Fissure Sealants Part I - Theory
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Questions and Answers

What factor should be assessed to understand a patient's caries risk?

  • Tooth sensitivity
  • Dietary habits (correct)
  • Cosmetic preferences
  • Prior dental visits

    • What is the primary focus of the International Caries Classification and Management System (ICCMS)?

  • Preventing new lesions and arresting existing ones (correct)
  • Identifying all carious lesions
  • Providing aesthetic alternatives to fillings
  • Standardizing treatment procedures

    • Which ICDAS score indicates a sound tooth with no evidence of caries after air drying?

  • ICDAS 2
  • ICDAS 1
  • ICDAS 3
  • ICDAS 0 (correct)

    • Which of the following conditions is classified as a contraindication for fissure sealants?

    <p>Known allergy to methacrylate (C)</p> Signup and view all the answers

    When classifying lesions, which category does the ICCMS assign to lesions that are moderately advanced in severity?

    <p>Moderate lesions (A)</p> Signup and view all the answers

    What should be done prior to the application of fissure sealants to manage caries?

    <p>Cleaning, drying, and illuminating the tooth (B)</p> Signup and view all the answers

    What must be done to visualize a distinct visual change in enamel classified as ICDAS 2?

    <p>View the tooth wet (A)</p> Signup and view all the answers

    Which of the following is NOT a key consideration for patient selection in dental practice?

    <p>Patient's cosmetic concerns (C)</p> Signup and view all the answers

    What indicates an ICDAS 1 score in terms of enamel condition?

    <p>First visible change in enamel with opacity (C)</p> Signup and view all the answers

    Which factor is explicitly indicated for the use of fissure sealants?

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

    What is the primary function of fissure sealants in dentistry?

    <p>To protect teeth from plaque retention and caries (D)</p> Signup and view all the answers

    Which of the following is NOT considered a caries susceptible site?

    <p>Smooth surfaces (A)</p> Signup and view all the answers

    Which statement accurately describes fissure sealants?

    <p>They provide a physical barrier against caries on occlusal surfaces. (C)</p> Signup and view all the answers

    What must be considered before placing a fissure sealant?

    <p>The presence of carious lesions and patient factors (B)</p> Signup and view all the answers

    Fissures represent areas at risk in which part of the tooth?

    <p>Occlusal surface between cusps (A)</p> Signup and view all the answers

    Which of the following best identifies fissure sealants?

    <p>Protective coatings applied to susceptible tooth surfaces (D)</p> Signup and view all the answers

    What is a common limitation of fissure sealants?

    <p>Their effectiveness decreases over time due to wear and tear. (A)</p> Signup and view all the answers

    Which condition would typically contraindicate the use of a fissure sealant?

    <p>Current carious lesions on the surface (C)</p> Signup and view all the answers

    What characterizes ICDAS 3 lesions?

    <p>Localized enamel breakdown due to caries (D)</p> Signup and view all the answers

    What is the role of fissure sealants in dental care?

    <p>They are only effective if fissures are fully covered (B)</p> Signup and view all the answers

    What is a recommended method for assessing fissure sealants?

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

    Which of these is NOT a clinical technique for fissure sealants?

    <p>Regular deep cleaning of all teeth (B)</p> Signup and view all the answers

    How should the effectiveness of fissure sealants be monitored?

    <p>Via regular recall visits with visual and physical checks (A)</p> Signup and view all the answers

    What should be done if a fissure sealant appears worn?

    <p>Reapply or ‘top up’ the sealant (C)</p> Signup and view all the answers

    What is the primary research cited regarding sealants?

    <p>A systematic review on sealants for preventing decay (A)</p> Signup and view all the answers

    What is the purpose of assessing caries risk during sealant maintenance?

    <p>To identify the likelihood of future decay (B)</p> Signup and view all the answers

    What was a key observation made by Buonocore in 1955 regarding acrylic resin retention?

    <p>Acid-etch treatment increases retention of acrylic resin (A)</p> Signup and view all the answers

    Which property is NOT ideal for fissure sealants?

    <p>High solubility (C)</p> Signup and view all the answers

    What is a primary disadvantage of glass ionomer sealants compared to composite resins?

