Dental Sealants: The procedure.

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.

Slideshow of the individual steps of dental sealant placement.

• 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.

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

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.

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

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.

Etched tooth enamel has a frosted-glass appearance.

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

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.

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

Step 4 (frame D) – Applying the sealant.

• 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.

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

Step 5 (frame E) – Curing the sealant.

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.

The sealant is finished and ready to go.

Step 6 (frame F) – Evaluating the sealant.

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.

Completed dental sealants.

Checking the bite.

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.

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.

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

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

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.

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.

As an aid, you might look through the following sequence of pictures below with your child and discuss with them each step and what to expect (as explained above on this page).

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Comments.

This section contains comments submitted in previous years. Many have been edited so to limit their scope to subjects discussed on this page.