Fissure Sealants Part I - Theory

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Questions and Answers

What is the primary chemical bonding mechanism of glass ionomers?

  • Acid-base reaction (correct)
  • Covalent bonding
  • Polymerisation reaction
  • Ionic bonding

Which material is known for having higher tensile strength?

  • Glass ionomer
  • Resin modified glass ionomer
  • Compomer
  • Composite resin (correct)

What property is associated with resin modified glass ionomers compared to compomers?

  • Greater retention (correct)
  • Higher viscosity
  • Increased water sensitivity
  • Shorter working time

Which type of fissure sealant requires a dry, acid-etched enamel for effective bonding?

<p>Composite resin (C)</p> Signup and view all the answers

Which sealant is hydrophilic and does not require etching for bonding?

<p>Glass ionomer (C)</p> Signup and view all the answers

What is a notable feature of unfilled resin sealants compared to filled sealants?

<p>Clear appearance (B)</p> Signup and view all the answers

What is the primary advantage of acid etching enamel before applying a resin sealant?

<p>Increases surface area for bonding (A)</p> Signup and view all the answers

What is a common outcome of applying resin-based sealants to molars?

<p>Reduction in caries incidence (B)</p> Signup and view all the answers

Which of the following statements about Bisphenol A (BPA) in dental materials is accurate?

<p>No evidence of adverse effects has been found (D)</p> Signup and view all the answers

What must be considered regarding the choice of sealant material?

<p>Both tooth and patient factors (D)</p> Signup and view all the answers

What characterizes ICDAS 1 or 2 lesions?

<p>Demineralization confined to enamel with no breakdown (A)</p> Signup and view all the answers

What is necessary for fissure sealants to be effective?

<p>All fissures must be fully covered (C)</p> Signup and view all the answers

Which of the following actions is recommended during a recall visit?

<p>Reapply if fissures are carious (D)</p> Signup and view all the answers

Which statement is NOT true regarding early moderate lesions (ICDAS 3)?

<p>Demineralization is wholly superficial (A)</p> Signup and view all the answers

What should be done if a fissure sealant appears worn?

<p>Revisit caries risk and consider reapplication (C)</p> Signup and view all the answers

What is an appropriate method to check for sealant integrity?

<p>Visual inspection and physical probe check (B)</p> Signup and view all the answers

During a recall visit, which of these actions should NOT be performed?

<p>Apply sealant without checking the fissure (D)</p> Signup and view all the answers

Which of the following documents specifically addresses the use of pit-and-fissure sealants?

<p>Evidence based clinical practice guideline for sealants (C)</p> Signup and view all the answers

What is the purpose of the Clinical Technique lecture mentioned?

<p>To cover the practical application of fissure sealants (D)</p> Signup and view all the answers

What indicates that a fissure sealant needs to be 'topped up'?

<p>Fissures are noticeable and potentially carious (A)</p> Signup and view all the answers

What factors must be assessed for patient selection in dental procedures?

<p>Medical history and co-operation level (D)</p> Signup and view all the answers

What does the ICDAS II system primarily focus on?

<p>Standardizing caries detection and assessment (D)</p> Signup and view all the answers

What is the significance of the ICDAS score 0?

<p>A sound tooth with no evidence of caries (C)</p> Signup and view all the answers

Which of the following conditions represents an indication for applying fissure sealants?

<p>Deep pits and fissures (D)</p> Signup and view all the answers

In the context of ICDAS, what characterizes score 2?

<p>Distinct visual change in enamel while wet (A)</p> Signup and view all the answers

What is a contraindication for applying fissure sealants?

<p>Shallow self-cleansing pits and fissures (B)</p> Signup and view all the answers

Which approach is suggested for ensuring patient co-operation, especially in children?

<p>Tell-show-do method (C)</p> Signup and view all the answers

How does the ICCMS™ classify dental lesions?

<p>Into initial, moderate, or extensive categories (B)</p> Signup and view all the answers

What is the primary function of fissure sealants?

<p>To act as a physical barrier against food debris and biofilm (B)</p> Signup and view all the answers

For which scenario is radiographic assessment typically warranted when managing early caries?

<p>To confirm a clean and dry tooth with pits or fissures (B)</p> Signup and view all the answers

What does an ICDAS score of 1 indicate?

<p>First visible change in enamel after drying (D)</p> Signup and view all the answers

Which of the following areas are the most caries susceptible and would benefit from fissure sealants?

<p>Occlusal surfaces of posterior teeth (A)</p> Signup and view all the answers

Which factors must be considered before placing a fissure sealant?

