Dental Sealants

Dental Sealants

What are dental sealants?

                A sealant is a plastic material that is applied to the chewing surfaces of the permanent back teeth- premolars and molars. This plastic resin bonds into the depressions and grooves (pits and fissures) of the chewing surfaces of the teeth. The sealant acts as a barrier, protecting enamel from plaque and acids.

                Thorough brushing and flossing help remove food particles and plaque from smooth surfaces of teeth; however, toothbrush bristles cannot reach all the way into depressions and grooves to extract food and plaque. Sealants protect these vulnerable areas by “sealing out” plaque and food.  Below is a magnified image of a single bristle from a toothbrush against the groove of a tooth. See how the bristle cannot reach the full depth of our grooves.

               Pit and fissure caries (cavities) account for approximately 80 to 90 percent of all caries in permanent posterior teeth and 44 percent in primary teeth. Pit and fissure sealant has been described as a material placed into the pits and fissures of caries-susceptible teeth that micromechanically bonds to the tooth preventing access by cariogenic bacteria to their source of nutrients, thus reducing the risk of caries in those susceptible pits and fissures.

               Studies incorporating patients that are seen every 6 months for cleanings and exams have reported sealant success levels of 80 to 90 percent after 10 or more years.

Is sealant application a complicated procedure?

                Sealants are easy to apply, and it only takes a few minutes to seal each tooth. The teeth that will be sealed are cleaned, then the chewing surfaces are roughened with an acid solution to help the sealant adhere to the tooth. The sealant is then ‘painted’ onto the tooth enamel, where it bonds directly to the tooth and hardens. A special curing light is used to help the sealant harden. The 2 most important things are to 1) Remove the plaque on the tooth and 2) Keep the tooth dry and isolated.  We use a special brush to remove the plaque, and a special straw to isolate the teeth and keep them dry during the procedure. 

                As long as the sealant remains intact, the tooth surface will be protected from decay. Sealants hold up well under the force of normal chewing and usually last several years before a reapplication is needed. During your regular dental visits, your dentist will check the condition of the sealants and reapply them when necessary.

Sealants are just for kids, right?

                The likelihood of developing pit and fissure decay begins early in life, so children and teenagers are obvious candidates. But adults can benefit from sealants as well. Children as young as 6 can have sealants applied if their permanent molars have grown in far enough to keep them isolated from oral fluids while the sealant is applied.

What about sealants for baby teeth?

                We do not routinely recommend sealants on baby molars due to the fact that their grooves are not normally as deep as permanent molars.  Additionally, even though placing sealants is an easy process, sometimes it can be difficult to isolate a young child’s baby molar, which can compromise the integrity of the sealant.  That being said, sometimes your dentist may recommend sealants on baby teeth due to high risk for decay, and if these can be placed efficiently, then they will definitely help prevent cavities in the grooves of these teeth!

             I hope this blog was helpful and educational. Please let us know what you think, and write us with any other topics you would like to learn about!

Pediatric Dental Trauma

Traumatic dental injuries occur with great frequency in today’s children.  Reports show that 25% of school children experience dental trauma.  One of the most common dental injuries in baby teeth are luxation injuries, when the teeth is displaced.  Another common injury in permanent teeth is a fracture.  Today’s blog will discuss some of the common injuries in pediatric dental patients.

1) Soft tissue tear- The injury to the upper frenum, or tissue connecting the upper lip to the gingiva, is often torn on children at a young age when they are learning to walk.  This is a self-resolving injury, and rarely requires any treatment.  If this occurs, call you dentist as soon as possible to set up an exam to rule out any other potential injuries, and to discuss management.  Firm pressure with moist gauze of towel can help to stop bleeding in the area.  Soft and bland diet during the healing phase will help avoid any discomfort.  Good oral hygiene is still crucial, being gentle around this area.

2) Bumped teeth

       a) Concussion- Bumped tooth that is in the same place as before

       b) Luxation- Bumped tooth that is in a different place (see photo below)

       c) Chipped tooth (See photo)

All of these injuries can be painful, and it important to see a dentist soon after the injury in order to properly manage the teeth to give the child’s teeth the best prognosis.  Sometimes, no treatment is needed, and the teeth are monitored.  Other times, treatment may be indicated to prevent any nerve damage and/or to place the teeth in the proper position. 

3)  Avulsion Injuries (knocked out teeth)-

a) Baby Tooth- If a baby tooth is knocked out, do not attempt to re-implant the tooth. Call your dentist as soon as possible to have your child seen. Weighing the risks and benefits of re-implanting the tooth or leaving it out, the best option is to leave the tooth out of the mouth in order to protect the underlying permanent tooth from damage.

b) Permanent Tooth- *Call a dentist immediately to arrange for care*

Here are the proper steps to manage a permanent tooth that has been knocked out.

