Dental Sealants: The procedure.

- The individual steps of the tooth sealing process. / What type of material is placed? / Inter-active sealant procedure graphic for kids.

Slideshow of each of the steps of the tooth sealing procedure.

Slideshow of the individual steps of dental sealant placement.

There are few dental procedures that are as easy, quick and painless as having sealants placed.

And considering that they help to prevent the need for a filling, anyone and everyone should be eager to have this procedure performed. It makes an especially good introductory dental procedure for children.

Here's an outline of the steps of this procedure:

Step 1 - Cleaning the tooth.

The dentist must first clean the surface of the tooth, otherwise the sealant will not bond to it properly.

The dentist will place a small brush in their dental drill ...

  • As the drill spins the brush, they'll scrub the tooth's surface and clean out its grooves.
  • It's common for a dentist to dip the brush in a slurry of pumice. It's gritty nature assists the brush in cleaning the tooth.

Variations: If after using a brush, if the grooves of the tooth still seem to harbor debris the dentist may take extra steps.

  • Air-abrasion technique. - This method involves using a mini sandblaster on your tooth. The machine itself will make a "blowing" noise, and using it can be a little messy. But overall the process of cleaning out the grooves of your tooth this way is painless.
  • Enameloplasty. - With this method the dentist uses their dental drill to buff out the remaining debris. The amount of trimming is very slight. No anesthetic is required.
Takeaways from this section.

It's also suggested that the use of these additional mechanical techniques may help to improve the retention and seal of the sealant.

A study by Agrawal evaluated the microleakage of sealants following different types of tooth surface preparation.

Its conclusions were: 1) Surface preparation using a drill produced results that were significantly superior to any other technique. 2) Air abrasion technique was significantly better than the use of a brush.

However, not all studies have reported these same kinds of findings. And in fact, many suggest that these kinds of extra steps really aren't as beneficial as they might seem.

So if your dentist does do some additional groove cleaning and shaping, don't be surprised. But if not, there's no reason to be concerned.

Section references - Agrawal, Nowak

References for both the above section and the remainder of this page - Dean, Nowak

Illustration of a tooth whose surface is being etched with a mild acid in preparation for sealant placement.

Etching gel is applied to the tooth's surface in preparation for sealant placement.

Step 2 (frame B) - Conditioning the tooth's surface.

After cleaning the tooth, the dentist will spread "etching" gel over that area where the dental sealant will be placed.

The gel is usually applied using a small brush, small bit of sponge, a cotton pellet or via some type of factory-loaded syringe-like applicator provided by the manufacturer.

They'll spread the etchant over an area that extends further than just the tooth's grooves, so there's no question that all tooth portions that end up under the sealant were treated.

Once they get the etchant positioned properly, they'll allow it to sit for somewhere between 20 and 60 seconds, and then wash it off.

What does this step do?

The etchant prepares the tooth's surface so the sealant will be able to bond to it (explained below).

Etchant FYIs:

  • Tooth etchants are acidic (they usually contain in the neighborhood of 30 to 50% phosphoric acid). If you were to get some on your tongue, it wouldn't hurt but it would taste bitter or sour.
  • The acidic nature of the etchant has the added benefit of killing bacteria that lie at the bottom of the tooth grooves being sealed.
 

Illustration of an etched tooth surface ready to receive a dental sealant.

Etched tooth enamel has a frosted-glass appearance.

Step 3 (frame C) - Evaluation of the etching step.

After performing a thorough washing (20 to 40 seconds), and using their air syringe (air nozzle) to blow the tooth dry, the dentist will evaluate their work.

The part of the tooth that has been treated should look white, frosty and dull (not unlike the way etched glass looks).

A simple warning.

Once your tooth's surface has been conditioned, it must remain dry for the remainder of the process. If saliva contamination occurs, the tooth must be re-etched. (So keep your mouth wide open.)

What the etching step has accomplished.

The tooth's frosty look holds the key to the whole dental-sealant bonding process.

At a microscopic level, the acidic etchant has dissolved some of the mineral content from the tooth's enamel surface. That means the tooth is now rough rather than smooth (hence the change in its appearance).

The dental sealant is able to stay in place because it can grasp onto (bond to) this roughened surface. (If you're interested in more details, this page explains the science associated with dental bonding.

Takeaways from this section.

The type of material whose use we describe on this page is referred to as resin-based sealant. And it is the kind most frequently used for this procedure.

Resin dental materials are plastic in nature, and this group includes the restoratives dentists use to create white (bonded) fillings.

Other classes of materials can be placed as sealants (most notably glass ionomer) but usually just in special situations. Some don't require an etching step, or the use of a curing light (the next steps discussed).

 

Illustration of the application of liquid dental sealant.

The sealant (a thick liquid) is dabbed into the tooth's grooves.

Step 4 (frame D) - Applying the sealant.

While the tooth is still dry, the dentist will apply the sealant (a liquid plastic) into the grooves of the tooth.

They might do this using a small brush, or squirt it out of a mini syringe.

  • The liquid nature of the sealant is such that it will flow into each groove's nooks and crannies.
  • The sealant isn't used to fill in the tooth's entire chewing surface but instead just those areas (chewing surface and sides) that have pits and fissures that have the potential to trap and retain debris.
 

Illustration of setting a dental sealant using a curing light.

The sealant is set by shining a curing light on it.

Step 5 (frame E) - Curing the sealant.

Once the dentist has the liquid sealant positioned properly, they'll trigger its set using a "curing" light. (This is a dental flashlight/wand type of device that shines blue light.

