Have you ever heard about something called dental sealants? Maybe you’re already familiar, because maybe you have had sealants yourself in the past. If not, read on to learn about this very simple and effective way to lower our children’s risk for getting cavities.
We'll discuss what sealants are, how they are done, and why they are so helpful in preventing cavity formation.
One thing I should mention before we get into the nitty-gritty of sealants is that prevention is our key strategy in controlling America’s #1 chronic childhood illness - Tooth decay, also known as dental caries. You may be shocked to hear this, but about half of the children in the US have had cavities by the time they start kindergarten. Since treatment is almost always more challenging and costly, whereas prevention is more budget-friendly and easy to tolerate for our children, it’s clear why prevention is so crucial.
Very simply put, a sealant is basically a barrier. This barrier is applied to cover up (and therefore “re-shape”) the deepest nooks and crannies that are part of the normal anatomy of many of our teeth. This barrier turns surfaces that are naturally rough or pitted into smoother and less susceptible areas, as it relates to build-up of plaque bacteria and food residue.
The official terminology of the nooks and crannies is “pits and fissures”, and the same way that we see lots of variety in hair, such as very straight to very curly hair, and everything in between, it’s similar with teeth, too. Some teeth have very few and very shallow grooves or dimples, while others have very deep and pronounced pits and fissures. This is a significant factor in determining someone’s risk of cavity formation, because the deep pits and fissures are very hard to keep clean.
We tend to think of sealants as only being applied to the back teeth (molars), but really any area that has a vulnerable and hard to clean spot could benefit from application of sealant. In that respect, it just depends on which particular teeth seem the most susceptible in your child.
Any tooth that is at risk for trapping bacteria and food residue, based on its anatomy. There are certain anatomic features on the back side of upper front teeth that can be sealed, and there are plenty of “nooks and crannies” on baby molars and permanent back teeth (molars and premolars) that can benefit tremendously from sealants.
When I do a caries risk assessment, meaning I’m evaluating how likely a child is to develop cavities, I often also take staining into consideration, since that’s an indicator that the pit or groove is deep enough that brushing is not sufficient to keep those parts of the tooth stain-free and perfectly clean.
Regardless of which specific materials are used and which techniques are employed, applying sealants is not painful and doesn’t require teeth to be numb. The process can be slightly annoying or a bit challenging to tolerate in children that have a very sensitive gag reflex, but it’s a quick visit with no particular issues or restrictions afterward. To help children with tolerance issues related to having a sensitive gag reflex, nitrous oxide (aka laughing gas), can easily help overcome that barrier.
Sealant application tends to be pretty well-tolerated by most kids, especially in the setting of a pediatric dental office, where we are all about Tell, Show, Do. And let’s be honest, it also helps that we have TVs in the ceiling!
We have had some exceptionally tolerant and brave 2 and 3 year olds who have had sealants applied to a few select teeth, and generally speaking, most kids are ready to handle sealants without much ado between ages 5-6.
In short, yes. Sometimes parents wonder if it’s worthwhile to take this additional preventive measure for baby teeth which are “going to fall out anyway”, but that reasoning is flawed because baby molars (the teeth in the back) that grow in between ages 1-2 don’t begin to fall out until our kids are 9, 10, or sometimes even 11-12 years old, so they are typically in the mouth for close to a decade, under normal circumstances.
If the baby teeth in the back start to form cavities, which we often see beginning between ages 2-4, we have to come up with a plan for how to handle that. And as you can imagine, treatment of cavities is much more challenging, especially in a young child, than applying sealants to protect the teeth.
More importantly, if cavities are left untreated, there will be problems that may likely take more time and money to fix, than the time and cost involved in proactive prevention. Plus, the other thing is, pain is pain. If your child is hurting from a toothache, it doesn’t matter if the source is a baby tooth or a permanent tooth, right?
No, I wish. Besides the pits and fissures that have been mentioned as great sites for sealants, another common site where cavities tend to form is in between the teeth, and unfortunately there is no way to apply sealants to those sites, as that’s just not physically possible. Those cavities form on the smooth surfaces right beneath the point of contact between two neighboring teeth. Prevention there is more dependent on plaque removal via floss or other interdental cleaners, as well as good overall hygiene, and a diet that is not excessively high in carbohydrates and/or acid.
However, sealants can reduce the risk of cavities on the chewing surfaces (pits and fissures) by up to 75%.
It depends. The longevity of sealants can be highly variable from child to child and from tooth to tooth, because a lot of it depends on what level of wear and tear is happening inside the mouth.
Other factors include type of material used, the specifics of the technique used, how deep the pits and fissures are, and ultimately, a child’s diet and oral hygiene habits. But just to give you an idea, we are not talking about just a few weeks or months, it’s still in the range of typically several years worth of protective benefits. Sealants can also be easily touched up or re-applied, as needed to provide continued protection.
Feel free to reach out with questions or for additional information. If you live in Rockville or the surrounding area, we’d love to help your kids with this fantastic preventive tool.
In Health and Happiness,
Dr. Bana Ball
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