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While 55 percent of American children aged five to 17 have never had a cavity, millions still experience unnecessary tooth decay. But with an increase in the use of sealants, more children could remain cavity free. "Study after study has shown effectiveness and cost savings from applying sealants to children's teeth", says David Miller, DDS, a general dentist who practices in Chicago. "If children were receiving sealants on a more wide-spread basis, we could see a nation of virtually cavity-free children." SEALANTS protect the top surfaces of molars where almost 90 percent of cavities in children five to 17 years old occur. The first set of permanent molars begin to erupt around age five, with a second set coming up between ages 11 and 16. The tops of these molars are covered with tiny grooves and hills and valleys, called pits and fisures, which help in grinding and chewing food. Because the grooves and crevices are too small for even a single toothbrush bristle, they trap bacteria and food particles and are highly susceptible to decay. SEALANTS provide a coating that seals molars from bacteria and decay. The application procedure is a quick, painless procedure. FIRST, teeth are cleaned and coated with an acid solution to increase bonding. After approximately one minute, the acid is washed away and the teeth are dried. A liquid plastic is then brushed over the tooth surface, flowing into the impossible-to reach pits and fisures. The procedure is completed when the sealants are dried, either with a special light or on their own. The treatment lasts anywhere from five to 45 minutes, depending on the number of teeth being filled and the level of cooperation. Materials for sealants first underwent clinical trials in the late 1960's before and pit and fisure sealants were introduced in 1967. However they were not commercially available until 1970. Finally, in 1976, sealants received full acceptance from the ADA. "Although the use of dental sealants has been credited with being 100 percent effective for preventing cavities, sealants do not prevent decay between teeth or on smooth surfaces," concludes Dr. Miller. "It is still necessary to brush, floss, receive regular fluoride treatments, eat a proper diet and regular dental visits." STUDIES CONFIRM According to members of the Chicago Dental Society, children can grow up without a single cavity-thanks to sealants. "When used properly, sealants are 100 percent effective in preventing decay," says Christos Pappas, a general dentist who practices in Oak Lawn, Ill. "Their success rate in saving teeth during the past 20 years has been phenomenal." A study published in the October 1991 issue of the Journal of the American Dental Association examined sealant's ability to prevent cavities fifteen years after application. The study found that teeth not covered by sealants were almost 8 times more likely than sealed teeth to develop a cavity. Cavities were present on 82.8 percent of tooth surfaces of unsealed teeth, compared to 31.3 percent of sealed teeth. More importantly, no cavities existed on teeth which had retained the entire sealant. Because the study also examined the retention rate of sealants, even in the case of complete 1088, sealants were never reapplied. Normally, sealants are checked during routine dental visits and reapplied when necessary. Although the effectiveness of sealants continues to be proven in countless scientific studies, the technology is still under-utilized in both private and public dental health practices. While the use of sealants has doubled in the past decade, it still remains low. The National Institute of Dental Research reported that only 19 percent of children in adolescents received the treatment. "Sealants are safe, painless, affordable and one of the best things you can do for a child," says Dr. Pappas. "Unfortunately, they also are the most under-used preventive measure available today." Factors contributing to a slow acceptance of sealants include insurance companies not covering the procedure, cost, misconceptions about safety and a general lack of understanding about their effectiveness. "Ask someone if they know what fluoride is and just about anyone can explain its use," explains Dr. Pappas. "Ask what a sealant is, and most of the time, you're not going to get an answer." MYTH VERSUS REALITY Despite more than 25 years of research, misconceptions about sealants remain, and millions of children still get avoidable cavities. "Patients worry about the reliablity of sealants, whether they worsen decay, and why the procedure is even necessary," explains Jim Sheldon, DDS, a general dentist who practices in Westchester, Ill. "They don't understand why they need to have a dental procedure done on healthy teeth." Sealants, which celebrate 20 years of success this year, are considered safe and effective, and are covered by many insurance companies. Yet, because general lack of understanding about their purpose, sealant use among children and adolescents remains low, particularly among minority populations. Some misconceptions about sealants include the following: MYTH: Sealants fall off teeth. FACT: A study published in the Journal of the American Dental Association found that 15 years after a sealant was applied, it was completely retained on 27.6 percent of molars and partially retained on 35.4 percent. Sealants, however, are not permanent. They need to be checked during routine dental visits and replaced or repaired when necessary. MYTH: Sealants seal in decay. FACT: Bacteria need air and nutrients to grow and live. Sealants cut off bacteria from their nutrients, eventually starving microorganisms. Even the earliest stages of cavities will not progress into further decay when covered by sealants. Technology also has enabled dentists to use sealants even when minor cavities already exist. Instead of filling an entire tooth, dentists remove the cavity, use colored fillings and then apply sealants. MYTH: Amalgam restorations(fillings) are preferable to sealants. FACT: Amalgams and sealants are used for entirely different purposes. Sealants prevent tooth decay from occurring whereas amalgams restore teeth already destroyed by decay. Also, while amalgams usually require anesthesia, involve enamel loss and may cause patient discomfort, applying sealants is a simple, painless procedure. MYTH: Dental insurance does not cover the cost of sealants. FACT: Beginning in 1986, most major dental plans have been offering sealants as a preventive service. As more people become knowledgeable about the benefits of the number of insurance companies covering the expense is expected to increase. MYTH: The safety of sealants is still questionable. FACT: More than 25 years of research and clinical trials have confirmed the safety and effectiveness of sealants. One study found that 15 years after sealants were applied, no cavities were found on teeth with complete or partial retention of a sealant. Studies are now focusing on why fewer than one in five youngsters receive this preventive measure. MYTH: Sealants are not cost effective when compared to amalgams. FACT: While the cost of sealants can range anywhere from $15 to $50 per tooth, it is still far cheaper than a filling-which usually costs twice as much. Sealants also eliminate the anxiety children experience when having a tooth filled. "It's very encouraging that cavities among children continue to decline, but we still have a long way to go," concludes Dr. Sheldon. "Decay happens, it can be treated, but more importantly, it can be prevented. Most people already know the benefits of brushing, flossing, proper diet and fluoride treatments. Now we need to get the message out about sealants." (by the Dental Assistant July/August 1997) |
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