microscopically roughened enamel surface that allows for sealant adhesion.
• The tooth is then washed and dried and is now ready to receive its sealant coating.
• Liquid sealant is applied to the tooth’s surface. A small brush or applicator tool is used to work it into the tooth’s grooves.
• Once positioned properly, the sealant is set (hardened) using a curing light (curing time – 30 seconds). (Some sealants are self-curing.)
• The cured sealant is then evaluated for completeness, integrity, and to ensure that it does not interfere with the patient’s bite.

There’s no wait time needed afterward. The sealant is set and ready to be used.

F) How long do dental sealants last?

Sealant loss.

A dentist would probably consider any sealant that remained intact for 3 to 5 years to be a success. However, any that require replacement or repair sooner than that should not necessarily be considered failures. Any length of time that one remains in place is a time period during which its tooth is protected.

• Feigal’s review of published dental literature estimated a sealant loss rate (including partial loss) on the order of 5 to 10% per year.
• A study by Dorantes came to similar conclusions. At one year, sealant retention was found to be 72%, with declines of approximately 10% found annually over the next 3 years.
• Jodkowska evaluated sealant loss rates over a 15-year period and determined that at this point 22% of teeth still maintained complete retention and 35% partial retention.

▲ Section references – Feigal, Dorantes, Jodkowska

Sealant wear.

Sealant wear doesn’t necessarily equate with a loss of protection. Even when it occurs remnants of the plastic usually remain in the depths of the tooth’s grooves, thus still providing its preventative function.

G) Aftercare and maintenance.

1) Dental sealants must be monitored and maintained.

A dental sealant can only provide optimal protection if it’s fully intact.

• If you notice that any portion, or even possibly all, of a sealant has come off, you should let your dentist know. This isn’t usually considered a dental emergency but should be given prompt consideration. After all, the tooth isn’t fully protected if the sealant isn’t present or intact.
• During each of your regular dental check-ups, your dentist will evaluate the integrity of your sealants and let you know if any of them require repair.

A second try may be more successful.

One reason why a sealant might come off is that the dentist wasn’t able to keep the tooth dry during its placement. This can certainly be the case where a child patient has been uncooperative (purposely or not).

As the child becomes older and more mature, even by several months or a year, it’s quite possible that a second attempt to seal the tooth may be more successful.

2) How important is sealant maintenance?

• A study by Mertz-Fairhurst concluded that the decay rate for molars with partially retained sealants was essentially the same as those that never received one.
• However, a study by Jodkowska (involving 360 children followed over a 15-year period) found that only 15% of teeth with partially retained sealants developed cavities whereas 31% of teeth with complete sealant loss did.

  This implies that even poorly maintained sealants still provide more benefits for teeth than never having placed them at all. (FYI: 7% of teeth maintaining complete sealant retention developed decay.)

• Griffin designed a study whose purpose was to specifically evaluate the consequences associated with partially and fully lost sealants. Its conclusions were: “Teeth with fully or partially lost sealant were not at a higher risk of developing caries than were teeth that had never been sealed.”

It’s important to note that each of these studies confirms the benefit of periodic evaluation, with repairs made as needed to keep the patient’s sealants fully intact.

3) How often should sealants be examined?

▲ Section references – Mertz-Fairhurst, Jodkowska, Griffin

H) Possible risks and side effects.

Potential health concerns with the plastics used for dental sealants?

The issue of patient bisphenol A (BPA) exposure as a result of (resin) dental sealant placement (as well as “white”/composite dental fillings) has been a topic of investigation and debate in dentistry, especially over the last two decades. This issue would be of most concern for children and pregnant patients.

What do studies suggest?

The general consensus of scientific research appears to be that, yes, increased patient BPA levels can be detected during the first hours or day following the placement of sealants. This increase correlates with the number of sealants placed. As weeks follow, BPA levels then return to baseline.

There would be great debate as to the clinical importance of these findings. Without question, more investigation is warranted.

Precautions – Recommendations.

The article “Once Resin Composites and Dental Sealants Release Bisphenol-A, How Might This Affect Our Clinical Management?—A Systematic Review” contains a fairly recent (2019) examination of this topic.

It includes an outline of steps a dentist can take to help reduce their patient’s exposure to BPA. (See the paper’s Conclusions section.) We would think that any dentist knowledgeable about this topic and the potential concerns it raises would at least be aware of these recommendations.

I) How much do dental sealants cost?

Here’s an estimate of what you might pay to have a sealant placed on your, or your child’s, tooth.

Note: The fee range shown is per tooth.

What’s included in the price?