<p>Both patient and tooth factors (B)</p> Signup and view all the answers

What are the pits and fissures in relation to caries susceptibility?

<p>Deep clefts and small depressions prone to plaque retention (C)</p> Signup and view all the answers

Which type of tooth surface is the least likely to benefit from fissure sealants?

<p>Smooth surfaces of anterior teeth (B)</p> Signup and view all the answers

What is a possible indication for the use of fissure sealants?

<p>High risk of caries in specific tooth surfaces (D)</p> Signup and view all the answers

What is an important limitation to consider with fissure sealants?

<p>They are not a substitute for regular dental care and hygiene (A)</p> Signup and view all the answers

Which condition is NOT an indication for the application of fissure sealants?

<p>Healthy, caries-free surfaces (A)</p> Signup and view all the answers

What is one of the key scientific principles underlying the use of fissure sealants?

<p>They form a physical barrier against decay (D)</p> Signup and view all the answers

What role do fissures play in relation to dental caries?

<p>They are areas at risk for plaque retention (D)</p> Signup and view all the answers

Flashcards

Fissures

Deep grooves or clefts between adjoining cusps on the chewing surface of teeth, making them susceptible to plaque and bacteria accumulation.

Pits

Small, pin-point depressions found within the developmental grooves on tooth surfaces.

What are fissure sealants?

Protective coatings bonded to the tooth surface, primarily on fissures and pits, to prevent plaque and bacteria build-up.

Why are occlusal surfaces vulnerable?

The occlusal surfaces of posterior teeth (premolars and molars) are most vulnerable to caries due to their complex anatomy with fissures and pits.

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How do fissure sealants work?

Fissure sealants act as a physical barrier, preventing the buildup of food debris and bacteria, thereby reducing the risk of tooth decay.

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What is the main purpose of fissure sealants?

Fissure sealants are used as a preventive measure to reduce the risk of tooth decay, especially in areas prone to plaque accumulation.

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Can fissure sealants be used for treating existing cavities?

Fissure sealants can also be used to manage early carious lesions, acting as a protective layer preventing further decay.

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What tooth characteristics increase caries risk?

The presence of deep fissures, pits, and developmental anomalies in tooth surfaces makes them susceptible to caries.

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What patient factors influence the use of fissure sealants?

Factors like patient age, oral hygiene habits, dietary intake, and the presence of existing caries all influence the need for and effectiveness of fissure sealants.

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What tooth characteristics make a tooth suitable for fissure sealants?

The size and shape of a tooth, the depth and complexity of fissures, and existing enamel defects all influence the decision to use fissure sealants.

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Acid etching

A process that involves treating enamel with acid to create microscopic irregularities, allowing for better adhesion of the sealant.

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Glass Ionomer Sealant

A type of sealant that uses an acid-base reaction to harden, known for its fluoride release and good adhesion to enamel.

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Compomer Sealant

A sealant made from a combination of resin and glass ionomer, offering good wear resistance and fluoride release, though with lower retention.

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Bis-GMA

The primary component of most resin sealants, derived from Bisphenol A, providing strength and durability.

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Smear Layer Removal

A technique used to remove the thin layer of debris that naturally forms on enamel, improving the bonding of sealants.

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Unfilled Resin Sealants

Sealants that are clear and offer lower wear resistance, but allow for better visualization of the tooth structure.

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Filled Resin Sealants

Sealants that contain filler particles, providing increased strength and wear resistance, but are less transparent.

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Sealant Retention

The ability of a sealant to remain in place and perform its protective function for a significant period.

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Light Activation

The process of using a light source to activate and harden the sealant, creating a durable protective layer.

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Bisphenol A (BPA)

A chemical compound found in some sealants and dental composites, also found in food packaging, with minimal evidence of adverse effects in low doses.

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What is ICDAS II?

The International Caries Detection and Assessment System II, a standardized system for recognizing and diagnosing caries at all stages. It aids in understanding the rate of decay and provides a consistent approach across various clinical settings.

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What is ICCMS™?

A clinical scoring system that classifies lesions into three groups: initial, moderate, or extensive. It promotes preventing new decay, treating existing lesions, and preserving tooth structure when necessary.

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What is an ICDAS score of 0?

A tooth that shows no signs of decay after five seconds of air drying. The enamel appears smooth and without any discoloration.

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What is an ICDAS score of 1?

The first visible change in enamel after air drying. It appears as a white or brown spot within the pit or fissure, indicating the initial stages of decay.

