Do Your Children’s Sealants Keep Falling Out?

If sealants are not done perfectly, not only will they fall out, but they could even cause cavities to occur in the teeth.

Sealants are one of Dr. Kurthy’s pet peeves.  Often sealants, which are supposed to prevent cavities, simply fall out, or worse yet, CAUSE cavities.

Don’t get us wrong – we are firmly in favor of sealants.  Sealants placed properly do an excellent job of preventing cavities.  But the fact is that the techniques of sealant placement taught are grossly inadequate.

To better understand, let’s first discuss why sealants can prevent cavities.  Back teeth are formed with numerous grooves and pits.  These grooves and pits are so narrow that tooth brush bristles just cannot reach the bottom of these grooves.

Toothbrush bristles just can’t fit down into these very narrow grooves 

You can now see how decay-causing bacteria hide deeply in these grooves, where even toothbrush bristles cannot clean them out.  These bacteria give off their acids and cause cavities.  This type of cavity is responsible for 80% of all cavities that occur.

Below see the typical progression of these pit & fissure cavities:

Now that you understand how decay progresses in the grooves, you will better understand why the most common technique of placing sealants is inadequate.

Schools currently teach dentists and dental staff members to first clean the tooth surface with a rubber cup device that you’ve had used on your teeth during cleaning appointments.  Here is what that rubber cup looks like:

The tip of the rubber cup holds the cleaning paste.  As you can see, it is impossible for this rubber cup to clean down in the ultra-thin grooves and pits to remove any bacteria.  The next step taught is to treat the surface of the tooth with a chemical that microscopically roughens the tooth surface so that the sealant can microscopically grip (bond to) the tooth.  But the problem is that the sealant material is too thick to adequately flow into these microscopic roughenings.

Tooth after cleaning with a rubber cup.  See plaque (yellow) still present down inside groove.	Tooth with sealant placed (purple), with plaque (yellow) trapped under the sealant.	Sealants are intended to wear down quickly, and only remain in the groove.  The sealant has worn down, and very little is holding it in place

In the diagram at left, the sealant (purple) has worn down to the point it has lost its bond on one side, and lifted up on one side.  This allows seepage of saliva, bacteria and dissolved sugars under the sealant, and enhances tooth decay (cavity -- red) formation (note that the sealant has lifted up on the right side, forming an open gap under the right side of the sealant).

As if this is not of enough concern, remember the diagrams above that showed that often small areas of decay are present without being detected.  Just imagine what can happen if decay is unknowingly sealed in under a sealant.  Well, studies have actually shown that the vast majority of teeth with deep grooves do have at least some small amount of tooth decay present, and this means that the vast majority of sealants do simply cover tooth decay.

So what’s the answer?  First of all, the new Laser Scanner will find decay even in the smallest amounts.

Sealants, in Dr. Kurthy’s opinion, must be placed with all the steps and impeccable technique that a bonded filling would be placed.  First, the tooth must be cleaned impeccably, including all the way down into the grooves.  All plaque and stain buildup must be removed from the grooves.  Any small areas of tooth decay must be found and removed.

First, prophy brushes (not prophy cups) should be used to clean the teeth first.   The bristles get far deeper into the grooves than the rubber cups do.

But this still leaves plaque and stain deeper in the grooves than the bristles can get.  There are highly specialized burs that fit in our drills that are not meant to drill away tooth structure, but to polish tooth structure.  These are made ultra-thin with needle-sharp tips so that they will extend down in the grooves and clean out the plaque and stain.  Since tooth decay is soft, these polishing tips will also polish off any small areas of tooth decay.

These specialized burs are then used to thoroughly clean out the grooves.  This will usually also polish off any small areas of tooth decay.  Once the grooves are fully clean and polished, any slightly larger areas of tooth decay (cavities) can now be easily found and removed.  These cavities are cavities that would have spread, destroying large portions of the tooth if not found and eliminated when ultra-small.

After the above diligent technique, the grooves are impeccably clean.

Next, we apply the chemical that creates a microscopic roughness of the tooth.  But instead of then simply placing the sealant material, we utilize a ‘bonding agent’, just like we would when doing a bonded filling.  This ensures the impeccable, strong and durable bond to this microscopically roughened tooth structure.

After utilization of the bonding agent, the sealant material is placed, which chemically fuses to the bonding agent.  The result is a sealant that is strongly bonded to impeccably clean tooth structure, with no bacteria or decayed tooth structure trapped underneath. 

Tooth with properly placed sealant	After the sealant has worn down

We often see new patients and find that they have had sealants that have simply fallen out.  And we often find patients with sealants on their teeth with large cavities underneath.  If this has happened to your children, this may be the reason.  The loss of sealants should virtually never happen if placed with the impeccable technique discussed above.  Sealants should remain indefinitely and fully protect against the formation of cavities that would have occurred without them.

Don’t let your children get tons of cavities like you may have gotten when you were young. We can provide sealants that STAY PUT!!