    <p>More susceptible to dessication (D)</p> Signup and view all the answers

    What technique is used to enhance the retention of resin sealants?

    <p>Micromechanical retention through acid etching (D)</p> Signup and view all the answers

    Which statement about compomers is true?

    <p>Compomers combine resin-based materials with glass ionomer properties (C)</p> Signup and view all the answers

    What is the primary method of curing resin sealants?

    <p>Light activation (B)</p> Signup and view all the answers

    Which factor is NOT typically considered when choosing a sealant for a patient?

    <p>Tooth color (B)</p> Signup and view all the answers

    What type of sealant provides a chemical bond and releases fluoride?

    <p>Glass ionomers (D)</p> Signup and view all the answers

    What is a common misconception about Bisphenol A (BPA) in dental materials?

    <p>BPA exposure leads to significant adverse effects (A)</p> Signup and view all the answers

    What is the role of fluoride in sealants?

    <p>To prevent caries by releasing fluoride (B)</p> Signup and view all the answers

    Study Notes

    Fissure Sealants Part I - Theory

    • Fissure sealants are protective coatings applied to caries-susceptible tooth surfaces.
    • Posterior teeth's occlusal surfaces are most vulnerable to dental caries.
    • Sealants prevent food debris and biofilm retention, thus preventing caries lesion development.
    • Sealants are also used in managing some existing carious lesions.
    • Fissures are deep clefts between adjoining cusps, prone to plaque buildup.
    • Pits are small depressions at developmental grooves.
    • Caries-susceptible sites include fissures, buccal and cingulum pits, dens in dente, and prominent cusps of Caribelli.
    • Sealant types include Glass Ionomer, Resin-modified Glass Ionomer, Polyacid-modified resin (compomer), and Composite resin.

    Learning Outcomes

    • Describe the scientific principles behind materials and biomaterials used in dentistry, including limitations and selection.
    • Advise on and apply preventive materials and treatments in dentistry as needed.

    Intended Learning Outcomes

    • Define fissure sealants.
    • Detail various fissure sealant types and evidence for their use.
    • Summarize indications and contraindications for fissure sealants.
    • Identify patient and tooth factors needing consideration before sealant application.

    Associated Reading Material

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

    Background

    • 1905: Miller used silver nitrate.
    • 1923: Hyatt introduced "Prophylactic odontomy".
    • 1955: Buonocore observed improved acrylic resin retention after enamel acid-etching.
    • 1965: Bowen et al developed Bis-GMA resin.
    • 1960s: Widespread use of sealants in preventative programs.

    Types of Fissure Sealant

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

    Ideal Fissure Sealant Properties

    • Retention
    • Dimensional stability
    • Wear resistance
    • Low solubility
    • Biocompatibility
    • Easy application

    Glass Ionomer and Composite Resins

    • Glass ionomers: Acid-base reaction, high acid-base bonding, less shrinkage on setting, high fluoride release, low thermal expansion, low tensile strength, susceptible to desiccation, and stiff.
    • Composite resins: Polymerization reaction, resin-dentine bonding, more shrinkage on setting, less fluoride release, less expansion, higher tensile strength, and low susceptibility to desiccation.

    Compomers and Resin-Modified Glass Ionomers

    • Compomers: Combine resin and glass ionomer properties, providing fluoride release.
    • Resin-modified glass ionomers: Modified glass ionomers with resin components, release fluoride, and have longer working times.

    Acid-Etch Technique

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

    Resin Sealants

    • Use Bis-GMA (Bisphenol A glycidyl methacrylate) monomer diluted with dimethacrylate monomer.
    • Fourth-generation sealants contain fluoride.
    • Prevent caries by acting as a physical barrier.
    • Effectiveness depends on retention longevity.
    • Filled: opaque, high wear resistance, and viscosity.
    • Unfilled: clear, less wear resistance.
    • Require a dry, acid-etched enamel surface for bonding.
    • Light-activated.