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What is an ICDAS score of 2?

An obvious visual change in enamel, even when wet. The enamel shows either a white spot or brown discoloration, signifying a progressed stage of decay.

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What is an ICDAS score of 3?

A localized breakdown of enamel. Though the tooth appears normal when wet, there's a distinct discoloration with a visible breakdown of enamel, indicating that the decay has progressed further.

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When are fissure sealants indicated?

A sealant is commonly used on teeth with deep fissures, newly erupted teeth, enamel defects, and individuals with a high risk of cavities.

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When are fissure sealants contraindicated?

Sealants are not recommended for teeth with optimal oral hygiene, shallow pits and fissures, partially erupted teeth, teeth with existing restorations, or those with allergies to methacrylate.

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How should a tooth be prepared for sealant application?

When assessing a tooth for sealant application, the dentist should thoroughly clean and dry the tooth, ensuring proper illumination. They should avoid probing into the pits and fissures, and may consider using radiographs to evaluate the tooth's structure.

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ICDAS I/II versus ICDAS 3 in fissure sealants

ICDAS I or 2 indicate early, microscopic demineralization limited to enamel where the tooth surface remains intact. ICDAS 3 signifies a visible breakdown of enamel, indicating a more progressed decay process.

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Why is regular monitoring of fissure sealants crucial?

The effectiveness of fissure sealants relies on complete coverage of all fissures. Regular checks ensure the sealant remains intact and is doing its job.

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What happens when a fissure sealant is worn?

If the sealant is worn or damaged, it needs to be reapplied to maintain its protective effect. This is a 'top-up' for the sealant.

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What factors influence the use of fissure sealants?

The decision to use fissure sealants should consider the patient's individual risk factors, including age, oral hygiene habits, and dietary information.

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Are fissure sealants a treatment for existing cavities?

Fissure sealants are designed for preventive care and are not typically used as a treatment method for existing cavities.

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Where are fissure sealants most commonly applied?

The sealants are usually applied to the occlusal surfaces of permanent molars and premolars, which are more susceptible to decay due to their complex anatomy with pits and grooves.

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How do you inspect fissure sealants?

Visual inspection, using a probe to feel for any imperfections, and reassessing the patient's individual risk assessment are key for monitoring sealants.

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What tooth characteristics suggest a good candidate for fissure sealants?

Deep fissures and pits, developmental anomalies, and specific tooth shapes are all indicators for good candidates for fissure sealants.

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Are fissure sealants effective?

Fissure sealants are very effective in preventing new cavities, particularly in children and adolescents with high caries risk.

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Study Notes

Fissure Sealants Part I - Theory

  • Fissure sealants are protective coatings applied to caries-prone tooth surfaces
  • Posterior teeth occlusal surfaces are most vulnerable to dental caries
  • Sealants create a physical barrier preventing food debris and biofilms from accumulating, stopping caries development
  • They control and manage some carious lesions in addition to preventing caries
  • Important areas for fissure sealants are fissures, buccal and cingulum pits, dens in dente, dens evaginatus and prominent cusp of Caribelli
  • Fissures are deep clefts between cusps, high risk for plaque accumulation
  • Pits are small depressions in developmental grooves

GDC Learning Outcomes

  • Describe scientific principles underpinning materials/biomaterials used in dentistry, including limitations and selection processes, with focus on those used in dentistry
  • Advise on and apply a range of preventive materials and treatments

Intended Learning Outcomes

  • Define fissure sealants
  • Describe different fissure sealant types and their evidence base
  • Explain indications and contraindications for fissure sealants
  • Identify patient and tooth factors to consider before sealant placement

Associated Reading Material

  • Aetiology of dental caries
  • Histopathology of enamel and dentine caries
  • Tooth morphology
  • Fissure sealants Part II - Clinical Technique lecture
  • Future biomaterials lectures as relevant to the course

Types of Fissure Sealant

  • Glass ionomer
  • Resin-modified glass ionomer
  • Polyacid-modified resin (compomer)
  • Composite resin

Ideal Fissure Sealant Properties

  • Retention
  • Dimensionally stable
  • Wear-resistant
  • Low solubility
  • Biocompatible
  • Easy to apply

Glass Ionomers and Composite Resins

  • Glass Ionomers:
    • Acid-base reaction
    • High acid-base bonding
    • Low shrinkage on setting
    • High fluoride release
    • Low thermal expansion
    • Low tensile strength
    • Susceptible to drying
    • Stiffer
  • Composite resins:
    • Polymerisation reaction
    • Resin-dentine bonding
    • Higher shrinkage on setting
    • Low fluoride release
    • Less expansion
    • High tensile strength
    • Low susceptibility to drying