After getting a hold of a dentist immediately, follow the steps below:

1) Pending the injury, rule out any potential head damage that would require immediate emergent hospital treatment.  If the child is unconscious, vomiting, has memory loss, is lethargic, it may indicate there are other more serious problems than the tooth. 

2) Find the tooth, and pick it up by the crown (not the root, see photo).

3) Rinse the tooth gently and briefly (10 seconds) with cold tap water

4) Do not scrub the tooth, do not clean the tooth with soap, alcohol, mouthwash or any other chemical

5) Do not wrap the tooth in tissue, cloth or plastic

6) Do not allow the tooth to dry

7) Place the tooth back into socket immediately and with gentle finger pressure (Best chance of saving the tooth). If you are not comfortable with this, that is OK. Getting to a dentist as soon as possible is crucial to give the tooth the best prognosis.

8) If unable to place the tooth back into its socket, transport the tooth in the following liquids listed in order of preference:

       i) Hanks Balanced Salt Solution (Save-A-Tooth®); sometimes found in first aid kits (tooth may be kept in this solution up to 24 hours) http://www.save-a-tooth.com/

       ii) Milk:  preferably cold and low fat (tooth may be kept in milk up to 3 hours)

       iii) Cold tap water or inside the child’s mouth (last resort – living cells on tooth may completely die within 1 hour)

GET TO A DENTIST AS SOON AS POSSIBLE! The sooner the tooth is placed back in the socket, the better chance the tooth has of surviving long term.

We hope this blog was informational and helpful. Please contact our office at 605-242-4700 with any questions or concerns. Thanks for reading!

Dental Timeline for a Growing Child

The American Academy of Pediatric Dentistry recommends that every child have a dental home established, along with a dental exam by the age of 1. The reason is for proper education and establishment of a prevention protocol. Studies are showing that early care is leading to improved prevention for children, resulting in less problems with their teeth as they get older.

AGE 0-6 Months: Edentulous Stage

• Wipe down your child’s mouth with a damp cloth after feedings, even when no teeth are present. It is especially important to cleanse their mouths before bedtime.
• Pacifier/Thumb/Finger sucking habits- It is normal for infants to have one of these habits. Sometimes, it can cause damage to teeth and cause jaw discrepancies if these habits persist long term. 

• Do NOT have your child go to bed with a bottle in his/her mouth

• Avoid sharing utensils and drinks with young children due to spread of oral bacteria that can cause cavities.

AGE 6 months-1 Year: Primary teeth or Baby dentition

• The first baby tooth normally appears at about 6 months. Some children get teeth early, and some children don’t get their first tooth until 1 year.

• Establish a dental home and have your child’s teeth and/or gums examined by one year of age

• Per the AAP (American Academy of Pediatrics), transitioning to a regular cup should occur by age 1. If your child has juice, it should be limited to 4-6 ounces per day, at meal time, drank out of a regular cup

• Spacing between teeth is normal and good

• Teeth often erupt “crooked” and normally straighten out over time

• Brush teeth as soon as they erupt, and brush everywhere along the gum line

AGE 1-5 Years: Primary dentition

• Normally, the last baby teeth to erupt are the 2nd molars, which erupt around age 2

• Flossing should be implemented when the teeth start to touch, and is very important between the back molars to prevent cavities occurring between the teeth

• Dental x-rays help visualize between teeth to assess for cavities, but depending on the child’s cooperation level, may not be recorded until they are 3 or 4 years old

• Tooth grinding is very common, and normally no treatment is recommended.

• If your child cannot spit, then a smear of fluoridated toothpaste should be used to minimize swallowing. Once your child can spit, a pea sized amount can be used

Age 6-12 Years: Mixed dentition

• Loss of the first baby tooth normally occurs around age 6 or 7

• Tenderness when chewing is common when teeth are loose

• We recommend for the children to wiggle their teeth when they get loose

• Sometimes, baby teeth do not get loose on their own, and permanent teeth can start to erupt. If this occurs, contact your dentist to see if extraction is indicated.

• Sealants are recommended when the permanent first molars are erupted
• A panoramic x-ray to assess oral structures and tooth growth and development

• Consider mouth guards for children playing sports

Age 13-18: Permanent Dentition

• Sealants on 2nd molars are recommended (normally erupt around age 12)

• Flossing and starting good habits is crucial at this age, as good (and bad) habits will carry into adulthood

• Orthodontic treatment is normally performed in this stage, although some children are seen for orthodontics as early as age 6-7 depending on the orthodontic problem

• Diet should be monitored closely, especially consumption of sugary drinks such as Gatorade, energy drinks, pop, and juice

• Hormonal changes during puberty can affect oral health, and proper oral hygiene becomes even more crucial

• Wisdom teeth should be evaluated throughout this stage for potential extraction to minimize risks and to improve healing time