Pit and Fissure Sealant Application

Rules / Regulations

Must be EFDA Expanded Function

Dental Assistant. Certified by: DANB

Dental Assisting National Board

CE class required Lecture / lab 6 hours

Pt. must have exam by Dentist.

Sealant must be indicated / prescribed.

Placed within 45 days. “Indirect supervision”

A dentist must be on the premises while the procedures are performed.

Pt. Health History

We’re only doing sealants…..why check the health history????? Medications…? Allergies……..?

Latex Can cause: Anaphylactic shock

Severe allergic reaction that can cause death.

Review / update At every visit. Should be current. Pediatric pts.

Review w/ parent or guardian.

Other health considerations…?

Emotional Psychological Behavioral

Infection Control

Universal precautions Treat / assume

All patients as if they are infectious.

Family Friends Seniors Kids Co-workers

That they have; Any and all

diseases.

Disease transmission Cross contamination

Contamination = Presence of an

infectious agent (pathogen).

Cross contamination The spreading of an

infectious agent. Direct contact Indirect contact Inhalation

Personal Protective Equipment

Gown Fluid resistant

Laundered Disposable

Mask Earloop or tie

Should protect mucus membranes.

Doesn’t work if worn below the nose or under the chin.

Personal Protective Equipment

Goggles / Safety glasses / eye protection. Should be shatter

resistant. Face shield is OK. Side shields on Rx

eyeglasses. Pt’s should be offered /

encouraged to use. Orange UV Tinted

Personal Protective Equipment

Gloves Must be worn anytime

working in the oral cavity.

Handling any item expected to be used in the oral cavity.

Latex Vinyl Nitrile

Latex

Vinyl (synthetic)

Nitrile

What are pits and fissures?

Areas in the fossa’s and grooves that have failed to form

Found on occlusal surfaces of posterior teeth

Found on lingual surfaces of anterior teeth

Narrow and deep grooves Can’t be reached by

brushing Acid producing bacteria in

these areas cause demineralization

What do Sealants do?

Act as a barrier Used to arrest incipient

decay Blocks carbohydrates Used with good oral

hygiene habits and fluoride provides and effective method of preventing tooth decay

Diagnosing / Indications

All Dx must be done by a licensed dentist.

Indications (reason to use, do) Non-invasive Deep pits / fissures Recently erupted teeth Hx of high # of occlusal

caries. Preventive Tx. Acts as a

barrier to plaques and bacteria

Seals composite margins

Contra-indications

Reasons not to use or do something. No caries

Four or more years Shallow grooves Blended pits and

fissures Caries present Restoration present Primary tooth will be

lost soon Poor cooperation

Blended Fissures

Caries

Restoration

Enamel Sealant Material

Most common BIS-GMA bisphenol A

diglycidylether methacrylate

Main component of dental composites and sealant material.

Diluted to allow “flow-ability”

Clear, opaque, color changing.

Other Material Glass ionomer

Used for restorative Contain fluoride Wear down faster

Filled Contains small

particles to add strength

Must adjust occlusion

Un-filled Will wear down 2-3

days

Enamel Sealant Material

Light cure Single component No mixing required Control set time

Cure light Aka ‘light cure unit’ Causes…..?

Polymerization Hardening of the

material

Enamel Sealant Material

Chemical cure Aka (self-cure)

Two components Base and catalyst

Must mix together Will polymerize in

about 1minute. Dual cure

Will start to polymerize chemically, can finish with a cure light.

Isolation

Necessary to: Keep acid etch from

contacting other tissue Keep saliva from

contaminating the tooth surface.

Keep the tooth dry. Essential for the

retention of the sealant

Rubber dam Preferred method Especially for

partially erupted teeth

Cotton rolls May have to change

if saturated or pack / add dry

cotton rolls on top of the saturated ones

Acid Etch / Conditioning

Steps necessary to retain the sealant. Phosphoric acid

Gel Liquid

Microscopically roughens the enamel surface.

Creates “mechanical” retention.

Not chemical

Gel

Liquid

Non-etched

Etched Frosty dull

Acid Etch / Conditioning

Tooth should be isolated. Rubber dam Cotton rolls

Dried Air-water syringe

Apply etch According to Dr. or

manufactures directions.

Acid Etch / Conditioning

Application Brush Cotton pellet Applicator tip Small sponge Should extend beyond

area (2-3mm) of where sealant is placed.

Motion Dabbing DO NOT RUB

Rinse 30 sec. (HVE)

Evaluation of the etch Tooth should appear

Frosty Dull Chalky

If not, Re-etch for 15 – 30

seconds. Re-etch if saliva

contacts the tooth Rinse 30 seconds

With HVE

Sealant Placement

With an applicator Place material so it

flows into Pits Fissures Etched area of the

tooth An applicator tip Or an explorer

Can be used to move the material and prevent air bubbles.

Evaluating the Sealant

After the sealant has cured. Check for…..

Hardness Smoothness Voids Irregularities Retention Occlusion Contacts

Adjustments Re-cure

If not set Re-isolate

If sealant comes off Re-etch

If area is contaminated

Re-apply If void or irregularity

Evaluating the Sealant

Occlusion Articulating paper

Have pt. bite and grind Evaluate for ‘high’

spots Filled material

Assistant can adjust With a slow-low speed

handpiece Round bur / Stone bur

Unfilled Will wear down 2-3

days (chewing)

Floss Sealants are usually

applied to Occlusal of post. teeth Lingual of ant. teeth Buccal or lingual

grooves or pits. So why floss……?

To ensure material did not get into the proximal area and close a contact.

Post operative instructions.

Preventative treatment. (only temporary) Should last 5-7 years Can brush / floss Eat anything.

(Hard stuff too) (do not have to wait 24 hrs. etc)

Pay attention to ‘bite’ Call office if any questions or concerns.

Success vs. Failure

Success depends on good isolation

Failure can be due to moisture contamination

Success depends on a good mechanical bond

Failure can be due to incomplete etching

Conclusion

Placing sealants is a treatment / procedure. You are the provider.

Be aware of laws, rules and regulations regarding sealant placement.

Never diagnose any treatment. Don’t be afraid to ask questions or ask for

help. Any questions…….?