    Bisphenol A (BPA)

    • Dental composites and sealants contain BisGMA derived from BPA.
    • Low BPA levels occur immediately after placement.
    • Most human BPA exposure stems from food and beverages.
    • No adverse effects are commonly reported.
    • Ensure the light-curing unit is calibrated.
    • Adhere to manufacturer instructions.
    • Wash, polish, and rinse the tooth after placement.
    • Use a rubber dam.

    Glass Ionomer Sealants

    • Use Fluoroaluminosilicate powder and polyacrylic acid solution.
    • Are hydrophilic.
    • Do not require etching.
    • Bond chemically and release fluoride.
    • Less retentive.

    Evidence

    • Resin-based sealants applied to occlusal surfaces of permanent molars reduced caries by 11–51% after two years compared to no sealant.

    Which Type of Sealant to Use

    • Evidence for superiority of one material over another is weak.
    • Resin sealants often preferred due to better retention.
    • Consider patient and tooth factors.

    Indications and Contraindications

    • Indications (Patient and Tooth): High caries risk, poor oral hygiene, recently erupted teeth, deep pits and fissures, fully erupted teeth needing sealant (especially considering GIC), enamel defects, orthodontic/appliance-induced wear, and initial carious lesions.
    • Contraindications: Low caries risk, optimal oral hygiene, shallow self-cleaning pits/fissures, partially erupted teeth with inadequate moisture control, teeth with existing pits/fissure restorations, known allergy to methacrylate, and frank cavitation/extensive carious lesions.

    Patient Selection

    • Assess caries risk, medical history, social history, dietary habits, plaque control, fluoride use, past caries experience, and clinical presentation.
    • Important to evaluate co-operation levels.

    Tooth Selection

    • Assess tooth morphology (highly fissured/deeply fissured molars, lateral incisors, cingulum pits, recently erupted teeth, and repaired previously sealed molars).
    • Evaluate isolation possibility.
    • Evaluate the caries status using radiographs or ICDAS/ICCMS™ codes.

    ICDAS II

    • A clinical scoring system used for diagnosing and staging caries.
    • Allows caries detection at every stage, characterizing activity.

    ICCMS™

    • System for classifying caries lesions into initial, moderate, or extensive stages.
    • Focuses on prevention of new lesions, arresting existing lesions, and preserving tooth structure.

    ICDAS Scores

    • ICDAS 0: Sound tooth.
    • ICDAS 1: Initial visual change in enamel.
    • ICDAS 2: Distinct visual change in enamel (wet).
    • ICDAS 3: Localized enamel breakdown (wet).

    Summary of Indications/Contraindications

    • Indications: High caries risk, poor oral hygiene, recently erupted teeth, deep pits/fissures, fully erupted teeth (GIC consideration), enamel defects, orthodontic/appliance wear, initial carious lesions
    • Contraindications: Low caries risk, optimal oral hygiene, shallow pits/fissures, partially erupted teeth lacking moisture control (GIC consideration), teeth with existing pits/fissure restorations, allergy to methacrylate, and frank cavitation/extensive carious lesions.

    Fissure Sealants in Managing Early Caries

    • Focuses on clean, dry, and well-illuminated teeth.
    • Do not probe pits or fissures.
    • Assess for radiographic/ICDAS I/II/III carious lesions.
    • Demineralization confined to enamel without localized enamel breakdown.
    • Localized enamel breakdown with no visible dentine or underlying shadow.

    Fissure Sealants – Review and Maintenance

    • Fissure sealants effective only if all fissures are fully covered.
    • Ensure regular monitoring, visual inspection, physical checks, and re-evaluation of caries risk.
    • Reapplication (top-up) of sealants is part of maintenance.

    Clinical Technique

    • Clinical technique lecture to follow, as this topic is covered in the next section of the course materials.

    References/Further Reading

    • Various articles on fissure sealants, caries detection, diagnosis, management, and Bisphenol A exposure. Extensive list of publications is provided.

    End

    • Fissure sealants Part II - Clinical Technique lecture to follow.
    • Formative assessment to follow.

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    Fissure Sealants Part 1 Theory (DTH22) PDF

    Description

    This quiz explores the theory behind fissure sealants used in dentistry. Learn about the types of fissure sealants, their applications, and how they prevent dental caries. Understand the significance of protecting caries-susceptible tooth surfaces and the materials involved.

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