Compomers and Resin-Modified Glass Ionomers

  • Compomers:
    • Polyacid-modified resin sealants
    • Combine resin-based material with fluoride and adhesive properties of glass ionomer
    • Poorer retention
  • Resin-modified glass ionomers:
    • Modified glass ionomers with resin components
    • Release fluoride
    • Longer working time
    • Less water sensitivity

Acid-etch Technique

  • Removes smear layer
  • Creates microporosities
  • Increases surface area
  • Creates micromechanical retention for resin sealant
  • Uses 35-37% phosphoric acid (liquid or gel)

Resin Sealants

  • Bis GMA (Bisphenol A glycidyl methacrylate) monomer mixed with low weight dimethacrylate
  • Fourth generation sealants contain fluoride
  • Formation of physical barrier against caries
  • Effectiveness depends on longevity of retention
  • Filled sealants - opaque, higher viscosity, greater wear resistance
  • Unfilled sealants - clear, less resistant to wear
  • Require a dry, acid-etched enamel surface for bonding
  • Light-activated

Bisphenol A (BPA)

  • Dental composites and sealants contain BisGMA derived from BPA
  • Low levels of BPA are present immediately after placement
  • Human exposure to BPA mostly through food and beverages
  • No demonstrable adverse effects
  • Ensure light-curing unit calibration and function
  • Adhere to manufacturer instructions
  • Wash/polish/rinse after placement
  • Rubber dam usage

Glass Ionomer Sealants

  • Fluoroaluminosilicate powder and polyacrylic acid solution
  • Hydrophilic
  • No etching required
  • Chemical bonding
  • Anticariogenic (fluoride release)
  • Less retentive

Evidence

  • Resin-based sealants reduce caries in permanent molars by 11-51% two years after application

Which Type of Sealant to Use

  • Evidence for superiority of one material over another is weak
  • Resin sealants are the material of choice
  • Consider tooth and patient factors

Indications and Contraindications

  • Patient factors:
    • Caries risk assessment for patient
    • Medical/social history, diet, fluoride use and plaque control
    • Patient level of co-operation is essential
  • Tooth factors: - Tooth morphology (highly fissured, lateral incisors, pits) - Tooth eruption stage (recently erupted, repair of previously sealed) - Isolation possibility - Caries status

Patient Selection

  • Caries risk
  • Level of co-operation
  • Assessing caries risk (medical, social, dietary habits, plaque control, fluoride use, past caries experience, and clinical presentation)
  • Introduction to dentistry (first experience, procedures, child-friendly language, co-operation)

Tooth Selection

  • Tooth Morphology (highly fissured/deeply fissured molars, lateral incisors & cingulum pits, recently erupted teeth, repair of previous sealants, isolation possibility)
  • Caries status (radiographs, ICDAS/ICCMS codes)
  • Refer to your tooth morphology and the aetiology of dental caries, histopathology of enamel and dentine caries lectures for more information

ICDAS II

  • International Caries Detection and Assessment System II
  • Clinical scoring system for diagnosing caries at every stage
  • Used for research/clinical/epidemiological purposes
  • Provides standardized way to detect and assess caries

ICCMS™

  • International Caries Classification and Management System
  • Classifies lesions into initial, moderate, or extensive stages
  • Focus on lesions prevention/arrest, maintaining tooth structure during treatment

ICDAS Score 0, 1, 2, 3

  • ICDAS 0: Sound tooth with no caries; no evidence of caries after 5 seconds of air drying
  • ICDAS 1: First visible change in enamel (opacity/discoloration, white or brown lesion not consistent with sound enamel, restricted to pit/fissure entrance)
  • ICDAS 2: Distinct visual change in enamel (wet tooth shows either white spot/brown discolouration- seen both wet and dry, for diagnosis, clinician must consider)
  • ICDAS 3: Localized enamel breakdown (wet tooth shows enamel breakdown, opacity/discoloration, no visual involvement of dentine observed on wet/dry)

Fissure Sealants - Review and Maintenance

  • Sealants effective only if all fissures covered
  • Monitor each recall visit
  • Visual inspection with probe
  • Reassess caries risk
  • Reapply sealants ('top-up')
  • Re-evaluate developing dentition

Clinical Technique

  • Fissure sealants Part II - Clinical Technique lecture

End

  • Fissure sealants Part II – Clinical Technique lecture
  • Formative assessment

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