1) Sealing the tooth.

Different than with fillings, the cost of sealing a tooth is calculated on a per-tooth basis, no matter how many separate locations or sides are treated.

For example, the two teeth in our picture above have each had a different number of individual areas sealed. Despite this difference, however, the fee charged for each tooth would be the same.

Also different than with fillings, sealants typically cost the same whether they are placed on baby teeth or permanent ones.

Two molars protected with dental sealant.

2) Is maintenance included? / Replacements.

For your own information, you should ask your dentist what their policy is in regard to fees charged for repairing or replacing lost or deficient sealants. For example, they may not charge for repairs made to one within a certain time period after its original placement date.

Replacement might also be cost-free if required within a certain initial time frame. (Also, see the “frequency” section below.)

3) An examination may be required.

If you don’t have an established relationship with a dental office, it’s unlikely that you’ll find one that will offer to place tooth sealants without examining the patient first.

During this exam, the dentist can confirm that the teeth in question are proper candidates for this procedure. The exam may possibly need to include a set of bite-wing X-rays (the type of X-rays dentists use to check for tooth decay) but not always. (School-based programs routinely rely on just a clinical examination of the teeth being treated.)

Additional cost information.

Because the fee estimates we show above have been developed by different means, you may also find the survey of dental fees published by DentistryIQ an interesting independent source: DentistryIQ – 2017 dental fee analysis by region and CDT procedure code

Are sealants covered by dental insurance?

Many dental plans/insurance policies do cover tooth sealants.

It’s easy to understand why. Since dental sealants are an effective means by which to reduce tooth decay, and thus fillings, these companies realize that if they do provide coverage it will save them money in the long run.

Possible policy limitations.

If you are covered by a plan that does provide coverage, there may be conditions and limitations involved.

• The policy may only provide coverage for certain teeth. It’s common for 1st and 2nd permanent molars to be covered. It’s much less likely for a policy to provide benefits for primary (baby) teeth or permanent bicuspids (premolars).
• Coverage for individual teeth may be limited to a specific age range. Age 16 years is a common cutoff point.

• There may be limitations as to the frequency with which a tooth may be sealed.

  For example, a plan may only provide benefits for sealing a tooth once. Or, the limitation may be a time interval such as once every 3 or 5 years. This type of stipulation may present a problem if a sealant requires repair.

• The policy’s deductible may or may not be involved. Some plans will provide full benefits for this procedure even before the policy’s deductible has been met. Others won’t be as generous.

Tooth sealant programs.

Some organizations/agencies run tooth-sealant clinics that your child may be eligible for. You’ll simply have to check and see what programs exist in your area. In some cases, this service might be provided free of charge.

Where to get information.

Here are some suggestions as to where you might find information about the availability of such programs.

• Your state’s Medicaid office. (Medicaid programs frequently cover this procedure.)
• Your child’s school.
• Your child’s pediatrician.
• Your county’s health department.
• Your state’s Dental Board.
• Your state’s dental association.

J) How cost-effective is dental sealant placement?

This is a very difficult question to answer and one that we don’t entirely have an answer for, at least in precise terms. But we can say:

• On the surface, a comparison of the cost of a sealant vs. a filling (about $50 vs. $120 or so plus) is easy enough to make. However, there is no guarantee that the tooth in question absolutely would have developed a cavity.
• It’s easier to demonstrate a cost-benefit for teeth where incipient (early, minor) decay has already begun. In these cases, placing a sealant is cheaper than a filling. But also, why would you want to run the risk of the tooth becoming further damaged when the simple act of placing a sealant now could prevent it?

• One shouldn’t overlook the fact that no dental restoration lasts forever. And that means that the filling needed because the tooth was not sealed will need to be replaced repeatedly over the child’s lifetime.

  Beyond just the time and cost involved with this repair work, each time a replacement is made a little bit more tooth structure will be lost, possibly compromising the structural integrity of the tooth.

• You should take note of the fact that many dental insurance companies do provide coverage for this procedure. It’s unlikely that they would do so unless they felt that it will save them money in the long run.

Information from research.

Here’s an interesting point from a study that sheds some light on the cost-effectiveness of placing dental sealants.

Research by Bravo determined that placing sealants in the grooves of a child’s teeth resulted in a lower decay rate on smooth tooth surfaces too (like in between teeth), on the order of 5 fold. (It’s suggested that, once sealants have been placed, the kinds of bacteria that cause cavities simply have a reduced foothold in the mouth, and therefore are less able to seed additional cavity-causing colonies.)

▲ Section references – Bravo

Comments.

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