At age 5, my son's pits and fissures on tooth T developed a carious lesion. My prevention-centered heart was so disappointed in myself as I was responsible for his oral health care. The caries had spread rapidly and needed a pulpotomy, and six months later it developed an abscess and needed to be extracted, with placement of a space maintainer.
To see my child go through this was heartbreaking and it helped me develop empathy for other parents. This led me to want to prevent this from happening to other children and parents. What were my options for the prevention of caries in the pits and fissures of the primary molars? Would placing a sealant in them have helped?
Sealing the primary molars
I did have to advocate for my son’s provider to seal the rest of the primary molars. They said they didn’t do this often in the primary dentition. Some anecdotal rationale provided for this are:
- They are technique-sensitive and usually need four-handed dentistry to place, which isn’t cost-effective.
- Some feel they are going to exfoliate so it’s not cost-effective to do a traditional sealant.
- The data on their effectiveness is conflicting and they really don’t work to prevent caries.
Even with these barriers, our goal is to prevent caries based on the evidence available. So, what are the most cost-effective options available today? A 2023 study of 3,000 children showed that over a two-year period, glass-ionomer sealants prevented caries 82% of the time, and one drop of silver diamine fluoride (SDF) placed in the pit and fissure sealants prevent 81% of caries.1
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Why SDF can work
Silver diamine fluoride (SDF) involves fewer steps than traditional sealants, naturally reducing the time it takes for placement. Watch our Hygiene Edge video with its steps to clean, rinse, dry, isolate, place, and let soak for one minute, then place a fluoride varnish on top. The one drop of fluoride varnish could also be used in an entire primary dentition. One drop of Advantage Arrest SDF is 84 cents, and one drop of FluoriMax Varnish is less than 22 centers per drop. If the pits and fissures are not cavitated, then the area will not turn black. If, however, the area treated does turn black, you have just arrested a lesion, preventing it from progressing, and that’s a win.
We know that traditional resin sealant application is very technique sensitive. Check out our placement video on Hygiene Edge with its steps to clean, rinse, dry, isolate, etch, rinse, dry, reisolate, place, light-cure, check occlusion/adjust occlusion, and floss. Resin-based sealants are more time consuming and technique sensitive, but they work to prevent caries.
A study published in 2019 concluded that the caries incidence between the glass ionomer and resin-based sealants was not statistically significant.2 The big differences in glass ionomer sealants versus resin sealants comes down to glass ionomer being easier to place because one doesn’t need isolation. With silver diamine fluoride costing less than other sealant materials, being less time consuming to place, and having similar preventive results, maybe SDF could be a good alternative to a sealant in your practice.
Hygiene Edge was created by three dental hygiene educators who love both dentistry and education. With over 40 years of experience both in the education space and in the dental field, Melia Lewis, Jessica Atkinson, and Shelley Brown love sharing their knowledge through helpful, short videos online, speaking, and working with amazing companies. You can find more information at Hygiene Edge, on YouTube, and Instagram @hygieneedge. Have a question or a tricky area? Let us know! We'd love to help.
References
- School dental program prevents 80 percent of cavities with one-time, non-invasive treatment. Science Daily. February 10, 2023. https://www.sciencedaily.com/releases/2023/02/230210145811.htm
- Prathibha B, Reddy PP, Anjum MS, Monica M, Praveen BH. Sealants revisited: An efficacy battle between the two major types of sealants – A randomized controlled clinical trial. Dent Res J. 2019;16(1):36-41.