The color of the light that's shone on the liquid sealant is important because these materials are formulated with a catalyst that's activated by light having this specific color.

That means the sealant will stay in liquid form for as long as the dentist needs it to. But once it's been positioned properly, it can be set instantly (in about 60 seconds or so) simply by shining the curing light on it.

 
Takeaways from this section.

As a variation, some types/brands of sealants autopolymerize. Two components (part A and part B) are mixed together. The mixture then sets on its own within a minute or two, which means the dentist has to work pretty quickly.

Illustration of a completed dental sealant.

The sealant is finished and ready to go.

Step 6 (frame F) - Evaluating the sealant.

Once the dentist has finished curing the sealant, it's fully hardened and ready to be used.

Of course, the dentist will want to evaluate their work. For example, they'll check to see that all of the grooves have been filled in sufficiently.

Picture of two teeth that have dental sealants.

Completed dental sealants.

Checking the bite.

They'll also need to check the way other teeth bite against the tooth. The dentist doesn't want the sealant's thickness to interfere with the way things normally close together.

If it does, the dentist will buff the sealant for a split second or two with their dental drill, so to thin it out.

Step 7 - The sealing process is now finished.

After it's passed its evaluation, the new sealant is ready to be used. Eating and drinking, even immediately, pose no problem.

Takeaways from this section.

Sometimes after you've left your dentist's office you'll notice that your bite seems to be just a little bit off.

That's usually because after staying open for a procedure, it's hard for a patient to just close normally when their dentist checks their bite. And as a result, something is missed and not buffed down.

You should let your dentist know if you notice this problem. However in most cases, since dental sealant material is relatively soft, it will wear off prominent locations fairly quickly on its own, thus returning your bite back to normal.

 

OK, time to see how
much you've learned!

How long does the whole process take?

Assuming that the patient is cooperative and the dentist has easy access and good visibility, the process of actually sealing any one tooth might take as little as 5 or 6 minutes, start to finish.

Is that really all there is to it?

Yes that's it, with the exception that your dentist needs to monitor the condition of your sealants at your future dental checkups.

 

Tooth isolation during your procedure.

Picture of 2 teeth isolated by a rubber dam ready for dental sealant placement.

Teeth that have been isolated using a rubber dam and are ready to be sealed.

During the sealing process, it's important for the dentist to keep the tooth they are working on dry (this is termed tooth "isolation"). A failure to do so will interfere with the bonding process, and typically results in sealant loss (partial or whole).

The dentist may choose to isolate the tooth by way of packing cotton rolls or gauze around it. Or, as shown in our picture, by placing a "rubber dam" around the tooth, or teeth, being treated.

Rubber dams.

A rubber dam is a sheet of latex. The dentist punches holes in it (one for each tooth) and then fits it over the teeth receiving treatment. Because it separates the portion of the teeth that the dentist is working on from the rest of the mouth, it is easy for the dentist to keep them dry.


What type of sealant material is placed?

  • The materials most frequently used to seal teeth are dimethacrylate monomer (BIS-GMA) diluted with a co-monomer, or else urethane dimethacrylate (UDMA).

    As complex as these names sound, they're just plastic compounds (or as dentists refer to them, "resins.") These materials are similar in nature to those that are used to create white fillings.

  • As alternatives to resin-based products, other types of materials can be used instead. This includes glass-ionomer dental cement, which has the added benefit that it releases fluoride. This is the most frequently used alternative.

    Historically, zinc phosphate dental cement has also been used. (FYI, both of these products, zinc phosphate and glass ionomer, can be used for other applications, like cementing dental crowns.)

Section references - Cvikl

Takeaways from this section.

When glass ionomer cement is used to seal teeth, the steps of the sealing process remain essentially the same as outlined above.

  • A major exception is that no etching step is needed. (An etched enamel surface is not required to create its bond with tooth enamel.)
  • Additionally, moisture control is less critical when glass ionomer cement is applied. This factor may be quite beneficial for some cases (like those involving patients that are very young or else uncooperative, or teeth that are not yet fully erupted).

 

Resin-based sealant options and variations.
  • Resin sealants can be white, clear or tinted. White and colored plastics are generally easier to see and therefore easier to monitor. But using clear resin makes it possible for the dentist to visualize what's going on underneath.
  • Some sealant formulations contain fluoride, which is considered an aid in increasing the tooth's resistance to decay formation.

How much did you learn?

Try to remember what the dentist does at each step of the sealing process. Click the number of each step to see if you're right!

1

2

3

4

5

6

 

Talk things up with your child.

Children who have never had a filling placed will have little concept of the type of difficulties the simple task of placing a sealant can prevent. And because of this, they may be unmotivated to offer much cooperation.

If that's the case, what is normally a very simple procedure may become a struggle. Or their lack of cooperation may affect the quality of the dentist's work.

As a parent, you should take efforts (before their appointment) to communicate with your child about the importance of giving the dentist their utmost cooperation. Doing so will improve their experience, and possibly the level of protection their sealant will be able to provide.

 
 
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Comments

Simple

I had this done. My dentist sand blasted my teeth. Then they washed and dried each tooth and then put a blue light on it. I'm 8. Easy

Brian

Thanks for the testimony.

To others reading, from Brian's (the patient's) perspective, that does seem to be about all that goes on. However for a fuller description of each step involved, see our text above.

The "sand blasting" he refers to is the dentist's use of air abrasion technique. This optional step is described above too.

Thanks again Brian.


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