Dental sealants and pediatric patients: Options, benefits, and drawbacks
Dental sealants represent a cost-effective and invaluable prophylactic intervention, with particular significance in the context of pediatric oral health.1 These thin, protective coatings are strategically applied to the occlusal surfaces of molars and premolars, and their importance derives from multifaceted considerations.
First, dental sealants serve as a strong barrier against one of the most prevalent dental issues among children: dental caries. The deep grooves and fissures on the back teeth often provide a favorable environment for food particles, plaque, and bacteria to accumulate, making these areas susceptible to decay. Sealants effectively seal off these areas, preventing the onset of caries.2 They are a noninvasive, painless procedure, making them accessible and comfortable for children.3 Application means minimal chair time, which decreases the concern for young patients and their parents or guardians.
Over time, dental sealants play a pivotal role in mitigating cost-intensive and intrusive restorative procedures, such as composite fillings, root canal therapy, and dental crowns. This preventive measure not only contributes to substantial financial savings for patients, but also aligns with our commitment to preserving the oral health and well-being of patients. By impeding dental issues at an early stage, sealants serve as a prudent and farsighted investment, affording patients a future free from complex and costly dental interventions.
As dental hygienists, we routinely encounter materials that promote various dental sealant products. Following is a comprehensive exploration of dental sealant options, underpinned by an assessment of their individual merits and drawbacks. There are four primary categories of sealant materials in wide use.
Resin-based sealants
Resin-based sealants are most commonly used for children. They can be further categorized into filled resin sealants that contain fillers such as silica, which increases their durability and wear resistance and are suitable for sealing molars and premolars in pediatric patients, and unfilled resin sealants, which are less viscous, flow more easily into deep fissures and pits, and are suitable for shallow or narrow fissures in primary and permanent teeth.
The primary drawback with resin-based sealants is the requirement for meticulous moisture control. This hinges on factors such as patient behavior, dental anatomical features, sustaining an adequately open oral cavity, and the presence of an operculum. Maintaining a moisture-free environment around the tooth during the application procedure can present challenges.
Glass ionomer sealants
These have earned distinction due to their fluoride release, rendering them an advantageous choice for safeguarding the oral health of pediatric patients. They furnish supplemental protection against dental caries. Moreover, they adhere effectively to both enamel and dentin, enhancing their utility for sealing diverse tooth surfaces.
However, the drawback associated with glass ionomer sealants pertains to their retention. Studies have demonstrated that these sealants exhibit a retention rate that’s markedly inferior when compared to their resin-based counterparts. The average retention rate for glass ionomer sealants is approximately 8%, in stark contrast to the robust 76% retention rate observed with resin-based sealants.4 This underscores the necessity for vigilant monitoring and potential reapplication in clinical practice.
Resin-modified glass ionomer sealants
These sealants amalgamate the attributes of both glass ionomer and resin-based materials, presenting an amalgam of improved tensile strength and superior adhesion compared to conventional glass ionomers.4 Potential drawbacks are limitations in long-term durability, susceptibility to moisture-induced complications during placement, and relatively diminished resistance to wear and tear.
Polyacid-modified resin sealants (compomers)
These release fluoride and exhibit good adhesion properties. They’re used in pediatric dentistry to protect against caries while benefiting from fluoride release. This particular sealant exhibits a comparatively modest fluoride release capacity compared to other choices.4 This sealant type is inherently hydrophobic, demanding meticulous moisture control in the application site to ensure optimal adhesion and performance.4
Selecting an optimal dental sealant for pediatric patients depends on an evaluation of several factors—the child’s age, their dental anatomy, their risk profile for dental caries, and the preferences of the clinician. In this process, experienced pediatric dentists and dental hygienists assume a crucial role. They assess these considerations to discern and ultimately prescribe the most judicious sealant type. By doing so, they ensure not only effective prevention of dental caries, but also the robust oral health and overall well-being of their pediatric patients.
References
1. Amilani U, Carter HE, Senanayake S, Hettiarachchi RM, McPhail SM, Kularatna S. A scoping review of cost‐effectiveness analyses of school‐based interventions for caries. Comm Dent Oral Epidemiol. 2020;48(5):357-363. doi.10.1111/cdoe.12553
2. Paglia L, Ferrazzano G, Beretta M. The role of pit and fissure sealants in the prevention of dental caries. Pit Fissure Sealants. 2018;2:(53-68). doi.10.1007/978-3-319-71979-5_4
3. Desai H, Stewart C, Finer Y. Minimally invasive therapies for the management of dental caries—a literature review. Dent J. 2021;9(12):147. doi.10.3390/dj9120147
4. Colombo S, Beretta M. Dental sealants part 3: Which material? Efficiency and effectiveness. Eur J Ped Dent. 2018;(19):247. doi.10.23804/ejpd.2018.19.03.15
Samantha Farrar, DHS, MPH, BSDH, RDH, is a skilled hygienist with a doctoral degree, excelling as a clinician, educator, and board examiner. With a special passion for pediatric dentistry and research, she brings 18 years of invaluable experience to her practices. As an adjunct faculty member at College of DuPage, she is dedicated to shaping the next generation of dental professionals. Driven by a commitment to oral health advancement, she continuously strives to improve dental care for patients of all ages.
Editor's note: This article appeared in the January-February 2024 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.
